St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW LOCKING 3.5 X 34MM

Facility IP

$333.13

Service Code	HCPCS C1713
Hospital Charge Code	64901914
Hospital Revenue Code	278
Min. Negotiated Rate	$166.56
Max. Negotiated Rate	$166.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$166.56
Rate for Payer: Hamaspik Choice Inc Medicare	$166.56

SCREW LOCKING 3.5 X 38

Facility IP

$490.00

Service Code	HCPCS C1713
Hospital Charge Code	64903739
Hospital Revenue Code	278
Min. Negotiated Rate	$245.00
Max. Negotiated Rate	$245.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$245.00
Rate for Payer: Hamaspik Choice Inc Medicare	$245.00

SCREW LOCKING 3.5 X 38

Facility OP

$490.00

Service Code	HCPCS C1713
Hospital Charge Code	64903739
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$514.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$269.50
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	$245.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$281.75
Rate for Payer: Fidelis Medicare Advantage	$514.50
Rate for Payer: Group Health Inc Commercial	$245.00
Rate for Payer: Group Health Inc Medicare	$171.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$245.00
Rate for Payer: Hamaspik Choice Inc Medicare	$245.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$318.50

SCREW LOCKING 3.5 X 38MM

Facility OP

$456.36

Service Code	HCPCS C1713
Hospital Charge Code	64906878
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 3.5 X 38MM

Facility IP

$456.36

Service Code	HCPCS C1713
Hospital Charge Code	64906878
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 3.5 X 42MM

Facility OP

$333.13

Service Code	HCPCS C1713
Hospital Charge Code	64902176
Hospital Revenue Code	278
Min. Negotiated Rate	$116.60
Max. Negotiated Rate	$349.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$183.22
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	$166.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$191.55
Rate for Payer: Fidelis Medicare Advantage	$349.79
Rate for Payer: Group Health Inc Commercial	$166.56
Rate for Payer: Group Health Inc Medicare	$116.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$166.56
Rate for Payer: Hamaspik Choice Inc Medicare	$166.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$216.53

SCREW LOCKING 3.5 X 42MM

Facility IP

$333.13

Service Code	HCPCS C1713
Hospital Charge Code	64902176
Hospital Revenue Code	278
Min. Negotiated Rate	$166.56
Max. Negotiated Rate	$166.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$166.56
Rate for Payer: Hamaspik Choice Inc Medicare	$166.56

SCREW LOCKING 3.5 X 48MM

Facility IP

$333.13

Service Code	HCPCS C1713
Hospital Charge Code	64902394
Hospital Revenue Code	278
Min. Negotiated Rate	$166.56
Max. Negotiated Rate	$166.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$166.56
Rate for Payer: Hamaspik Choice Inc Medicare	$166.56

SCREW LOCKING 3.5 X 48MM

Facility OP

$333.13

Service Code	HCPCS C1713
Hospital Charge Code	64902394
Hospital Revenue Code	278
Min. Negotiated Rate	$116.60
Max. Negotiated Rate	$349.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$183.22
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	$166.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$191.55
Rate for Payer: Fidelis Medicare Advantage	$349.79
Rate for Payer: Group Health Inc Commercial	$166.56
Rate for Payer: Group Health Inc Medicare	$116.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$166.56
Rate for Payer: Hamaspik Choice Inc Medicare	$166.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$216.53

SCREW LOCKING 3.5 X 50MM FT T10

Facility IP

$732.50

Service Code	HCPCS C1713
Hospital Charge Code	64905317
Hospital Revenue Code	278
Min. Negotiated Rate	$366.25
Max. Negotiated Rate	$366.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.25
Rate for Payer: Hamaspik Choice Inc Medicare	$366.25

SCREW LOCKING 3.5 X 50MM FT T10

Facility OP

$732.50

Service Code	HCPCS C1713
Hospital Charge Code	64905317
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$769.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$402.88
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	$366.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$421.19
Rate for Payer: Fidelis Medicare Advantage	$769.12
Rate for Payer: Group Health Inc Commercial	$366.25
Rate for Payer: Group Health Inc Medicare	$256.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.25
Rate for Payer: Hamaspik Choice Inc Medicare	$366.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$476.12

SCREW LOCKING 4.0

Facility IP

$561.00

Service Code	HCPCS C1713
Hospital Charge Code	64903299
Hospital Revenue Code	278
Min. Negotiated Rate	$280.50
Max. Negotiated Rate	$280.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$280.50
Rate for Payer: Hamaspik Choice Inc Medicare	$280.50

SCREW LOCKING 4.0

Facility OP

$561.00

Service Code	HCPCS C1713
Hospital Charge Code	64903299
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$589.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$308.55
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	$280.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$322.58
Rate for Payer: Fidelis Medicare Advantage	$589.05
Rate for Payer: Group Health Inc Commercial	$280.50
Rate for Payer: Group Health Inc Medicare	$196.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$280.50
Rate for Payer: Hamaspik Choice Inc Medicare	$280.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$364.65

