St. Barnabas Hospital

All Charges

Charge

Type

Price

BONE SCREW 4.0 X 55

Facility IP

$309.40

Service Code	HCPCS C1713
Hospital Charge Code	64905149
Hospital Revenue Code	278
Min. Negotiated Rate	$154.70
Max. Negotiated Rate	$154.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$154.70
Rate for Payer: Hamaspik Choice Inc Medicare	$154.70

BONE SCREW 6.5X30 SELF TAP

Facility OP

$345.00

Service Code	HCPCS C1713
Hospital Charge Code	64905775
Hospital Revenue Code	278
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$362.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$189.75
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	$172.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$198.38
Rate for Payer: Fidelis Medicare Advantage	$362.25
Rate for Payer: Group Health Inc Commercial	$172.50
Rate for Payer: Group Health Inc Medicare	$120.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.50
Rate for Payer: Hamaspik Choice Inc Medicare	$172.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$224.25

BONE SCREW 6.5X30 SELF TAP

Facility IP

$345.00

Service Code	HCPCS C1713
Hospital Charge Code	64905775
Hospital Revenue Code	278
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$172.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.50
Rate for Payer: Hamaspik Choice Inc Medicare	$172.50

BONE SCREW 6.5X35 SELF TAP

Facility OP

$368.00

Service Code	HCPCS C1713
Hospital Charge Code	40204613
Hospital Revenue Code	278
Min. Negotiated Rate	$128.80
Max. Negotiated Rate	$386.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$202.40
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	$184.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$211.60
Rate for Payer: Fidelis Medicare Advantage	$386.40
Rate for Payer: Group Health Inc Commercial	$184.00
Rate for Payer: Group Health Inc Medicare	$128.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$184.00
Rate for Payer: Hamaspik Choice Inc Medicare	$184.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$239.20

BONE SCREW 6.5X35 SELF TAP

Facility OP

$368.00

Service Code	HCPCS C1776
Hospital Charge Code	40007532
Hospital Revenue Code	278
Min. Negotiated Rate	$128.80
Max. Negotiated Rate	$386.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$202.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$184.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$211.60
Rate for Payer: Fidelis Medicare Advantage	$386.40
Rate for Payer: Group Health Inc Commercial	$184.00
Rate for Payer: Group Health Inc Medicare	$128.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$184.00
Rate for Payer: Hamaspik Choice Inc Medicare	$184.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$239.20

BONE SCREW 6.5X35 SELF TAP

Facility IP

$368.00

Service Code	HCPCS C1713
Hospital Charge Code	40204613
Hospital Revenue Code	278
Min. Negotiated Rate	$184.00
Max. Negotiated Rate	$184.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$184.00
Rate for Payer: Hamaspik Choice Inc Medicare	$184.00

BONE SCREW 6.5X35 SELF TAP

Facility IP

$368.00

Service Code	HCPCS C1776
Hospital Charge Code	40007532
Hospital Revenue Code	278
Min. Negotiated Rate	$184.00
Max. Negotiated Rate	$184.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$184.00
Rate for Payer: Hamaspik Choice Inc Medicare	$184.00

BONE SCREW 6.5X35 SELF TAP A

Facility IP

$345.00

Service Code	HCPCS C1713
Hospital Charge Code	64905563
Hospital Revenue Code	278
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$172.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.50
Rate for Payer: Hamaspik Choice Inc Medicare	$172.50

BONE SCREW 6.5X35 SELF TAP A

Facility OP

$345.00

Service Code	HCPCS C1713
Hospital Charge Code	64905563
Hospital Revenue Code	278
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$362.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$189.75
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	$172.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$198.38
Rate for Payer: Fidelis Medicare Advantage	$362.25
Rate for Payer: Group Health Inc Commercial	$172.50
Rate for Payer: Group Health Inc Medicare	$120.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.50
Rate for Payer: Hamaspik Choice Inc Medicare	$172.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$224.25

BONE SCREW 6.5X35 SELF TAP B

Facility IP

$345.00

Service Code	HCPCS C1713
Hospital Charge Code	64905805
Hospital Revenue Code	278
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$172.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.50
Rate for Payer: Hamaspik Choice Inc Medicare	$172.50

BONE SCREW 6.5X35 SELF TAP B

Facility OP

$345.00

Service Code	HCPCS C1713
Hospital Charge Code	64905805
Hospital Revenue Code	278
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$362.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$189.75
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	$172.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$198.38
Rate for Payer: Fidelis Medicare Advantage	$362.25
Rate for Payer: Group Health Inc Commercial	$172.50
Rate for Payer: Group Health Inc Medicare	$120.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.50
Rate for Payer: Hamaspik Choice Inc Medicare	$172.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$224.25

BONE SCREW 6.6X40 SELF TAP

Facility IP

$345.00

Service Code	HCPCS C1713
Hospital Charge Code	64905564
Hospital Revenue Code	278
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$172.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.50
Rate for Payer: Hamaspik Choice Inc Medicare	$172.50

BONE SCREW 6.6X40 SELF TAP

Facility OP

$345.00

Service Code	HCPCS C1713
Hospital Charge Code	64905564
Hospital Revenue Code	278
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$362.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$189.75
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	$172.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$198.38
Rate for Payer: Fidelis Medicare Advantage	$362.25
Rate for Payer: Group Health Inc Commercial	$172.50
Rate for Payer: Group Health Inc Medicare	$120.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.50
Rate for Payer: Hamaspik Choice Inc Medicare	$172.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$224.25

