St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW SELF- TAP TI 2.0X5MM

Facility IP

$120.00

Service Code	HCPCS C1776
Hospital Charge Code	40202445
Hospital Revenue Code	278
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00

SCREW SELF- TAP TI 2.0X5MM

Facility OP

$120.00

Service Code	HCPCS C1776
Hospital Charge Code	40202445
Hospital Revenue Code	278
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.00
Rate for Payer: Fidelis Medicare Advantage	$126.00
Rate for Payer: Group Health Inc Commercial	$60.00
Rate for Payer: Group Health Inc Medicare	$42.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$78.00

SCREWS EMERGENCY 1.7MM

Facility IP

$145.28

Service Code	HCPCS C1713
Hospital Charge Code	64901868
Hospital Revenue Code	278
Min. Negotiated Rate	$72.64
Max. Negotiated Rate	$72.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.64
Rate for Payer: Hamaspik Choice Inc Medicare	$72.64

SCREWS EMERGENCY 1.7MM

Facility OP

$145.28

Service Code	HCPCS C1713
Hospital Charge Code	64901868
Hospital Revenue Code	278
Min. Negotiated Rate	$50.85
Max. Negotiated Rate	$152.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$79.90
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	$72.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$83.54
Rate for Payer: Fidelis Medicare Advantage	$152.54
Rate for Payer: Group Health Inc Commercial	$72.64
Rate for Payer: Group Health Inc Medicare	$50.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.64
Rate for Payer: Hamaspik Choice Inc Medicare	$72.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$94.43

SCREW SEQUOIA 6.5 X 50

Facility IP

$3,497.50

Service Code	HCPCS C1713
Hospital Charge Code	64904094
Hospital Revenue Code	278
Min. Negotiated Rate	$1,748.75
Max. Negotiated Rate	$1,748.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,748.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,748.75

SCREW SEQUOIA 6.5 X 50

Facility OP

$3,497.50

Service Code	HCPCS C1713
Hospital Charge Code	64904094
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,672.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,923.62
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	$1,748.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,011.06
Rate for Payer: Fidelis Medicare Advantage	$3,672.38
Rate for Payer: Group Health Inc Commercial	$1,748.75
Rate for Payer: Group Health Inc Medicare	$1,224.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,748.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,748.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,273.38

SCREW SEQUOIS 6.5 X 40

Facility OP

$3,497.50

Service Code	HCPCS C1713
Hospital Charge Code	64904506
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,672.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,923.62
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	$1,748.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,011.06
Rate for Payer: Fidelis Medicare Advantage	$3,672.38
Rate for Payer: Group Health Inc Commercial	$1,748.75
Rate for Payer: Group Health Inc Medicare	$1,224.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,748.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,748.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,273.38

SCREW SEQUOIS 6.5 X 40

Facility IP

$3,497.50

Service Code	HCPCS C1713
Hospital Charge Code	64904506
Hospital Revenue Code	278
Min. Negotiated Rate	$1,748.75
Max. Negotiated Rate	$1,748.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,748.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,748.75

SCREW SEQUOIS 6.5 X 45

Facility OP

$3,497.50

Service Code	HCPCS C1713
Hospital Charge Code	64904507
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,672.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,923.62
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	$1,748.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,011.06
Rate for Payer: Fidelis Medicare Advantage	$3,672.38
Rate for Payer: Group Health Inc Commercial	$1,748.75
Rate for Payer: Group Health Inc Medicare	$1,224.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,748.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,748.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,273.38

SCREW SEQUOIS 6.5 X 45

Facility IP

$3,497.50

Service Code	HCPCS C1713
Hospital Charge Code	64904507
Hospital Revenue Code	278
Min. Negotiated Rate	$1,748.75
Max. Negotiated Rate	$1,748.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,748.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,748.75

SCREW SERRATO POLY 6.5X45MM

Facility IP

$4,665.58

Service Code	HCPCS C1713
Hospital Charge Code	64906683
Hospital Revenue Code	278
Min. Negotiated Rate	$2,332.79
Max. Negotiated Rate	$2,332.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,332.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2,332.79

SCREW SERRATO POLY 6.5X45MM

Facility OP

$4,665.58

Service Code	HCPCS C1713
Hospital Charge Code	64906683
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,898.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,566.07
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	$2,332.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,682.71
Rate for Payer: Fidelis Medicare Advantage	$4,898.86
Rate for Payer: Group Health Inc Commercial	$2,332.79
Rate for Payer: Group Health Inc Medicare	$1,632.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,332.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2,332.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,032.63

SCREW SERRATO X 40

Facility IP

$5,830.00

Service Code	HCPCS C1713
Hospital Charge Code	64907117
Hospital Revenue Code	278
Min. Negotiated Rate	$2,915.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,915.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,915.00

