St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW BONE 3.5MM DIA 14MML TT

Facility OP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901766
Hospital Revenue Code	278
Min. Negotiated Rate	$19.91
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.28
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	$28.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.71
Rate for Payer: Fidelis Medicare Advantage	$59.72
Rate for Payer: Group Health Inc Commercial	$28.44
Rate for Payer: Group Health Inc Medicare	$19.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.44
Rate for Payer: Hamaspik Choice Inc Medicare	$28.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.97

SCREW BONE 3.5MM DIA 14MML TT

Facility IP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901766
Hospital Revenue Code	278
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$28.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.44
Rate for Payer: Hamaspik Choice Inc Medicare	$28.44

SCREW BONE 3.5MM DIA 16MML TT

Facility IP

$56.75

Service Code	HCPCS C1713
Hospital Charge Code	64901767
Hospital Revenue Code	278
Min. Negotiated Rate	$28.38
Max. Negotiated Rate	$28.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.38
Rate for Payer: Hamaspik Choice Inc Medicare	$28.38

SCREW BONE 3.5MM DIA 16MML TT

Facility OP

$56.75

Service Code	HCPCS C1713
Hospital Charge Code	64901767
Hospital Revenue Code	278
Min. Negotiated Rate	$19.86
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.21
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	$28.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.63
Rate for Payer: Fidelis Medicare Advantage	$59.59
Rate for Payer: Group Health Inc Commercial	$28.38
Rate for Payer: Group Health Inc Medicare	$19.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.38
Rate for Payer: Hamaspik Choice Inc Medicare	$28.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.89

SCREW BONE 3.5MM DIA 26MML T

Facility IP

$77.05

Service Code	HCPCS C1713
Hospital Charge Code	64903658
Hospital Revenue Code	278
Min. Negotiated Rate	$38.52
Max. Negotiated Rate	$38.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.52
Rate for Payer: Hamaspik Choice Inc Medicare	$38.52

SCREW BONE 3.5MM DIA 26MML T

Facility OP

$77.05

Service Code	HCPCS C1713
Hospital Charge Code	64903658
Hospital Revenue Code	278
Min. Negotiated Rate	$26.97
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.38
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	$38.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.30
Rate for Payer: Fidelis Medicare Advantage	$80.90
Rate for Payer: Group Health Inc Commercial	$38.52
Rate for Payer: Group Health Inc Medicare	$26.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.52
Rate for Payer: Hamaspik Choice Inc Medicare	$38.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$50.08

SCREW BONE 3.5MM DIA 26MML TT

Facility IP

$333.13

Service Code	HCPCS C1713
Hospital Charge Code	64902179
Hospital Revenue Code	278
Min. Negotiated Rate	$166.56
Max. Negotiated Rate	$166.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$166.56
Rate for Payer: Hamaspik Choice Inc Medicare	$166.56

SCREW BONE 3.5MM DIA 26MML TT

Facility OP

$333.13

Service Code	HCPCS C1713
Hospital Charge Code	64902179
Hospital Revenue Code	278
Min. Negotiated Rate	$116.60
Max. Negotiated Rate	$349.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$183.22
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	$166.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$191.55
Rate for Payer: Fidelis Medicare Advantage	$349.79
Rate for Payer: Group Health Inc Commercial	$166.56
Rate for Payer: Group Health Inc Medicare	$116.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$166.56
Rate for Payer: Hamaspik Choice Inc Medicare	$166.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$216.53

SCREW BONE 3.5MM DIA 28MML TT

Facility OP

$89.25

Service Code	HCPCS C1713
Hospital Charge Code	64903174
Hospital Revenue Code	278
Min. Negotiated Rate	$31.24
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$49.09
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	$44.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.32
Rate for Payer: Fidelis Medicare Advantage	$93.71
Rate for Payer: Group Health Inc Commercial	$44.62
Rate for Payer: Group Health Inc Medicare	$31.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.62
Rate for Payer: Hamaspik Choice Inc Medicare	$44.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$58.01

SCREW BONE 3.5MM DIA 28MML TT

Facility IP

$89.25

Service Code	HCPCS C1713
Hospital Charge Code	64903174
Hospital Revenue Code	278
Min. Negotiated Rate	$44.62
Max. Negotiated Rate	$44.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.62
Rate for Payer: Hamaspik Choice Inc Medicare	$44.62

SCREW BONE 3.5MM DIA 30MML TT

Facility IP

$80.00

Service Code	HCPCS C1713
Hospital Charge Code	64903315
Hospital Revenue Code	278
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$40.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.00
Rate for Payer: Hamaspik Choice Inc Medicare	$40.00

SCREW BONE 3.5MM DIA 30MML TT

Facility OP

$80.00

Service Code	HCPCS C1713
Hospital Charge Code	64903315
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.00
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	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.00
Rate for Payer: Fidelis Medicare Advantage	$84.00
Rate for Payer: Group Health Inc Commercial	$40.00
Rate for Payer: Group Health Inc Medicare	$28.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.00
Rate for Payer: Hamaspik Choice Inc Medicare	$40.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.00

