St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW 55MM

Facility IP

$318.00

Service Code	HCPCS C1776
Hospital Charge Code	40201512
Hospital Revenue Code	278
Min. Negotiated Rate	$159.00
Max. Negotiated Rate	$159.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.00
Rate for Payer: Hamaspik Choice Inc Medicare	$159.00

SCREW 55MM

Facility OP

$318.00

Service Code	HCPCS C1776
Hospital Charge Code	40201512
Hospital Revenue Code	278
Min. Negotiated Rate	$111.30
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$174.90
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	$159.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$182.85
Rate for Payer: Fidelis Medicare Advantage	$333.90
Rate for Payer: Group Health Inc Commercial	$159.00
Rate for Payer: Group Health Inc Medicare	$111.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.00
Rate for Payer: Hamaspik Choice Inc Medicare	$159.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$206.70

SCREW 5.5 X .30 XIA

Facility IP

$3,032.50

Service Code	HCPCS C1713
Hospital Charge Code	64907534
Hospital Revenue Code	278
Min. Negotiated Rate	$1,516.25
Max. Negotiated Rate	$1,516.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,516.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,516.25

SCREW 5.5 X .30 XIA

Facility OP

$3,032.50

Service Code	HCPCS C1713
Hospital Charge Code	64907534
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,184.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,667.88
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	$1,516.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,743.69
Rate for Payer: Fidelis Medicare Advantage	$3,184.12
Rate for Payer: Group Health Inc Commercial	$1,516.25
Rate for Payer: Group Health Inc Medicare	$1,061.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,516.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,516.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,971.12

SCREW 5.5X50SH ES2

Facility IP

$8,552.70

Service Code	HCPCS C1713
Hospital Charge Code	64905226
Hospital Revenue Code	278
Min. Negotiated Rate	$4,276.35
Max. Negotiated Rate	$4,276.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,276.35
Rate for Payer: Hamaspik Choice Inc Medicare	$4,276.35

SCREW 5.5X50SH ES2

Facility OP

$8,552.70

Service Code	HCPCS C1713
Hospital Charge Code	64905226
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$8,980.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,703.98
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	$4,276.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,917.80
Rate for Payer: Fidelis Medicare Advantage	$8,980.34
Rate for Payer: Group Health Inc Commercial	$4,276.35
Rate for Payer: Group Health Inc Medicare	$2,993.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,276.35
Rate for Payer: Hamaspik Choice Inc Medicare	$4,276.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,559.26

SCREW 5MM X2.0MM

Facility OP

$116.00

Service Code	HCPCS C1776
Hospital Charge Code	40206058
Hospital Revenue Code	278
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$63.80
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	$58.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$66.70
Rate for Payer: Fidelis Medicare Advantage	$121.80
Rate for Payer: Group Health Inc Commercial	$58.00
Rate for Payer: Group Health Inc Medicare	$40.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.00
Rate for Payer: Hamaspik Choice Inc Medicare	$58.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$75.40

SCREW 5MM X2.0MM

Facility IP

$116.00

Service Code	HCPCS C1776
Hospital Charge Code	40206058
Hospital Revenue Code	278
Min. Negotiated Rate	$58.00
Max. Negotiated Rate	$58.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.00
Rate for Payer: Hamaspik Choice Inc Medicare	$58.00

SCREW 5 X 52MM 5052S

Facility IP

$693.00

Service Code	HCPCS C1713
Hospital Charge Code	64906720
Hospital Revenue Code	278
Min. Negotiated Rate	$346.50
Max. Negotiated Rate	$346.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$346.50
Rate for Payer: Hamaspik Choice Inc Medicare	$346.50

SCREW 5 X 52MM 5052S

Facility OP

$693.00

Service Code	HCPCS C1713
Hospital Charge Code	64906720
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$727.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$381.15
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	$346.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$398.48
Rate for Payer: Fidelis Medicare Advantage	$727.65
Rate for Payer: Group Health Inc Commercial	$346.50
Rate for Payer: Group Health Inc Medicare	$242.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$346.50
Rate for Payer: Hamaspik Choice Inc Medicare	$346.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$450.45

SCREW 5 X 65MM 5065S

Facility IP

$693.00

Service Code	HCPCS C1713
Hospital Charge Code	64906721
Hospital Revenue Code	278
Min. Negotiated Rate	$346.50
Max. Negotiated Rate	$346.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$346.50
Rate for Payer: Hamaspik Choice Inc Medicare	$346.50

SCREW 5 X 65MM 5065S

Facility OP

$693.00

Service Code	HCPCS C1713
Hospital Charge Code	64906721
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$727.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$381.15
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	$346.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$398.48
Rate for Payer: Fidelis Medicare Advantage	$727.65
Rate for Payer: Group Health Inc Commercial	$346.50
Rate for Payer: Group Health Inc Medicare	$242.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$346.50
Rate for Payer: Hamaspik Choice Inc Medicare	$346.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$450.45

SCREW 6.55 X 65

Facility IP

$81.25

Service Code	HCPCS C1713
Hospital Charge Code	64903675
Hospital Revenue Code	278
Min. Negotiated Rate	$40.62
Max. Negotiated Rate	$40.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.62
Rate for Payer: Hamaspik Choice Inc Medicare	$40.62

