St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW BONE EMG 1.9

Facility OP

$224.20

Service Code	HCPCS C1713
Hospital Charge Code	64907451
Hospital Revenue Code	278
Min. Negotiated Rate	$78.47
Max. Negotiated Rate	$235.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$123.31
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	$112.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$128.92
Rate for Payer: Fidelis Medicare Advantage	$235.41
Rate for Payer: Group Health Inc Commercial	$112.10
Rate for Payer: Group Health Inc Medicare	$78.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.10
Rate for Payer: Hamaspik Choice Inc Medicare	$112.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$145.73

SCREW BONE EMG 1.9

Facility IP

$224.20

Service Code	HCPCS C1713
Hospital Charge Code	64907451
Hospital Revenue Code	278
Min. Negotiated Rate	$112.10
Max. Negotiated Rate	$112.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.10
Rate for Payer: Hamaspik Choice Inc Medicare	$112.10

SCREW BONE ER 2.7MM CROSS PIN

Facility IP

$163.05

Service Code	HCPCS C1713
Hospital Charge Code	40201317
Hospital Revenue Code	278
Min. Negotiated Rate	$81.52
Max. Negotiated Rate	$81.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.52
Rate for Payer: Hamaspik Choice Inc Medicare	$81.52

SCREW BONE ER 2.7MM CROSS PIN

Facility OP

$163.05

Service Code	HCPCS C1713
Hospital Charge Code	40201317
Hospital Revenue Code	278
Min. Negotiated Rate	$57.07
Max. Negotiated Rate	$171.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.68
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	$81.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.75
Rate for Payer: Fidelis Medicare Advantage	$171.20
Rate for Payer: Group Health Inc Commercial	$81.52
Rate for Payer: Group Health Inc Medicare	$57.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.52
Rate for Payer: Hamaspik Choice Inc Medicare	$81.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.98

SCREW BONE ER CRSS PIN 2.7X5MM

Facility IP

$146.90

Service Code	HCPCS C1713
Hospital Charge Code	64901501
Hospital Revenue Code	278
Min. Negotiated Rate	$73.45
Max. Negotiated Rate	$73.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.45
Rate for Payer: Hamaspik Choice Inc Medicare	$73.45

SCREW BONE ER CRSS PIN 2.7X5MM

Facility OP

$146.90

Service Code	HCPCS C1713
Hospital Charge Code	64901501
Hospital Revenue Code	278
Min. Negotiated Rate	$51.42
Max. Negotiated Rate	$154.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.80
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	$73.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$84.47
Rate for Payer: Fidelis Medicare Advantage	$154.24
Rate for Payer: Group Health Inc Commercial	$73.45
Rate for Payer: Group Health Inc Medicare	$51.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.45
Rate for Payer: Hamaspik Choice Inc Medicare	$73.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$95.48

SCREW BONE FULL THRD 2.7 X 38MM

Facility IP

$299.72

Service Code	HCPCS C1713
Hospital Charge Code	64906953
Hospital Revenue Code	278
Min. Negotiated Rate	$149.86
Max. Negotiated Rate	$149.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$149.86
Rate for Payer: Hamaspik Choice Inc Medicare	$149.86

SCREW BONE FULL THRD 2.7 X 38MM

Facility OP

$299.72

Service Code	HCPCS C1713
Hospital Charge Code	64906953
Hospital Revenue Code	278
Min. Negotiated Rate	$104.90
Max. Negotiated Rate	$314.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$164.85
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	$149.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$172.34
Rate for Payer: Fidelis Medicare Advantage	$314.71
Rate for Payer: Group Health Inc Commercial	$149.86
Rate for Payer: Group Health Inc Medicare	$104.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$149.86
Rate for Payer: Hamaspik Choice Inc Medicare	$149.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$194.82

SCREW BONE HBRD 4.0X14MM VA-SD

Facility OP

$945.92

Service Code	HCPCS C1713
Hospital Charge Code	64906562
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$993.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$520.26
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	$472.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$543.90
Rate for Payer: Fidelis Medicare Advantage	$993.22
Rate for Payer: Group Health Inc Commercial	$472.96
Rate for Payer: Group Health Inc Medicare	$331.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$472.96
Rate for Payer: Hamaspik Choice Inc Medicare	$472.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$614.85

SCREW BONE HBRD 4.0X14MM VA-SD

Facility IP

$945.92

Service Code	HCPCS C1713
Hospital Charge Code	64906562
Hospital Revenue Code	278
Min. Negotiated Rate	$472.96
Max. Negotiated Rate	$472.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$472.96
Rate for Payer: Hamaspik Choice Inc Medicare	$472.96

SCREW BONE LAG 10.5 X 75MM

Facility IP

$1,289.75

Service Code	HCPCS C1713
Hospital Charge Code	64902521
Hospital Revenue Code	278
Min. Negotiated Rate	$644.88
Max. Negotiated Rate	$644.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$644.88
Rate for Payer: Hamaspik Choice Inc Medicare	$644.88

