St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW BONE CANCELL 4.0MM DIA 40

Facility IP

$58.50

Service Code	HCPCS C1713
Hospital Charge Code	64905268
Hospital Revenue Code	278
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.25
Rate for Payer: Hamaspik Choice Inc Medicare	$29.25

SCREW BONE CANCELL 4.0MM DIA 40

Facility OP

$58.50

Service Code	HCPCS C1713
Hospital Charge Code	64905268
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.18
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	$29.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.64
Rate for Payer: Fidelis Medicare Advantage	$61.42
Rate for Payer: Group Health Inc Commercial	$29.25
Rate for Payer: Group Health Inc Medicare	$20.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.25
Rate for Payer: Hamaspik Choice Inc Medicare	$29.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.02

SCREW BONE CANCELL 4.0MM DIA 453

Facility OP

$58.50

Service Code	HCPCS C1713
Hospital Charge Code	64905270
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.18
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	$29.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.64
Rate for Payer: Fidelis Medicare Advantage	$61.42
Rate for Payer: Group Health Inc Commercial	$29.25
Rate for Payer: Group Health Inc Medicare	$20.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.25
Rate for Payer: Hamaspik Choice Inc Medicare	$29.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.02

SCREW BONE CANCELL 4.0MM DIA 453

Facility IP

$58.50

Service Code	HCPCS C1713
Hospital Charge Code	64905270
Hospital Revenue Code	278
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.25
Rate for Payer: Hamaspik Choice Inc Medicare	$29.25

SCREW BONE CANCELL 4.0MM / L32MM

Facility OP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64904904
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$157.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
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	$75.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.25
Rate for Payer: Fidelis Medicare Advantage	$157.50
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$97.50

SCREW BONE CANCELL 4.0MM / L32MM

Facility IP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64904904
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

SCREW BONE CANCELL 4.0MM / L40MM

Facility OP

$142.50

Service Code	HCPCS C1713
Hospital Charge Code	64904067
Hospital Revenue Code	278
Min. Negotiated Rate	$49.88
Max. Negotiated Rate	$149.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.38
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	$71.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.94
Rate for Payer: Fidelis Medicare Advantage	$149.62
Rate for Payer: Group Health Inc Commercial	$71.25
Rate for Payer: Group Health Inc Medicare	$49.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.25
Rate for Payer: Hamaspik Choice Inc Medicare	$71.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$92.62

SCREW BONE CANCELL 4.0MM / L40MM

Facility IP

$142.50

Service Code	HCPCS C1713
Hospital Charge Code	64904067
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$71.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.25
Rate for Payer: Hamaspik Choice Inc Medicare	$71.25

SCREW BONE CANCELL 4.0MM / L42MM

Facility OP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64904207
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$157.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
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	$75.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.25
Rate for Payer: Fidelis Medicare Advantage	$157.50
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$97.50

SCREW BONE CANCELL 4.0MM / L42MM

Facility IP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64904207
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

SCREW BONE CANCELL 4.0MM / L44MM

Facility IP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64904996
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

SCREW BONE CANCELL 4.0MM / L44MM

Facility OP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64904996
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$157.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
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	$75.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.25
Rate for Payer: Fidelis Medicare Advantage	$157.50
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$97.50

SCREW BONE CANCELL 4.0MM / L46MM

Facility OP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64904209
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$157.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
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	$75.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.25
Rate for Payer: Fidelis Medicare Advantage	$157.50
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$97.50

SCREW BONE CANCELL 4.0MM / L46MM

Facility IP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64904209
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

SCREW BONE CANCELL 4.0MM / L50MM

Facility OP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64904068
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$157.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
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	$75.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.25
Rate for Payer: Fidelis Medicare Advantage	$157.50
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$97.50

SCREW BONE CANCELL 4.0MM / L50MM

Facility IP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64904068
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

SCREW BONE CANCELL 4.0MM / L55MM

Facility IP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64905003
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

SCREW BONE CANCELL 4.0MM / L55MM

Facility OP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64905003
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$157.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
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	$75.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.25
Rate for Payer: Fidelis Medicare Advantage	$157.50
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$97.50

SCREW BONE CANCELL 4.0MM / L65MM

Facility OP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64904906
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$157.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
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	$75.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.25
Rate for Payer: Fidelis Medicare Advantage	$157.50
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$97.50

SCREW BONE CANCELL 4.0MM / L65MM

Facility IP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64904906
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

SCREW BONE CANCELL 4.0MM / L70MM

Facility IP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64904907
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

SCREW BONE CANCELL 4.0MM / L70MM

Facility OP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64904907
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$157.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
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	$75.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.25
Rate for Payer: Fidelis Medicare Advantage	$157.50
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$97.50

SCREW BONE CANCELL 4.0 X 22MM

Facility OP

$68.75

Service Code	HCPCS C1713
Hospital Charge Code	64903262
Hospital Revenue Code	278
Min. Negotiated Rate	$24.06
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.81
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	$34.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.53
Rate for Payer: Fidelis Medicare Advantage	$72.19
Rate for Payer: Group Health Inc Commercial	$34.38
Rate for Payer: Group Health Inc Medicare	$24.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.38
Rate for Payer: Hamaspik Choice Inc Medicare	$34.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$44.69

SCREW BONE CANCELL 4.0 X 22MM

Facility IP

$68.75

Service Code	HCPCS C1713
Hospital Charge Code	64903262
Hospital Revenue Code	278
Min. Negotiated Rate	$34.38
Max. Negotiated Rate	$34.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.38
Rate for Payer: Hamaspik Choice Inc Medicare	$34.38

SCREW BONE CANCELL 4.0 X 24MM

Facility IP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64905065
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

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