St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW BONE CANCELL 4.0 X 24MM

Facility OP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64905065
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 26MM

Facility OP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64905067
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 26MM

Facility IP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64905067
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 4.0 X 38MM

Facility OP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64905069
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 38MM

Facility IP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64905069
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 4.0 X 48MM

Facility IP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64905071
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 4.0 X 48MM

Facility OP

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	64905071
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 6.0MM / L55MM

Facility IP

$170.00

Service Code	HCPCS C1713
Hospital Charge Code	64903830
Hospital Revenue Code	278
Min. Negotiated Rate	$85.00
Max. Negotiated Rate	$85.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.00
Rate for Payer: Hamaspik Choice Inc Medicare	$85.00

SCREW BONE CANCELL 6.0MM / L55MM

Facility OP

$170.00

Service Code	HCPCS C1713
Hospital Charge Code	64903830
Hospital Revenue Code	278
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$178.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.50
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	$85.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$97.75
Rate for Payer: Fidelis Medicare Advantage	$178.50
Rate for Payer: Group Health Inc Commercial	$85.00
Rate for Payer: Group Health Inc Medicare	$59.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.00
Rate for Payer: Hamaspik Choice Inc Medicare	$85.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$110.50

SCREW BONE CANCELL 6.0MM / L80MM

Facility OP

$177.50

Service Code	HCPCS C1713
Hospital Charge Code	64904088
Hospital Revenue Code	278
Min. Negotiated Rate	$62.12
Max. Negotiated Rate	$186.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$97.62
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	$88.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.06
Rate for Payer: Fidelis Medicare Advantage	$186.38
Rate for Payer: Group Health Inc Commercial	$88.75
Rate for Payer: Group Health Inc Medicare	$62.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$88.75
Rate for Payer: Hamaspik Choice Inc Medicare	$88.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$115.38

SCREW BONE CANCELL 6.0MM / L80MM

Facility IP

$177.50

Service Code	HCPCS C1713
Hospital Charge Code	64904088
Hospital Revenue Code	278
Min. Negotiated Rate	$88.75
Max. Negotiated Rate	$88.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$88.75
Rate for Payer: Hamaspik Choice Inc Medicare	$88.75

SCREW BONE CANCELL 6.0MM / L85MM

Facility IP

$177.50

Service Code	HCPCS C1713
Hospital Charge Code	64903832
Hospital Revenue Code	278
Min. Negotiated Rate	$88.75
Max. Negotiated Rate	$88.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$88.75
Rate for Payer: Hamaspik Choice Inc Medicare	$88.75

SCREW BONE CANCELL 6.0MM / L85MM

Facility OP

$177.50

Service Code	HCPCS C1713
Hospital Charge Code	64903832
Hospital Revenue Code	278
Min. Negotiated Rate	$62.12
Max. Negotiated Rate	$186.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$97.62
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	$88.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.06
Rate for Payer: Fidelis Medicare Advantage	$186.38
Rate for Payer: Group Health Inc Commercial	$88.75
Rate for Payer: Group Health Inc Medicare	$62.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$88.75
Rate for Payer: Hamaspik Choice Inc Medicare	$88.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$115.38

SCREW BONE CANCELL 8MM 3MM/6.5

Facility IP

$81.25

Service Code	HCPCS C1713
Hospital Charge Code	64903664
Hospital Revenue Code	278
Min. Negotiated Rate	$40.62
Max. Negotiated Rate	$40.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.62
Rate for Payer: Hamaspik Choice Inc Medicare	$40.62

SCREW BONE CANCELL 8MM 3MM/6.5

Facility OP

$81.25

Service Code	HCPCS C1713
Hospital Charge Code	64903664
Hospital Revenue Code	278
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.69
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	$40.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.72
Rate for Payer: Fidelis Medicare Advantage	$85.31
Rate for Payer: Group Health Inc Commercial	$40.62
Rate for Payer: Group Health Inc Medicare	$28.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.62
Rate for Payer: Hamaspik Choice Inc Medicare	$40.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.81

