St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW LOCKING T10 FT 3.5MM/L46MM

Facility OP

$626.88

Service Code	HCPCS C1713
Hospital Charge Code	64905618
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$658.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$344.78
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	$313.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$360.46
Rate for Payer: Fidelis Medicare Advantage	$658.22
Rate for Payer: Group Health Inc Commercial	$313.44
Rate for Payer: Group Health Inc Medicare	$219.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$313.44
Rate for Payer: Hamaspik Choice Inc Medicare	$313.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$407.47

SCREW LOCKING T10 FT 3.5MM/L46MM

Facility IP

$626.88

Service Code	HCPCS C1713
Hospital Charge Code	64905618
Hospital Revenue Code	278
Min. Negotiated Rate	$313.44
Max. Negotiated Rate	$313.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$313.44
Rate for Payer: Hamaspik Choice Inc Medicare	$313.44

SCREW LOCKING T25 STRDRV 5X38MM

Facility OP

$540.00

Service Code	HCPCS C1713
Hospital Charge Code	64902627
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$567.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$297.00
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	$270.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$310.50
Rate for Payer: Fidelis Medicare Advantage	$567.00
Rate for Payer: Group Health Inc Commercial	$270.00
Rate for Payer: Group Health Inc Medicare	$189.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$270.00
Rate for Payer: Hamaspik Choice Inc Medicare	$270.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$351.00

SCREW LOCKING T25 STRDRV 5X38MM

Facility IP

$540.00

Service Code	HCPCS C1713
Hospital Charge Code	64902627
Hospital Revenue Code	278
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$270.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$270.00
Rate for Payer: Hamaspik Choice Inc Medicare	$270.00

SCREW,LOCKING T2 F/T 5MMX37.5MM

Facility OP

$343.20

Service Code	HCPCS C1713
Hospital Charge Code	40005908
Hospital Revenue Code	278
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$360.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$188.76
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	$171.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$197.34
Rate for Payer: Fidelis Medicare Advantage	$360.36
Rate for Payer: Group Health Inc Commercial	$171.60
Rate for Payer: Group Health Inc Medicare	$120.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$171.60
Rate for Payer: Hamaspik Choice Inc Medicare	$171.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$223.08

SCREW,LOCKING T2 F/T 5MMX37.5MM

Facility IP

$343.20

Service Code	HCPCS C1713
Hospital Charge Code	40005908
Hospital Revenue Code	278
Min. Negotiated Rate	$171.60
Max. Negotiated Rate	$171.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$171.60
Rate for Payer: Hamaspik Choice Inc Medicare	$171.60

SCREW LOCKING T8FL THRD 2.7 L34

Facility IP

$409.96

Service Code	HCPCS C1713
Hospital Charge Code	64906532
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 T8FL THRD 2.7 L34

Facility OP

$409.96

Service Code	HCPCS C1713
Hospital Charge Code	64906532
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 T8 FULL 2.4 L26

Facility IP

$662.50

Service Code	HCPCS C1713
Hospital Charge Code	64905035
Hospital Revenue Code	278
Min. Negotiated Rate	$331.25
Max. Negotiated Rate	$331.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$331.25
Rate for Payer: Hamaspik Choice Inc Medicare	$331.25

SCREW LOCKING T8 FULL 2.4 L26

Facility OP

$662.50

Service Code	HCPCS C1713
Hospital Charge Code	64905035
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$695.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$364.38
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	$331.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$380.94
Rate for Payer: Fidelis Medicare Advantage	$695.62
Rate for Payer: Group Health Inc Commercial	$331.25
Rate for Payer: Group Health Inc Medicare	$231.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$331.25
Rate for Payer: Hamaspik Choice Inc Medicare	$331.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$430.62

SCREW LOCKING T8 FULL 2.7 L26

Facility OP

$563.13

Service Code	HCPCS C1713
Hospital Charge Code	64905011
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$591.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$309.72
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	$281.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$323.80
Rate for Payer: Fidelis Medicare Advantage	$591.29
Rate for Payer: Group Health Inc Commercial	$281.56
Rate for Payer: Group Health Inc Medicare	$197.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.56
Rate for Payer: Hamaspik Choice Inc Medicare	$281.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$366.03

SCREW LOCKING T8 FULL 2.7 L26

Facility IP

$563.13

Service Code	HCPCS C1713
Hospital Charge Code	64905011
Hospital Revenue Code	278
Min. Negotiated Rate	$281.56
Max. Negotiated Rate	$281.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.56
Rate for Payer: Hamaspik Choice Inc Medicare	$281.56

SCREW LOCKNG CORT 3.5X16M

Facility IP

$460.00

Service Code	HCPCS C1713
Hospital Charge Code	64906552
Hospital Revenue Code	278
Min. Negotiated Rate	$230.00
Max. Negotiated Rate	$230.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$230.00
Rate for Payer: Hamaspik Choice Inc Medicare	$230.00

