St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW 6.5X70MM

Facility IP

$81.25

Service Code	HCPCS C1713
Hospital Charge Code	64903911
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 6.5X75MM

Facility OP

$81.25

Service Code	HCPCS C1713
Hospital Charge Code	64903913
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 6.5X75MM

Facility IP

$81.25

Service Code	HCPCS C1713
Hospital Charge Code	64903913
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 6.5 X 90

Facility IP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64903604
Hospital Revenue Code	278
Min. Negotiated Rate	$307.12
Max. Negotiated Rate	$307.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$307.12
Rate for Payer: Hamaspik Choice Inc Medicare	$307.12

SCREW 6.5 X 90

Facility OP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64903604
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$644.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$337.84
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	$307.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$353.19
Rate for Payer: Fidelis Medicare Advantage	$644.96
Rate for Payer: Group Health Inc Commercial	$307.12
Rate for Payer: Group Health Inc Medicare	$214.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$307.12
Rate for Payer: Hamaspik Choice Inc Medicare	$307.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$399.26

SCREW 6MMX40MM POLY

Facility OP

$3,550.00

Service Code	HCPCS C1776
Hospital Charge Code	40205093
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,727.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,952.50
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	$1,775.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,041.25
Rate for Payer: Fidelis Medicare Advantage	$3,727.50
Rate for Payer: Group Health Inc Commercial	$1,775.00
Rate for Payer: Group Health Inc Medicare	$1,242.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,775.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,775.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,307.50

SCREW 6MMX40MM POLY

Facility IP

$3,550.00

Service Code	HCPCS C1776
Hospital Charge Code	40205093
Hospital Revenue Code	278
Min. Negotiated Rate	$1,775.00
Max. Negotiated Rate	$1,775.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,775.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,775.00

SCREW 75MM

Facility IP

$317.80

Service Code	HCPCS C1776
Hospital Charge Code	40205064
Hospital Revenue Code	278
Min. Negotiated Rate	$158.90
Max. Negotiated Rate	$158.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$158.90
Rate for Payer: Hamaspik Choice Inc Medicare	$158.90

SCREW 75MM

Facility OP

$317.80

Service Code	HCPCS C1776
Hospital Charge Code	40205064
Hospital Revenue Code	278
Min. Negotiated Rate	$111.23
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$174.79
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	$158.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$182.74
Rate for Payer: Fidelis Medicare Advantage	$333.69
Rate for Payer: Group Health Inc Commercial	$158.90
Rate for Payer: Group Health Inc Medicare	$111.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$158.90
Rate for Payer: Hamaspik Choice Inc Medicare	$158.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$206.57

SCREW 7.5 X 45

Facility IP

$4,754.35

Service Code	HCPCS C1713
Hospital Charge Code	64905288
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 7.5 X 45

Facility OP

$4,754.35

Service Code	HCPCS C1713
Hospital Charge Code	64905288
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 80MM

Facility OP

$406.00

Service Code	HCPCS C1776
Hospital Charge Code	40205100
Hospital Revenue Code	278
Min. Negotiated Rate	$142.10
Max. Negotiated Rate	$426.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$223.30
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	$203.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$233.45
Rate for Payer: Fidelis Medicare Advantage	$426.30
Rate for Payer: Group Health Inc Commercial	$203.00
Rate for Payer: Group Health Inc Medicare	$142.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.00
Rate for Payer: Hamaspik Choice Inc Medicare	$203.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$263.90

SCREW 80MM

Facility IP

$406.00

Service Code	HCPCS C1776
Hospital Charge Code	40205100
Hospital Revenue Code	278
Min. Negotiated Rate	$203.00
Max. Negotiated Rate	$203.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.00
Rate for Payer: Hamaspik Choice Inc Medicare	$203.00

SCREW 85MM

Facility IP

$512.00

Service Code	HCPCS C1776
Hospital Charge Code	40207051
Hospital Revenue Code	278
Min. Negotiated Rate	$256.00
Max. Negotiated Rate	$256.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$256.00
Rate for Payer: Hamaspik Choice Inc Medicare	$256.00

