St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW,BONE,1.2X12MM CRSSPIN SELFT

Facility IP

$123.50

Service Code	HCPCS C1713
Hospital Charge Code	40005903
Hospital Revenue Code	278
Min. Negotiated Rate	$61.75
Max. Negotiated Rate	$61.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.75
Rate for Payer: Hamaspik Choice Inc Medicare	$61.75

SCREW BONE 1.2X14MM CROSSPIN

Facility IP

$154.38

Service Code	HCPCS C1713
Hospital Charge Code	64905478
Hospital Revenue Code	278
Min. Negotiated Rate	$77.19
Max. Negotiated Rate	$77.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.19
Rate for Payer: Hamaspik Choice Inc Medicare	$77.19

SCREW BONE 1.2X14MM CROSSPIN

Facility OP

$154.38

Service Code	HCPCS C1713
Hospital Charge Code	64905478
Hospital Revenue Code	278
Min. Negotiated Rate	$54.03
Max. Negotiated Rate	$162.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$84.91
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	$77.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$88.77
Rate for Payer: Fidelis Medicare Advantage	$162.10
Rate for Payer: Group Health Inc Commercial	$77.19
Rate for Payer: Group Health Inc Medicare	$54.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.19
Rate for Payer: Hamaspik Choice Inc Medicare	$77.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$100.35

SCREW,BONE,1.2X14MM CRSSPIN SELFT

Facility IP

$123.50

Service Code	HCPCS C1713
Hospital Charge Code	40005904
Hospital Revenue Code	278
Min. Negotiated Rate	$61.75
Max. Negotiated Rate	$61.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.75
Rate for Payer: Hamaspik Choice Inc Medicare	$61.75

SCREW,BONE,1.2X14MM CRSSPIN SELFT

Facility OP

$123.50

Service Code	HCPCS C1713
Hospital Charge Code	40005904
Hospital Revenue Code	278
Min. Negotiated Rate	$43.22
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$67.92
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	$61.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$71.01
Rate for Payer: Fidelis Medicare Advantage	$129.68
Rate for Payer: Group Health Inc Commercial	$61.75
Rate for Payer: Group Health Inc Medicare	$43.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.75
Rate for Payer: Hamaspik Choice Inc Medicare	$61.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$80.28

SCREW BONE 1.2 X 4MM

Facility IP

$154.38

Service Code	HCPCS C1713
Hospital Charge Code	64903033
Hospital Revenue Code	278
Min. Negotiated Rate	$77.19
Max. Negotiated Rate	$77.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.19
Rate for Payer: Hamaspik Choice Inc Medicare	$77.19

SCREW BONE 1.2 X 4MM

Facility OP

$154.38

Service Code	HCPCS C1713
Hospital Charge Code	64903033
Hospital Revenue Code	278
Min. Negotiated Rate	$54.03
Max. Negotiated Rate	$162.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$84.91
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	$77.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$88.77
Rate for Payer: Fidelis Medicare Advantage	$162.10
Rate for Payer: Group Health Inc Commercial	$77.19
Rate for Payer: Group Health Inc Medicare	$54.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.19
Rate for Payer: Hamaspik Choice Inc Medicare	$77.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$100.35

SCREW BONE 1.5MM DIA 5MML

Facility IP

$149.50

Service Code	HCPCS C1713
Hospital Charge Code	64904151
Hospital Revenue Code	278
Min. Negotiated Rate	$74.75
Max. Negotiated Rate	$74.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.75
Rate for Payer: Hamaspik Choice Inc Medicare	$74.75

SCREW BONE 1.5MM DIA 5MML

Facility OP

$149.50

Service Code	HCPCS C1713
Hospital Charge Code	64904151
Hospital Revenue Code	278
Min. Negotiated Rate	$52.32
Max. Negotiated Rate	$156.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.22
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	$74.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$85.96
Rate for Payer: Fidelis Medicare Advantage	$156.98
Rate for Payer: Group Health Inc Commercial	$74.75
Rate for Payer: Group Health Inc Medicare	$52.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.75
Rate for Payer: Hamaspik Choice Inc Medicare	$74.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$97.18

SCREW BONE 1.7MM DIA 10MML TT

Facility OP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64902560
Hospital Revenue Code	278
Min. Negotiated Rate	$62.56
Max. Negotiated Rate	$187.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$98.31
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	$89.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.78
Rate for Payer: Fidelis Medicare Advantage	$187.69
Rate for Payer: Group Health Inc Commercial	$89.38
Rate for Payer: Group Health Inc Medicare	$62.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.38
Rate for Payer: Hamaspik Choice Inc Medicare	$89.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$116.19

SCREW BONE 1.7MM DIA 10MML TT

Facility IP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64902560
Hospital Revenue Code	278
Min. Negotiated Rate	$89.38
Max. Negotiated Rate	$89.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.38
Rate for Payer: Hamaspik Choice Inc Medicare	$89.38

SCREW BONE 1.7MM DIA 12MML TT

Facility IP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64904497
Hospital Revenue Code	278
Min. Negotiated Rate	$89.38
Max. Negotiated Rate	$89.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.38
Rate for Payer: Hamaspik Choice Inc Medicare	$89.38

