St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW

Facility OP

$487.80

Service Code	HCPCS C1713
Hospital Charge Code	40203571
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$512.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$268.29
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	$243.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$280.48
Rate for Payer: Fidelis Medicare Advantage	$512.19
Rate for Payer: Group Health Inc Commercial	$243.90
Rate for Payer: Group Health Inc Medicare	$170.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.90
Rate for Payer: Hamaspik Choice Inc Medicare	$243.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$317.07

SCREW 100-299

Facility OP

$342.92

Service Code	HCPCS C1713
Hospital Charge Code	40203069
Hospital Revenue Code	278
Min. Negotiated Rate	$120.02
Max. Negotiated Rate	$360.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$188.61
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	$171.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$197.18
Rate for Payer: Fidelis Medicare Advantage	$360.07
Rate for Payer: Group Health Inc Commercial	$171.46
Rate for Payer: Group Health Inc Medicare	$120.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$171.46
Rate for Payer: Hamaspik Choice Inc Medicare	$171.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$222.90

SCREW 100-299

Facility IP

$342.92

Service Code	HCPCS C1713
Hospital Charge Code	40203069
Hospital Revenue Code	278
Min. Negotiated Rate	$171.46
Max. Negotiated Rate	$171.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$171.46
Rate for Payer: Hamaspik Choice Inc Medicare	$171.46

SCREW 10MM VIRAGE

Facility OP

$2,798.00

Service Code	HCPCS C1713
Hospital Charge Code	40005333
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,937.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,538.90
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	$1,399.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,608.85
Rate for Payer: Fidelis Medicare Advantage	$2,937.90
Rate for Payer: Group Health Inc Commercial	$1,399.00
Rate for Payer: Group Health Inc Medicare	$979.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,399.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,399.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,818.70

SCREW 10MM VIRAGE

Facility IP

$2,798.00

Service Code	HCPCS C1713
Hospital Charge Code	40005333
Hospital Revenue Code	278
Min. Negotiated Rate	$1,399.00
Max. Negotiated Rate	$1,399.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,399.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,399.00

SCREW- 10MM VIRAGE

Facility IP

$2,798.00

Service Code	HCPCS C1713
Hospital Charge Code	40204585
Hospital Revenue Code	278
Min. Negotiated Rate	$1,399.00
Max. Negotiated Rate	$1,399.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,399.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,399.00

SCREW- 10MM VIRAGE

Facility OP

$2,798.00

Service Code	HCPCS C1713
Hospital Charge Code	40204585
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,937.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,538.90
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	$1,399.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,608.85
Rate for Payer: Fidelis Medicare Advantage	$2,937.90
Rate for Payer: Group Health Inc Commercial	$1,399.00
Rate for Payer: Group Health Inc Medicare	$979.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,399.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,399.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,818.70

SCREW- 10MM VIRAGE

Facility OP

$2,798.00

Service Code	HCPCS L8699
Hospital Charge Code	40007504
Hospital Revenue Code	278
Min. Negotiated Rate	$979.30
Max. Negotiated Rate	$2,937.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,538.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,399.00
Rate for Payer: Aetna Government	$1,399.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,399.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,608.85
Rate for Payer: Fidelis Medicare Advantage	$2,937.90
Rate for Payer: Group Health Inc Commercial	$1,399.00
Rate for Payer: Group Health Inc Medicare	$979.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,399.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,399.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,818.70

SCREW- 10MM VIRAGE

Facility IP

$2,798.00

Service Code	HCPCS L8699
Hospital Charge Code	40007504
Hospital Revenue Code	278
Min. Negotiated Rate	$1,399.00
Max. Negotiated Rate	$1,399.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,399.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,399.00

SCREW 120MM L

Facility OP

$1,282.13

Service Code	HCPCS C1713
Hospital Charge Code	64904878
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,346.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$705.17
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	$641.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$737.22
Rate for Payer: Fidelis Medicare Advantage	$1,346.24
Rate for Payer: Group Health Inc Commercial	$641.06
Rate for Payer: Group Health Inc Medicare	$448.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$641.06
Rate for Payer: Hamaspik Choice Inc Medicare	$641.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$833.38

SCREW 120MM L

Facility IP

$1,282.13

Service Code	HCPCS C1713
Hospital Charge Code	64904878
Hospital Revenue Code	278
Min. Negotiated Rate	$641.06
Max. Negotiated Rate	$641.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$641.06
Rate for Payer: Hamaspik Choice Inc Medicare	$641.06

SCREW 1.2 X 3MM SELF DRILL

Facility OP

$149.15

Service Code	HCPCS C1713
Hospital Charge Code	64901550
Hospital Revenue Code	278
Min. Negotiated Rate	$52.20
Max. Negotiated Rate	$156.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.03
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	$74.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$85.76
Rate for Payer: Fidelis Medicare Advantage	$156.61
Rate for Payer: Group Health Inc Commercial	$74.58
Rate for Payer: Group Health Inc Medicare	$52.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.58
Rate for Payer: Hamaspik Choice Inc Medicare	$74.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$96.95

SCREW 1.2 X 3MM SELF DRILL

Facility IP

$149.15

Service Code	HCPCS C1713
Hospital Charge Code	64901550
Hospital Revenue Code	278
Min. Negotiated Rate	$74.58
Max. Negotiated Rate	$74.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.58
Rate for Payer: Hamaspik Choice Inc Medicare	$74.58

