St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SCREW BONE 3.5MM DIA 28MML TT

Facility

$89.25

Service Code	HCPCS C1713
Hospital Charge Code	64903174
Hospital Revenue Code	278
Min. Negotiated Rate	$31.24
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$49.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$53.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$44.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.32
Rate for Payer: EmblemHealth Commercial	$44.62
Rate for Payer: Fidelis Medicare Advantage	$93.71
Rate for Payer: Group Health Inc Commercial	$44.62
Rate for Payer: Group Health Inc Medicare	$31.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.62
Rate for Payer: Hamaspik Choice Inc Medicare	$44.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$58.01

SCREW BONE 3.5MM DIA 30MML TT

Facility

$80.00

Service Code	HCPCS C1713
Hospital Charge Code	64903315
Hospital Revenue Code	278
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$40.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.00
Rate for Payer: Hamaspik Choice Inc Medicare	$40.00

SCREW BONE 3.5MM DIA 30MML TT

Facility

$80.00

Service Code	HCPCS C1713
Hospital Charge Code	64903315
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$48.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.00
Rate for Payer: EmblemHealth Commercial	$40.00
Rate for Payer: Fidelis Medicare Advantage	$84.00
Rate for Payer: Group Health Inc Commercial	$40.00
Rate for Payer: Group Health Inc Medicare	$28.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.00
Rate for Payer: Hamaspik Choice Inc Medicare	$40.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.00

SCREW BONE 3.5MM DIA 32MML TT

Facility

$77.05

Service Code	HCPCS C1713
Hospital Charge Code	64903301
Hospital Revenue Code	278
Min. Negotiated Rate	$38.52
Max. Negotiated Rate	$38.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.52
Rate for Payer: Hamaspik Choice Inc Medicare	$38.52

SCREW BONE 3.5MM DIA 32MML TT

Facility

$77.05

Service Code	HCPCS C1713
Hospital Charge Code	64903301
Hospital Revenue Code	278
Min. Negotiated Rate	$26.97
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$46.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.30
Rate for Payer: EmblemHealth Commercial	$38.52
Rate for Payer: Fidelis Medicare Advantage	$80.90
Rate for Payer: Group Health Inc Commercial	$38.52
Rate for Payer: Group Health Inc Medicare	$26.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.52
Rate for Payer: Hamaspik Choice Inc Medicare	$38.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$50.08

SCREW BONE 3.5MM DIA 34MML TT

Facility

$80.00

Service Code	HCPCS C1713
Hospital Charge Code	64903320
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$48.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.00
Rate for Payer: EmblemHealth Commercial	$40.00
Rate for Payer: Fidelis Medicare Advantage	$84.00
Rate for Payer: Group Health Inc Commercial	$40.00
Rate for Payer: Group Health Inc Medicare	$28.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.00
Rate for Payer: Hamaspik Choice Inc Medicare	$40.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.00

SCREW BONE 3.5MM DIA 34MML TT

Facility

$80.00

Service Code	HCPCS C1713
Hospital Charge Code	64903320
Hospital Revenue Code	278
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$40.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.00
Rate for Payer: Hamaspik Choice Inc Medicare	$40.00

SCREW BONE 3.5MM DIA 42MML TT

Facility

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	64905230
Hospital Revenue Code	278
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$50.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00

SCREW BONE 3.5MM DIA 42MML TT

Facility

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	64905230
Hospital Revenue Code	278
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$60.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.50
Rate for Payer: EmblemHealth Commercial	$50.00
Rate for Payer: Fidelis Medicare Advantage	$105.00
Rate for Payer: Group Health Inc Commercial	$50.00
Rate for Payer: Group Health Inc Medicare	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.00

SCREW BONE 3.5MM DIA 46MML TT

Facility

$74.10

Service Code	HCPCS C1713
Hospital Charge Code	64904061
Hospital Revenue Code	278
Min. Negotiated Rate	$37.05
Max. Negotiated Rate	$37.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.05
Rate for Payer: Hamaspik Choice Inc Medicare	$37.05

SCREW BONE 3.5MM DIA 46MML TT

Facility

$74.10

Service Code	HCPCS C1713
Hospital Charge Code	64904061
Hospital Revenue Code	278
Min. Negotiated Rate	$25.94
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$40.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$44.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$42.61
Rate for Payer: EmblemHealth Commercial	$37.05
Rate for Payer: Fidelis Medicare Advantage	$77.80
Rate for Payer: Group Health Inc Commercial	$37.05
Rate for Payer: Group Health Inc Medicare	$25.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.05
Rate for Payer: Hamaspik Choice Inc Medicare	$37.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$48.16