BONE SCREW 6.6X40 SELF TAP

Facility IP

$368.00

Service Code	HCPCS C1713
Hospital Charge Code	40204614
Hospital Revenue Code	278
Min. Negotiated Rate	$184.00
Max. Negotiated Rate	$184.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$184.00
Rate for Payer: Hamaspik Choice Inc Medicare	$184.00

BONE SCREW 6.6X40 SELF TAP

Facility OP

$368.00

Service Code	HCPCS C1776
Hospital Charge Code	40007533
Hospital Revenue Code	278
Min. Negotiated Rate	$128.80
Max. Negotiated Rate	$386.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$202.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$184.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$211.60
Rate for Payer: Fidelis Medicare Advantage	$386.40
Rate for Payer: Group Health Inc Commercial	$184.00
Rate for Payer: Group Health Inc Medicare	$128.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$184.00
Rate for Payer: Hamaspik Choice Inc Medicare	$184.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$239.20

BONE SCREW 6.6X40 SELF TAP

Facility IP

$368.00

Service Code	HCPCS C1776
Hospital Charge Code	40007533
Hospital Revenue Code	278
Min. Negotiated Rate	$184.00
Max. Negotiated Rate	$184.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$184.00
Rate for Payer: Hamaspik Choice Inc Medicare	$184.00

BONE SCREW 6.6X40 SELF TAP

Facility OP

$368.00

Service Code	HCPCS C1713
Hospital Charge Code	40204614
Hospital Revenue Code	278
Min. Negotiated Rate	$128.80
Max. Negotiated Rate	$386.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$202.40
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	$184.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$211.60
Rate for Payer: Fidelis Medicare Advantage	$386.40
Rate for Payer: Group Health Inc Commercial	$184.00
Rate for Payer: Group Health Inc Medicare	$128.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$184.00
Rate for Payer: Hamaspik Choice Inc Medicare	$184.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$239.20

BONE SCREW LOCKING 4.0 X 44MM

Facility OP

$627.50

Service Code	HCPCS C1713
Hospital Charge Code	64905446
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$658.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$345.12
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	$313.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$360.81
Rate for Payer: Fidelis Medicare Advantage	$658.88
Rate for Payer: Group Health Inc Commercial	$313.75
Rate for Payer: Group Health Inc Medicare	$219.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$313.75
Rate for Payer: Hamaspik Choice Inc Medicare	$313.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$407.88

BONE SCREW LOCKING 4.0 X 44MM

Facility IP

$627.50

Service Code	HCPCS C1713
Hospital Charge Code	64905446
Hospital Revenue Code	278
Min. Negotiated Rate	$313.75
Max. Negotiated Rate	$313.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$313.75
Rate for Payer: Hamaspik Choice Inc Medicare	$313.75

BONE SCREW NEURO 1.5 X 4MM

Facility OP

$148.25

Service Code	HCPCS C1713
Hospital Charge Code	64902869
Hospital Revenue Code	278
Min. Negotiated Rate	$51.89
Max. Negotiated Rate	$155.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$81.54
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	$74.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$85.24
Rate for Payer: Fidelis Medicare Advantage	$155.66
Rate for Payer: Group Health Inc Commercial	$74.12
Rate for Payer: Group Health Inc Medicare	$51.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.12
Rate for Payer: Hamaspik Choice Inc Medicare	$74.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$96.36

BONE SCREW NEURO 1.5 X 4MM

Facility IP

$148.25

Service Code	HCPCS C1713
Hospital Charge Code	64902869
Hospital Revenue Code	278
Min. Negotiated Rate	$74.12
Max. Negotiated Rate	$74.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.12
Rate for Payer: Hamaspik Choice Inc Medicare	$74.12

BONE SCREW NONLOCKING 2.3X18

Facility OP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64905153
Hospital Revenue Code	278
Min. Negotiated Rate	$62.56
Max. Negotiated Rate	$187.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$98.31
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	$89.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.78
Rate for Payer: Fidelis Medicare Advantage	$187.69
Rate for Payer: Group Health Inc Commercial	$89.38
Rate for Payer: Group Health Inc Medicare	$62.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.38
Rate for Payer: Hamaspik Choice Inc Medicare	$89.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$116.19

BONE SCREW NONLOCKING 2.3X18

Facility IP

$178.75

Service Code	HCPCS C1713
Hospital Charge Code	64905153
Hospital Revenue Code	278
Min. Negotiated Rate	$89.38
Max. Negotiated Rate	$89.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.38
Rate for Payer: Hamaspik Choice Inc Medicare	$89.38

BONE SCREW NONLOCKING 2.7 X 24

Facility OP

$329.38

Service Code	HCPCS C1713
Hospital Charge Code	64905290
Hospital Revenue Code	278
Min. Negotiated Rate	$115.28
Max. Negotiated Rate	$345.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$181.16
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	$164.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$189.39
Rate for Payer: Fidelis Medicare Advantage	$345.85
Rate for Payer: Group Health Inc Commercial	$164.69
Rate for Payer: Group Health Inc Medicare	$115.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$164.69
Rate for Payer: Hamaspik Choice Inc Medicare	$164.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$214.10

BONE SCREW NONLOCKING 2.7 X 24

Facility IP

$329.38

Service Code	HCPCS C1713
Hospital Charge Code	64905290
Hospital Revenue Code	278
Min. Negotiated Rate	$164.69
Max. Negotiated Rate	$164.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$164.69
Rate for Payer: Hamaspik Choice Inc Medicare	$164.69

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