SCREW BONE LAG 10.5 X 75MM

Facility OP

$1,289.75

Service Code	HCPCS C1713
Hospital Charge Code	64902521
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,354.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$709.36
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	$644.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$741.61
Rate for Payer: Fidelis Medicare Advantage	$1,354.24
Rate for Payer: Group Health Inc Commercial	$644.88
Rate for Payer: Group Health Inc Medicare	$451.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$644.88
Rate for Payer: Hamaspik Choice Inc Medicare	$644.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$838.34

SCREW BONE LAG 95MM

Facility OP

$729.63

Service Code	HCPCS C1713
Hospital Charge Code	64902849
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$766.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$401.30
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	$364.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$419.54
Rate for Payer: Fidelis Medicare Advantage	$766.11
Rate for Payer: Group Health Inc Commercial	$364.82
Rate for Payer: Group Health Inc Medicare	$255.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$364.82
Rate for Payer: Hamaspik Choice Inc Medicare	$364.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$474.26

SCREW BONE LAG 95MM

Facility IP

$729.63

Service Code	HCPCS C1713
Hospital Charge Code	64902849
Hospital Revenue Code	278
Min. Negotiated Rate	$364.82
Max. Negotiated Rate	$364.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$364.82
Rate for Payer: Hamaspik Choice Inc Medicare	$364.82

SCREW BONE LOCKING 2.3 X 16

Facility IP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64905418
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 LOCKING 2.3 X 16

Facility OP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64905418
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 LOCKING 2.7 X 20

Facility OP

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	64905366
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$682.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$357.50
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	$325.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$373.75
Rate for Payer: Fidelis Medicare Advantage	$682.50
Rate for Payer: Group Health Inc Commercial	$325.00
Rate for Payer: Group Health Inc Medicare	$227.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$325.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$422.50

SCREW BONE LOCKING 2.7 X 20

Facility IP

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	64905366
Hospital Revenue Code	278
Min. Negotiated Rate	$325.00
Max. Negotiated Rate	$325.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$325.00

SCREW BONE LOCKING 3.5 X 48

Facility OP

$732.50

Service Code	HCPCS C1713
Hospital Charge Code	64905367
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$769.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$402.88
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	$366.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$421.19
Rate for Payer: Fidelis Medicare Advantage	$769.12
Rate for Payer: Group Health Inc Commercial	$366.25
Rate for Payer: Group Health Inc Medicare	$256.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.25
Rate for Payer: Hamaspik Choice Inc Medicare	$366.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$476.12

SCREW BONE LOCKING 3.5 X 48

Facility IP

$732.50

Service Code	HCPCS C1713
Hospital Charge Code	64905367
Hospital Revenue Code	278
Min. Negotiated Rate	$366.25
Max. Negotiated Rate	$366.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.25
Rate for Payer: Hamaspik Choice Inc Medicare	$366.25

SCREW BONE LOCKING 4.0 X 26

Facility OP

$561.00

Service Code	HCPCS C1713
Hospital Charge Code	64905432
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$589.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$308.55
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	$280.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$322.58
Rate for Payer: Fidelis Medicare Advantage	$589.05
Rate for Payer: Group Health Inc Commercial	$280.50
Rate for Payer: Group Health Inc Medicare	$196.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$280.50
Rate for Payer: Hamaspik Choice Inc Medicare	$280.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$364.65

SCREW BONE LOCKING 4.0 X 26

Facility IP

$561.00

Service Code	HCPCS C1713
Hospital Charge Code	64905432
Hospital Revenue Code	278
Min. Negotiated Rate	$280.50
Max. Negotiated Rate	$280.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$280.50
Rate for Payer: Hamaspik Choice Inc Medicare	$280.50

SCREW BONE LOCKING 4.0 X 46

Facility IP

$561.00

Service Code	HCPCS C1713
Hospital Charge Code	64905364
Hospital Revenue Code	278
Min. Negotiated Rate	$280.50
Max. Negotiated Rate	$280.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$280.50
Rate for Payer: Hamaspik Choice Inc Medicare	$280.50

SCREW BONE LOCKING 4.0 X 46

Facility OP

$561.00

Service Code	HCPCS C1713
Hospital Charge Code	64905364
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$589.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$308.55
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	$280.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$322.58
Rate for Payer: Fidelis Medicare Advantage	$589.05
Rate for Payer: Group Health Inc Commercial	$280.50
Rate for Payer: Group Health Inc Medicare	$196.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$280.50
Rate for Payer: Hamaspik Choice Inc Medicare	$280.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$364.65

SCREW BONE LOCKING 4.0 X 90

Facility OP

$680.00

Service Code	HCPCS C1713
Hospital Charge Code	64905434
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$714.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$374.00
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	$340.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$391.00
Rate for Payer: Fidelis Medicare Advantage	$714.00
Rate for Payer: Group Health Inc Commercial	$340.00
Rate for Payer: Group Health Inc Medicare	$238.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$340.00
Rate for Payer: Hamaspik Choice Inc Medicare	$340.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$442.00

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