St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW HDLS 2.5

Facility OP

$875.00

Service Code	HCPCS C1713
Hospital Charge Code	64907186
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$918.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$481.25
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	$437.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$503.12
Rate for Payer: Fidelis Medicare Advantage	$918.75
Rate for Payer: Group Health Inc Commercial	$437.50
Rate for Payer: Group Health Inc Medicare	$306.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$437.50
Rate for Payer: Hamaspik Choice Inc Medicare	$437.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$568.75

SCREW H DRIVER BIT (703880)

Facility IP

$331.00

Service Code	HCPCS C1713
Hospital Charge Code	40201544
Hospital Revenue Code	278
Min. Negotiated Rate	$165.50
Max. Negotiated Rate	$165.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.50
Rate for Payer: Hamaspik Choice Inc Medicare	$165.50

SCREW H DRIVER BIT (703880)

Facility OP

$331.00

Service Code	HCPCS C1713
Hospital Charge Code	40201544
Hospital Revenue Code	278
Min. Negotiated Rate	$115.85
Max. Negotiated Rate	$347.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$182.05
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	$165.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$190.32
Rate for Payer: Fidelis Medicare Advantage	$347.55
Rate for Payer: Group Health Inc Commercial	$165.50
Rate for Payer: Group Health Inc Medicare	$115.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.50
Rate for Payer: Hamaspik Choice Inc Medicare	$165.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$215.15

SCREW H DRIVER BIT (703880)

Facility OP

$1,395.00

Service Code	HCPCS C1713
Hospital Charge Code	64904682
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,464.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$767.25
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	$697.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$802.12
Rate for Payer: Fidelis Medicare Advantage	$1,464.75
Rate for Payer: Group Health Inc Commercial	$697.50
Rate for Payer: Group Health Inc Medicare	$488.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$697.50
Rate for Payer: Hamaspik Choice Inc Medicare	$697.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$906.75

SCREW H DRIVER BIT (703880)

Facility IP

$1,395.00

Service Code	HCPCS C1713
Hospital Charge Code	64904682
Hospital Revenue Code	278
Min. Negotiated Rate	$697.50
Max. Negotiated Rate	$697.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$697.50
Rate for Payer: Hamaspik Choice Inc Medicare	$697.50

SCREW HEADLESS

Facility IP

$875.00

Service Code	HCPCS C1713
Hospital Charge Code	64907190
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

SCREW HEADLESS

Facility OP

$875.00

Service Code	HCPCS C1713
Hospital Charge Code	64907190
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$918.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$481.25
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	$437.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$503.12
Rate for Payer: Fidelis Medicare Advantage	$918.75
Rate for Payer: Group Health Inc Commercial	$437.50
Rate for Payer: Group Health Inc Medicare	$306.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$437.50
Rate for Payer: Hamaspik Choice Inc Medicare	$437.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$568.75

SCREW HEADLESS 4.0 X 34

Facility OP

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	64905292
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,443.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$756.25
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	$687.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$790.62
Rate for Payer: Fidelis Medicare Advantage	$1,443.75
Rate for Payer: Group Health Inc Commercial	$687.50
Rate for Payer: Group Health Inc Medicare	$481.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$687.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$893.75

SCREW HEADLESS 4.0 X 34

Facility IP

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	64905292
Hospital Revenue Code	278
Min. Negotiated Rate	$687.50
Max. Negotiated Rate	$687.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$687.50

SCREW HEADLESS 4.0 X 46

Facility OP

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	64905294
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,443.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$756.25
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	$687.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$790.62
Rate for Payer: Fidelis Medicare Advantage	$1,443.75
Rate for Payer: Group Health Inc Commercial	$687.50
Rate for Payer: Group Health Inc Medicare	$481.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$687.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$893.75

SCREW HEADLESS 4.0 X 46

Facility IP

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	64905294
Hospital Revenue Code	278
Min. Negotiated Rate	$687.50
Max. Negotiated Rate	$687.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$687.50

SCREW HEADLESS 4.0 X 75

Facility OP

$1,473.75

Service Code	HCPCS C1713
Hospital Charge Code	64905428
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,547.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$810.56
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	$736.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$847.41
Rate for Payer: Fidelis Medicare Advantage	$1,547.44
Rate for Payer: Group Health Inc Commercial	$736.88
Rate for Payer: Group Health Inc Medicare	$515.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$736.88
Rate for Payer: Hamaspik Choice Inc Medicare	$736.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$957.94

