St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW GAMMA3 TI LAG 10.5X80MM

Facility OP

$963.20

Service Code	HCPCS C1713
Hospital Charge Code	40205453
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,011.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$529.76
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	$481.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$553.84
Rate for Payer: Fidelis Medicare Advantage	$1,011.36
Rate for Payer: Group Health Inc Commercial	$481.60
Rate for Payer: Group Health Inc Medicare	$337.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$481.60
Rate for Payer: Hamaspik Choice Inc Medicare	$481.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$626.08

SCREW GAMMA3 TI LAG 10.5X80MM

Facility IP

$1,282.13

Service Code	HCPCS C1713
Hospital Charge Code	64901442
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 GO-EZ 2.0 X 14MM

Facility IP

$262.50

Service Code	HCPCS C1713
Hospital Charge Code	64902444
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.25
Rate for Payer: Hamaspik Choice Inc Medicare	$131.25

SCREW GO-EZ 2.0 X 14MM

Facility OP

$262.50

Service Code	HCPCS C1713
Hospital Charge Code	64902444
Hospital Revenue Code	278
Min. Negotiated Rate	$91.88
Max. Negotiated Rate	$275.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$144.38
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	$131.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$150.94
Rate for Payer: Fidelis Medicare Advantage	$275.62
Rate for Payer: Group Health Inc Commercial	$131.25
Rate for Payer: Group Health Inc Medicare	$91.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.25
Rate for Payer: Hamaspik Choice Inc Medicare	$131.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$170.62

SCREW GO-EZ 2.5 X 12MM

Facility OP

$262.50

Service Code	HCPCS C1713
Hospital Charge Code	64902075
Hospital Revenue Code	278
Min. Negotiated Rate	$91.88
Max. Negotiated Rate	$275.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$144.38
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	$131.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$150.94
Rate for Payer: Fidelis Medicare Advantage	$275.62
Rate for Payer: Group Health Inc Commercial	$131.25
Rate for Payer: Group Health Inc Medicare	$91.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.25
Rate for Payer: Hamaspik Choice Inc Medicare	$131.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$170.62

SCREW GO-EZ 2.5 X 12MM

Facility IP

$262.50

Service Code	HCPCS C1713
Hospital Charge Code	64902075
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.25
Rate for Payer: Hamaspik Choice Inc Medicare	$131.25

SCREW GO-EZ 2.5 X 14MM

Facility OP

$362.50

Service Code	HCPCS C1713
Hospital Charge Code	64902076
Hospital Revenue Code	278
Min. Negotiated Rate	$126.88
Max. Negotiated Rate	$380.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$199.38
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	$181.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$208.44
Rate for Payer: Fidelis Medicare Advantage	$380.62
Rate for Payer: Group Health Inc Commercial	$181.25
Rate for Payer: Group Health Inc Medicare	$126.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$181.25
Rate for Payer: Hamaspik Choice Inc Medicare	$181.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$235.62

SCREW GO-EZ 2.5 X 14MM

Facility IP

$362.50

Service Code	HCPCS C1713
Hospital Charge Code	64902076
Hospital Revenue Code	278
Min. Negotiated Rate	$181.25
Max. Negotiated Rate	$181.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$181.25
Rate for Payer: Hamaspik Choice Inc Medicare	$181.25

SCREW GO-EZ 2.5 X 16MM

Facility IP

$375.00

Service Code	HCPCS C1713
Hospital Charge Code	64902078
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

SCREW GO-EZ 2.5 X 16MM

Facility OP

$375.00

Service Code	HCPCS C1713
Hospital Charge Code	64902078
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: Cigna HMO/Network Benefit Plan/Open Access	$187.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$215.62
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

SCREW GO EZ 2X8

Facility IP

$262.50

Service Code	HCPCS C1713
Hospital Charge Code	64903729
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.25
Rate for Payer: Hamaspik Choice Inc Medicare	$131.25

SCREW GO EZ 2X8

Facility OP

$262.50

Service Code	HCPCS C1713
Hospital Charge Code	64903729
Hospital Revenue Code	278
Min. Negotiated Rate	$91.88
Max. Negotiated Rate	$275.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$144.38
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	$131.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$150.94
Rate for Payer: Fidelis Medicare Advantage	$275.62
Rate for Payer: Group Health Inc Commercial	$131.25
Rate for Payer: Group Health Inc Medicare	$91.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.25
Rate for Payer: Hamaspik Choice Inc Medicare	$131.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$170.62

SCREW GO-EZ 3.0 X 10MM

Facility OP

$131.25

Service Code	HCPCS C1713
Hospital Charge Code	64902082
Hospital Revenue Code	278
Min. Negotiated Rate	$45.94
Max. Negotiated Rate	$137.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$72.19
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	$65.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$75.47
Rate for Payer: Fidelis Medicare Advantage	$137.81
Rate for Payer: Group Health Inc Commercial	$65.62
Rate for Payer: Group Health Inc Medicare	$45.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.62
Rate for Payer: Hamaspik Choice Inc Medicare	$65.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$85.31