SCREW BONE 1.7MM DIA 12MML TT

Facility OP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64904497
Hospital Revenue Code	278
Min. Negotiated Rate	$62.56
Max. Negotiated Rate	$187.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$98.31
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	$89.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.78
Rate for Payer: Fidelis Medicare Advantage	$187.69
Rate for Payer: Group Health Inc Commercial	$89.38
Rate for Payer: Group Health Inc Medicare	$62.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.38
Rate for Payer: Hamaspik Choice Inc Medicare	$89.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$116.19

SCREW BONE 1.7MM DIA 14MML TT

Facility OP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64904499
Hospital Revenue Code	278
Min. Negotiated Rate	$62.56
Max. Negotiated Rate	$187.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$98.31
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	$89.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.78
Rate for Payer: Fidelis Medicare Advantage	$187.69
Rate for Payer: Group Health Inc Commercial	$89.38
Rate for Payer: Group Health Inc Medicare	$62.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.38
Rate for Payer: Hamaspik Choice Inc Medicare	$89.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$116.19

SCREW BONE 1.7MM DIA 14MML TT

Facility IP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64904499
Hospital Revenue Code	278
Min. Negotiated Rate	$89.38
Max. Negotiated Rate	$89.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.38
Rate for Payer: Hamaspik Choice Inc Medicare	$89.38

SCREW BONE 1.7MM DIA 18MML TT

Facility IP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64904500
Hospital Revenue Code	278
Min. Negotiated Rate	$89.38
Max. Negotiated Rate	$89.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.38
Rate for Payer: Hamaspik Choice Inc Medicare	$89.38

SCREW BONE 1.7MM DIA 18MML TT

Facility OP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64904500
Hospital Revenue Code	278
Min. Negotiated Rate	$62.56
Max. Negotiated Rate	$187.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$98.31
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	$89.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.78
Rate for Payer: Fidelis Medicare Advantage	$187.69
Rate for Payer: Group Health Inc Commercial	$89.38
Rate for Payer: Group Health Inc Medicare	$62.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.38
Rate for Payer: Hamaspik Choice Inc Medicare	$89.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$116.19

SCREW BONE 1.7MM DIA 5MML TTA

Facility OP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64903035
Hospital Revenue Code	278
Min. Negotiated Rate	$62.56
Max. Negotiated Rate	$187.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$98.31
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	$89.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.78
Rate for Payer: Fidelis Medicare Advantage	$187.69
Rate for Payer: Group Health Inc Commercial	$89.38
Rate for Payer: Group Health Inc Medicare	$62.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.38
Rate for Payer: Hamaspik Choice Inc Medicare	$89.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$116.19

SCREW BONE 1.7MM DIA 5MML TTA

Facility IP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64903035
Hospital Revenue Code	278
Min. Negotiated Rate	$89.38
Max. Negotiated Rate	$89.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.38
Rate for Payer: Hamaspik Choice Inc Medicare	$89.38

SCREW BONE 1.7MM DIA 6MML TTA

Facility OP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64904464
Hospital Revenue Code	278
Min. Negotiated Rate	$62.56
Max. Negotiated Rate	$187.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$98.31
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	$89.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.78
Rate for Payer: Fidelis Medicare Advantage	$187.69
Rate for Payer: Group Health Inc Commercial	$89.38
Rate for Payer: Group Health Inc Medicare	$62.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.38
Rate for Payer: Hamaspik Choice Inc Medicare	$89.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$116.19

SCREW BONE 1.7MM DIA 6MML TTA

Facility IP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64904464
Hospital Revenue Code	278
Min. Negotiated Rate	$89.38
Max. Negotiated Rate	$89.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.38
Rate for Payer: Hamaspik Choice Inc Medicare	$89.38

SCREW BONE 1.7MM DIA 7MML TTA

Facility IP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64903633
Hospital Revenue Code	278
Min. Negotiated Rate	$89.38
Max. Negotiated Rate	$89.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.38
Rate for Payer: Hamaspik Choice Inc Medicare	$89.38

SCREW BONE 1.7MM DIA 7MML TTA

Facility OP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64903633
Hospital Revenue Code	278
Min. Negotiated Rate	$62.56
Max. Negotiated Rate	$187.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$98.31
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	$89.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.78
Rate for Payer: Fidelis Medicare Advantage	$187.69
Rate for Payer: Group Health Inc Commercial	$89.38
Rate for Payer: Group Health Inc Medicare	$62.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.38
Rate for Payer: Hamaspik Choice Inc Medicare	$89.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$116.19

SCREW BONE 1.7MM DIA 8MML TTA

Facility IP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64902561
Hospital Revenue Code	278
Min. Negotiated Rate	$89.38
Max. Negotiated Rate	$89.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.38
Rate for Payer: Hamaspik Choice Inc Medicare	$89.38

SCREW BONE 1.7MM DIA 8MML TTA

Facility OP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64902561
Hospital Revenue Code	278
Min. Negotiated Rate	$62.56
Max. Negotiated Rate	$187.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$98.31
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	$89.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.78
Rate for Payer: Fidelis Medicare Advantage	$187.69
Rate for Payer: Group Health Inc Commercial	$89.38
Rate for Payer: Group Health Inc Medicare	$62.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.38
Rate for Payer: Hamaspik Choice Inc Medicare	$89.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$116.19

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