SCREW BONE 3.5MM DIA 32MML TT

Facility OP

$77.05

Service Code	HCPCS C1713
Hospital Charge Code	64903301
Hospital Revenue Code	278
Min. Negotiated Rate	$26.97
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.38
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	$38.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.30
Rate for Payer: Fidelis Medicare Advantage	$80.90
Rate for Payer: Group Health Inc Commercial	$38.52
Rate for Payer: Group Health Inc Medicare	$26.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.52
Rate for Payer: Hamaspik Choice Inc Medicare	$38.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$50.08

SCREW BONE 3.5MM DIA 32MML TT

Facility IP

$77.05

Service Code	HCPCS C1713
Hospital Charge Code	64903301
Hospital Revenue Code	278
Min. Negotiated Rate	$38.52
Max. Negotiated Rate	$38.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.52
Rate for Payer: Hamaspik Choice Inc Medicare	$38.52

SCREW BONE 3.5MM DIA 34MML TT

Facility OP

$80.00

Service Code	HCPCS C1713
Hospital Charge Code	64903320
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.00
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	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.00
Rate for Payer: Fidelis Medicare Advantage	$84.00
Rate for Payer: Group Health Inc Commercial	$40.00
Rate for Payer: Group Health Inc Medicare	$28.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.00
Rate for Payer: Hamaspik Choice Inc Medicare	$40.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.00

SCREW BONE 3.5MM DIA 34MML TT

Facility IP

$80.00

Service Code	HCPCS C1713
Hospital Charge Code	64903320
Hospital Revenue Code	278
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$40.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.00
Rate for Payer: Hamaspik Choice Inc Medicare	$40.00

SCREW BONE 3.5MM DIA 42MML TT

Facility OP

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	64905230
Hospital Revenue Code	278
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.00
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	$50.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.50
Rate for Payer: Fidelis Medicare Advantage	$105.00
Rate for Payer: Group Health Inc Commercial	$50.00
Rate for Payer: Group Health Inc Medicare	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.00

SCREW BONE 3.5MM DIA 42MML TT

Facility IP

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	64905230
Hospital Revenue Code	278
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$50.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00

SCREW BONE 3.5MM DIA 46MML TT

Facility IP

$74.10

Service Code	HCPCS C1713
Hospital Charge Code	64904061
Hospital Revenue Code	278
Min. Negotiated Rate	$37.05
Max. Negotiated Rate	$37.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.05
Rate for Payer: Hamaspik Choice Inc Medicare	$37.05

SCREW BONE 3.5MM DIA 46MML TT

Facility OP

$74.10

Service Code	HCPCS C1713
Hospital Charge Code	64904061
Hospital Revenue Code	278
Min. Negotiated Rate	$25.94
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$40.76
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	$37.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$42.61
Rate for Payer: Fidelis Medicare Advantage	$77.80
Rate for Payer: Group Health Inc Commercial	$37.05
Rate for Payer: Group Health Inc Medicare	$25.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.05
Rate for Payer: Hamaspik Choice Inc Medicare	$37.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$48.16

SCREW BONE 3.5MM DIA 50MML TT

Facility OP

$94.50

Service Code	HCPCS C1713
Hospital Charge Code	64904063
Hospital Revenue Code	278
Min. Negotiated Rate	$33.08
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.98
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	$47.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$54.34
Rate for Payer: Fidelis Medicare Advantage	$99.22
Rate for Payer: Group Health Inc Commercial	$47.25
Rate for Payer: Group Health Inc Medicare	$33.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.25
Rate for Payer: Hamaspik Choice Inc Medicare	$47.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$61.42

SCREW BONE 3.5MM DIA 50MML TT

Facility IP

$94.50

Service Code	HCPCS C1713
Hospital Charge Code	64904063
Hospital Revenue Code	278
Min. Negotiated Rate	$47.25
Max. Negotiated Rate	$47.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.25
Rate for Payer: Hamaspik Choice Inc Medicare	$47.25

SCREW BONE 3.5MM DIA 60MML T

Facility IP

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	64903171
Hospital Revenue Code	278
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$50.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00

SCREW BONE 3.5MM DIA 60MML T

Facility OP

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	64903171
Hospital Revenue Code	278
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.00
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	$50.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.50
Rate for Payer: Fidelis Medicare Advantage	$105.00
Rate for Payer: Group Health Inc Commercial	$50.00
Rate for Payer: Group Health Inc Medicare	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.00

SCREW BONE 3.5MM DIA 65MML TT

Facility OP

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	64903170
Hospital Revenue Code	278
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.00
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	$50.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.50
Rate for Payer: Fidelis Medicare Advantage	$105.00
Rate for Payer: Group Health Inc Commercial	$50.00
Rate for Payer: Group Health Inc Medicare	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.00

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