St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW CORTEX 4.5X50MM HEX FT ST

Facility IP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901678
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 CORTEX 4.5X56MM HEX FT ST

Facility IP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64902212
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 CORTEX 4.5X56MM HEX FT ST

Facility OP

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64902212
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 CORTEX SELF-TAPPING

Facility IP

$88.75

Service Code	HCPCS C1713
Hospital Charge Code	64901113
Hospital Revenue Code	278
Min. Negotiated Rate	$44.38
Max. Negotiated Rate	$44.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.38
Rate for Payer: Hamaspik Choice Inc Medicare	$44.38

SCREW CORTEX SELF-TAPPING

Facility OP

$88.75

Service Code	HCPCS C1713
Hospital Charge Code	64901113
Hospital Revenue Code	278
Min. Negotiated Rate	$31.06
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.81
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	$44.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.03
Rate for Payer: Fidelis Medicare Advantage	$93.19
Rate for Payer: Group Health Inc Commercial	$44.38
Rate for Payer: Group Health Inc Medicare	$31.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.38
Rate for Payer: Hamaspik Choice Inc Medicare	$44.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$57.69

SCREW CORTEX SELF TAPPING 12MM

Facility OP

$84.38

Service Code	HCPCS C1713
Hospital Charge Code	64901152
Hospital Revenue Code	278
Min. Negotiated Rate	$29.53
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.41
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	$42.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.52
Rate for Payer: Fidelis Medicare Advantage	$88.60
Rate for Payer: Group Health Inc Commercial	$42.19
Rate for Payer: Group Health Inc Medicare	$29.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.19
Rate for Payer: Hamaspik Choice Inc Medicare	$42.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$54.85

SCREW CORTEX SELF TAPPING 12MM

Facility IP

$84.38

Service Code	HCPCS C1713
Hospital Charge Code	64901152
Hospital Revenue Code	278
Min. Negotiated Rate	$42.19
Max. Negotiated Rate	$42.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.19
Rate for Payer: Hamaspik Choice Inc Medicare	$42.19

SCREW CORTEX SELF TAPPING 18MM

Facility IP

$84.38

Service Code	HCPCS C1713
Hospital Charge Code	64901150
Hospital Revenue Code	278
Min. Negotiated Rate	$42.19
Max. Negotiated Rate	$42.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.19
Rate for Payer: Hamaspik Choice Inc Medicare	$42.19

SCREW CORTEX SELF TAPPING 18MM

Facility OP

$84.38

Service Code	HCPCS C1713
Hospital Charge Code	64901150
Hospital Revenue Code	278
Min. Negotiated Rate	$29.53
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.41
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	$42.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.52
Rate for Payer: Fidelis Medicare Advantage	$88.60
Rate for Payer: Group Health Inc Commercial	$42.19
Rate for Payer: Group Health Inc Medicare	$29.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.19
Rate for Payer: Hamaspik Choice Inc Medicare	$42.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$54.85

SCREW CORTEX SLF-STRDRV 2.7MM

Facility IP

$132.50

Service Code	HCPCS C1713
Hospital Charge Code	64902931
Hospital Revenue Code	278
Min. Negotiated Rate	$66.25
Max. Negotiated Rate	$66.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.25
Rate for Payer: Hamaspik Choice Inc Medicare	$66.25

SCREW CORTEX SLF-STRDRV 2.7MM

Facility OP

$132.50

Service Code	HCPCS C1713
Hospital Charge Code	64902931
Hospital Revenue Code	278
Min. Negotiated Rate	$46.38
Max. Negotiated Rate	$139.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$72.88
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	$66.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.19
Rate for Payer: Fidelis Medicare Advantage	$139.12
Rate for Payer: Group Health Inc Commercial	$66.25
Rate for Payer: Group Health Inc Medicare	$46.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.25
Rate for Payer: Hamaspik Choice Inc Medicare	$66.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$86.12

SCREW CORTEX ST 3.5MM D 36MM

Facility IP

$36.00

Service Code	HCPCS C1776
Hospital Charge Code	40205098
Hospital Revenue Code	278
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$18.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.00
Rate for Payer: Hamaspik Choice Inc Medicare	$18.00

SCREW CORTEX ST 3.5MM D 36MM

Facility OP

$36.00

Service Code	HCPCS C1776
Hospital Charge Code	40205098
Hospital Revenue Code	278
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.80
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	$18.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.70
Rate for Payer: Fidelis Medicare Advantage	$37.80
Rate for Payer: Group Health Inc Commercial	$18.00
Rate for Payer: Group Health Inc Medicare	$12.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.00
Rate for Payer: Hamaspik Choice Inc Medicare	$18.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.40