SCREW 1.2 X 3MM SELF TAP

Facility OP

$133.10

Service Code	HCPCS C1713
Hospital Charge Code	64901546
Hospital Revenue Code	278
Min. Negotiated Rate	$46.58
Max. Negotiated Rate	$139.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$73.20
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	$66.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.53
Rate for Payer: Fidelis Medicare Advantage	$139.76
Rate for Payer: Group Health Inc Commercial	$66.55
Rate for Payer: Group Health Inc Medicare	$46.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.55
Rate for Payer: Hamaspik Choice Inc Medicare	$66.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$86.52

SCREW 1.2 X 3MM SELF TAP

Facility IP

$133.10

Service Code	HCPCS C1713
Hospital Charge Code	64901546
Hospital Revenue Code	278
Min. Negotiated Rate	$66.55
Max. Negotiated Rate	$66.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.55
Rate for Payer: Hamaspik Choice Inc Medicare	$66.55

SCREW1.2X4MM CRS PIN SLF TAPP

Facility OP

$117.08

Service Code	HCPCS C1713
Hospital Charge Code	40200747
Hospital Revenue Code	278
Min. Negotiated Rate	$40.98
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.39
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	$58.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$67.32
Rate for Payer: Fidelis Medicare Advantage	$122.93
Rate for Payer: Group Health Inc Commercial	$58.54
Rate for Payer: Group Health Inc Medicare	$40.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.54
Rate for Payer: Hamaspik Choice Inc Medicare	$58.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$76.10

SCREW1.2X4MM CRS PIN SLF TAPP

Facility IP

$117.08

Service Code	HCPCS C1713
Hospital Charge Code	40200747
Hospital Revenue Code	278
Min. Negotiated Rate	$58.54
Max. Negotiated Rate	$58.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.54
Rate for Payer: Hamaspik Choice Inc Medicare	$58.54

SCREW 1.2 X 4MM SELF TAP

Facility IP

$133.10

Service Code	HCPCS C1713
Hospital Charge Code	64901547
Hospital Revenue Code	278
Min. Negotiated Rate	$66.55
Max. Negotiated Rate	$66.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.55
Rate for Payer: Hamaspik Choice Inc Medicare	$66.55

SCREW 1.2 X 4MM SELF TAP

Facility OP

$133.10

Service Code	HCPCS C1713
Hospital Charge Code	64901547
Hospital Revenue Code	278
Min. Negotiated Rate	$46.58
Max. Negotiated Rate	$139.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$73.20
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	$66.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.53
Rate for Payer: Fidelis Medicare Advantage	$139.76
Rate for Payer: Group Health Inc Commercial	$66.55
Rate for Payer: Group Health Inc Medicare	$46.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.55
Rate for Payer: Hamaspik Choice Inc Medicare	$66.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$86.52

SCREW 1.2 X 4MM SLF DRILL

Facility IP

$149.15

Service Code	HCPCS C1713
Hospital Charge Code	64901392
Hospital Revenue Code	278
Min. Negotiated Rate	$74.58
Max. Negotiated Rate	$74.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.58
Rate for Payer: Hamaspik Choice Inc Medicare	$74.58

SCREW 1.2 X 4MM SLF DRILL

Facility OP

$149.15

Service Code	HCPCS C1713
Hospital Charge Code	64901392
Hospital Revenue Code	278
Min. Negotiated Rate	$52.20
Max. Negotiated Rate	$156.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.03
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	$74.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$85.76
Rate for Payer: Fidelis Medicare Advantage	$156.61
Rate for Payer: Group Health Inc Commercial	$74.58
Rate for Payer: Group Health Inc Medicare	$52.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.58
Rate for Payer: Hamaspik Choice Inc Medicare	$74.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$96.95

SCREW 1.2X6MM BONE XPNS ELFT

Facility IP

$154.38

Service Code	HCPCS C1713
Hospital Charge Code	64905648
Hospital Revenue Code	278
Min. Negotiated Rate	$77.19
Max. Negotiated Rate	$77.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.19
Rate for Payer: Hamaspik Choice Inc Medicare	$77.19

SCREW 1.2X6MM BONE XPNS ELFT

Facility OP

$154.38

Service Code	HCPCS C1713
Hospital Charge Code	64905648
Hospital Revenue Code	278
Min. Negotiated Rate	$54.03
Max. Negotiated Rate	$162.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$84.91
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	$77.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$88.77
Rate for Payer: Fidelis Medicare Advantage	$162.10
Rate for Payer: Group Health Inc Commercial	$77.19
Rate for Payer: Group Health Inc Medicare	$54.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.19
Rate for Payer: Hamaspik Choice Inc Medicare	$77.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$100.35

SCREW 1.2 X 6MM SELF TAP

Facility IP

$133.10

Service Code	HCPCS C1713
Hospital Charge Code	64901548
Hospital Revenue Code	278
Min. Negotiated Rate	$66.55
Max. Negotiated Rate	$66.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.55
Rate for Payer: Hamaspik Choice Inc Medicare	$66.55

SCREW 1.2 X 6MM SELF TAP

Facility OP

$133.10

Service Code	HCPCS C1713
Hospital Charge Code	64901548
Hospital Revenue Code	278
Min. Negotiated Rate	$46.58
Max. Negotiated Rate	$139.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$73.20
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	$66.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.53
Rate for Payer: Fidelis Medicare Advantage	$139.76
Rate for Payer: Group Health Inc Commercial	$66.55
Rate for Payer: Group Health Inc Medicare	$46.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.55
Rate for Payer: Hamaspik Choice Inc Medicare	$66.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$86.52

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