St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW BONE 1.7MM DIA 9MML TT

Facility IP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64903990
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 9MML TT

Facility OP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64903990
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 9MML TTA

Facility IP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64903635
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 9MML TTA

Facility OP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64903635
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 1.7 X 11 TITAN AL

Facility OP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64905021
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 1.7 X 11 TITAN AL

Facility IP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64905021
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 1.7 X 15

Facility OP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64904524
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 1.7 X 15

Facility IP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64904524
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 1.7 X 18

Facility OP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64904527
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 1.7 X 18

Facility IP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64904527
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 1.7 X 4MM

Facility OP

$113.30

Service Code	HCPCS C1713
Hospital Charge Code	64903218
Hospital Revenue Code	278
Min. Negotiated Rate	$39.66
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.32
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	$56.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.15
Rate for Payer: Fidelis Medicare Advantage	$118.96
Rate for Payer: Group Health Inc Commercial	$56.65
Rate for Payer: Group Health Inc Medicare	$39.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.65
Rate for Payer: Hamaspik Choice Inc Medicare	$56.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$73.64

SCREW BONE 1.7 X 4MM

Facility IP

$113.30

Service Code	HCPCS C1713
Hospital Charge Code	64903218
Hospital Revenue Code	278
Min. Negotiated Rate	$56.65
Max. Negotiated Rate	$56.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.65
Rate for Payer: Hamaspik Choice Inc Medicare	$56.65

SCREW BONE 1.7X6MM LOCKING

Facility OP

$229.13

Service Code	HCPCS C1713
Hospital Charge Code	64905787
Hospital Revenue Code	278
Min. Negotiated Rate	$80.20
Max. Negotiated Rate	$240.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.02
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	$114.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$131.75
Rate for Payer: Fidelis Medicare Advantage	$240.59
Rate for Payer: Group Health Inc Commercial	$114.56
Rate for Payer: Group Health Inc Medicare	$80.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.56
Rate for Payer: Hamaspik Choice Inc Medicare	$114.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$148.93

SCREW BONE 1.7X6MM LOCKING

Facility IP

$229.13

Service Code	HCPCS C1713
Hospital Charge Code	64905787
Hospital Revenue Code	278
Min. Negotiated Rate	$114.56
Max. Negotiated Rate	$114.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.56
Rate for Payer: Hamaspik Choice Inc Medicare	$114.56

SCREW BONE 2.0 12MM

Facility OP

$107.10

Service Code	HCPCS C1713
Hospital Charge Code	64903208
Hospital Revenue Code	278
Min. Negotiated Rate	$37.48
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.90
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	$53.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$61.58
Rate for Payer: Fidelis Medicare Advantage	$112.46
Rate for Payer: Group Health Inc Commercial	$53.55
Rate for Payer: Group Health Inc Medicare	$37.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.55
Rate for Payer: Hamaspik Choice Inc Medicare	$53.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$69.62

SCREW BONE 2.0 12MM

Facility IP

$107.10

Service Code	HCPCS C1713
Hospital Charge Code	64903208
Hospital Revenue Code	278
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$53.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.55
Rate for Payer: Hamaspik Choice Inc Medicare	$53.55

SCREW BONE 2.0 6MM

Facility OP

$107.10

Service Code	HCPCS C1713
Hospital Charge Code	64903205
Hospital Revenue Code	278
Min. Negotiated Rate	$37.48
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.90
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	$53.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$61.58
Rate for Payer: Fidelis Medicare Advantage	$112.46
Rate for Payer: Group Health Inc Commercial	$53.55
Rate for Payer: Group Health Inc Medicare	$37.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.55
Rate for Payer: Hamaspik Choice Inc Medicare	$53.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$69.62

SCREW BONE 2.0 6MM

Facility IP

$107.10

Service Code	HCPCS C1713
Hospital Charge Code	64903205
Hospital Revenue Code	278
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$53.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.55
Rate for Payer: Hamaspik Choice Inc Medicare	$53.55

SCREW BONE 2.0 DIA 6MM SD A

Facility OP

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	64902784
Hospital Revenue Code	278
Min. Negotiated Rate	$110.25
Max. Negotiated Rate	$330.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$173.25
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	$157.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$181.12
Rate for Payer: Fidelis Medicare Advantage	$330.75
Rate for Payer: Group Health Inc Commercial	$157.50
Rate for Payer: Group Health Inc Medicare	$110.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.50
Rate for Payer: Hamaspik Choice Inc Medicare	$157.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$204.75

SCREW BONE 2.0 DIA 6MM SD A

Facility IP

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	64902784
Hospital Revenue Code	278
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$157.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.50
Rate for Payer: Hamaspik Choice Inc Medicare	$157.50

SCREW BONE 2.0 DIA 8MM SD

Facility OP

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	64902823
Hospital Revenue Code	278
Min. Negotiated Rate	$110.25
Max. Negotiated Rate	$330.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$173.25
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	$157.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$181.12
Rate for Payer: Fidelis Medicare Advantage	$330.75
Rate for Payer: Group Health Inc Commercial	$157.50
Rate for Payer: Group Health Inc Medicare	$110.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.50
Rate for Payer: Hamaspik Choice Inc Medicare	$157.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$204.75

SCREW BONE 2.0 DIA 8MM SD

Facility IP

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	64902823
Hospital Revenue Code	278
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$157.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.50
Rate for Payer: Hamaspik Choice Inc Medicare	$157.50

SCREW BONE 2.0X5MM MP CRSS PIN

Facility IP

$128.78

Service Code	HCPCS C1713
Hospital Charge Code	64901847
Hospital Revenue Code	278
Min. Negotiated Rate	$64.39
Max. Negotiated Rate	$64.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.39
Rate for Payer: Hamaspik Choice Inc Medicare	$64.39

SCREW BONE 2.0X5MM MP CRSS PIN

Facility OP

$128.78

Service Code	HCPCS C1713
Hospital Charge Code	64901847
Hospital Revenue Code	278
Min. Negotiated Rate	$45.07
Max. Negotiated Rate	$135.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.83
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	$64.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.05
Rate for Payer: Fidelis Medicare Advantage	$135.22
Rate for Payer: Group Health Inc Commercial	$64.39
Rate for Payer: Group Health Inc Medicare	$45.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.39
Rate for Payer: Hamaspik Choice Inc Medicare	$64.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$83.71

SCREW BONE 23MM 26MML

Facility OP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64905462
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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