St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW BONE LOCKING 4.0 X 90

Facility IP

$680.00

Service Code	HCPCS C1713
Hospital Charge Code	64905434
Hospital Revenue Code	278
Min. Negotiated Rate	$340.00
Max. Negotiated Rate	$340.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$340.00
Rate for Payer: Hamaspik Choice Inc Medicare	$340.00

SCREW BONE LOCK SELF TAP

Facility OP

$541.45

Service Code	HCPCS C1713
Hospital Charge Code	64907246
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$568.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$297.80
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	$270.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$311.33
Rate for Payer: Fidelis Medicare Advantage	$568.52
Rate for Payer: Group Health Inc Commercial	$270.72
Rate for Payer: Group Health Inc Medicare	$189.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$270.72
Rate for Payer: Hamaspik Choice Inc Medicare	$270.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$351.94

SCREW BONE LOCK SELF TAP

Facility IP

$541.45

Service Code	HCPCS C1713
Hospital Charge Code	64907246
Hospital Revenue Code	278
Min. Negotiated Rate	$270.72
Max. Negotiated Rate	$270.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$270.72
Rate for Payer: Hamaspik Choice Inc Medicare	$270.72

SCREW BONE MICRO 20MM

Facility IP

$1,320.00

Service Code	HCPCS C1713
Hospital Charge Code	64903643
Hospital Revenue Code	278
Min. Negotiated Rate	$660.00
Max. Negotiated Rate	$660.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$660.00
Rate for Payer: Hamaspik Choice Inc Medicare	$660.00

SCREW BONE MICRO 20MM

Facility OP

$1,320.00

Service Code	HCPCS C1713
Hospital Charge Code	64903643
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,386.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$726.00
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	$660.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$759.00
Rate for Payer: Fidelis Medicare Advantage	$1,386.00
Rate for Payer: Group Health Inc Commercial	$660.00
Rate for Payer: Group Health Inc Medicare	$462.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$660.00
Rate for Payer: Hamaspik Choice Inc Medicare	$660.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$858.00

SCREW BONE MP 2.0X14MM CRS PIN

Facility OP

$130.95

Service Code	HCPCS C1713
Hospital Charge Code	64905924
Hospital Revenue Code	278
Min. Negotiated Rate	$45.83
Max. Negotiated Rate	$137.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$72.02
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	$65.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$75.30
Rate for Payer: Fidelis Medicare Advantage	$137.50
Rate for Payer: Group Health Inc Commercial	$65.48
Rate for Payer: Group Health Inc Medicare	$45.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.48
Rate for Payer: Hamaspik Choice Inc Medicare	$65.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$85.12

SCREW BONE MP 2.0X14MM CRS PIN

Facility IP

$130.95

Service Code	HCPCS C1713
Hospital Charge Code	64905924
Hospital Revenue Code	278
Min. Negotiated Rate	$65.48
Max. Negotiated Rate	$65.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.48
Rate for Payer: Hamaspik Choice Inc Medicare	$65.48

SCREW BONE MP 2.0X4MM CRS PIN

Facility OP

$128.78

Service Code	HCPCS C1713
Hospital Charge Code	64902010
Hospital Revenue Code	278
Min. Negotiated Rate	$45.07
Max. Negotiated Rate	$135.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.83
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	$64.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.05
Rate for Payer: Fidelis Medicare Advantage	$135.22
Rate for Payer: Group Health Inc Commercial	$64.39
Rate for Payer: Group Health Inc Medicare	$45.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.39
Rate for Payer: Hamaspik Choice Inc Medicare	$64.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$83.71

SCREW BONE MP 2.0X4MM CRS PIN

Facility IP

$128.78

Service Code	HCPCS C1713
Hospital Charge Code	64902010
Hospital Revenue Code	278
Min. Negotiated Rate	$64.39
Max. Negotiated Rate	$64.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.39
Rate for Payer: Hamaspik Choice Inc Medicare	$64.39

SCREW BONE SLF DRL VARI 4X16MM

Facility IP

$4,482.40

Service Code	HCPCS C1713
Hospital Charge Code	64906750
Hospital Revenue Code	278
Min. Negotiated Rate	$2,241.20
Max. Negotiated Rate	$2,241.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,241.20
Rate for Payer: Hamaspik Choice Inc Medicare	$2,241.20

