St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW NCB CORT 4.0X30MM SELF-TAP

Facility OP

$222.48

Service Code	HCPCS C1713
Hospital Charge Code	40204619
Hospital Revenue Code	278
Min. Negotiated Rate	$77.87
Max. Negotiated Rate	$233.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$122.36
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	$111.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$127.93
Rate for Payer: Fidelis Medicare Advantage	$233.60
Rate for Payer: Group Health Inc Commercial	$111.24
Rate for Payer: Group Health Inc Medicare	$77.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.24
Rate for Payer: Hamaspik Choice Inc Medicare	$111.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$144.61

SCREW NCB CORT 4.0 X 30MM ST

Facility IP

$278.10

Service Code	HCPCS C1713
Hospital Charge Code	64905600
Hospital Revenue Code	278
Min. Negotiated Rate	$139.05
Max. Negotiated Rate	$139.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.05
Rate for Payer: Hamaspik Choice Inc Medicare	$139.05

SCREW NCB CORT 4.0 X 30MM ST

Facility OP

$278.10

Service Code	HCPCS C1713
Hospital Charge Code	64905600
Hospital Revenue Code	278
Min. Negotiated Rate	$97.34
Max. Negotiated Rate	$292.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$152.96
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	$139.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$159.91
Rate for Payer: Fidelis Medicare Advantage	$292.00
Rate for Payer: Group Health Inc Commercial	$139.05
Rate for Payer: Group Health Inc Medicare	$97.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.05
Rate for Payer: Hamaspik Choice Inc Medicare	$139.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$180.76

SCREW NCB CORT 4.0 X 32MM

Facility OP

$278.10

Service Code	HCPCS C1713
Hospital Charge Code	64905484
Hospital Revenue Code	278
Min. Negotiated Rate	$97.34
Max. Negotiated Rate	$292.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$152.96
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	$139.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$159.91
Rate for Payer: Fidelis Medicare Advantage	$292.00
Rate for Payer: Group Health Inc Commercial	$139.05
Rate for Payer: Group Health Inc Medicare	$97.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.05
Rate for Payer: Hamaspik Choice Inc Medicare	$139.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$180.76

SCREW NCB CORT 4.0 X 32MM

Facility IP

$278.10

Service Code	HCPCS C1713
Hospital Charge Code	64905484
Hospital Revenue Code	278
Min. Negotiated Rate	$139.05
Max. Negotiated Rate	$139.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.05
Rate for Payer: Hamaspik Choice Inc Medicare	$139.05

SCREW NCB CORT 4.0X32MM SELF-TAP

Facility IP

$358.00

Service Code	HCPCS C1713
Hospital Charge Code	40204575
Hospital Revenue Code	278
Min. Negotiated Rate	$179.00
Max. Negotiated Rate	$179.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00
Rate for Payer: Hamaspik Choice Inc Medicare	$179.00

SCREW NCB CORT 4.0X32MM SELF-TAP

Facility OP

$358.00

Service Code	HCPCS C1713
Hospital Charge Code	40204575
Hospital Revenue Code	278
Min. Negotiated Rate	$125.30
Max. Negotiated Rate	$375.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$196.90
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	$179.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$205.85
Rate for Payer: Fidelis Medicare Advantage	$375.90
Rate for Payer: Group Health Inc Commercial	$179.00
Rate for Payer: Group Health Inc Medicare	$125.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00
Rate for Payer: Hamaspik Choice Inc Medicare	$179.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$232.70

SCREW, NCB CORT 4.0X32MM SELF-TAP

Facility OP

$222.48

Service Code	HCPCS C1713
Hospital Charge Code	40006601
Hospital Revenue Code	278
Min. Negotiated Rate	$77.87
Max. Negotiated Rate	$233.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$122.36
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	$111.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$127.93
Rate for Payer: Fidelis Medicare Advantage	$233.60
Rate for Payer: Group Health Inc Commercial	$111.24
Rate for Payer: Group Health Inc Medicare	$77.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.24
Rate for Payer: Hamaspik Choice Inc Medicare	$111.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$144.61