SCREW BONE 3.5MM DIA 50MML TT

Facility

$94.50

Service Code	HCPCS C1713
Hospital Charge Code	64904063
Hospital Revenue Code	278
Min. Negotiated Rate	$47.25
Max. Negotiated Rate	$47.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.25
Rate for Payer: Hamaspik Choice Inc Medicare	$47.25

SCREW BONE 3.5MM DIA 50MML TT

Facility

$94.50

Service Code	HCPCS C1713
Hospital Charge Code	64904063
Hospital Revenue Code	278
Min. Negotiated Rate	$33.08
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$56.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$54.34
Rate for Payer: EmblemHealth Commercial	$47.25
Rate for Payer: Fidelis Medicare Advantage	$99.22
Rate for Payer: Group Health Inc Commercial	$47.25
Rate for Payer: Group Health Inc Medicare	$33.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.25
Rate for Payer: Hamaspik Choice Inc Medicare	$47.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$61.42

SCREW BONE 3.5MM DIA 60MML T

Facility

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	64903171
Hospital Revenue Code	278
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$50.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00

SCREW BONE 3.5MM DIA 60MML T

Facility

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	64903171
Hospital Revenue Code	278
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$60.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.50
Rate for Payer: EmblemHealth Commercial	$50.00
Rate for Payer: Fidelis Medicare Advantage	$105.00
Rate for Payer: Group Health Inc Commercial	$50.00
Rate for Payer: Group Health Inc Medicare	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.00

SCREW BONE 3.5MM DIA 65MML TT

Facility

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	64903170
Hospital Revenue Code	278
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$50.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00

SCREW BONE 3.5MM DIA 65MML TT

Facility

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	64903170
Hospital Revenue Code	278
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$60.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.50
Rate for Payer: EmblemHealth Commercial	$50.00
Rate for Payer: Fidelis Medicare Advantage	$105.00
Rate for Payer: Group Health Inc Commercial	$50.00
Rate for Payer: Group Health Inc Medicare	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.00

SCREW BONE 3.5MM DIA 70MML TT

Facility

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64903109
Hospital Revenue Code	278
Min. Negotiated Rate	$51.76
Max. Negotiated Rate	$155.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$81.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$88.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$73.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$85.03
Rate for Payer: EmblemHealth Commercial	$73.94
Rate for Payer: Fidelis Medicare Advantage	$155.27
Rate for Payer: Group Health Inc Commercial	$73.94
Rate for Payer: Group Health Inc Medicare	$51.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.94
Rate for Payer: Hamaspik Choice Inc Medicare	$73.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$96.12

SCREW BONE 3.5MM DIA 70MML TT

Facility

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64903109
Hospital Revenue Code	278
Min. Negotiated Rate	$73.94
Max. Negotiated Rate	$73.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.94
Rate for Payer: Hamaspik Choice Inc Medicare	$73.94

SCREW BONE 3.5MM DIA 75MML TT

Facility

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	64903502
Hospital Revenue Code	278
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$60.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.50
Rate for Payer: EmblemHealth Commercial	$50.00
Rate for Payer: Fidelis Medicare Advantage	$105.00
Rate for Payer: Group Health Inc Commercial	$50.00
Rate for Payer: Group Health Inc Medicare	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.00

SCREW BONE 3.5MM DIA 75MML TT

Facility

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	64903502
Hospital Revenue Code	278
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$50.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00

SCREW BONE 3.5MM DIA 80MML TT

Facility

$105.00

Service Code	HCPCS C1713
Hospital Charge Code	64903169
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50

SCREW BONE 3.5MM DIA 80MML TT

Facility

$105.00

Service Code	HCPCS C1713
Hospital Charge Code	64903169
Hospital Revenue Code	278
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$63.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$60.38
Rate for Payer: EmblemHealth Commercial	$52.50
Rate for Payer: Fidelis Medicare Advantage	$110.25
Rate for Payer: Group Health Inc Commercial	$52.50
Rate for Payer: Group Health Inc Medicare	$36.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$68.25

SCREW BONE 3.5MM DIA 85MML TT

Facility

$105.00

Service Code	HCPCS C1713
Hospital Charge Code	64904992
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50

SCREW BONE 3.5MM DIA 85MML TT

Facility

$105.00

Service Code	HCPCS C1713
Hospital Charge Code	64904992
Hospital Revenue Code	278
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$63.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$60.38
Rate for Payer: EmblemHealth Commercial	$52.50
Rate for Payer: Fidelis Medicare Advantage	$110.25
Rate for Payer: Group Health Inc Commercial	$52.50
Rate for Payer: Group Health Inc Medicare	$36.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$68.25

Know your out-of-pocket cost for care.

All Charges