SCREW SERRATO X 40

Facility OP

$5,830.00

Service Code	HCPCS C1713
Hospital Charge Code	64907117
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,121.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,206.50
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	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,352.25
Rate for Payer: Fidelis Medicare Advantage	$6,121.50
Rate for Payer: Group Health Inc Commercial	$2,915.00
Rate for Payer: Group Health Inc Medicare	$2,040.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,915.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,915.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,789.50

SCREW SERRATO X45

Facility IP

$4,665.58

Service Code	HCPCS C1713
Hospital Charge Code	64906866
Hospital Revenue Code	278
Min. Negotiated Rate	$2,332.79
Max. Negotiated Rate	$2,332.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,332.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2,332.79

SCREW SERRATO X45

Facility OP

$4,665.58

Service Code	HCPCS C1713
Hospital Charge Code	64906866
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,898.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,566.07
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	$2,332.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,682.71
Rate for Payer: Fidelis Medicare Advantage	$4,898.86
Rate for Payer: Group Health Inc Commercial	$2,332.79
Rate for Payer: Group Health Inc Medicare	$1,632.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,332.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2,332.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,032.63

SCREW SERRATO X 50

Facility IP

$4,665.58

Service Code	HCPCS C1713
Hospital Charge Code	64906867
Hospital Revenue Code	278
Min. Negotiated Rate	$2,332.79
Max. Negotiated Rate	$2,332.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,332.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2,332.79

SCREW SERRATO X 50

Facility OP

$4,665.58

Service Code	HCPCS C1713
Hospital Charge Code	64906867
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,898.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,566.07
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	$2,332.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,682.71
Rate for Payer: Fidelis Medicare Advantage	$4,898.86
Rate for Payer: Group Health Inc Commercial	$2,332.79
Rate for Payer: Group Health Inc Medicare	$1,632.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,332.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2,332.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,032.63

SCREW SET A

Facility OP

$435.50

Service Code	HCPCS C1713
Hospital Charge Code	64902896
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$457.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$239.52
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	$217.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$250.41
Rate for Payer: Fidelis Medicare Advantage	$457.28
Rate for Payer: Group Health Inc Commercial	$217.75
Rate for Payer: Group Health Inc Medicare	$152.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$217.75
Rate for Payer: Hamaspik Choice Inc Medicare	$217.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$283.08

SCREW SET A

Facility IP

$435.50

Service Code	HCPCS C1713
Hospital Charge Code	64902896
Hospital Revenue Code	278
Min. Negotiated Rate	$217.75
Max. Negotiated Rate	$217.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$217.75
Rate for Payer: Hamaspik Choice Inc Medicare	$217.75

SCREW SET B

Facility OP

$562.50

Service Code	HCPCS C1713
Hospital Charge Code	64904581
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$590.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$309.38
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	$281.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$323.44
Rate for Payer: Fidelis Medicare Advantage	$590.62
Rate for Payer: Group Health Inc Commercial	$281.25
Rate for Payer: Group Health Inc Medicare	$196.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.25
Rate for Payer: Hamaspik Choice Inc Medicare	$281.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$365.62

SCREW SET B

Facility IP

$562.50

Service Code	HCPCS C1713
Hospital Charge Code	64904581
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$281.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.25
Rate for Payer: Hamaspik Choice Inc Medicare	$281.25

SCREW SET C

Facility OP

$945.00

Service Code	HCPCS C1713
Hospital Charge Code	64904701
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$992.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$519.75
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	$472.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$543.38
Rate for Payer: Fidelis Medicare Advantage	$992.25
Rate for Payer: Group Health Inc Commercial	$472.50
Rate for Payer: Group Health Inc Medicare	$330.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$472.50
Rate for Payer: Hamaspik Choice Inc Medicare	$472.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$614.25

SCREW SET C

Facility IP

$945.00

Service Code	HCPCS C1713
Hospital Charge Code	64904701
Hospital Revenue Code	278
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$472.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$472.50
Rate for Payer: Hamaspik Choice Inc Medicare	$472.50

SCREW SET HEX-FIX

Facility OP

$36.53

Service Code	HCPCS C1713
Hospital Charge Code	64901939
Hospital Revenue Code	278
Min. Negotiated Rate	$12.79
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.09
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	$18.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.00
Rate for Payer: Fidelis Medicare Advantage	$38.36
Rate for Payer: Group Health Inc Commercial	$18.26
Rate for Payer: Group Health Inc Medicare	$12.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.26
Rate for Payer: Hamaspik Choice Inc Medicare	$18.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.74

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