St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW LOCKING 5.0 X 70

Facility OP

$667.50

Service Code	HCPCS C1713
Hospital Charge Code	64903132
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$700.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$367.12
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	$333.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$383.81
Rate for Payer: Fidelis Medicare Advantage	$700.88
Rate for Payer: Group Health Inc Commercial	$333.75
Rate for Payer: Group Health Inc Medicare	$233.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$333.75
Rate for Payer: Hamaspik Choice Inc Medicare	$333.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$433.88

SCREW LOCKING 5.0 X 70

Facility IP

$667.50

Service Code	HCPCS C1713
Hospital Charge Code	64903132
Hospital Revenue Code	278
Min. Negotiated Rate	$333.75
Max. Negotiated Rate	$333.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$333.75
Rate for Payer: Hamaspik Choice Inc Medicare	$333.75

SCREW LOCKING 5.0 X 75

Facility OP

$625.00

Service Code	HCPCS C1713
Hospital Charge Code	64903137
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$656.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$343.75
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	$312.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$359.38
Rate for Payer: Fidelis Medicare Advantage	$656.25
Rate for Payer: Group Health Inc Commercial	$312.50
Rate for Payer: Group Health Inc Medicare	$218.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$312.50
Rate for Payer: Hamaspik Choice Inc Medicare	$312.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$406.25

SCREW LOCKING 5.0 X 75

Facility IP

$625.00

Service Code	HCPCS C1713
Hospital Charge Code	64903137
Hospital Revenue Code	278
Min. Negotiated Rate	$312.50
Max. Negotiated Rate	$312.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$312.50
Rate for Payer: Hamaspik Choice Inc Medicare	$312.50

SCREW LOCKING 5.0 X 75MM

Facility IP

$256.25

Service Code	HCPCS C1713
Hospital Charge Code	64902617
Hospital Revenue Code	278
Min. Negotiated Rate	$128.12
Max. Negotiated Rate	$128.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$128.12
Rate for Payer: Hamaspik Choice Inc Medicare	$128.12

SCREW LOCKING 5.0 X 75MM

Facility OP

$256.25

Service Code	HCPCS C1713
Hospital Charge Code	64902617
Hospital Revenue Code	278
Min. Negotiated Rate	$89.69
Max. Negotiated Rate	$269.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$140.94
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	$128.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$147.34
Rate for Payer: Fidelis Medicare Advantage	$269.06
Rate for Payer: Group Health Inc Commercial	$128.12
Rate for Payer: Group Health Inc Medicare	$89.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$128.12
Rate for Payer: Hamaspik Choice Inc Medicare	$128.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$166.56

SCREW LOCKING 5.0 X 80

Facility OP

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	64903250
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$735.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$385.00
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	$350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$402.50
Rate for Payer: Fidelis Medicare Advantage	$735.00
Rate for Payer: Group Health Inc Commercial	$350.00
Rate for Payer: Group Health Inc Medicare	$245.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$455.00

SCREW LOCKING 5.0 X 80

Facility IP

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	64903250
Hospital Revenue Code	278
Min. Negotiated Rate	$350.00
Max. Negotiated Rate	$350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00

SCREW LOCKING 5.0 X 85

Facility IP

$667.50

Service Code	HCPCS C1713
Hospital Charge Code	64903135
Hospital Revenue Code	278
Min. Negotiated Rate	$333.75
Max. Negotiated Rate	$333.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$333.75
Rate for Payer: Hamaspik Choice Inc Medicare	$333.75

SCREW LOCKING 5.0 X 85

Facility OP

$667.50

Service Code	HCPCS C1713
Hospital Charge Code	64903135
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$700.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$367.12
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	$333.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$383.81
Rate for Payer: Fidelis Medicare Advantage	$700.88
Rate for Payer: Group Health Inc Commercial	$333.75
Rate for Payer: Group Health Inc Medicare	$233.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$333.75
Rate for Payer: Hamaspik Choice Inc Medicare	$333.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$433.88

SCREW LOCKING 5MM 5.0MM

Facility IP

$667.50

Service Code	HCPCS C1713
Hospital Charge Code	64904030
Hospital Revenue Code	278
Min. Negotiated Rate	$333.75
Max. Negotiated Rate	$333.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$333.75
Rate for Payer: Hamaspik Choice Inc Medicare	$333.75