SCREW BONE SLF DRL VARI 4X16MM

Facility OP

$4,482.40

Service Code	HCPCS C1713
Hospital Charge Code	64906750
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,706.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,465.32
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	$2,241.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,577.38
Rate for Payer: Fidelis Medicare Advantage	$4,706.52
Rate for Payer: Group Health Inc Commercial	$2,241.20
Rate for Payer: Group Health Inc Medicare	$1,568.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,241.20
Rate for Payer: Hamaspik Choice Inc Medicare	$2,241.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,913.56

SCREW BONE SL TP 6.5MMD 20MM

Facility IP

$138.00

Service Code	HCPCS C1713
Hospital Charge Code	64906445
Hospital Revenue Code	278
Min. Negotiated Rate	$69.00
Max. Negotiated Rate	$69.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$69.00
Rate for Payer: Hamaspik Choice Inc Medicare	$69.00

SCREW BONE SL TP 6.5MMD 20MM

Facility OP

$138.00

Service Code	HCPCS C1713
Hospital Charge Code	64906445
Hospital Revenue Code	278
Min. Negotiated Rate	$48.30
Max. Negotiated Rate	$144.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$75.90
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	$69.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$79.35
Rate for Payer: Fidelis Medicare Advantage	$144.90
Rate for Payer: Group Health Inc Commercial	$69.00
Rate for Payer: Group Health Inc Medicare	$48.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$69.00
Rate for Payer: Hamaspik Choice Inc Medicare	$69.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$89.70

SCREW BONE T10 2.7 X 16MM

Facility OP

$134.88

Service Code	HCPCS C1713
Hospital Charge Code	64902465
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 T10 2.7 X 16MM

Facility IP

$134.88

Service Code	HCPCS C1713
Hospital Charge Code	64902465
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 T10 2.7 X 18MM

Facility IP

$134.88

Service Code	HCPCS C1713
Hospital Charge Code	64902462
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 T10 2.7 X 18MM

Facility OP

$134.88

Service Code	HCPCS C1713
Hospital Charge Code	64902462
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 T10 3.5X46MM

Facility OP

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64902728
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 T10 3.5X46MM

Facility IP

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64902728
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 T10 FL THR 2.7MM/L12MM

Facility OP

$272.00

Service Code	HCPCS C1713
Hospital Charge Code	40005906
Hospital Revenue Code	278
Min. Negotiated Rate	$95.20
Max. Negotiated Rate	$285.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$149.60
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	$136.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$156.40
Rate for Payer: Fidelis Medicare Advantage	$285.60
Rate for Payer: Group Health Inc Commercial	$136.00
Rate for Payer: Group Health Inc Medicare	$95.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$136.00
Rate for Payer: Hamaspik Choice Inc Medicare	$136.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$176.80

SCREW,BONE T10 FL THR 2.7MM/L12MM

Facility IP

$272.00

Service Code	HCPCS C1713
Hospital Charge Code	40005906
Hospital Revenue Code	278
Min. Negotiated Rate	$136.00
Max. Negotiated Rate	$136.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$136.00
Rate for Payer: Hamaspik Choice Inc Medicare	$136.00

SCREW BONE T10 FT 2.7L16MM

Facility IP

$136.00

Service Code	HCPCS C1713
Hospital Charge Code	64906305
Hospital Revenue Code	278
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$68.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.00
Rate for Payer: Hamaspik Choice Inc Medicare	$68.00

SCREW BONE T10 FT 2.7L16MM

Facility OP

$136.00

Service Code	HCPCS C1713
Hospital Charge Code	64906305
Hospital Revenue Code	278
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$142.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.80
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	$68.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$78.20
Rate for Payer: Fidelis Medicare Advantage	$142.80
Rate for Payer: Group Health Inc Commercial	$68.00
Rate for Payer: Group Health Inc Medicare	$47.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.00
Rate for Payer: Hamaspik Choice Inc Medicare	$68.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$88.40

SCREW BONE T10 FT 2.7MM/L10MM

Facility OP

$626.88

Service Code	HCPCS C1713
Hospital Charge Code	64905799
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$658.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$344.78
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	$313.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$360.46
Rate for Payer: Fidelis Medicare Advantage	$658.22
Rate for Payer: Group Health Inc Commercial	$313.44
Rate for Payer: Group Health Inc Medicare	$219.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$313.44
Rate for Payer: Hamaspik Choice Inc Medicare	$313.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$407.47

SCREW BONE T10 FT 2.7MM/L10MM

Facility IP

$626.88

Service Code	HCPCS C1713
Hospital Charge Code	64905799
Hospital Revenue Code	278
Min. Negotiated Rate	$313.44
Max. Negotiated Rate	$313.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$313.44
Rate for Payer: Hamaspik Choice Inc Medicare	$313.44

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All Charges