St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SCREW BONE 3.5MM DIA 90MML TT

Facility

$105.00

Service Code	HCPCS C1713
Hospital Charge Code	64904902
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 90MML TT

Facility

$105.00

Service Code	HCPCS C1713
Hospital Charge Code	64904902
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 X 20MM

Facility

$525.00

Service Code	HCPCS C1713
Hospital Charge Code	64902841
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50

SCREW BONE 3.5MM X 20MM

Facility

$525.00

Service Code	HCPCS C1713
Hospital Charge Code	64902841
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$551.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$288.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$315.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$262.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$301.88
Rate for Payer: EmblemHealth Commercial	$262.50
Rate for Payer: Fidelis Medicare Advantage	$551.25
Rate for Payer: Group Health Inc Commercial	$262.50
Rate for Payer: Group Health Inc Medicare	$183.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$341.25

SCREW BONE 3.5MM X 30 MML TT

Facility

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64902796
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 X 30 MML TT

Facility

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64902796
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 3.5 X 10MM

Facility

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64902242
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 3.5 X 10MM

Facility

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64902242
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 3.5 X 12MM A

Facility

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64902230
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 3.5 X 12MM A

Facility

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64902230
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 3.5 X 12MM B

Facility

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64902408
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 3.5 X 12MM B

Facility

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64902408
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 3.5 X 14 A

Facility

$340.00

Service Code	HCPCS C1713
Hospital Charge Code	64904552
Hospital Revenue Code	278
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$170.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$170.00
Rate for Payer: Hamaspik Choice Inc Medicare	$170.00

SCREW BONE 3.5 X 14 A

Facility

$340.00

Service Code	HCPCS C1713
Hospital Charge Code	64904552
Hospital Revenue Code	278
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$357.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$187.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$204.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$170.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$195.50
Rate for Payer: EmblemHealth Commercial	$170.00
Rate for Payer: Fidelis Medicare Advantage	$357.00
Rate for Payer: Group Health Inc Commercial	$170.00
Rate for Payer: Group Health Inc Medicare	$119.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$170.00
Rate for Payer: Hamaspik Choice Inc Medicare	$170.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$221.00

SCREW BONE 3.5 X 14 B

Facility

$525.00

Service Code	HCPCS C1713
Hospital Charge Code	64904722
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50

SCREW BONE 3.5 X 14 B

Facility

$525.00

Service Code	HCPCS C1713
Hospital Charge Code	64904722
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$551.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$288.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$315.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$262.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$301.88
Rate for Payer: EmblemHealth Commercial	$262.50
Rate for Payer: Fidelis Medicare Advantage	$551.25
Rate for Payer: Group Health Inc Commercial	$262.50
Rate for Payer: Group Health Inc Medicare	$183.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$341.25

SCREW BONE 3.5 X 14MM A

Facility

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64902232
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 3.5 X 14MM A

Facility

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64902232
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 3.5 X 14MM B

Facility

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64902460
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 3.5 X 14MM B

Facility

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64902460
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 3.5 X 16

Facility

$340.00

Service Code	HCPCS C1713
Hospital Charge Code	64904553
Hospital Revenue Code	278
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$357.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$187.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$204.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$170.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$195.50
Rate for Payer: EmblemHealth Commercial	$170.00
Rate for Payer: Fidelis Medicare Advantage	$357.00
Rate for Payer: Group Health Inc Commercial	$170.00
Rate for Payer: Group Health Inc Medicare	$119.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$170.00
Rate for Payer: Hamaspik Choice Inc Medicare	$170.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$221.00

SCREW BONE 3.5 X 16

Facility

$340.00

Service Code	HCPCS C1713
Hospital Charge Code	64904553
Hospital Revenue Code	278
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$170.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$170.00
Rate for Payer: Hamaspik Choice Inc Medicare	$170.00

SCREW BONE 3.5 X 16MM A

Facility

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64902171
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 3.5 X 16MM A

Facility

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64902171
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 3.5 X 16MM B

Facility

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64902244
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

Know your out-of-pocket cost for care.

All Charges