SCREW 85MM

Facility OP

$512.00

Service Code	HCPCS C1776
Hospital Charge Code	40207051
Hospital Revenue Code	278
Min. Negotiated Rate	$179.20
Max. Negotiated Rate	$537.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$281.60
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	$256.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$294.40
Rate for Payer: Fidelis Medicare Advantage	$537.60
Rate for Payer: Group Health Inc Commercial	$256.00
Rate for Payer: Group Health Inc Medicare	$179.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$256.00
Rate for Payer: Hamaspik Choice Inc Medicare	$256.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$332.80

SCREW 90MM

Facility OP

$340.00

Service Code	HCPCS C1776
Hospital Charge Code	40205102
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	$339.17
Rate for Payer: Aetna Government	$339.17
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

SCREW 90MM

Facility IP

$340.00

Service Code	HCPCS C1776
Hospital Charge Code	40205102
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

SCREW > 999

Facility IP

$3,109.92

Service Code	HCPCS C1713
Hospital Charge Code	40203080
Hospital Revenue Code	278
Min. Negotiated Rate	$1,554.96
Max. Negotiated Rate	$1,554.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,554.96
Rate for Payer: Hamaspik Choice Inc Medicare	$1,554.96

SCREW > 999

Facility OP

$3,109.92

Service Code	HCPCS C1713
Hospital Charge Code	40203080
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,265.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,710.46
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	$1,554.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,788.20
Rate for Payer: Fidelis Medicare Advantage	$3,265.42
Rate for Payer: Group Health Inc Commercial	$1,554.96
Rate for Payer: Group Health Inc Medicare	$1,088.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,554.96
Rate for Payer: Hamaspik Choice Inc Medicare	$1,554.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,021.45

SCREW 9X23

Facility IP

$840.00

Service Code	HCPCS C1713
Hospital Charge Code	64903916
Hospital Revenue Code	278
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$420.00

SCREW 9X23

Facility OP

$840.00

Service Code	HCPCS C1713
Hospital Charge Code	64903916
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$882.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$462.00
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	$420.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$483.00
Rate for Payer: Fidelis Medicare Advantage	$882.00
Rate for Payer: Group Health Inc Commercial	$420.00
Rate for Payer: Group Health Inc Medicare	$294.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$420.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$546.00

SCREW ACETAB CANC 6.5X25MM UNIV

Facility IP

$268.00

Service Code	HCPCS C1713
Hospital Charge Code	40202213
Hospital Revenue Code	278
Min. Negotiated Rate	$134.00
Max. Negotiated Rate	$134.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.00
Rate for Payer: Hamaspik Choice Inc Medicare	$134.00

SCREW ACETAB CANC 6.5X25MM UNIV

Facility OP

$268.00

Service Code	HCPCS C1713
Hospital Charge Code	40202213
Hospital Revenue Code	278
Min. Negotiated Rate	$93.80
Max. Negotiated Rate	$281.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$147.40
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	$134.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$154.10
Rate for Payer: Fidelis Medicare Advantage	$281.40
Rate for Payer: Group Health Inc Commercial	$134.00
Rate for Payer: Group Health Inc Medicare	$93.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.00
Rate for Payer: Hamaspik Choice Inc Medicare	$134.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$174.20

SCREW ACETUB 6.5MM 25L

Facility IP

$336.00

Service Code	HCPCS C1713
Hospital Charge Code	64906851
Hospital Revenue Code	278
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$168.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.00
Rate for Payer: Hamaspik Choice Inc Medicare	$168.00

SCREW ACETUB 6.5MM 25L

Facility OP

$336.00

Service Code	HCPCS C1713
Hospital Charge Code	64906851
Hospital Revenue Code	278
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$352.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$184.80
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	$168.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$193.20
Rate for Payer: Fidelis Medicare Advantage	$352.80
Rate for Payer: Group Health Inc Commercial	$168.00
Rate for Payer: Group Health Inc Medicare	$117.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.00
Rate for Payer: Hamaspik Choice Inc Medicare	$168.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$218.40

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