SCREW 6.55 X 65

Facility OP

$81.25

Service Code	HCPCS C1713
Hospital Charge Code	64903675
Hospital Revenue Code	278
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.69
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	$40.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.72
Rate for Payer: Fidelis Medicare Advantage	$85.31
Rate for Payer: Group Health Inc Commercial	$40.62
Rate for Payer: Group Health Inc Medicare	$28.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.62
Rate for Payer: Hamaspik Choice Inc Medicare	$40.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.81

SCREW 6.5 X 50MM- 16330

Facility IP

$2,292.40

Service Code	HCPCS C1713
Hospital Charge Code	64906729
Hospital Revenue Code	278
Min. Negotiated Rate	$1,146.20
Max. Negotiated Rate	$1,146.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,146.20
Rate for Payer: Hamaspik Choice Inc Medicare	$1,146.20

SCREW 6.5 X 50MM- 16330

Facility OP

$2,292.40

Service Code	HCPCS C1713
Hospital Charge Code	64906729
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,407.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,260.82
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	$1,146.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,318.13
Rate for Payer: Fidelis Medicare Advantage	$2,407.02
Rate for Payer: Group Health Inc Commercial	$1,146.20
Rate for Payer: Group Health Inc Medicare	$802.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,146.20
Rate for Payer: Hamaspik Choice Inc Medicare	$1,146.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,490.06

SCREW 6.5 X 50MM XIA 3

Facility IP

$4,754.35

Service Code	HCPCS C1713
Hospital Charge Code	64902975
Hospital Revenue Code	278
Min. Negotiated Rate	$2,377.18
Max. Negotiated Rate	$2,377.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,377.18
Rate for Payer: Hamaspik Choice Inc Medicare	$2,377.18

SCREW 6.5 X 50MM XIA 3

Facility OP

$4,754.35

Service Code	HCPCS C1713
Hospital Charge Code	64902975
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,992.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,614.89
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	$2,377.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,733.75
Rate for Payer: Fidelis Medicare Advantage	$4,992.07
Rate for Payer: Group Health Inc Commercial	$2,377.18
Rate for Payer: Group Health Inc Medicare	$1,664.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,377.18
Rate for Payer: Hamaspik Choice Inc Medicare	$2,377.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,090.33

SCREW 6.5X55MM

Facility OP

$81.25

Service Code	HCPCS C1713
Hospital Charge Code	64903906
Hospital Revenue Code	278
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.69
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	$40.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.72
Rate for Payer: Fidelis Medicare Advantage	$85.31
Rate for Payer: Group Health Inc Commercial	$40.62
Rate for Payer: Group Health Inc Medicare	$28.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.62
Rate for Payer: Hamaspik Choice Inc Medicare	$40.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.81

SCREW 6.5X55MM

Facility IP

$81.25

Service Code	HCPCS C1713
Hospital Charge Code	64903906
Hospital Revenue Code	278
Min. Negotiated Rate	$40.62
Max. Negotiated Rate	$40.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.62
Rate for Payer: Hamaspik Choice Inc Medicare	$40.62

SCREW 6.5X60MM

Facility OP

$81.25

Service Code	HCPCS C1713
Hospital Charge Code	64903908
Hospital Revenue Code	278
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.69
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	$40.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.72
Rate for Payer: Fidelis Medicare Advantage	$85.31
Rate for Payer: Group Health Inc Commercial	$40.62
Rate for Payer: Group Health Inc Medicare	$28.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.62
Rate for Payer: Hamaspik Choice Inc Medicare	$40.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.81

SCREW 6.5X60MM

Facility IP

$81.25

Service Code	HCPCS C1713
Hospital Charge Code	64903908
Hospital Revenue Code	278
Min. Negotiated Rate	$40.62
Max. Negotiated Rate	$40.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.62
Rate for Payer: Hamaspik Choice Inc Medicare	$40.62

SCREW 6.5X65MM

Facility IP

$81.25

Service Code	HCPCS C1713
Hospital Charge Code	64903909
Hospital Revenue Code	278
Min. Negotiated Rate	$40.62
Max. Negotiated Rate	$40.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.62
Rate for Payer: Hamaspik Choice Inc Medicare	$40.62

SCREW 6.5X65MM

Facility OP

$81.25

Service Code	HCPCS C1713
Hospital Charge Code	64903909
Hospital Revenue Code	278
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.69
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	$40.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.72
Rate for Payer: Fidelis Medicare Advantage	$85.31
Rate for Payer: Group Health Inc Commercial	$40.62
Rate for Payer: Group Health Inc Medicare	$28.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.62
Rate for Payer: Hamaspik Choice Inc Medicare	$40.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.81

SCREW 6.5X70MM

Facility OP

$81.25

Service Code	HCPCS C1713
Hospital Charge Code	64903911
Hospital Revenue Code	278
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.69
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	$40.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.72
Rate for Payer: Fidelis Medicare Advantage	$85.31
Rate for Payer: Group Health Inc Commercial	$40.62
Rate for Payer: Group Health Inc Medicare	$28.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.62
Rate for Payer: Hamaspik Choice Inc Medicare	$40.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.81

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