St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW 3.5MM LOW PROFILE CORT 40MM

Facility OP

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40204630
Hospital Revenue Code	278
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$136.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.75
Rate for Payer: Fidelis Medicare Advantage	$136.50
Rate for Payer: Group Health Inc Commercial	$65.00
Rate for Payer: Group Health Inc Medicare	$45.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$84.50

SCREW 3.5MM LOW PROFILE CORT 40MM

Facility OP

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40007549
Hospital Revenue Code	278
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$136.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.75
Rate for Payer: Fidelis Medicare Advantage	$136.50
Rate for Payer: Group Health Inc Commercial	$65.00
Rate for Payer: Group Health Inc Medicare	$45.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$84.50

SCREW 3.5MM LOW PROFILE CORT 50MM

Facility OP

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40204631
Hospital Revenue Code	278
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$136.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.75
Rate for Payer: Fidelis Medicare Advantage	$136.50
Rate for Payer: Group Health Inc Commercial	$65.00
Rate for Payer: Group Health Inc Medicare	$45.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$84.50

SCREW 3.5MM LOW PROFILE CORT 50MM

Facility IP

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40007550
Hospital Revenue Code	278
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$65.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00

SCREW 3.5MM LOW PROFILE CORT 50MM

Facility IP

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40204631
Hospital Revenue Code	278
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$65.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00

SCREW 3.5MM LOW PROFILE CORT 50MM

Facility OP

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40007550
Hospital Revenue Code	278
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$136.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.75
Rate for Payer: Fidelis Medicare Advantage	$136.50
Rate for Payer: Group Health Inc Commercial	$65.00
Rate for Payer: Group Health Inc Medicare	$45.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$84.50

SCREW 3.5MM LP CORTICAL 24MM

Facility IP

$162.50

Service Code	HCPCS C1713
Hospital Charge Code	64905624
Hospital Revenue Code	278
Min. Negotiated Rate	$81.25
Max. Negotiated Rate	$81.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.25
Rate for Payer: Hamaspik Choice Inc Medicare	$81.25

SCREW 3.5MM LP CORTICAL 24MM

Facility OP

$162.50

Service Code	HCPCS C1713
Hospital Charge Code	64905624
Hospital Revenue Code	278
Min. Negotiated Rate	$56.88
Max. Negotiated Rate	$170.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.44
Rate for Payer: Fidelis Medicare Advantage	$170.62
Rate for Payer: Group Health Inc Commercial	$81.25
Rate for Payer: Group Health Inc Medicare	$56.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.25
Rate for Payer: Hamaspik Choice Inc Medicare	$81.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.62

SCREW 3.5MM LP CORTICAL 40MM

Facility IP

$162.50

Service Code	HCPCS C1713
Hospital Charge Code	64905625
Hospital Revenue Code	278
Min. Negotiated Rate	$81.25
Max. Negotiated Rate	$81.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.25
Rate for Payer: Hamaspik Choice Inc Medicare	$81.25

SCREW 3.5MM LP CORTICAL 40MM

Facility OP

$162.50

Service Code	HCPCS C1713
Hospital Charge Code	64905625
Hospital Revenue Code	278
Min. Negotiated Rate	$56.88
Max. Negotiated Rate	$170.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.44
Rate for Payer: Fidelis Medicare Advantage	$170.62
Rate for Payer: Group Health Inc Commercial	$81.25
Rate for Payer: Group Health Inc Medicare	$56.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.25
Rate for Payer: Hamaspik Choice Inc Medicare	$81.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.62

SCREW 3.5MM LP CORTICAL 50MM

Facility OP

$162.50

Service Code	HCPCS C1713
Hospital Charge Code	64905627
Hospital Revenue Code	278
Min. Negotiated Rate	$56.88
Max. Negotiated Rate	$170.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.44
Rate for Payer: Fidelis Medicare Advantage	$170.62
Rate for Payer: Group Health Inc Commercial	$81.25
Rate for Payer: Group Health Inc Medicare	$56.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.25
Rate for Payer: Hamaspik Choice Inc Medicare	$81.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.62

SCREW 3.5MM LP CORTICAL 50MM

Facility IP

$162.50

Service Code	HCPCS C1713
Hospital Charge Code	64905627
Hospital Revenue Code	278
Min. Negotiated Rate	$81.25
Max. Negotiated Rate	$81.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.25
Rate for Payer: Hamaspik Choice Inc Medicare	$81.25

SCREW 35 NL X 10

Facility IP

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64903520
Hospital Revenue Code	278
Min. Negotiated Rate	$73.94
Max. Negotiated Rate	$73.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.94
Rate for Payer: Hamaspik Choice Inc Medicare	$73.94