SCREW, NCB CORT 4.0X32MM SELF-TAP

Facility IP

$222.48

Service Code	HCPCS C1713
Hospital Charge Code	40006601
Hospital Revenue Code	278
Min. Negotiated Rate	$111.24
Max. Negotiated Rate	$111.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.24
Rate for Payer: Hamaspik Choice Inc Medicare	$111.24

SCREW NCB CORT 4.0 X 34MM

Facility IP

$278.10

Service Code	HCPCS C1713
Hospital Charge Code	64905485
Hospital Revenue Code	278
Min. Negotiated Rate	$139.05
Max. Negotiated Rate	$139.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.05
Rate for Payer: Hamaspik Choice Inc Medicare	$139.05

SCREW NCB CORT 4.0 X 34MM

Facility OP

$278.10

Service Code	HCPCS C1713
Hospital Charge Code	64905485
Hospital Revenue Code	278
Min. Negotiated Rate	$97.34
Max. Negotiated Rate	$292.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$152.96
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	$139.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$159.91
Rate for Payer: Fidelis Medicare Advantage	$292.00
Rate for Payer: Group Health Inc Commercial	$139.05
Rate for Payer: Group Health Inc Medicare	$97.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.05
Rate for Payer: Hamaspik Choice Inc Medicare	$139.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$180.76

SCREW NCB CORT 4.0X34MM SELF-TAP

Facility OP

$358.00

Service Code	HCPCS C1713
Hospital Charge Code	40204576
Hospital Revenue Code	278
Min. Negotiated Rate	$125.30
Max. Negotiated Rate	$375.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$196.90
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	$179.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$205.85
Rate for Payer: Fidelis Medicare Advantage	$375.90
Rate for Payer: Group Health Inc Commercial	$179.00
Rate for Payer: Group Health Inc Medicare	$125.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00
Rate for Payer: Hamaspik Choice Inc Medicare	$179.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$232.70

SCREW NCB CORT 4.0X34MM SELF-TAP

Facility IP

$358.00

Service Code	HCPCS C1713
Hospital Charge Code	40204576
Hospital Revenue Code	278
Min. Negotiated Rate	$179.00
Max. Negotiated Rate	$179.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00
Rate for Payer: Hamaspik Choice Inc Medicare	$179.00

SCREW,NCB CORT 4.0X34MM SELF-TAP

Facility IP

$222.48

Service Code	HCPCS C1713
Hospital Charge Code	40006602
Hospital Revenue Code	278
Min. Negotiated Rate	$111.24
Max. Negotiated Rate	$111.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.24
Rate for Payer: Hamaspik Choice Inc Medicare	$111.24

SCREW,NCB CORT 4.0X34MM SELF-TAP

Facility OP

$222.48

Service Code	HCPCS C1713
Hospital Charge Code	40006602
Hospital Revenue Code	278
Min. Negotiated Rate	$77.87
Max. Negotiated Rate	$233.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$122.36
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	$111.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$127.93
Rate for Payer: Fidelis Medicare Advantage	$233.60
Rate for Payer: Group Health Inc Commercial	$111.24
Rate for Payer: Group Health Inc Medicare	$77.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.24
Rate for Payer: Hamaspik Choice Inc Medicare	$111.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$144.61

SCREW NCB CORT 4.0 X 36MM

Facility IP

$278.10

Service Code	HCPCS C1713
Hospital Charge Code	64905622
Hospital Revenue Code	278
Min. Negotiated Rate	$139.05
Max. Negotiated Rate	$139.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.05
Rate for Payer: Hamaspik Choice Inc Medicare	$139.05

SCREW NCB CORT 4.0 X 36MM

Facility OP

$278.10

Service Code	HCPCS C1713
Hospital Charge Code	64905622
Hospital Revenue Code	278
Min. Negotiated Rate	$97.34
Max. Negotiated Rate	$292.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$152.96
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	$139.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$159.91
Rate for Payer: Fidelis Medicare Advantage	$292.00
Rate for Payer: Group Health Inc Commercial	$139.05
Rate for Payer: Group Health Inc Medicare	$97.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.05
Rate for Payer: Hamaspik Choice Inc Medicare	$139.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$180.76