SCREW GO-EZ 3.0 X 10MM

Facility IP

$131.25

Service Code	HCPCS C1713
Hospital Charge Code	64902082
Hospital Revenue Code	278
Min. Negotiated Rate	$65.62
Max. Negotiated Rate	$65.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.62
Rate for Payer: Hamaspik Choice Inc Medicare	$65.62

SCREW GO-EZ 3.0 X 14MM

Facility IP

$262.50

Service Code	HCPCS C1713
Hospital Charge Code	64902019
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.25
Rate for Payer: Hamaspik Choice Inc Medicare	$131.25

SCREW GO-EZ 3.0 X 14MM

Facility OP

$262.50

Service Code	HCPCS C1713
Hospital Charge Code	64902019
Hospital Revenue Code	278
Min. Negotiated Rate	$91.88
Max. Negotiated Rate	$275.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$144.38
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	$131.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$150.94
Rate for Payer: Fidelis Medicare Advantage	$275.62
Rate for Payer: Group Health Inc Commercial	$131.25
Rate for Payer: Group Health Inc Medicare	$91.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.25
Rate for Payer: Hamaspik Choice Inc Medicare	$131.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$170.62

SCREW GO-EZ 3.0 X 16MM

Facility IP

$262.50

Service Code	HCPCS C1713
Hospital Charge Code	64902131
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.25
Rate for Payer: Hamaspik Choice Inc Medicare	$131.25

SCREW GO-EZ 3.0 X 16MM

Facility OP

$262.50

Service Code	HCPCS C1713
Hospital Charge Code	64902131
Hospital Revenue Code	278
Min. Negotiated Rate	$91.88
Max. Negotiated Rate	$275.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$144.38
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	$131.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$150.94
Rate for Payer: Fidelis Medicare Advantage	$275.62
Rate for Payer: Group Health Inc Commercial	$131.25
Rate for Payer: Group Health Inc Medicare	$91.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.25
Rate for Payer: Hamaspik Choice Inc Medicare	$131.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$170.62

SCREW GO-EZ 3.5 X 8MM

Facility IP

$262.50

Service Code	HCPCS C1713
Hospital Charge Code	64902086
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.25
Rate for Payer: Hamaspik Choice Inc Medicare	$131.25

SCREW GO-EZ 3.5 X 8MM

Facility OP

$262.50

Service Code	HCPCS C1713
Hospital Charge Code	64902086
Hospital Revenue Code	278
Min. Negotiated Rate	$91.88
Max. Negotiated Rate	$275.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$144.38
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	$131.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$150.94
Rate for Payer: Fidelis Medicare Advantage	$275.62
Rate for Payer: Group Health Inc Commercial	$131.25
Rate for Payer: Group Health Inc Medicare	$91.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.25
Rate for Payer: Hamaspik Choice Inc Medicare	$131.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$170.62

SCREW H 20X25

Facility IP

$1,307.50

Service Code	HCPCS C1713
Hospital Charge Code	64903573
Hospital Revenue Code	278
Min. Negotiated Rate	$653.75
Max. Negotiated Rate	$653.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$653.75
Rate for Payer: Hamaspik Choice Inc Medicare	$653.75

SCREW H 20X25

Facility OP

$1,307.50

Service Code	HCPCS C1713
Hospital Charge Code	64903573
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,372.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$719.12
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	$653.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$751.81
Rate for Payer: Fidelis Medicare Advantage	$1,372.88
Rate for Payer: Group Health Inc Commercial	$653.75
Rate for Payer: Group Health Inc Medicare	$457.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$653.75
Rate for Payer: Hamaspik Choice Inc Medicare	$653.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$849.88

SCREW H 22X25

Facility OP

$1,307.50

Service Code	HCPCS C1713
Hospital Charge Code	64903571
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,372.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$719.12
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	$653.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$751.81
Rate for Payer: Fidelis Medicare Advantage	$1,372.88
Rate for Payer: Group Health Inc Commercial	$653.75
Rate for Payer: Group Health Inc Medicare	$457.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$653.75
Rate for Payer: Hamaspik Choice Inc Medicare	$653.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$849.88

SCREW H 22X25

Facility IP

$1,307.50

Service Code	HCPCS C1713
Hospital Charge Code	64903571
Hospital Revenue Code	278
Min. Negotiated Rate	$653.75
Max. Negotiated Rate	$653.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$653.75
Rate for Payer: Hamaspik Choice Inc Medicare	$653.75

SCREW HDLS 2.5

Facility IP

$875.00

Service Code	HCPCS C1713
Hospital Charge Code	64907186
Hospital Revenue Code	278
Min. Negotiated Rate	$437.50
Max. Negotiated Rate	$437.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$437.50
Rate for Payer: Hamaspik Choice Inc Medicare	$437.50

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