St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW CANCEL 4.0 X 40MM PT SS

Facility OP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901857
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 CANCEL 4.0 X 45MM FT SS

Facility OP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64902381
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 CANCEL 4.0 X 45MM FT SS

Facility IP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64902381
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 CANCEL 4.0 X 50MM FT SS

Facility OP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901949
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 CANCEL 4.0 X 50MM FT SS

Facility IP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901949
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 CANCEL 4.0 X 60MM FT SS

Facility IP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901453
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 CANCEL 4.0 X 60MM FT SS

Facility OP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901453
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 CANCEL 4.0 X 65MM FT SS

Facility OP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901747
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 CANCEL 4.0 X 65MM FT SS

Facility IP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901747
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 CANCELL BONE 6.5 16MM

Facility OP

$423.00

Service Code	HCPCS C1713
Hospital Charge Code	64905735
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$444.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$232.65
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	$211.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$243.22
Rate for Payer: Fidelis Medicare Advantage	$444.15
Rate for Payer: Group Health Inc Commercial	$211.50
Rate for Payer: Group Health Inc Medicare	$148.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$211.50
Rate for Payer: Hamaspik Choice Inc Medicare	$211.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$274.95

SCREW CANCELL BONE 6.5 16MM

Facility IP

$423.00

Service Code	HCPCS C1713
Hospital Charge Code	64905735
Hospital Revenue Code	278
Min. Negotiated Rate	$211.50
Max. Negotiated Rate	$211.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$211.50
Rate for Payer: Hamaspik Choice Inc Medicare	$211.50

SCREW CANCELLOUS 4.0 SS2

Facility OP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64902852
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 CANCELLOUS 4.0 SS2

Facility IP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64902852
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 CANCELLOUS 4.0 SS4

Facility OP

$68.25

Service Code	HCPCS C1713
Hospital Charge Code	64902854
Hospital Revenue Code	278
Min. Negotiated Rate	$23.89
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.54
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	$34.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.24
Rate for Payer: Fidelis Medicare Advantage	$71.66
Rate for Payer: Group Health Inc Commercial	$34.12
Rate for Payer: Group Health Inc Medicare	$23.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.12
Rate for Payer: Hamaspik Choice Inc Medicare	$34.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$44.36

SCREW CANCELLOUS 4.0 SS4

Facility IP

$68.25

Service Code	HCPCS C1713
Hospital Charge Code	64902854
Hospital Revenue Code	278
Min. Negotiated Rate	$34.12
Max. Negotiated Rate	$34.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.12
Rate for Payer: Hamaspik Choice Inc Medicare	$34.12

SCREW CANCELLOUS 4.0 SS5

Facility OP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64902856
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 CANCELLOUS 4.0 SS5

Facility IP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64902856
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 CANCELLOUS 4.0 X 20

Facility OP

$35.00

Service Code	HCPCS C1713
Hospital Charge Code	64906358
Hospital Revenue Code	278
Min. Negotiated Rate	$12.25
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.25
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	$17.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.12
Rate for Payer: Fidelis Medicare Advantage	$36.75
Rate for Payer: Group Health Inc Commercial	$17.50
Rate for Payer: Group Health Inc Medicare	$12.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.50
Rate for Payer: Hamaspik Choice Inc Medicare	$17.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.75

SCREW CANCELLOUS 4.0 X 20

Facility IP

$35.00

Service Code	HCPCS C1713
Hospital Charge Code	64906358
Hospital Revenue Code	278
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.50
Rate for Payer: Hamaspik Choice Inc Medicare	$17.50

SCREW CANCELLOUS 6'

Facility IP

$137.28

Service Code	HCPCS C1713
Hospital Charge Code	64907236
Hospital Revenue Code	278
Min. Negotiated Rate	$68.64
Max. Negotiated Rate	$68.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.64
Rate for Payer: Hamaspik Choice Inc Medicare	$68.64

SCREW CANCELLOUS 6'

Facility OP

$137.28

Service Code	HCPCS C1713
Hospital Charge Code	64907236
Hospital Revenue Code	278
Min. Negotiated Rate	$48.05
Max. Negotiated Rate	$144.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$75.50
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	$68.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$78.94
Rate for Payer: Fidelis Medicare Advantage	$144.14
Rate for Payer: Group Health Inc Commercial	$68.64
Rate for Payer: Group Health Inc Medicare	$48.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.64
Rate for Payer: Hamaspik Choice Inc Medicare	$68.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$89.23

SCREW CANN 3.75 X 34 MM

Facility OP

$572.00

Service Code	HCPCS C1713
Hospital Charge Code	40004886
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$600.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$314.60
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	$286.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$328.90
Rate for Payer: Fidelis Medicare Advantage	$600.60
Rate for Payer: Group Health Inc Commercial	$286.00
Rate for Payer: Group Health Inc Medicare	$200.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$286.00
Rate for Payer: Hamaspik Choice Inc Medicare	$286.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$371.80

SCREW CANN 3.75 X 34 MM

Facility IP

$572.00

Service Code	HCPCS C1713
Hospital Charge Code	40004886
Hospital Revenue Code	278
Min. Negotiated Rate	$286.00
Max. Negotiated Rate	$286.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$286.00
Rate for Payer: Hamaspik Choice Inc Medicare	$286.00

SCREW CANN 3.75 X 36 MM

Facility OP

$572.00

Service Code	HCPCS C1713
Hospital Charge Code	40004887
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$600.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$314.60
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	$286.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$328.90
Rate for Payer: Fidelis Medicare Advantage	$600.60
Rate for Payer: Group Health Inc Commercial	$286.00
Rate for Payer: Group Health Inc Medicare	$200.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$286.00
Rate for Payer: Hamaspik Choice Inc Medicare	$286.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$371.80

SCREW CANN 3.75 X 36 MM

Facility IP

$572.00

Service Code	HCPCS C1713
Hospital Charge Code	40004887
Hospital Revenue Code	278
Min. Negotiated Rate	$286.00
Max. Negotiated Rate	$286.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$286.00
Rate for Payer: Hamaspik Choice Inc Medicare	$286.00

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