St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW RELINE 6.5X50MM

Facility OP

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	64904181
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,648.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,911.25
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	$1,737.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,998.12
Rate for Payer: Fidelis Medicare Advantage	$3,648.75
Rate for Payer: Group Health Inc Commercial	$1,737.50
Rate for Payer: Group Health Inc Medicare	$1,216.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,737.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,737.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,258.75

SCREW RELINE MAS 6.5X40MM

Facility OP

$4,200.00

Service Code	HCPCS C1713
Hospital Charge Code	64905337
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,410.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,310.00
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	$2,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,415.00
Rate for Payer: Fidelis Medicare Advantage	$4,410.00
Rate for Payer: Group Health Inc Commercial	$2,100.00
Rate for Payer: Group Health Inc Medicare	$1,470.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,730.00

SCREW RELINE MAS 6.5X40MM

Facility IP

$4,200.00

Service Code	HCPCS C1713
Hospital Charge Code	64905337
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$2,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,100.00

SCREW RELINE O 7.5X40MM 2S

Facility IP

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	64904809
Hospital Revenue Code	278
Min. Negotiated Rate	$1,737.50
Max. Negotiated Rate	$1,737.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,737.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,737.50

SCREW RELINE O 7.5X40MM 2S

Facility OP

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	64904809
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,648.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,911.25
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	$1,737.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,998.12
Rate for Payer: Fidelis Medicare Advantage	$3,648.75
Rate for Payer: Group Health Inc Commercial	$1,737.50
Rate for Payer: Group Health Inc Medicare	$1,216.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,737.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,737.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,258.75

SCREW RELINE O 7.5X45 2S POLY

Facility IP

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	64904619
Hospital Revenue Code	278
Min. Negotiated Rate	$1,737.50
Max. Negotiated Rate	$1,737.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,737.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,737.50

SCREW RELINE O 7.5X45 2S POLY

Facility OP

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	64904619
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,648.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,911.25
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	$1,737.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,998.12
Rate for Payer: Fidelis Medicare Advantage	$3,648.75
Rate for Payer: Group Health Inc Commercial	$1,737.50
Rate for Payer: Group Health Inc Medicare	$1,216.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,737.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,737.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,258.75

SCREW RELINE-O 7.5 X 70MM 2S

Facility IP

$3,725.00

Service Code	HCPCS C1713
Hospital Charge Code	64904929
Hospital Revenue Code	278
Min. Negotiated Rate	$1,862.50
Max. Negotiated Rate	$1,862.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,862.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,862.50

SCREW RELINE-O 7.5 X 70MM 2S

Facility OP

$3,725.00

Service Code	HCPCS C1713
Hospital Charge Code	64904929
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,911.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,048.75
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	$1,862.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,141.88
Rate for Payer: Fidelis Medicare Advantage	$3,911.25
Rate for Payer: Group Health Inc Commercial	$1,862.50
Rate for Payer: Group Health Inc Medicare	$1,303.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,862.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,862.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,421.25

SCREW RELINE O 8.5X70MM 2S

Facility OP

$3,725.00

Service Code	HCPCS C1713
Hospital Charge Code	64904811
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,911.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,048.75
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	$1,862.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,141.88
Rate for Payer: Fidelis Medicare Advantage	$3,911.25
Rate for Payer: Group Health Inc Commercial	$1,862.50
Rate for Payer: Group Health Inc Medicare	$1,303.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,862.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,862.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,421.25

SCREW RELINE O 8.5X70MM 2S

Facility IP

$3,725.00

Service Code	HCPCS C1713
Hospital Charge Code	64904811
Hospital Revenue Code	278
Min. Negotiated Rate	$1,862.50
Max. Negotiated Rate	$1,862.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,862.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,862.50

SCREW REL-O 6.5X55MM 2S POLY

Facility OP

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	64904873
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,648.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,911.25
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	$1,737.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,998.12
Rate for Payer: Fidelis Medicare Advantage	$3,648.75
Rate for Payer: Group Health Inc Commercial	$1,737.50
Rate for Payer: Group Health Inc Medicare	$1,216.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,737.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,737.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,258.75

SCREW REL-O 6.5X55MM 2S POLY

Facility IP

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	64904873
Hospital Revenue Code	278
Min. Negotiated Rate	$1,737.50
Max. Negotiated Rate	$1,737.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,737.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,737.50