SCREW HEADLESS 4.0 X 75

Facility IP

$1,473.75

Service Code	HCPCS C1713
Hospital Charge Code	64905428
Hospital Revenue Code	278
Min. Negotiated Rate	$736.88
Max. Negotiated Rate	$736.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$736.88
Rate for Payer: Hamaspik Choice Inc Medicare	$736.88

SCREW HEADLESS 5.0 X 70MM

Facility OP

$1,251.25

Service Code	HCPCS C1713
Hospital Charge Code	64906952
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,313.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$688.19
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	$625.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$719.47
Rate for Payer: Fidelis Medicare Advantage	$1,313.81
Rate for Payer: Group Health Inc Commercial	$625.62
Rate for Payer: Group Health Inc Medicare	$437.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$625.62
Rate for Payer: Hamaspik Choice Inc Medicare	$625.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$813.31

SCREW HEADLESS 5.0 X 70MM

Facility IP

$1,251.25

Service Code	HCPCS C1713
Hospital Charge Code	64906952
Hospital Revenue Code	278
Min. Negotiated Rate	$625.62
Max. Negotiated Rate	$625.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$625.62
Rate for Payer: Hamaspik Choice Inc Medicare	$625.62

SCREW HEADLESS COMP 5.0MM/L55MM

Facility IP

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	64905897
Hospital Revenue Code	278
Min. Negotiated Rate	$687.50
Max. Negotiated Rate	$687.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$687.50

SCREW HEADLESS COMP 5.0MM/L55MM

Facility OP

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	64905897
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,443.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$756.25
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	$687.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$790.62
Rate for Payer: Fidelis Medicare Advantage	$1,443.75
Rate for Payer: Group Health Inc Commercial	$687.50
Rate for Payer: Group Health Inc Medicare	$481.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$687.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$893.75

SCREW HEADLESS COMPRESSION 4.0A

Facility IP

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	64904596
Hospital Revenue Code	278
Min. Negotiated Rate	$687.50
Max. Negotiated Rate	$687.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$687.50

SCREW HEADLESS COMPRESSION 4.0A

Facility OP

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	64904596
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,443.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$756.25
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	$687.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$790.62
Rate for Payer: Fidelis Medicare Advantage	$1,443.75
Rate for Payer: Group Health Inc Commercial	$687.50
Rate for Payer: Group Health Inc Medicare	$481.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$687.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$893.75

SCREW HEADLESS COMPRESSION 4.0B

Facility IP

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	64904600
Hospital Revenue Code	278
Min. Negotiated Rate	$687.50
Max. Negotiated Rate	$687.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$687.50

SCREW HEADLESS COMPRESSION 4.0B

Facility OP

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	64904600
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,443.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$756.25
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	$687.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$790.62
Rate for Payer: Fidelis Medicare Advantage	$1,443.75
Rate for Payer: Group Health Inc Commercial	$687.50
Rate for Payer: Group Health Inc Medicare	$481.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$687.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$893.75

SCREW HEADLESS COMPRESSION 4X42

Facility IP

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	64904598
Hospital Revenue Code	278
Min. Negotiated Rate	$687.50
Max. Negotiated Rate	$687.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$687.50

SCREW HEADLESS COMPRESSION 4X42

Facility OP

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	64904598
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,443.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$756.25
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	$687.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$790.62
Rate for Payer: Fidelis Medicare Advantage	$1,443.75
Rate for Payer: Group Health Inc Commercial	$687.50
Rate for Payer: Group Health Inc Medicare	$481.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$687.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$893.75

SCREW HEADLESS COMPRESSION 5.0A

Facility IP

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	64904602
Hospital Revenue Code	278
Min. Negotiated Rate	$687.50
Max. Negotiated Rate	$687.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$687.50

SCREW HEADLESS COMPRESSION 5.0A

Facility OP

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	64904602
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,443.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$756.25
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	$687.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$790.62
Rate for Payer: Fidelis Medicare Advantage	$1,443.75
Rate for Payer: Group Health Inc Commercial	$687.50
Rate for Payer: Group Health Inc Medicare	$481.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$687.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$893.75

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