St. Barnabas Hospital

All Charges

Charge

Type

Price

BONE SCREW T10 FT 3.5MM / L24MM

Facility IP

$400.00

Service Code	HCPCS C1713
Hospital Charge Code	64904556
Hospital Revenue Code	278
Min. Negotiated Rate	$200.00
Max. Negotiated Rate	$200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$200.00

BONE SCREW T10 FT 3.5MM / L26MM

Facility IP

$340.00

Service Code	HCPCS C1713
Hospital Charge Code	64904567
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

BONE SCREW T10 FT 3.5MM / L26MM

Facility OP

$340.00

Service Code	HCPCS C1713
Hospital Charge Code	64904567
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: Cigna HMO/Network Benefit Plan/Open Access	$170.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$195.50
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

BONE SCREW T10 FT 3.5MM / L28MM

Facility OP

$340.00

Service Code	HCPCS C1713
Hospital Charge Code	64904639
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: Cigna HMO/Network Benefit Plan/Open Access	$170.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$195.50
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

BONE SCREW T10 FT 3.5MM / L28MM

Facility IP

$340.00

Service Code	HCPCS C1713
Hospital Charge Code	64904639
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

BONE SCREW T10 FT 3.5MM / L30MM

Facility OP

$340.00

Service Code	HCPCS C1713
Hospital Charge Code	64904665
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: Cigna HMO/Network Benefit Plan/Open Access	$170.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$195.50
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

BONE SCREW T10 FT 3.5MM / L30MM

Facility IP

$340.00

Service Code	HCPCS C1713
Hospital Charge Code	64904665
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

BONE SCREW T10 FT 3.5MM / L32MM

Facility IP

$340.00

Service Code	HCPCS C1713
Hospital Charge Code	64904569
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

BONE SCREW T10 FT 3.5MM / L32MM

Facility OP

$340.00

Service Code	HCPCS C1713
Hospital Charge Code	64904569
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: Cigna HMO/Network Benefit Plan/Open Access	$170.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$195.50
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

BONE SCREW T10 FT 3.5MM / L8MM

Facility OP

$385.00

Service Code	HCPCS C1713
Hospital Charge Code	64905260
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$404.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$211.75
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	$192.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$221.38
Rate for Payer: Fidelis Medicare Advantage	$404.25
Rate for Payer: Group Health Inc Commercial	$192.50
Rate for Payer: Group Health Inc Medicare	$134.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$192.50
Rate for Payer: Hamaspik Choice Inc Medicare	$192.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$250.25

BONE SCREW T10 FT 3.5MM / L8MM

Facility IP

$385.00

Service Code	HCPCS C1713
Hospital Charge Code	64905260
Hospital Revenue Code	278
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$192.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$192.50
Rate for Payer: Hamaspik Choice Inc Medicare	$192.50

BONE SCREW T8 FL THRD 2.7/L34MM

Facility OP

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	64906295
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: Cigna HMO/Network Benefit Plan/Open Access	$60.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.00
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

BONE SCREW T8 FL THRD 2.7/L34MM

Facility IP

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	64906295
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

BONE SCREW T8 FT 2.4MM / L14MM

Facility OP

$329.38

Service Code	HCPCS C1713
Hospital Charge Code	64905250
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 T8 FT 2.4MM / L14MM

Facility IP

$329.38

Service Code	HCPCS C1713
Hospital Charge Code	64905250
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

BONE SCREW T8 FT 2.4MM / L16MM

Facility OP

$329.38

Service Code	HCPCS C1713
Hospital Charge Code	64904774
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 T8 FT 2.4MM / L16MM

Facility IP

$329.38

Service Code	HCPCS C1713
Hospital Charge Code	64904774
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

BONE SCREW T8 FT 2.4MM / L18MM

Facility IP

$381.25

Service Code	HCPCS C1713
Hospital Charge Code	64904399
Hospital Revenue Code	278
Min. Negotiated Rate	$190.62
Max. Negotiated Rate	$190.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.62
Rate for Payer: Hamaspik Choice Inc Medicare	$190.62

BONE SCREW T8 FT 2.4MM / L18MM

Facility OP

$381.25

Service Code	HCPCS C1713
Hospital Charge Code	64904399
Hospital Revenue Code	278
Min. Negotiated Rate	$133.44
Max. Negotiated Rate	$400.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$209.69
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	$190.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$219.22
Rate for Payer: Fidelis Medicare Advantage	$400.31
Rate for Payer: Group Health Inc Commercial	$190.62
Rate for Payer: Group Health Inc Medicare	$133.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.62
Rate for Payer: Hamaspik Choice Inc Medicare	$190.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$247.81

BONE SCREW T8 FT 2.4MM / L20MM

Facility IP

$387.50

Service Code	HCPCS C1713
Hospital Charge Code	64904401
Hospital Revenue Code	278
Min. Negotiated Rate	$193.75
Max. Negotiated Rate	$193.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$193.75
Rate for Payer: Hamaspik Choice Inc Medicare	$193.75

BONE SCREW T8 FT 2.4MM / L20MM

Facility OP

$387.50

Service Code	HCPCS C1713
Hospital Charge Code	64904401
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$406.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$213.12
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	$193.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$222.81
Rate for Payer: Fidelis Medicare Advantage	$406.88
Rate for Payer: Group Health Inc Commercial	$193.75
Rate for Payer: Group Health Inc Medicare	$135.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$193.75
Rate for Payer: Hamaspik Choice Inc Medicare	$193.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$251.88

BONE SCREW T8 FT 2.4MM / L22MM

Facility OP

$329.38

Service Code	HCPCS C1713
Hospital Charge Code	64904532
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 T8 FT 2.4MM / L22MM

Facility IP

$329.38

Service Code	HCPCS C1713
Hospital Charge Code	64904532
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

BONE SCREW T8 FT 2.4MM / L24MM

Facility OP

$329.38

Service Code	HCPCS C1713
Hospital Charge Code	64904472
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 T8 FT 2.4MM / L24MM

Facility IP

$329.38

Service Code	HCPCS C1713
Hospital Charge Code	64904472
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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