SCREW CORTEX ST SS 4.5 X 20MM

Facility OP

$61.25

Service Code	HCPCS C1713
Hospital Charge Code	64902488
Hospital Revenue Code	278
Min. Negotiated Rate	$21.44
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.69
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	$30.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.22
Rate for Payer: Fidelis Medicare Advantage	$64.31
Rate for Payer: Group Health Inc Commercial	$30.62
Rate for Payer: Group Health Inc Medicare	$21.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.62
Rate for Payer: Hamaspik Choice Inc Medicare	$30.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.81

SCREW CORTEX ST SS 4.5 X 20MM

Facility IP

$61.25

Service Code	HCPCS C1713
Hospital Charge Code	64902488
Hospital Revenue Code	278
Min. Negotiated Rate	$30.62
Max. Negotiated Rate	$30.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.62
Rate for Payer: Hamaspik Choice Inc Medicare	$30.62

SCREW CORTEX ST SS 4.5 X 32MM

Facility IP

$61.25

Service Code	HCPCS C1713
Hospital Charge Code	64901105
Hospital Revenue Code	278
Min. Negotiated Rate	$30.62
Max. Negotiated Rate	$30.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.62
Rate for Payer: Hamaspik Choice Inc Medicare	$30.62

SCREW CORTEX ST SS 4.5 X 32MM

Facility OP

$61.25

Service Code	HCPCS C1713
Hospital Charge Code	64901105
Hospital Revenue Code	278
Min. Negotiated Rate	$21.44
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.69
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	$30.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.22
Rate for Payer: Fidelis Medicare Advantage	$64.31
Rate for Payer: Group Health Inc Commercial	$30.62
Rate for Payer: Group Health Inc Medicare	$21.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.62
Rate for Payer: Hamaspik Choice Inc Medicare	$30.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.81

SCREW CORTEX ST SS 4.5X34MM

Facility OP

$34.00

Service Code	HCPCS C1771
Hospital Charge Code	40205287
Hospital Revenue Code	278
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$560.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$560.38
Rate for Payer: Aetna Government	$560.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.55
Rate for Payer: Fidelis Medicare Advantage	$35.70
Rate for Payer: Group Health Inc Commercial	$17.00
Rate for Payer: Group Health Inc Medicare	$11.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.10

SCREW CORTEX ST SS 4.5X34MM

Facility IP

$34.00

Service Code	HCPCS C1771
Hospital Charge Code	40205287
Hospital Revenue Code	278
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$17.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17.00

SCREW CORTEX ST SS 4.5 X 40MM

Facility IP

$88.75

Service Code	HCPCS C1713
Hospital Charge Code	64901109
Hospital Revenue Code	278
Min. Negotiated Rate	$44.38
Max. Negotiated Rate	$44.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.38
Rate for Payer: Hamaspik Choice Inc Medicare	$44.38

SCREW CORTEX ST SS 4.5 X 40MM

Facility OP

$88.75

Service Code	HCPCS C1713
Hospital Charge Code	64901109
Hospital Revenue Code	278
Min. Negotiated Rate	$31.06
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.81
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	$44.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.03
Rate for Payer: Fidelis Medicare Advantage	$93.19
Rate for Payer: Group Health Inc Commercial	$44.38
Rate for Payer: Group Health Inc Medicare	$31.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.38
Rate for Payer: Hamaspik Choice Inc Medicare	$44.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$57.69

SCREW CORTEX ST SS 4.5 X 42MM

Facility OP

$88.75

Service Code	HCPCS C1713
Hospital Charge Code	64901111
Hospital Revenue Code	278
Min. Negotiated Rate	$31.06
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.81
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	$44.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.03
Rate for Payer: Fidelis Medicare Advantage	$93.19
Rate for Payer: Group Health Inc Commercial	$44.38
Rate for Payer: Group Health Inc Medicare	$31.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.38
Rate for Payer: Hamaspik Choice Inc Medicare	$44.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$57.69

SCREW CORTEX ST SS 4.5 X 42MM

Facility IP

$88.75

Service Code	HCPCS C1713
Hospital Charge Code	64901111
Hospital Revenue Code	278
Min. Negotiated Rate	$44.38
Max. Negotiated Rate	$44.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.38
Rate for Payer: Hamaspik Choice Inc Medicare	$44.38

SCREW CORTICAL

Facility OP

$462.50

Service Code	HCPCS C1713
Hospital Charge Code	64907126
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$485.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$254.38
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	$231.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$265.94
Rate for Payer: Fidelis Medicare Advantage	$485.62
Rate for Payer: Group Health Inc Commercial	$231.25
Rate for Payer: Group Health Inc Medicare	$161.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$231.25
Rate for Payer: Hamaspik Choice Inc Medicare	$231.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$300.62

SCREW CORTICAL

Facility IP

$462.50

Service Code	HCPCS C1713
Hospital Charge Code	64907126
Hospital Revenue Code	278
Min. Negotiated Rate	$231.25
Max. Negotiated Rate	$231.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$231.25
Rate for Payer: Hamaspik Choice Inc Medicare	$231.25

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