SCREW LOCKING 4.0 24

Facility OP

$627.50

Service Code	HCPCS C1713
Hospital Charge Code	64904070
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$658.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$345.12
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	$313.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$360.81
Rate for Payer: Fidelis Medicare Advantage	$658.88
Rate for Payer: Group Health Inc Commercial	$313.75
Rate for Payer: Group Health Inc Medicare	$219.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$313.75
Rate for Payer: Hamaspik Choice Inc Medicare	$313.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$407.88

SCREW LOCKING 4.0 24

Facility IP

$627.50

Service Code	HCPCS C1713
Hospital Charge Code	64904070
Hospital Revenue Code	278
Min. Negotiated Rate	$313.75
Max. Negotiated Rate	$313.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$313.75
Rate for Payer: Hamaspik Choice Inc Medicare	$313.75

SCREW LOCKING 40 A

Facility IP

$549.00

Service Code	HCPCS C1713
Hospital Charge Code	64903655
Hospital Revenue Code	278
Min. Negotiated Rate	$274.50
Max. Negotiated Rate	$274.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$274.50
Rate for Payer: Hamaspik Choice Inc Medicare	$274.50

SCREW LOCKING 40 A

Facility OP

$549.00

Service Code	HCPCS C1713
Hospital Charge Code	64903655
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$576.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$301.95
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	$274.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$315.68
Rate for Payer: Fidelis Medicare Advantage	$576.45
Rate for Payer: Group Health Inc Commercial	$274.50
Rate for Payer: Group Health Inc Medicare	$192.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$274.50
Rate for Payer: Hamaspik Choice Inc Medicare	$274.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$356.85

SCREW LOCKING 40 B

Facility IP

$502.00

Service Code	HCPCS C1713
Hospital Charge Code	64903657
Hospital Revenue Code	278
Min. Negotiated Rate	$251.00
Max. Negotiated Rate	$251.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.00
Rate for Payer: Hamaspik Choice Inc Medicare	$251.00

SCREW LOCKING 40 B

Facility OP

$502.00

Service Code	HCPCS C1713
Hospital Charge Code	64903657
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$527.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$276.10
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	$251.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$288.65
Rate for Payer: Fidelis Medicare Advantage	$527.10
Rate for Payer: Group Health Inc Commercial	$251.00
Rate for Payer: Group Health Inc Medicare	$175.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.00
Rate for Payer: Hamaspik Choice Inc Medicare	$251.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$326.30

SCREW LOCKING 4.0 X 14MM

Facility OP

$241.25

Service Code	HCPCS C1713
Hospital Charge Code	64902273
Hospital Revenue Code	278
Min. Negotiated Rate	$84.44
Max. Negotiated Rate	$253.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.69
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	$120.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$138.72
Rate for Payer: Fidelis Medicare Advantage	$253.31
Rate for Payer: Group Health Inc Commercial	$120.62
Rate for Payer: Group Health Inc Medicare	$84.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.62
Rate for Payer: Hamaspik Choice Inc Medicare	$120.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$156.81

SCREW LOCKING 4.0 X 14MM

Facility IP

$241.25

Service Code	HCPCS C1713
Hospital Charge Code	64902273
Hospital Revenue Code	278
Min. Negotiated Rate	$120.62
Max. Negotiated Rate	$120.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.62
Rate for Payer: Hamaspik Choice Inc Medicare	$120.62

SCREW LOCKING 4.0 X 18MM

Facility IP

$241.25

Service Code	HCPCS C1713
Hospital Charge Code	64902092
Hospital Revenue Code	278
Min. Negotiated Rate	$120.62
Max. Negotiated Rate	$120.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.62
Rate for Payer: Hamaspik Choice Inc Medicare	$120.62

SCREW LOCKING 4.0 X 18MM

Facility OP

$241.25

Service Code	HCPCS C1713
Hospital Charge Code	64902092
Hospital Revenue Code	278
Min. Negotiated Rate	$84.44
Max. Negotiated Rate	$253.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.69
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	$120.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$138.72
Rate for Payer: Fidelis Medicare Advantage	$253.31
Rate for Payer: Group Health Inc Commercial	$120.62
Rate for Payer: Group Health Inc Medicare	$84.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.62
Rate for Payer: Hamaspik Choice Inc Medicare	$120.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$156.81

SCREW LOCKING 4.0 X 26MM

Facility IP

$241.25

Service Code	HCPCS C1713
Hospital Charge Code	64902194
Hospital Revenue Code	278
Min. Negotiated Rate	$120.62
Max. Negotiated Rate	$120.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.62
Rate for Payer: Hamaspik Choice Inc Medicare	$120.62

SCREW LOCKING 4.0 X 26MM

Facility OP

$241.25

Service Code	HCPCS C1713
Hospital Charge Code	64902194
Hospital Revenue Code	278
Min. Negotiated Rate	$84.44
Max. Negotiated Rate	$253.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.69
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	$120.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$138.72
Rate for Payer: Fidelis Medicare Advantage	$253.31
Rate for Payer: Group Health Inc Commercial	$120.62
Rate for Payer: Group Health Inc Medicare	$84.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.62
Rate for Payer: Hamaspik Choice Inc Medicare	$120.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$156.81

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