SCREW REPLACEMENT STEM EXT

Facility OP

$227.38

Service Code	HCPCS C1713
Hospital Charge Code	64905106
Hospital Revenue Code	278
Min. Negotiated Rate	$79.58
Max. Negotiated Rate	$238.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$125.06
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	$113.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$130.74
Rate for Payer: Fidelis Medicare Advantage	$238.75
Rate for Payer: Group Health Inc Commercial	$113.69
Rate for Payer: Group Health Inc Medicare	$79.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.69
Rate for Payer: Hamaspik Choice Inc Medicare	$113.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$147.80

SCREW REPLACEMENT STEM EXT

Facility IP

$227.38

Service Code	HCPCS C1713
Hospital Charge Code	64905106
Hospital Revenue Code	278
Min. Negotiated Rate	$113.69
Max. Negotiated Rate	$113.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.69
Rate for Payer: Hamaspik Choice Inc Medicare	$113.69

SCREW RES 4.6 X 12

Facility OP

$866.25

Service Code	HCPCS C1713
Hospital Charge Code	64904023
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$909.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$476.44
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	$433.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$498.09
Rate for Payer: Fidelis Medicare Advantage	$909.56
Rate for Payer: Group Health Inc Commercial	$433.12
Rate for Payer: Group Health Inc Medicare	$303.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$433.12
Rate for Payer: Hamaspik Choice Inc Medicare	$433.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$563.06

SCREW RES 4.6 X 12

Facility IP

$866.25

Service Code	HCPCS C1713
Hospital Charge Code	64904023
Hospital Revenue Code	278
Min. Negotiated Rate	$433.12
Max. Negotiated Rate	$433.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$433.12
Rate for Payer: Hamaspik Choice Inc Medicare	$433.12

SCREW RES 4.6 X 16

Facility IP

$866.25

Service Code	HCPCS C1713
Hospital Charge Code	64904015
Hospital Revenue Code	278
Min. Negotiated Rate	$433.12
Max. Negotiated Rate	$433.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$433.12
Rate for Payer: Hamaspik Choice Inc Medicare	$433.12

SCREW RES 4.6 X 16

Facility OP

$866.25

Service Code	HCPCS C1713
Hospital Charge Code	64904015
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$909.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$476.44
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	$433.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$498.09
Rate for Payer: Fidelis Medicare Advantage	$909.56
Rate for Payer: Group Health Inc Commercial	$433.12
Rate for Payer: Group Health Inc Medicare	$303.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$433.12
Rate for Payer: Hamaspik Choice Inc Medicare	$433.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$563.06

SCREW RETAINED PLATE

Facility OP

$500.00

Service Code	HCPCS D7292
Hospital Charge Code	42303426
Hospital Revenue Code	361
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$176.31
Rate for Payer: Aetna Government	$176.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

SCREW REVISION 5.5 X 25MM

Facility IP

$2,412.50

Service Code	HCPCS C1713
Hospital Charge Code	64905308
Hospital Revenue Code	278
Min. Negotiated Rate	$1,206.25
Max. Negotiated Rate	$1,206.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,206.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,206.25

SCREW REVISION 5.5 X 25MM

Facility OP

$2,412.50

Service Code	HCPCS C1713
Hospital Charge Code	64905308
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,533.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,326.88
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	$1,206.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,387.19
Rate for Payer: Fidelis Medicare Advantage	$2,533.12
Rate for Payer: Group Health Inc Commercial	$1,206.25
Rate for Payer: Group Health Inc Medicare	$844.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,206.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,206.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,568.12

SCREW RONE 3.0 X 16

Facility IP

$525.00

Service Code	HCPCS C1713
Hospital Charge Code	64903202
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50

SCREW RONE 3.0 X 16

Facility OP

$525.00

Service Code	HCPCS C1713
Hospital Charge Code	64903202
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$551.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$288.75
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	$262.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$301.88
Rate for Payer: Fidelis Medicare Advantage	$551.25
Rate for Payer: Group Health Inc Commercial	$262.50
Rate for Payer: Group Health Inc Medicare	$183.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$341.25

SCREW ROS 4.6 X 14

Facility OP

$866.25

Service Code	HCPCS C1713
Hospital Charge Code	64904594
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$909.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$476.44
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	$433.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$498.09
Rate for Payer: Fidelis Medicare Advantage	$909.56
Rate for Payer: Group Health Inc Commercial	$433.12
Rate for Payer: Group Health Inc Medicare	$303.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$433.12
Rate for Payer: Hamaspik Choice Inc Medicare	$433.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$563.06

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