St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BONE SCREW T8 FT 2.4MM / L18MM

Facility

$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 / L20MM

Facility

$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

$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: Brighton Health Commercial	$232.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$193.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$222.81
Rate for Payer: EmblemHealth Commercial	$193.75
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

$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 / L22MM

Facility

$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: Brighton Health Commercial	$197.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$164.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$189.39
Rate for Payer: EmblemHealth Commercial	$164.69
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

$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

BONE SCREW T8 FT 2.4MM / L24MM

Facility

$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: Brighton Health Commercial	$197.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$164.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$189.39
Rate for Payer: EmblemHealth Commercial	$164.69
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 / L28MM

Facility

$387.50

Service Code	HCPCS C1713
Hospital Charge Code	64904988
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: Brighton Health Commercial	$232.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$193.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$222.81
Rate for Payer: EmblemHealth Commercial	$193.75
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 / L28MM

Facility

$387.50

Service Code	HCPCS C1713
Hospital Charge Code	64904988
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 2.7MM / L10MM

Facility

$387.50

Service Code	HCPCS C1713
Hospital Charge Code	64904421
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 2.7MM / L10MM

Facility

$387.50

Service Code	HCPCS C1713
Hospital Charge Code	64904421
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: Brighton Health Commercial	$232.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$193.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$222.81
Rate for Payer: EmblemHealth Commercial	$193.75
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 2.7MM / L12MM

Facility

$375.00

Service Code	HCPCS C1713
Hospital Charge Code	64904409
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.50
Rate for Payer: Hamaspik Choice Inc Medicare	$187.50

BONE SCREW T8 FT 2.7MM / L12MM

Facility

$375.00

Service Code	HCPCS C1713
Hospital Charge Code	64904409
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$393.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$206.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$225.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$187.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$215.62
Rate for Payer: EmblemHealth Commercial	$187.50
Rate for Payer: Fidelis Medicare Advantage	$393.75
Rate for Payer: Group Health Inc Commercial	$187.50
Rate for Payer: Group Health Inc Medicare	$131.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.50
Rate for Payer: Hamaspik Choice Inc Medicare	$187.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$243.75

BONE SCREW T8 FT 2.7MM / L14MM

Facility

$375.00

Service Code	HCPCS C1713
Hospital Charge Code	64904407
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$393.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$206.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$225.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$187.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$215.62
Rate for Payer: EmblemHealth Commercial	$187.50
Rate for Payer: Fidelis Medicare Advantage	$393.75
Rate for Payer: Group Health Inc Commercial	$187.50
Rate for Payer: Group Health Inc Medicare	$131.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.50
Rate for Payer: Hamaspik Choice Inc Medicare	$187.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$243.75

BONE SCREW T8 FT 2.7MM / L14MM

Facility

$375.00

Service Code	HCPCS C1713
Hospital Charge Code	64904407
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.50
Rate for Payer: Hamaspik Choice Inc Medicare	$187.50

BONE SCREW T8 FT 2.7MM / L16MM

Facility

$329.38

Service Code	HCPCS C1713
Hospital Charge Code	64904519
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: Brighton Health Commercial	$197.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$164.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$189.39
Rate for Payer: EmblemHealth Commercial	$164.69
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 2.7MM / L16MM

Facility

$329.38

Service Code	HCPCS C1713
Hospital Charge Code	64904519
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 2.7MM / L18MM

Facility

$329.38

Service Code	HCPCS C1713
Hospital Charge Code	64904796
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 2.7MM / L18MM

Facility

$329.38

Service Code	HCPCS C1713
Hospital Charge Code	64904796
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: Brighton Health Commercial	$197.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$164.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$189.39
Rate for Payer: EmblemHealth Commercial	$164.69
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 2.7MM / L20MM

Facility

$387.50

Service Code	HCPCS C1713
Hospital Charge Code	64904628
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 2.7MM / L20MM

Facility

$387.50

Service Code	HCPCS C1713
Hospital Charge Code	64904628
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: Brighton Health Commercial	$232.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$193.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$222.81
Rate for Payer: EmblemHealth Commercial	$193.75
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 2.7MM / L22MM

Facility

$329.38

Service Code	HCPCS C1713
Hospital Charge Code	64904630
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: Brighton Health Commercial	$197.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$164.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$189.39
Rate for Payer: EmblemHealth Commercial	$164.69
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 2.7MM / L22MM

Facility

$329.38

Service Code	HCPCS C1713
Hospital Charge Code	64904630
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 SUBSTITUTE

Facility

$822.60

Service Code	HCPCS C1713
Hospital Charge Code	40203151
Hospital Revenue Code	278
Min. Negotiated Rate	$411.30
Max. Negotiated Rate	$411.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$411.30
Rate for Payer: Hamaspik Choice Inc Medicare	$411.30

BONE SUBSTITUTE

Facility

$6,300.00

Service Code	HCPCS C1713
Hospital Charge Code	40009115
Hospital Revenue Code	278
Min. Negotiated Rate	$3,150.00
Max. Negotiated Rate	$3,150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,150.00

Know your out-of-pocket cost for care.

All Charges