St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW LOCKING 2.7X14

Facility IP

$317.50

Service Code	HCPCS C1713
Hospital Charge Code	64903933
Hospital Revenue Code	278
Min. Negotiated Rate	$158.75
Max. Negotiated Rate	$158.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$158.75
Rate for Payer: Hamaspik Choice Inc Medicare	$158.75

SCREW LOCKING 2.7X14

Facility OP

$317.50

Service Code	HCPCS C1713
Hospital Charge Code	64903933
Hospital Revenue Code	278
Min. Negotiated Rate	$111.12
Max. Negotiated Rate	$333.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$174.62
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	$158.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$182.56
Rate for Payer: Fidelis Medicare Advantage	$333.38
Rate for Payer: Group Health Inc Commercial	$158.75
Rate for Payer: Group Health Inc Medicare	$111.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$158.75
Rate for Payer: Hamaspik Choice Inc Medicare	$158.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$206.38

SCREW LOCKING 2.7 X 14MM B

Facility IP

$287.00

Service Code	HCPCS C1713
Hospital Charge Code	64902312
Hospital Revenue Code	278
Min. Negotiated Rate	$143.50
Max. Negotiated Rate	$143.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.50
Rate for Payer: Hamaspik Choice Inc Medicare	$143.50

SCREW LOCKING 2.7 X 14MM B

Facility OP

$287.00

Service Code	HCPCS C1713
Hospital Charge Code	64902312
Hospital Revenue Code	278
Min. Negotiated Rate	$100.45
Max. Negotiated Rate	$301.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.85
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	$143.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$165.02
Rate for Payer: Fidelis Medicare Advantage	$301.35
Rate for Payer: Group Health Inc Commercial	$143.50
Rate for Payer: Group Health Inc Medicare	$100.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.50
Rate for Payer: Hamaspik Choice Inc Medicare	$143.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$186.55

SCREW LOCKING 2.7 X 14MM C

Facility OP

$287.00

Service Code	HCPCS C1713
Hospital Charge Code	64902471
Hospital Revenue Code	278
Min. Negotiated Rate	$100.45
Max. Negotiated Rate	$301.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.85
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	$143.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$165.02
Rate for Payer: Fidelis Medicare Advantage	$301.35
Rate for Payer: Group Health Inc Commercial	$143.50
Rate for Payer: Group Health Inc Medicare	$100.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.50
Rate for Payer: Hamaspik Choice Inc Medicare	$143.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$186.55

SCREW LOCKING 2.7 X 14MM C

Facility IP

$287.00

Service Code	HCPCS C1713
Hospital Charge Code	64902471
Hospital Revenue Code	278
Min. Negotiated Rate	$143.50
Max. Negotiated Rate	$143.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.50
Rate for Payer: Hamaspik Choice Inc Medicare	$143.50

SCREW LOCKING 2.7 X 16MM B

Facility OP

$287.00

Service Code	HCPCS C1713
Hospital Charge Code	64902168
Hospital Revenue Code	278
Min. Negotiated Rate	$100.45
Max. Negotiated Rate	$301.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.85
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	$143.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$165.02
Rate for Payer: Fidelis Medicare Advantage	$301.35
Rate for Payer: Group Health Inc Commercial	$143.50
Rate for Payer: Group Health Inc Medicare	$100.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.50
Rate for Payer: Hamaspik Choice Inc Medicare	$143.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$186.55

SCREW LOCKING 2.7 X 16MM B

Facility IP

$287.00

Service Code	HCPCS C1713
Hospital Charge Code	64902168
Hospital Revenue Code	278
Min. Negotiated Rate	$143.50
Max. Negotiated Rate	$143.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.50
Rate for Payer: Hamaspik Choice Inc Medicare	$143.50

SCREW LOCKING 2.7 X 16MM C

Facility OP

$287.00

Service Code	HCPCS C1713
Hospital Charge Code	64902297
Hospital Revenue Code	278
Min. Negotiated Rate	$100.45
Max. Negotiated Rate	$301.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.85
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	$143.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$165.02
Rate for Payer: Fidelis Medicare Advantage	$301.35
Rate for Payer: Group Health Inc Commercial	$143.50
Rate for Payer: Group Health Inc Medicare	$100.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.50
Rate for Payer: Hamaspik Choice Inc Medicare	$143.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$186.55

SCREW LOCKING 2.7 X 16MM C

Facility IP

$287.00

Service Code	HCPCS C1713
Hospital Charge Code	64902297
Hospital Revenue Code	278
Min. Negotiated Rate	$143.50
Max. Negotiated Rate	$143.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.50
Rate for Payer: Hamaspik Choice Inc Medicare	$143.50

SCREW LOCKING 2.7 X 18MM

Facility OP

$287.00

Service Code	HCPCS C1713
Hospital Charge Code	64902310
Hospital Revenue Code	278
Min. Negotiated Rate	$100.45
Max. Negotiated Rate	$301.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.85
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	$143.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$165.02
Rate for Payer: Fidelis Medicare Advantage	$301.35
Rate for Payer: Group Health Inc Commercial	$143.50
Rate for Payer: Group Health Inc Medicare	$100.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.50
Rate for Payer: Hamaspik Choice Inc Medicare	$143.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$186.55

