St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW BONE 2.7MM DIA 38MML TT

Facility OP

$406.00

Service Code	HCPCS C1713
Hospital Charge Code	64902926
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$426.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$223.30
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	$203.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$233.45
Rate for Payer: Fidelis Medicare Advantage	$426.30
Rate for Payer: Group Health Inc Commercial	$203.00
Rate for Payer: Group Health Inc Medicare	$142.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.00
Rate for Payer: Hamaspik Choice Inc Medicare	$203.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$263.90

SCREW BONE 2.7MM DIA 8MML TT

Facility OP

$134.88

Service Code	HCPCS C1713
Hospital Charge Code	64903111
Hospital Revenue Code	278
Min. Negotiated Rate	$47.21
Max. Negotiated Rate	$141.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.18
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	$67.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.56
Rate for Payer: Fidelis Medicare Advantage	$141.62
Rate for Payer: Group Health Inc Commercial	$67.44
Rate for Payer: Group Health Inc Medicare	$47.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.44
Rate for Payer: Hamaspik Choice Inc Medicare	$67.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$87.67

SCREW BONE 2.7MM DIA 8MML TT

Facility IP

$134.88

Service Code	HCPCS C1713
Hospital Charge Code	64903111
Hospital Revenue Code	278
Min. Negotiated Rate	$67.44
Max. Negotiated Rate	$67.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.44
Rate for Payer: Hamaspik Choice Inc Medicare	$67.44

SCREW BONE 2.7 X 12MM B

Facility OP

$134.88

Service Code	HCPCS C1713
Hospital Charge Code	64902293
Hospital Revenue Code	278
Min. Negotiated Rate	$47.21
Max. Negotiated Rate	$141.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.18
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	$67.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.56
Rate for Payer: Fidelis Medicare Advantage	$141.62
Rate for Payer: Group Health Inc Commercial	$67.44
Rate for Payer: Group Health Inc Medicare	$47.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.44
Rate for Payer: Hamaspik Choice Inc Medicare	$67.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$87.67

SCREW BONE 2.7 X 12MM B

Facility IP

$134.88

Service Code	HCPCS C1713
Hospital Charge Code	64902293
Hospital Revenue Code	278
Min. Negotiated Rate	$67.44
Max. Negotiated Rate	$67.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.44
Rate for Payer: Hamaspik Choice Inc Medicare	$67.44

SCREW BONE 2.7 X 14MM

Facility IP

$134.88

Service Code	HCPCS C1713
Hospital Charge Code	64902607
Hospital Revenue Code	278
Min. Negotiated Rate	$67.44
Max. Negotiated Rate	$67.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.44
Rate for Payer: Hamaspik Choice Inc Medicare	$67.44

SCREW BONE 2.7 X 14MM

Facility OP

$134.88

Service Code	HCPCS C1713
Hospital Charge Code	64902607
Hospital Revenue Code	278
Min. Negotiated Rate	$47.21
Max. Negotiated Rate	$141.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.18
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	$67.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.56
Rate for Payer: Fidelis Medicare Advantage	$141.62
Rate for Payer: Group Health Inc Commercial	$67.44
Rate for Payer: Group Health Inc Medicare	$47.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.44
Rate for Payer: Hamaspik Choice Inc Medicare	$67.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$87.67

SCREW BONE 2.7 X 16 MM

Facility OP

$160.00

Service Code	HCPCS C1713
Hospital Charge Code	40201316
Hospital Revenue Code	278
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$168.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$88.00
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	$80.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$92.00
Rate for Payer: Fidelis Medicare Advantage	$168.00
Rate for Payer: Group Health Inc Commercial	$80.00
Rate for Payer: Group Health Inc Medicare	$56.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.00
Rate for Payer: Hamaspik Choice Inc Medicare	$80.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$104.00

SCREW BONE 2.7 X 16 MM

Facility IP

$160.00

Service Code	HCPCS C1713
Hospital Charge Code	40201316
Hospital Revenue Code	278
Min. Negotiated Rate	$80.00
Max. Negotiated Rate	$80.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.00
Rate for Payer: Hamaspik Choice Inc Medicare	$80.00

SCREW BONE 2.7 X 16MM

Facility IP

$134.88

Service Code	HCPCS C1713
Hospital Charge Code	64901895
Hospital Revenue Code	278
Min. Negotiated Rate	$67.44
Max. Negotiated Rate	$67.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.44
Rate for Payer: Hamaspik Choice Inc Medicare	$67.44

