St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW LOCK CORT 2.5

Facility OP

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	64907034
Hospital Revenue Code	278
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$299.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$156.75
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	$142.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.88
Rate for Payer: Fidelis Medicare Advantage	$299.25
Rate for Payer: Group Health Inc Commercial	$142.50
Rate for Payer: Group Health Inc Medicare	$99.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.25

SCREW LOCK CORT 2.5

Facility IP

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	64907034
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$142.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50

SCREW LOCK F-THRD T10 2.7MM L46

Facility IP

$228.18

Service Code	HCPCS C1713
Hospital Charge Code	64906434
Hospital Revenue Code	278
Min. Negotiated Rate	$114.09
Max. Negotiated Rate	$114.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.09
Rate for Payer: Hamaspik Choice Inc Medicare	$114.09

SCREW LOCK F-THRD T10 2.7MM L46

Facility OP

$228.18

Service Code	HCPCS C1713
Hospital Charge Code	64906434
Hospital Revenue Code	278
Min. Negotiated Rate	$79.86
Max. Negotiated Rate	$239.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$125.50
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	$114.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$131.20
Rate for Payer: Fidelis Medicare Advantage	$239.59
Rate for Payer: Group Health Inc Commercial	$114.09
Rate for Payer: Group Health Inc Medicare	$79.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.09
Rate for Payer: Hamaspik Choice Inc Medicare	$114.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$148.32

SCREW LOCK F-THRD T10 2.7MM L50

Facility IP

$912.72

Service Code	HCPCS C1713
Hospital Charge Code	64906812
Hospital Revenue Code	278
Min. Negotiated Rate	$456.36
Max. Negotiated Rate	$456.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$456.36
Rate for Payer: Hamaspik Choice Inc Medicare	$456.36

SCREW LOCK F-THRD T10 2.7MM L50

Facility OP

$912.72

Service Code	HCPCS C1713
Hospital Charge Code	64906812
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$958.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$502.00
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	$456.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$524.81
Rate for Payer: Fidelis Medicare Advantage	$958.36
Rate for Payer: Group Health Inc Commercial	$456.36
Rate for Payer: Group Health Inc Medicare	$319.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$456.36
Rate for Payer: Hamaspik Choice Inc Medicare	$456.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$593.27

SCREW LOCK FULL THRD 5X65MM

Facility IP

$318.00

Service Code	HCPCS C1776
Hospital Charge Code	40202426
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 LOCK FULL THRD 5X65MM

Facility OP

$318.00

Service Code	HCPCS C1776
Hospital Charge Code	40202426
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 LOCKIG FULL THRD T10 2.7X40

Facility IP

$228.18

Service Code	HCPCS C1713
Hospital Charge Code	64906504
Hospital Revenue Code	278
Min. Negotiated Rate	$114.09
Max. Negotiated Rate	$114.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.09
Rate for Payer: Hamaspik Choice Inc Medicare	$114.09

SCREW LOCKIG FULL THRD T10 2.7X40

Facility OP

$228.18

Service Code	HCPCS C1713
Hospital Charge Code	64906504
Hospital Revenue Code	278
Min. Negotiated Rate	$79.86
Max. Negotiated Rate	$239.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$125.50
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	$114.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$131.20
Rate for Payer: Fidelis Medicare Advantage	$239.59
Rate for Payer: Group Health Inc Commercial	$114.09
Rate for Payer: Group Health Inc Medicare	$79.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.09
Rate for Payer: Hamaspik Choice Inc Medicare	$114.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$148.32

SCREW LOCKING

Facility OP

$318.00

Service Code	HCPCS C1776
Hospital Charge Code	40202425
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 LOCKING

Facility IP

$429.00

Service Code	HCPCS C1713
Hospital Charge Code	64901231
Hospital Revenue Code	278
Min. Negotiated Rate	$214.50
Max. Negotiated Rate	$214.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$214.50
Rate for Payer: Hamaspik Choice Inc Medicare	$214.50

SCREW LOCKING

Facility OP

$429.00

Service Code	HCPCS C1713
Hospital Charge Code	64901231
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$450.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$235.95
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	$214.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$246.68
Rate for Payer: Fidelis Medicare Advantage	$450.45
Rate for Payer: Group Health Inc Commercial	$214.50
Rate for Payer: Group Health Inc Medicare	$150.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$214.50
Rate for Payer: Hamaspik Choice Inc Medicare	$214.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$278.85

SCREW LOCKING

Facility IP

$318.00

Service Code	HCPCS C1776
Hospital Charge Code	40202425
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 LOCKING #12 3.5MM

