St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW CORTEX 3.5 X 48MM FT ST

Facility IP

$65.00

Service Code	HCPCS C1713
Hospital Charge Code	64901815
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 48MM FT ST

Facility OP

$65.00

Service Code	HCPCS C1713
Hospital Charge Code	64901815
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 50MM FT ST

Facility OP

$53.65

Service Code	HCPCS C1713
Hospital Charge Code	64901201
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 50MM FT ST

Facility IP

$53.65

Service Code	HCPCS C1713
Hospital Charge Code	64901201
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 60MM FT ST

Facility IP

$65.00

Service Code	HCPCS C1713
Hospital Charge Code	64901666
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 60MM FT ST

Facility OP

$65.00

Service Code	HCPCS C1713
Hospital Charge Code	64901666
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 65MM FT ST

Facility IP

$65.00

Service Code	HCPCS C1713
Hospital Charge Code	64901667
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 65MM FT ST

Facility OP

$65.00

Service Code	HCPCS C1713
Hospital Charge Code	64901667
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 70MM

Facility OP

$87.50

Service Code	HCPCS C1713
Hospital Charge Code	64902204
Hospital Revenue Code	278
Min. Negotiated Rate	$30.62
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.12
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	$43.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$50.31
Rate for Payer: Fidelis Medicare Advantage	$91.88
Rate for Payer: Group Health Inc Commercial	$43.75
Rate for Payer: Group Health Inc Medicare	$30.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.75
Rate for Payer: Hamaspik Choice Inc Medicare	$43.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$56.88

SCREW CORTEX 3.5 X 70MM

Facility IP

$87.50

Service Code	HCPCS C1713
Hospital Charge Code	64902204
Hospital Revenue Code	278
Min. Negotiated Rate	$43.75
Max. Negotiated Rate	$43.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.75
Rate for Payer: Hamaspik Choice Inc Medicare	$43.75

SCREW CORTEX 3.5 X 70MM FT ST

Facility OP

$53.65

Service Code	HCPCS C1713
Hospital Charge Code	64901669
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 70MM FT ST

Facility IP

$53.65

Service Code	HCPCS C1713
Hospital Charge Code	64901669
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 75MM FT ST

Facility OP

$65.00

Service Code	HCPCS C1713
Hospital Charge Code	64902045
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 75MM FT ST

Facility IP

$65.00

Service Code	HCPCS C1713
Hospital Charge Code	64902045
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 85MM FT ST

Facility IP

$65.00

Service Code	HCPCS C1713
Hospital Charge Code	64901963
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 85MM FT ST

Facility OP

$65.00

Service Code	HCPCS C1713
Hospital Charge Code	64901963
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 90MM FT ST

Facility IP

$65.00

Service Code	HCPCS C1713
Hospital Charge Code	64902090
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 90MM FT ST

Facility OP

$65.00

Service Code	HCPCS C1713
Hospital Charge Code	64902090
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 4.5 65

Facility IP

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	64904371
Hospital Revenue Code	278
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00

SCREW CORTEX 4.5 65

Facility OP

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	64904371
Hospital Revenue Code	278
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.00
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	$60.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.00
Rate for Payer: Fidelis Medicare Advantage	$126.00
Rate for Payer: Group Health Inc Commercial	$60.00
Rate for Payer: Group Health Inc Medicare	$42.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$78.00

SCREW CORTEX 4.5 8.5

Facility IP

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	64904034
Hospital Revenue Code	278
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00

SCREW CORTEX 4.5 8.5

Facility OP

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	64904034
Hospital Revenue Code	278
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.00
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	$60.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.00
Rate for Payer: Fidelis Medicare Advantage	$126.00
Rate for Payer: Group Health Inc Commercial	$60.00
Rate for Payer: Group Health Inc Medicare	$42.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$78.00

SCREW CORTEX 4.5 X 32

Facility IP

$115.00

Service Code	HCPCS C1713
Hospital Charge Code	64903834
Hospital Revenue Code	278
Min. Negotiated Rate	$57.50
Max. Negotiated Rate	$57.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.50
Rate for Payer: Hamaspik Choice Inc Medicare	$57.50

SCREW CORTEX 4.5 X 32

Facility OP

$115.00

Service Code	HCPCS C1713
Hospital Charge Code	64903834
Hospital Revenue Code	278
Min. Negotiated Rate	$40.25
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$63.25
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	$57.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$66.12
Rate for Payer: Fidelis Medicare Advantage	$120.75
Rate for Payer: Group Health Inc Commercial	$57.50
Rate for Payer: Group Health Inc Medicare	$40.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.50
Rate for Payer: Hamaspik Choice Inc Medicare	$57.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$74.75

SCREW CORTEX 4.5X50MM HEX FT ST

Facility OP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901678
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

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