SCREW LOCKING 5MM 5.0MM

Facility OP

$667.50

Service Code	HCPCS C1713
Hospital Charge Code	64904030
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$700.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$367.12
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	$333.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$383.81
Rate for Payer: Fidelis Medicare Advantage	$700.88
Rate for Payer: Group Health Inc Commercial	$333.75
Rate for Payer: Group Health Inc Medicare	$233.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$333.75
Rate for Payer: Hamaspik Choice Inc Medicare	$333.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$433.88

SCREW LOCKING 5MM 5.0MM, 55MML

Facility IP

$217.00

Service Code	HCPCS C1713
Hospital Charge Code	64906484
Hospital Revenue Code	278
Min. Negotiated Rate	$108.50
Max. Negotiated Rate	$108.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$108.50
Rate for Payer: Hamaspik Choice Inc Medicare	$108.50

SCREW LOCKING 5MM 5.0MM, 55MML

Facility OP

$217.00

Service Code	HCPCS C1713
Hospital Charge Code	64906484
Hospital Revenue Code	278
Min. Negotiated Rate	$75.95
Max. Negotiated Rate	$227.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$119.35
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	$108.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.78
Rate for Payer: Fidelis Medicare Advantage	$227.85
Rate for Payer: Group Health Inc Commercial	$108.50
Rate for Payer: Group Health Inc Medicare	$75.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$108.50
Rate for Payer: Hamaspik Choice Inc Medicare	$108.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$141.05

SCREW LOCKING 5MM L30MM (661130)

Facility OP

$238.00

Service Code	HCPCS C1713
Hospital Charge Code	64906439
Hospital Revenue Code	278
Min. Negotiated Rate	$83.30
Max. Negotiated Rate	$249.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.90
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	$119.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.85
Rate for Payer: Fidelis Medicare Advantage	$249.90
Rate for Payer: Group Health Inc Commercial	$119.00
Rate for Payer: Group Health Inc Medicare	$83.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.00
Rate for Payer: Hamaspik Choice Inc Medicare	$119.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.70

SCREW LOCKING 5MM L30MM (661130)

Facility IP

$238.00

Service Code	HCPCS C1713
Hospital Charge Code	64906439
Hospital Revenue Code	278
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$119.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.00
Rate for Payer: Hamaspik Choice Inc Medicare	$119.00

SCREW LOCKING 5 X 32MML

Facility OP

$433.16

Service Code	HCPCS C1713
Hospital Charge Code	64906789
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$454.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$238.24
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	$216.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$249.07
Rate for Payer: Fidelis Medicare Advantage	$454.82
Rate for Payer: Group Health Inc Commercial	$216.58
Rate for Payer: Group Health Inc Medicare	$151.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$216.58
Rate for Payer: Hamaspik Choice Inc Medicare	$216.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$281.55

SCREW LOCKING 5 X 32MML

Facility IP

$433.16

Service Code	HCPCS C1713
Hospital Charge Code	64906789
Hospital Revenue Code	278
Min. Negotiated Rate	$216.58
Max. Negotiated Rate	$216.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$216.58
Rate for Payer: Hamaspik Choice Inc Medicare	$216.58

SCREW LOCKING 5 X 37.5

Facility IP

$429.00

Service Code	HCPCS C1713
Hospital Charge Code	64902890
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 5 X 37.5

Facility OP

$429.00

Service Code	HCPCS C1713
Hospital Charge Code	64902890
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 5 X 40MM FT T2

Facility OP

$429.00

Service Code	HCPCS C1713
Hospital Charge Code	64901234
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 5 X 40MM FT T2

Facility IP

$429.00

Service Code	HCPCS C1713
Hospital Charge Code	64901234
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 5 X 45MM T2 FT

Facility OP

$429.00

Service Code	HCPCS C1713
Hospital Charge Code	64901646
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 5 X 45MM T2 FT

Facility IP

$429.00

Service Code	HCPCS C1713
Hospital Charge Code	64901646
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 5 X 50MM

Facility IP

$693.00

Service Code	HCPCS C1713
Hospital Charge Code	64906876
Hospital Revenue Code	278
Min. Negotiated Rate	$346.50
Max. Negotiated Rate	$346.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$346.50
Rate for Payer: Hamaspik Choice Inc Medicare	$346.50

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