SCREW 35 NL X 10

Facility OP

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64903520
Hospital Revenue Code	278
Min. Negotiated Rate	$51.76
Max. Negotiated Rate	$155.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$81.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$73.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$85.03
Rate for Payer: Fidelis Medicare Advantage	$155.27
Rate for Payer: Group Health Inc Commercial	$73.94
Rate for Payer: Group Health Inc Medicare	$51.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.94
Rate for Payer: Hamaspik Choice Inc Medicare	$73.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$96.12

SCREW 3.5 X 12

Facility IP

$3,497.50

Service Code	HCPCS C1713
Hospital Charge Code	64904156
Hospital Revenue Code	278
Min. Negotiated Rate	$1,748.75
Max. Negotiated Rate	$1,748.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,748.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,748.75

SCREW 3.5 X 12

Facility OP

$3,497.50

Service Code	HCPCS C1713
Hospital Charge Code	64904156
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,672.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,923.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,748.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,011.06
Rate for Payer: Fidelis Medicare Advantage	$3,672.38
Rate for Payer: Group Health Inc Commercial	$1,748.75
Rate for Payer: Group Health Inc Medicare	$1,224.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,748.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,748.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,273.38

SCREW 3.5 X 12

Facility OP

$3,497.50

Service Code	HCPCS C1713
Hospital Charge Code	64904116
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,672.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,923.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,748.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,011.06
Rate for Payer: Fidelis Medicare Advantage	$3,672.38
Rate for Payer: Group Health Inc Commercial	$1,748.75
Rate for Payer: Group Health Inc Medicare	$1,224.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,748.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,748.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,273.38

SCREW 3.5 X 12

Facility IP

$3,497.50

Service Code	HCPCS C1713
Hospital Charge Code	64904116
Hospital Revenue Code	278
Min. Negotiated Rate	$1,748.75
Max. Negotiated Rate	$1,748.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,748.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,748.75

SCREW 3.5 X 12MM

Facility IP

$1,112.50

Service Code	HCPCS C1713
Hospital Charge Code	64905104
Hospital Revenue Code	278
Min. Negotiated Rate	$556.25
Max. Negotiated Rate	$556.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$556.25
Rate for Payer: Hamaspik Choice Inc Medicare	$556.25

SCREW 3.5 X 12MM

Facility OP

$1,112.50

Service Code	HCPCS C1713
Hospital Charge Code	64905104
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,168.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$611.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$556.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$639.69
Rate for Payer: Fidelis Medicare Advantage	$1,168.12
Rate for Payer: Group Health Inc Commercial	$556.25
Rate for Payer: Group Health Inc Medicare	$389.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$556.25
Rate for Payer: Hamaspik Choice Inc Medicare	$556.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$723.12

SCREW 3.5 X 14MM SELF

Facility IP

$1,112.50

Service Code	HCPCS C1713
Hospital Charge Code	64904839
Hospital Revenue Code	278
Min. Negotiated Rate	$556.25
Max. Negotiated Rate	$556.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$556.25
Rate for Payer: Hamaspik Choice Inc Medicare	$556.25

SCREW 3.5 X 14MM SELF

Facility OP

$1,112.50

Service Code	HCPCS C1713
Hospital Charge Code	64904839
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,168.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$611.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$556.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$639.69
Rate for Payer: Fidelis Medicare Advantage	$1,168.12
Rate for Payer: Group Health Inc Commercial	$556.25
Rate for Payer: Group Health Inc Medicare	$389.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$556.25
Rate for Payer: Hamaspik Choice Inc Medicare	$556.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$723.12

SCREW 3.5 X 16 MM SELF

Facility OP

$1,112.50

Service Code	HCPCS C1713
Hospital Charge Code	64904841
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,168.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$611.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$556.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$639.69
Rate for Payer: Fidelis Medicare Advantage	$1,168.12
Rate for Payer: Group Health Inc Commercial	$556.25
Rate for Payer: Group Health Inc Medicare	$389.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$556.25
Rate for Payer: Hamaspik Choice Inc Medicare	$556.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$723.12

SCREW 3.5 X 16 MM SELF

Facility IP

$1,112.50

Service Code	HCPCS C1713
Hospital Charge Code	64904841
Hospital Revenue Code	278
Min. Negotiated Rate	$556.25
Max. Negotiated Rate	$556.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$556.25
Rate for Payer: Hamaspik Choice Inc Medicare	$556.25

SCREW 3.5 X 18 MM

Facility IP

$762.50

Service Code	HCPCS C1713
Hospital Charge Code	64904049
Hospital Revenue Code	278
Min. Negotiated Rate	$381.25
Max. Negotiated Rate	$381.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$381.25
Rate for Payer: Hamaspik Choice Inc Medicare	$381.25

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