SCREW BONE 2.7 X 16MM

Facility OP

$134.88

Service Code	HCPCS C1713
Hospital Charge Code	64901895
Hospital Revenue Code	278
Min. Negotiated Rate	$47.21
Max. Negotiated Rate	$141.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.18
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	$67.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.56
Rate for Payer: Fidelis Medicare Advantage	$141.62
Rate for Payer: Group Health Inc Commercial	$67.44
Rate for Payer: Group Health Inc Medicare	$47.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.44
Rate for Payer: Hamaspik Choice Inc Medicare	$67.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$87.67

SCREW BONE 2.7 X 18MM

Facility IP

$134.88

Service Code	HCPCS C1713
Hospital Charge Code	64902292
Hospital Revenue Code	278
Min. Negotiated Rate	$67.44
Max. Negotiated Rate	$67.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.44
Rate for Payer: Hamaspik Choice Inc Medicare	$67.44

SCREW BONE 2.7 X 18MM

Facility OP

$134.88

Service Code	HCPCS C1713
Hospital Charge Code	64902292
Hospital Revenue Code	278
Min. Negotiated Rate	$47.21
Max. Negotiated Rate	$141.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.18
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	$67.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.56
Rate for Payer: Fidelis Medicare Advantage	$141.62
Rate for Payer: Group Health Inc Commercial	$67.44
Rate for Payer: Group Health Inc Medicare	$47.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.44
Rate for Payer: Hamaspik Choice Inc Medicare	$67.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$87.67

SCREW BONE 2.7 X 34

Facility OP

$134.88

Service Code	HCPCS C1713
Hospital Charge Code	64903969
Hospital Revenue Code	278
Min. Negotiated Rate	$47.21
Max. Negotiated Rate	$141.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.18
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	$67.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.56
Rate for Payer: Fidelis Medicare Advantage	$141.62
Rate for Payer: Group Health Inc Commercial	$67.44
Rate for Payer: Group Health Inc Medicare	$47.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.44
Rate for Payer: Hamaspik Choice Inc Medicare	$67.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$87.67

SCREW BONE 2.7 X 34

Facility IP

$134.88

Service Code	HCPCS C1713
Hospital Charge Code	64903969
Hospital Revenue Code	278
Min. Negotiated Rate	$67.44
Max. Negotiated Rate	$67.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.44
Rate for Payer: Hamaspik Choice Inc Medicare	$67.44

SCREW BONE 2.7 X 36

Facility OP

$134.88

Service Code	HCPCS C1713
Hospital Charge Code	64904536
Hospital Revenue Code	278
Min. Negotiated Rate	$47.21
Max. Negotiated Rate	$141.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.18
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	$67.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.56
Rate for Payer: Fidelis Medicare Advantage	$141.62
Rate for Payer: Group Health Inc Commercial	$67.44
Rate for Payer: Group Health Inc Medicare	$47.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.44
Rate for Payer: Hamaspik Choice Inc Medicare	$67.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$87.67

SCREW BONE 2.7 X 36

Facility IP

$134.88

Service Code	HCPCS C1713
Hospital Charge Code	64904536
Hospital Revenue Code	278
Min. Negotiated Rate	$67.44
Max. Negotiated Rate	$67.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.44
Rate for Payer: Hamaspik Choice Inc Medicare	$67.44

SCREW BONE 3.0 X 14

Facility IP

$525.00

Service Code	HCPCS C1713
Hospital Charge Code	64903203
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50

SCREW BONE 3.0 X 14

Facility OP

$525.00

Service Code	HCPCS C1713
Hospital Charge Code	64903203
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$551.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$288.75
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	$262.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$301.88
Rate for Payer: Fidelis Medicare Advantage	$551.25
Rate for Payer: Group Health Inc Commercial	$262.50
Rate for Payer: Group Health Inc Medicare	$183.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$341.25

SCREW BONE 3.0 X 2.0

Facility IP

$525.00

Service Code	HCPCS C1713
Hospital Charge Code	64904720
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50

SCREW BONE 3.0 X 2.0

Facility OP

$525.00

Service Code	HCPCS C1713
Hospital Charge Code	64904720
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$551.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$288.75
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	$262.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$301.88
Rate for Payer: Fidelis Medicare Advantage	$551.25
Rate for Payer: Group Health Inc Commercial	$262.50
Rate for Payer: Group Health Inc Medicare	$183.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$341.25

SCREW BONE 35 48

Facility IP

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64903884
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 BONE 35 48

Facility OP

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64903884
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 BONE 3.5-50

Facility IP

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64902893
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 BONE 3.5-50

Facility OP

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64902893
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

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