SCREW LOCKING 2.7 X 18MM

Facility IP

$287.00

Service Code	HCPCS C1713
Hospital Charge Code	64902310
Hospital Revenue Code	278
Min. Negotiated Rate	$143.50
Max. Negotiated Rate	$143.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.50
Rate for Payer: Hamaspik Choice Inc Medicare	$143.50

SCREW LOCKING 2.7 X 28MM

Facility IP

$456.36

Service Code	HCPCS C1713
Hospital Charge Code	64906833
Hospital Revenue Code	278
Min. Negotiated Rate	$228.18
Max. Negotiated Rate	$228.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$228.18
Rate for Payer: Hamaspik Choice Inc Medicare	$228.18

SCREW LOCKING 2.7 X 28MM

Facility OP

$456.36

Service Code	HCPCS C1713
Hospital Charge Code	64906833
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$479.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$251.00
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	$228.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$262.41
Rate for Payer: Fidelis Medicare Advantage	$479.18
Rate for Payer: Group Health Inc Commercial	$228.18
Rate for Payer: Group Health Inc Medicare	$159.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$228.18
Rate for Payer: Hamaspik Choice Inc Medicare	$228.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$296.63

SCREW LOCKING 2.7 X 38MM(656338)

Facility OP

$409.96

Service Code	HCPCS C1713
Hospital Charge Code	64906531
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$430.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$225.48
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	$204.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$235.73
Rate for Payer: Fidelis Medicare Advantage	$430.46
Rate for Payer: Group Health Inc Commercial	$204.98
Rate for Payer: Group Health Inc Medicare	$143.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$204.98
Rate for Payer: Hamaspik Choice Inc Medicare	$204.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$266.47

SCREW LOCKING 2.7 X 38MM(656338)

Facility IP

$409.96

Service Code	HCPCS C1713
Hospital Charge Code	64906531
Hospital Revenue Code	278
Min. Negotiated Rate	$204.98
Max. Negotiated Rate	$204.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$204.98
Rate for Payer: Hamaspik Choice Inc Medicare	$204.98

SCREW LOCKING 2.7X8

Facility IP

$302.50

Service Code	HCPCS C1713
Hospital Charge Code	64903751
Hospital Revenue Code	278
Min. Negotiated Rate	$151.25
Max. Negotiated Rate	$151.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$151.25
Rate for Payer: Hamaspik Choice Inc Medicare	$151.25

SCREW LOCKING 2.7X8

Facility OP

$302.50

Service Code	HCPCS C1713
Hospital Charge Code	64903751
Hospital Revenue Code	278
Min. Negotiated Rate	$105.88
Max. Negotiated Rate	$317.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$166.38
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	$151.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.94
Rate for Payer: Fidelis Medicare Advantage	$317.62
Rate for Payer: Group Health Inc Commercial	$151.25
Rate for Payer: Group Health Inc Medicare	$105.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$151.25
Rate for Payer: Hamaspik Choice Inc Medicare	$151.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$196.62

SCREW LOCKING 3.0 X 16

Facility OP

$762.50

Service Code	HCPCS C1713
Hospital Charge Code	64903269
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$800.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$419.38
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	$381.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$438.44
Rate for Payer: Fidelis Medicare Advantage	$800.62
Rate for Payer: Group Health Inc Commercial	$381.25
Rate for Payer: Group Health Inc Medicare	$266.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$381.25
Rate for Payer: Hamaspik Choice Inc Medicare	$381.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$495.62

SCREW LOCKING 3.0 X 16

Facility IP

$762.50

Service Code	HCPCS C1713
Hospital Charge Code	64903269
Hospital Revenue Code	278
Min. Negotiated Rate	$381.25
Max. Negotiated Rate	$381.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$381.25
Rate for Payer: Hamaspik Choice Inc Medicare	$381.25

SCREW LOCKING 3.0X18MM

Facility IP

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	40200746
Hospital Revenue Code	278
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$50.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00

SCREW LOCKING 3.0X18MM

Facility OP

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	40200746
Hospital Revenue Code	278
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.00
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	$50.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.50
Rate for Payer: Fidelis Medicare Advantage	$105.00
Rate for Payer: Group Health Inc Commercial	$50.00
Rate for Payer: Group Health Inc Medicare	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.00

SCREW LOCKING 35 14MM 883514

Facility IP

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	64906651
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 35 14MM 883514

Facility OP

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	64906651
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 3.5 24MM 816135024

Facility OP

$228.00

Service Code	HCPCS C1713
Hospital Charge Code	64906553
Hospital Revenue Code	278
Min. Negotiated Rate	$79.80
Max. Negotiated Rate	$239.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$125.40
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	$114.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$131.10
Rate for Payer: Fidelis Medicare Advantage	$239.40
Rate for Payer: Group Health Inc Commercial	$114.00
Rate for Payer: Group Health Inc Medicare	$79.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.00
Rate for Payer: Hamaspik Choice Inc Medicare	$114.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$148.20

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