St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SCREW BONE 4.5MM DIA 36MML TT

Facility

$115.00

Service Code	HCPCS C1713
Hospital Charge Code	64903836
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 BONE 4.5MM DIA 38MML STA

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901672
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 BONE 4.5MM DIA 38MML STA

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901672
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: Brighton Health Commercial	$34.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.71
Rate for Payer: EmblemHealth Commercial	$28.44
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 BONE 4.5MM DIA 38MML TT

Facility

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	64903124
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: Brighton Health Commercial	$72.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.00
Rate for Payer: EmblemHealth Commercial	$60.00
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 BONE 4.5MM DIA 38MML TT

Facility

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	64903124
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 BONE 4.5MM DIA 40MML STA

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901674
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 BONE 4.5MM DIA 40MML STA

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901674
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: Brighton Health Commercial	$34.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.71
Rate for Payer: EmblemHealth Commercial	$28.44
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 BONE 4.5MM DIA 42MML STA

Facility

$50.00

Service Code	HCPCS C1713
Hospital Charge Code	64901675
Hospital Revenue Code	278
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$25.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00

SCREW BONE 4.5MM DIA 42MML STA

Facility

$50.00

Service Code	HCPCS C1713
Hospital Charge Code	64901675
Hospital Revenue Code	278
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$30.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.75
Rate for Payer: EmblemHealth Commercial	$25.00
Rate for Payer: Fidelis Medicare Advantage	$52.50
Rate for Payer: Group Health Inc Commercial	$25.00
Rate for Payer: Group Health Inc Medicare	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$32.50

SCREW BONE 4.5MM DIA 42MML TT

Facility

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	64903252
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: Brighton Health Commercial	$72.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.00
Rate for Payer: EmblemHealth Commercial	$60.00
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 BONE 4.5MM DIA 42MML TT

Facility

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	64903252
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 BONE 4.5MM DIA 44MML STA

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64902347
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 BONE 4.5MM DIA 44MML STA

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64902347
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: Brighton Health Commercial	$34.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.71
Rate for Payer: EmblemHealth Commercial	$28.44
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 BONE 4.5MM DIA 44MML TT

Facility

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	64903871
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 BONE 4.5MM DIA 44MML TT

Facility

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	64903871
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: Brighton Health Commercial	$72.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.00
Rate for Payer: EmblemHealth Commercial	$60.00
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 BONE 4.5MM DIA 46MML STA

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901677
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: Brighton Health Commercial	$34.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.71
Rate for Payer: EmblemHealth Commercial	$28.44
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 BONE 4.5MM DIA 46MML STA

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901677
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 BONE 4.5MM DIA 46MML TT

Facility

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	64903254
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: Brighton Health Commercial	$72.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.00
Rate for Payer: EmblemHealth Commercial	$60.00
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 BONE 4.5MM DIA 46MML TT

Facility

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	64903254
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 BONE 4.5MM DIA 48MML STA

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64902515
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: Brighton Health Commercial	$34.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.71
Rate for Payer: EmblemHealth Commercial	$28.44
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 BONE 4.5MM DIA 48MML STA

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64902515
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 BONE 4.5MM DIA 48MML TT

Facility

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	64903840
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 BONE 4.5MM DIA 48MML TT

Facility

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	64903840
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: Brighton Health Commercial	$72.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.00
Rate for Payer: EmblemHealth Commercial	$60.00
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 BONE 4.5MM DIA 50MML TT

Facility

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	64904032
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 BONE 4.5MM DIA 50MML TT

Facility

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	64904032
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: Brighton Health Commercial	$72.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.00
Rate for Payer: EmblemHealth Commercial	$60.00
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

Know your out-of-pocket cost for care.

All Charges