St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW CORTEX 3.5 X 24MM FT ST

Facility IP

$65.00

Service Code	HCPCS C1713
Hospital Charge Code	64901631
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

SCREW CORTEX 3.5 X 28MM FT ST

Facility OP

$54.38

Service Code	HCPCS C1713
Hospital Charge Code	64901626
Hospital Revenue Code	278
Min. Negotiated Rate	$19.03
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.91
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	$27.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.27
Rate for Payer: Fidelis Medicare Advantage	$57.10
Rate for Payer: Group Health Inc Commercial	$27.19
Rate for Payer: Group Health Inc Medicare	$19.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.19
Rate for Payer: Hamaspik Choice Inc Medicare	$27.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$35.35

SCREW CORTEX 3.5 X 28MM FT ST

Facility IP

$54.38

Service Code	HCPCS C1713
Hospital Charge Code	64901626
Hospital Revenue Code	278
Min. Negotiated Rate	$27.19
Max. Negotiated Rate	$27.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.19
Rate for Payer: Hamaspik Choice Inc Medicare	$27.19

SCREW CORTEX 3.5X30MM

Facility OP

$65.00

Service Code	HCPCS C1713
Hospital Charge Code	64902765
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
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	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

SCREW CORTEX 3.5X30MM

Facility IP

$65.00

Service Code	HCPCS C1713
Hospital Charge Code	64902765
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

SCREW CORTEX 3.5 X 30MM ST FT

Facility IP

$18.00

Service Code	HCPCS C1776
Hospital Charge Code	40202442
Hospital Revenue Code	278
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9.00

SCREW CORTEX 3.5 X 30MM ST FT

Facility OP

$18.00

Service Code	HCPCS C1776
Hospital Charge Code	40202442
Hospital Revenue Code	278
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.90
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	$9.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.35
Rate for Payer: Fidelis Medicare Advantage	$18.90
Rate for Payer: Group Health Inc Commercial	$9.00
Rate for Payer: Group Health Inc Medicare	$6.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.70

SCREW CORTEX 3.5 X 32MM FT ST

Facility IP

$52.50

Service Code	HCPCS C1713
Hospital Charge Code	64901663
Hospital Revenue Code	278
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.25
Rate for Payer: Hamaspik Choice Inc Medicare	$26.25

SCREW CORTEX 3.5 X 32MM FT ST

Facility OP

$52.50

Service Code	HCPCS C1713
Hospital Charge Code	64901663
Hospital Revenue Code	278
Min. Negotiated Rate	$18.38
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.88
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	$26.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.19
Rate for Payer: Fidelis Medicare Advantage	$55.12
Rate for Payer: Group Health Inc Commercial	$26.25
Rate for Payer: Group Health Inc Medicare	$18.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.25
Rate for Payer: Hamaspik Choice Inc Medicare	$26.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34.12

SCREW CORTEX 3.5 X3.4MM

Facility OP

$213.00

Service Code	HCPCS C1776
Hospital Charge Code	40202409
Hospital Revenue Code	278
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$117.15
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	$106.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$122.48
Rate for Payer: Fidelis Medicare Advantage	$223.65
Rate for Payer: Group Health Inc Commercial	$106.50
Rate for Payer: Group Health Inc Medicare	$74.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$106.50
Rate for Payer: Hamaspik Choice Inc Medicare	$106.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$138.45

SCREW CORTEX 3.5 X3.4MM

Facility IP

$213.00

Service Code	HCPCS C1776
Hospital Charge Code	40202409
Hospital Revenue Code	278
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$106.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$106.50
Rate for Payer: Hamaspik Choice Inc Medicare	$106.50

SCREW CORTEX 3.5 X 34MM FT ST

Facility OP

$65.00

Service Code	HCPCS C1713
Hospital Charge Code	64901627
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
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	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

SCREW CORTEX 3.5 X 34MM FT ST

Facility IP

$65.00

Service Code	HCPCS C1713
Hospital Charge Code	64901627
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

SCREW CORTEX 3.5 X 36MM FT ST

Facility IP

$53.65

Service Code	HCPCS C1713
Hospital Charge Code	64901422
Hospital Revenue Code	278
Min. Negotiated Rate	$26.82
Max. Negotiated Rate	$26.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.82
Rate for Payer: Hamaspik Choice Inc Medicare	$26.82

SCREW CORTEX 3.5 X 36MM FT ST

Facility OP

$53.65

Service Code	HCPCS C1713
Hospital Charge Code	64901422
Hospital Revenue Code	278
Min. Negotiated Rate	$18.78
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.51
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	$26.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.85
Rate for Payer: Fidelis Medicare Advantage	$56.33
Rate for Payer: Group Health Inc Commercial	$26.82
Rate for Payer: Group Health Inc Medicare	$18.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.82
Rate for Payer: Hamaspik Choice Inc Medicare	$26.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34.87

SCREW CORTEX 3.5 X 38MM FT ST

Facility OP

$53.38

Service Code	HCPCS C1713
Hospital Charge Code	64901628
Hospital Revenue Code	278
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.36
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	$26.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.69
Rate for Payer: Fidelis Medicare Advantage	$56.05
Rate for Payer: Group Health Inc Commercial	$26.69
Rate for Payer: Group Health Inc Medicare	$18.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.69
Rate for Payer: Hamaspik Choice Inc Medicare	$26.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34.70

SCREW CORTEX 3.5 X 38MM FT ST

Facility IP

$53.38

Service Code	HCPCS C1713
Hospital Charge Code	64901628
Hospital Revenue Code	278
Min. Negotiated Rate	$26.69
Max. Negotiated Rate	$26.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.69
Rate for Payer: Hamaspik Choice Inc Medicare	$26.69

SCREW CORTEX 3.5 X 40MM FT ST

Facility OP

$52.70

Service Code	HCPCS C1713
Hospital Charge Code	64901633
Hospital Revenue Code	278
Min. Negotiated Rate	$18.44
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.98
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	$26.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.30
Rate for Payer: Fidelis Medicare Advantage	$55.34
Rate for Payer: Group Health Inc Commercial	$26.35
Rate for Payer: Group Health Inc Medicare	$18.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.35
Rate for Payer: Hamaspik Choice Inc Medicare	$26.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34.26

SCREW CORTEX 3.5 X 40MM FT ST

Facility IP

$52.70

Service Code	HCPCS C1713
Hospital Charge Code	64901633
Hospital Revenue Code	278
Min. Negotiated Rate	$26.35
Max. Negotiated Rate	$26.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.35
Rate for Payer: Hamaspik Choice Inc Medicare	$26.35

SCREW CORTEX 3.5 X 40MM FT ST

Facility OP

$65.00

Service Code	HCPCS C1713
Hospital Charge Code	64902598
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
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	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

SCREW CORTEX 3.5 X 40MM FT ST

Facility IP

$65.00

Service Code	HCPCS C1713
Hospital Charge Code	64902598
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

SCREW CORTEX 3.5 X 45MM FT ST

Facility IP

$65.00

Service Code	HCPCS C1713
Hospital Charge Code	64902286
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

SCREW CORTEX 3.5 X 45MM FT ST

Facility OP

$65.00

Service Code	HCPCS C1713
Hospital Charge Code	64902286
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
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	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

SCREW CORTEX 3.5 X 46MM FT ST

Facility OP

$65.00

Service Code	HCPCS C1713
Hospital Charge Code	64901664
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
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	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

SCREW CORTEX 3.5 X 46MM FT ST

Facility IP

$65.00

Service Code	HCPCS C1713
Hospital Charge Code	64901664
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

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