SCREW BONE CANCELL 8MM/3MM 6.5

Facility IP

$81.25

Service Code	HCPCS C1713
Hospital Charge Code	64903662
Hospital Revenue Code	278
Min. Negotiated Rate	$40.62
Max. Negotiated Rate	$40.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.62
Rate for Payer: Hamaspik Choice Inc Medicare	$40.62

SCREW BONE CANCELL 8MM/3MM 6.5

Facility OP

$81.25

Service Code	HCPCS C1713
Hospital Charge Code	64903662
Hospital Revenue Code	278
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.69
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	$40.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.72
Rate for Payer: Fidelis Medicare Advantage	$85.31
Rate for Payer: Group Health Inc Commercial	$40.62
Rate for Payer: Group Health Inc Medicare	$28.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.62
Rate for Payer: Hamaspik Choice Inc Medicare	$40.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.81

SCREW BONE CANCELL 8MM/3MM/6.5

Facility IP

$81.25

Service Code	HCPCS C1713
Hospital Charge Code	64903660
Hospital Revenue Code	278
Min. Negotiated Rate	$40.62
Max. Negotiated Rate	$40.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.62
Rate for Payer: Hamaspik Choice Inc Medicare	$40.62

SCREW BONE CANCELL 8MM/3MM/6.5

Facility OP

$81.25

Service Code	HCPCS C1713
Hospital Charge Code	64903660
Hospital Revenue Code	278
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.69
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	$40.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.72
Rate for Payer: Fidelis Medicare Advantage	$85.31
Rate for Payer: Group Health Inc Commercial	$40.62
Rate for Payer: Group Health Inc Medicare	$28.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.62
Rate for Payer: Hamaspik Choice Inc Medicare	$40.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.81

SCREW BONE CANCELLOUS 4.0MM

Facility IP

$72.80

Service Code	HCPCS C1713
Hospital Charge Code	40205911
Hospital Revenue Code	278
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$36.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.40
Rate for Payer: Hamaspik Choice Inc Medicare	$36.40

SCREW BONE CANCELLOUS 4.0MM

Facility OP

$72.80

Service Code	HCPCS C1713
Hospital Charge Code	40205911
Hospital Revenue Code	278
Min. Negotiated Rate	$25.48
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$40.04
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	$36.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$41.86
Rate for Payer: Fidelis Medicare Advantage	$76.44
Rate for Payer: Group Health Inc Commercial	$36.40
Rate for Payer: Group Health Inc Medicare	$25.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.40
Rate for Payer: Hamaspik Choice Inc Medicare	$36.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$47.32

SCREW BONE CANCELLOUS SS 4

Facility OP

$34.00

Service Code	HCPCS C1776
Hospital Charge Code	40206033
Hospital Revenue Code	278
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.55
Rate for Payer: Fidelis Medicare Advantage	$35.70
Rate for Payer: Group Health Inc Commercial	$17.00
Rate for Payer: Group Health Inc Medicare	$11.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.10

SCREW BONE CANCELLOUS SS 4

Facility IP

$34.00

Service Code	HCPCS C1776
Hospital Charge Code	40206033
Hospital Revenue Code	278
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$17.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17.00

SCREW BONE CANN SS7.3X95MM

Facility IP

$406.00

Service Code	HCPCS C1776
Hospital Charge Code	40205103
Hospital Revenue Code	278
Min. Negotiated Rate	$203.00
Max. Negotiated Rate	$203.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.00
Rate for Payer: Hamaspik Choice Inc Medicare	$203.00

SCREW BONE CANN SS7.3X95MM

Facility OP

$406.00

Service Code	HCPCS C1776
Hospital Charge Code	40205103
Hospital Revenue Code	278
Min. Negotiated Rate	$142.10
Max. Negotiated Rate	$426.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$223.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
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

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