Facility IP

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	64906675
Hospital Revenue Code	278
Min. Negotiated Rate	$115.00
Max. Negotiated Rate	$115.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00

SCREW LOCKING #12 3.5MM

Facility OP

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	64906675
Hospital Revenue Code	278
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$241.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.50
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	$115.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.25
Rate for Payer: Fidelis Medicare Advantage	$241.50
Rate for Payer: Group Health Inc Commercial	$115.00
Rate for Payer: Group Health Inc Medicare	$80.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$149.50

SCREW LOCKING 1.7 X 5

Facility OP

$229.13

Service Code	HCPCS C1713
Hospital Charge Code	64904751
Hospital Revenue Code	278
Min. Negotiated Rate	$80.20
Max. Negotiated Rate	$240.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.02
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	$114.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$131.75
Rate for Payer: Fidelis Medicare Advantage	$240.59
Rate for Payer: Group Health Inc Commercial	$114.56
Rate for Payer: Group Health Inc Medicare	$80.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.56
Rate for Payer: Hamaspik Choice Inc Medicare	$114.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$148.93

SCREW LOCKING 1.7 X 5

Facility IP

$229.13

Service Code	HCPCS C1713
Hospital Charge Code	64904751
Hospital Revenue Code	278
Min. Negotiated Rate	$114.56
Max. Negotiated Rate	$114.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.56
Rate for Payer: Hamaspik Choice Inc Medicare	$114.56

SCREW LOCKING 1.7 X 8

Facility IP

$229.13

Service Code	HCPCS C1713
Hospital Charge Code	64904924
Hospital Revenue Code	278
Min. Negotiated Rate	$114.56
Max. Negotiated Rate	$114.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.56
Rate for Payer: Hamaspik Choice Inc Medicare	$114.56

SCREW LOCKING 1.7 X 8

Facility OP

$229.13

Service Code	HCPCS C1713
Hospital Charge Code	64904924
Hospital Revenue Code	278
Min. Negotiated Rate	$80.20
Max. Negotiated Rate	$240.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.02
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	$114.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$131.75
Rate for Payer: Fidelis Medicare Advantage	$240.59
Rate for Payer: Group Health Inc Commercial	$114.56
Rate for Payer: Group Health Inc Medicare	$80.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.56
Rate for Payer: Hamaspik Choice Inc Medicare	$114.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$148.93

SCREW LOCKING 2.0

Facility IP

$792.50

Service Code	HCPCS C1713
Hospital Charge Code	64907031
Hospital Revenue Code	278
Min. Negotiated Rate	$396.25
Max. Negotiated Rate	$396.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.25
Rate for Payer: Hamaspik Choice Inc Medicare	$396.25

SCREW LOCKING 2.0

Facility OP

$792.50

Service Code	HCPCS C1713
Hospital Charge Code	64907031
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$832.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$435.88
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	$396.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$455.69
Rate for Payer: Fidelis Medicare Advantage	$832.12
Rate for Payer: Group Health Inc Commercial	$396.25
Rate for Payer: Group Health Inc Medicare	$277.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.25
Rate for Payer: Hamaspik Choice Inc Medicare	$396.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$515.12

SCREW LOCKING 2.0 10MM

Facility IP

$195.48

Service Code	HCPCS C1713
Hospital Charge Code	64903210
Hospital Revenue Code	278
Min. Negotiated Rate	$97.74
Max. Negotiated Rate	$97.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$97.74
Rate for Payer: Hamaspik Choice Inc Medicare	$97.74

SCREW LOCKING 2.0 10MM

Facility OP

$195.48

Service Code	HCPCS C1713
Hospital Charge Code	64903210
Hospital Revenue Code	278
Min. Negotiated Rate	$68.42
Max. Negotiated Rate	$205.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$107.51
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	$97.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$112.40
Rate for Payer: Fidelis Medicare Advantage	$205.25
Rate for Payer: Group Health Inc Commercial	$97.74
Rate for Payer: Group Health Inc Medicare	$68.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$97.74
Rate for Payer: Hamaspik Choice Inc Medicare	$97.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$127.06

SCREW LOCKING 2.0 12MM

Facility IP

$195.55

Service Code	HCPCS C1713
Hospital Charge Code	64903207
Hospital Revenue Code	278
Min. Negotiated Rate	$97.78
Max. Negotiated Rate	$97.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$97.78
Rate for Payer: Hamaspik Choice Inc Medicare	$97.78

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