SCREW NCB CORT 4.0X36MM SELF-TAP

Facility OP

$222.48

Service Code	HCPCS C1713
Hospital Charge Code	40204628
Hospital Revenue Code	278
Min. Negotiated Rate	$77.87
Max. Negotiated Rate	$233.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$122.36
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	$111.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$127.93
Rate for Payer: Fidelis Medicare Advantage	$233.60
Rate for Payer: Group Health Inc Commercial	$111.24
Rate for Payer: Group Health Inc Medicare	$77.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.24
Rate for Payer: Hamaspik Choice Inc Medicare	$111.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$144.61

SCREW NCB CORT 4.0X36MM SELF-TAP

Facility IP

$222.48

Service Code	HCPCS C1713
Hospital Charge Code	40204628
Hospital Revenue Code	278
Min. Negotiated Rate	$111.24
Max. Negotiated Rate	$111.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.24
Rate for Payer: Hamaspik Choice Inc Medicare	$111.24

SCREW NCB CORT 4.0X36MM SELF-TAP

Facility OP

$222.48

Service Code	HCPCS C1713
Hospital Charge Code	40007547
Hospital Revenue Code	278
Min. Negotiated Rate	$77.87
Max. Negotiated Rate	$233.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$122.36
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	$111.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$127.93
Rate for Payer: Fidelis Medicare Advantage	$233.60
Rate for Payer: Group Health Inc Commercial	$111.24
Rate for Payer: Group Health Inc Medicare	$77.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.24
Rate for Payer: Hamaspik Choice Inc Medicare	$111.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$144.61

SCREW NCB CORT 4.0X36MM SELF-TAP

Facility IP

$222.48

Service Code	HCPCS C1713
Hospital Charge Code	40007547
Hospital Revenue Code	278
Min. Negotiated Rate	$111.24
Max. Negotiated Rate	$111.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.24
Rate for Payer: Hamaspik Choice Inc Medicare	$111.24

SCREW NCB CORT 4.0 X 38MM

Facility OP

$278.10

Service Code	HCPCS C1713
Hospital Charge Code	64905487
Hospital Revenue Code	278
Min. Negotiated Rate	$97.34
Max. Negotiated Rate	$292.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$152.96
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	$139.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$159.91
Rate for Payer: Fidelis Medicare Advantage	$292.00
Rate for Payer: Group Health Inc Commercial	$139.05
Rate for Payer: Group Health Inc Medicare	$97.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.05
Rate for Payer: Hamaspik Choice Inc Medicare	$139.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$180.76

SCREW NCB CORT 4.0 X 38MM

Facility IP

$278.10

Service Code	HCPCS C1713
Hospital Charge Code	64905487
Hospital Revenue Code	278
Min. Negotiated Rate	$139.05
Max. Negotiated Rate	$139.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.05
Rate for Payer: Hamaspik Choice Inc Medicare	$139.05

SCREW NCB CORT 4.0X38MM SELF-TAP

Facility OP

$358.00

Service Code	HCPCS C1713
Hospital Charge Code	40204577
Hospital Revenue Code	278
Min. Negotiated Rate	$125.30
Max. Negotiated Rate	$375.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$196.90
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	$179.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$205.85
Rate for Payer: Fidelis Medicare Advantage	$375.90
Rate for Payer: Group Health Inc Commercial	$179.00
Rate for Payer: Group Health Inc Medicare	$125.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00
Rate for Payer: Hamaspik Choice Inc Medicare	$179.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$232.70

SCREW NCB CORT 4.0X38MM SELF-TAP

Facility IP

$358.00

Service Code	HCPCS C1713
Hospital Charge Code	40204577
Hospital Revenue Code	278
Min. Negotiated Rate	$179.00
Max. Negotiated Rate	$179.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00
Rate for Payer: Hamaspik Choice Inc Medicare	$179.00

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