St. Barnabas Hospital

All Charges

Charge

Type

Price

BOLT LOCK 4.9X32MM FEM/TIB NAIL

Facility IP

$324.00

Service Code	HCPCS C1713
Hospital Charge Code	40200118
Hospital Revenue Code	278
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$162.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.00
Rate for Payer: Hamaspik Choice Inc Medicare	$162.00

BOLT LOCK 4.9X32MM FEM/TIB NAIL

Facility OP

$324.00

Service Code	HCPCS C1713
Hospital Charge Code	40200118
Hospital Revenue Code	278
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$340.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$178.20
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	$162.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$186.30
Rate for Payer: Fidelis Medicare Advantage	$340.20
Rate for Payer: Group Health Inc Commercial	$162.00
Rate for Payer: Group Health Inc Medicare	$113.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.00
Rate for Payer: Hamaspik Choice Inc Medicare	$162.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$210.60

BOLT LOCKING 50MM

Facility OP

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200119
Hospital Revenue Code	278
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$310.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$162.80
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	$148.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.20
Rate for Payer: Fidelis Medicare Advantage	$310.80
Rate for Payer: Group Health Inc Commercial	$148.00
Rate for Payer: Group Health Inc Medicare	$103.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$192.40

BOLT LOCKING 50MM

Facility IP

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200119
Hospital Revenue Code	278
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$148.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00

BOLT LOCKING 54MM

Facility IP

$274.00

Service Code	HCPCS C1713
Hospital Charge Code	40200120
Hospital Revenue Code	278
Min. Negotiated Rate	$137.00
Max. Negotiated Rate	$137.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.00
Rate for Payer: Hamaspik Choice Inc Medicare	$137.00

BOLT LOCKING 54MM

Facility OP

$274.00

Service Code	HCPCS C1713
Hospital Charge Code	40200120
Hospital Revenue Code	278
Min. Negotiated Rate	$95.90
Max. Negotiated Rate	$287.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$150.70
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	$137.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$157.55
Rate for Payer: Fidelis Medicare Advantage	$287.70
Rate for Payer: Group Health Inc Commercial	$137.00
Rate for Payer: Group Health Inc Medicare	$95.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.00
Rate for Payer: Hamaspik Choice Inc Medicare	$137.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$178.10

BOLT LOCKING 58MM

Facility OP

$324.00

Service Code	HCPCS C1713
Hospital Charge Code	40200121
Hospital Revenue Code	278
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$340.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$178.20
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	$162.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$186.30
Rate for Payer: Fidelis Medicare Advantage	$340.20
Rate for Payer: Group Health Inc Commercial	$162.00
Rate for Payer: Group Health Inc Medicare	$113.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.00
Rate for Payer: Hamaspik Choice Inc Medicare	$162.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$210.60

BOLT LOCKING 58MM

Facility IP

$324.00

Service Code	HCPCS C1713
Hospital Charge Code	40200121
Hospital Revenue Code	278
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$162.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.00
Rate for Payer: Hamaspik Choice Inc Medicare	$162.00

BOLT LOCKING 60MM

Facility OP

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200122
Hospital Revenue Code	278
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$310.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$162.80
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	$148.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.20
Rate for Payer: Fidelis Medicare Advantage	$310.80
Rate for Payer: Group Health Inc Commercial	$148.00
Rate for Payer: Group Health Inc Medicare	$103.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$192.40

BOLT LOCKING 60MM

Facility IP

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200122
Hospital Revenue Code	278
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$148.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00

BOLT LOCKING TI 26MM

Facility IP

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200123
Hospital Revenue Code	278
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$148.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00

BOLT LOCKING TI 26MM

Facility OP

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200123
Hospital Revenue Code	278
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$310.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$162.80
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	$148.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.20
Rate for Payer: Fidelis Medicare Advantage	$310.80
Rate for Payer: Group Health Inc Commercial	$148.00
Rate for Payer: Group Health Inc Medicare	$103.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$192.40

BOLT LOCKING TI 28MM

Facility OP

$274.00

Service Code	HCPCS C1713
Hospital Charge Code	40200124
Hospital Revenue Code	278
Min. Negotiated Rate	$95.90
Max. Negotiated Rate	$287.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$150.70
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	$137.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$157.55
Rate for Payer: Fidelis Medicare Advantage	$287.70
Rate for Payer: Group Health Inc Commercial	$137.00
Rate for Payer: Group Health Inc Medicare	$95.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.00
Rate for Payer: Hamaspik Choice Inc Medicare	$137.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$178.10