SCREW LOCKNG CORT 3.5X16M

Facility OP

$460.00

Service Code	HCPCS C1713
Hospital Charge Code	64906552
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$483.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$253.00
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	$230.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$264.50
Rate for Payer: Fidelis Medicare Advantage	$483.00
Rate for Payer: Group Health Inc Commercial	$230.00
Rate for Payer: Group Health Inc Medicare	$161.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$230.00
Rate for Payer: Hamaspik Choice Inc Medicare	$230.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$299.00

SCREW LOCKNG D5X37.5L(2360-5037S)

Facility OP

$346.50

Service Code	HCPCS C1713
Hospital Charge Code	64906347
Hospital Revenue Code	278
Min. Negotiated Rate	$121.28
Max. Negotiated Rate	$363.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$190.58
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	$173.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$199.24
Rate for Payer: Fidelis Medicare Advantage	$363.82
Rate for Payer: Group Health Inc Commercial	$173.25
Rate for Payer: Group Health Inc Medicare	$121.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$173.25
Rate for Payer: Hamaspik Choice Inc Medicare	$173.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$225.22

SCREW LOCKNG D5X37.5L(2360-5037S)

Facility IP

$346.50

Service Code	HCPCS C1713
Hospital Charge Code	64906347
Hospital Revenue Code	278
Min. Negotiated Rate	$173.25
Max. Negotiated Rate	$173.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$173.25
Rate for Payer: Hamaspik Choice Inc Medicare	$173.25

SCREW LOCKNG D5X42.5L(2360-5042S)

Facility OP

$346.50

Service Code	HCPCS C1713
Hospital Charge Code	64906349
Hospital Revenue Code	278
Min. Negotiated Rate	$121.28
Max. Negotiated Rate	$363.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$190.58
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	$173.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$199.24
Rate for Payer: Fidelis Medicare Advantage	$363.82
Rate for Payer: Group Health Inc Commercial	$173.25
Rate for Payer: Group Health Inc Medicare	$121.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$173.25
Rate for Payer: Hamaspik Choice Inc Medicare	$173.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$225.22

SCREW LOCKNG D5X42.5L(2360-5042S)

Facility IP

$346.50

Service Code	HCPCS C1713
Hospital Charge Code	64906349
Hospital Revenue Code	278
Min. Negotiated Rate	$173.25
Max. Negotiated Rate	$173.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$173.25
Rate for Payer: Hamaspik Choice Inc Medicare	$173.25

SCREW LOCKNG D5X47.5L(2360-5047S)

Facility OP

$346.50

Service Code	HCPCS C1713
Hospital Charge Code	64906351
Hospital Revenue Code	278
Min. Negotiated Rate	$121.28
Max. Negotiated Rate	$363.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$190.58
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	$173.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$199.24
Rate for Payer: Fidelis Medicare Advantage	$363.82
Rate for Payer: Group Health Inc Commercial	$173.25
Rate for Payer: Group Health Inc Medicare	$121.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$173.25
Rate for Payer: Hamaspik Choice Inc Medicare	$173.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$225.22

SCREW LOCKNG D5X47.5L(2360-5047S)

Facility IP

$346.50

Service Code	HCPCS C1713
Hospital Charge Code	64906351
Hospital Revenue Code	278
Min. Negotiated Rate	$173.25
Max. Negotiated Rate	$173.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$173.25
Rate for Payer: Hamaspik Choice Inc Medicare	$173.25

SCREW LOCKNG FL THRD 2.7MM L48MM

Facility IP

$456.36

Service Code	HCPCS C1713
Hospital Charge Code	64906808
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 LOCKNG FL THRD 2.7MM L48MM

Facility OP

$456.36

Service Code	HCPCS C1713
Hospital Charge Code	64906808
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 LOCK ST SS 3.5X20MM

Facility OP

$362.25

Service Code	HCPCS C1713
Hospital Charge Code	64901292
Hospital Revenue Code	278
Min. Negotiated Rate	$126.79
Max. Negotiated Rate	$380.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$199.24
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	$181.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$208.29
Rate for Payer: Fidelis Medicare Advantage	$380.36
Rate for Payer: Group Health Inc Commercial	$181.12
Rate for Payer: Group Health Inc Medicare	$126.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$181.12
Rate for Payer: Hamaspik Choice Inc Medicare	$181.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$235.46

SCREW LOCK ST SS 3.5X20MM

Facility IP

$362.25

Service Code	HCPCS C1713
Hospital Charge Code	64901292
Hospital Revenue Code	278
Min. Negotiated Rate	$181.12
Max. Negotiated Rate	$181.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$181.12
Rate for Payer: Hamaspik Choice Inc Medicare	$181.12

SCREW LOCK ST SS 3.5X24MM STR

Facility IP

$242.00

Service Code	HCPCS C1713
Hospital Charge Code	40209007
Hospital Revenue Code	278
Min. Negotiated Rate	$121.00
Max. Negotiated Rate	$121.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$121.00
Rate for Payer: Hamaspik Choice Inc Medicare	$121.00

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