BOLT LOCKING TI 28MM

Facility IP

$274.00

Service Code	HCPCS C1713
Hospital Charge Code	40200124
Hospital Revenue Code	278
Min. Negotiated Rate	$137.00
Max. Negotiated Rate	$137.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.00
Rate for Payer: Hamaspik Choice Inc Medicare	$137.00

BOLT LOCKING TI 3.9MM

Facility IP

$274.00

Service Code	HCPCS C1713
Hospital Charge Code	40200125
Hospital Revenue Code	278
Min. Negotiated Rate	$137.00
Max. Negotiated Rate	$137.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.00
Rate for Payer: Hamaspik Choice Inc Medicare	$137.00

BOLT LOCKING TI 3.9MM

Facility OP

$274.00

Service Code	HCPCS C1713
Hospital Charge Code	40200125
Hospital Revenue Code	278
Min. Negotiated Rate	$95.90
Max. Negotiated Rate	$287.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$150.70
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	$137.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$157.55
Rate for Payer: Fidelis Medicare Advantage	$287.70
Rate for Payer: Group Health Inc Commercial	$137.00
Rate for Payer: Group Health Inc Medicare	$95.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.00
Rate for Payer: Hamaspik Choice Inc Medicare	$137.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$178.10

BOLT LOCKING TI 4.0X46MM

Facility OP

$312.00

Service Code	HCPCS C1713
Hospital Charge Code	40200126
Hospital Revenue Code	278
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$327.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$171.60
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	$156.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$179.40
Rate for Payer: Fidelis Medicare Advantage	$327.60
Rate for Payer: Group Health Inc Commercial	$156.00
Rate for Payer: Group Health Inc Medicare	$109.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.00
Rate for Payer: Hamaspik Choice Inc Medicare	$156.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$202.80

BOLT LOCKING TI 4.0X46MM

Facility IP

$312.00

Service Code	HCPCS C1713
Hospital Charge Code	40200126
Hospital Revenue Code	278
Min. Negotiated Rate	$156.00
Max. Negotiated Rate	$156.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.00
Rate for Payer: Hamaspik Choice Inc Medicare	$156.00

BOLT LOCKING TI 4.9X36MM

Facility IP

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200127
Hospital Revenue Code	278
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$148.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00

BOLT LOCKING TI 4.9X36MM

Facility OP

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200127
Hospital Revenue Code	278
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$310.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$162.80
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	$148.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.20
Rate for Payer: Fidelis Medicare Advantage	$310.80
Rate for Payer: Group Health Inc Commercial	$148.00
Rate for Payer: Group Health Inc Medicare	$103.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$192.40

BOLT LOCKING TI 4.9X38MM

Facility IP

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200128
Hospital Revenue Code	278
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$148.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00

BOLT LOCKING TI 4.9X38MM

Facility OP

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200128
Hospital Revenue Code	278
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$310.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$162.80
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	$148.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.20
Rate for Payer: Fidelis Medicare Advantage	$310.80
Rate for Payer: Group Health Inc Commercial	$148.00
Rate for Payer: Group Health Inc Medicare	$103.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$192.40

BOLT LOCKING TI 4.9X40MM

Facility OP

$312.00

Service Code	HCPCS C1713
Hospital Charge Code	40200129
Hospital Revenue Code	278
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$327.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$171.60
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	$156.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$179.40
Rate for Payer: Fidelis Medicare Advantage	$327.60
Rate for Payer: Group Health Inc Commercial	$156.00
Rate for Payer: Group Health Inc Medicare	$109.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.00
Rate for Payer: Hamaspik Choice Inc Medicare	$156.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$202.80

BOLT LOCKING TI 4.9X40MM

Facility IP

$312.00

Service Code	HCPCS C1713
Hospital Charge Code	40200129
Hospital Revenue Code	278
Min. Negotiated Rate	$156.00
Max. Negotiated Rate	$156.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.00
Rate for Payer: Hamaspik Choice Inc Medicare	$156.00

BOLT LOCKING TI 4.9X42MM

Facility OP

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40200130
Hospital Revenue Code	278
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$310.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$162.80
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	$148.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.20
Rate for Payer: Fidelis Medicare Advantage	$310.80
Rate for Payer: Group Health Inc Commercial	$148.00
Rate for Payer: Group Health Inc Medicare	$103.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$192.40

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