St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW TULIP AND LAM HOOK

Facility IP

$625.00

Service Code	HCPCS C1713
Hospital Charge Code	64903803
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 TWIST OFF 2.0 X 11

Facility OP

$1,307.50

Service Code	HCPCS C1713
Hospital Charge Code	64905438
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,372.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$719.12
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	$653.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$751.81
Rate for Payer: Fidelis Medicare Advantage	$1,372.88
Rate for Payer: Group Health Inc Commercial	$653.75
Rate for Payer: Group Health Inc Medicare	$457.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$653.75
Rate for Payer: Hamaspik Choice Inc Medicare	$653.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$849.88

SCREW TWIST OFF 2.0 X 11

Facility IP

$1,307.50

Service Code	HCPCS C1713
Hospital Charge Code	64905438
Hospital Revenue Code	278
Min. Negotiated Rate	$653.75
Max. Negotiated Rate	$653.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$653.75
Rate for Payer: Hamaspik Choice Inc Medicare	$653.75

SCREW,UNIII AXS 1.5 X 4MM

Facility IP

$205.00

Service Code	HCPCS C1713
Hospital Charge Code	64905048
Hospital Revenue Code	278
Min. Negotiated Rate	$102.50
Max. Negotiated Rate	$102.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$102.50
Rate for Payer: Hamaspik Choice Inc Medicare	$102.50

SCREW,UNIII AXS 1.5 X 4MM

Facility OP

$205.00

Service Code	HCPCS C1713
Hospital Charge Code	64905048
Hospital Revenue Code	278
Min. Negotiated Rate	$71.75
Max. Negotiated Rate	$215.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$112.75
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	$102.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$117.88
Rate for Payer: Fidelis Medicare Advantage	$215.25
Rate for Payer: Group Health Inc Commercial	$102.50
Rate for Payer: Group Health Inc Medicare	$71.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$102.50
Rate for Payer: Hamaspik Choice Inc Medicare	$102.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$133.25

SCREW VACIABLE ANGLE 4 X 12 SELF

Facility IP

$1,400.75

Service Code	HCPCS C1713
Hospital Charge Code	64904433
Hospital Revenue Code	278
Min. Negotiated Rate	$700.38
Max. Negotiated Rate	$700.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$700.38
Rate for Payer: Hamaspik Choice Inc Medicare	$700.38

SCREW VACIABLE ANGLE 4 X 12 SELF

Facility OP

$1,400.75

Service Code	HCPCS C1713
Hospital Charge Code	64904433
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,470.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$770.41
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	$700.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$805.43
Rate for Payer: Fidelis Medicare Advantage	$1,470.79
Rate for Payer: Group Health Inc Commercial	$700.38
Rate for Payer: Group Health Inc Medicare	$490.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$700.38
Rate for Payer: Hamaspik Choice Inc Medicare	$700.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$910.49

SCREW VAL

Facility OP

$350.00

Service Code	HCPCS C1713
Hospital Charge Code	64907392
Hospital Revenue Code	278
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$367.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
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	$175.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.25
Rate for Payer: Fidelis Medicare Advantage	$367.50
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$227.50

SCREW VAL

Facility IP

$350.00

Service Code	HCPCS C1713
Hospital Charge Code	64907392
Hospital Revenue Code	278
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

SCREW VAR ANGL

Facility OP

$1,055.00

Service Code	HCPCS C1713
Hospital Charge Code	64907480
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,107.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$580.25
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	$527.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$606.62
Rate for Payer: Fidelis Medicare Advantage	$1,107.75
Rate for Payer: Group Health Inc Commercial	$527.50
Rate for Payer: Group Health Inc Medicare	$369.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$527.50
Rate for Payer: Hamaspik Choice Inc Medicare	$527.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$685.75

SCREW VAR ANGL

Facility IP

$1,055.00

Service Code	HCPCS C1713
Hospital Charge Code	64907480
Hospital Revenue Code	278
Min. Negotiated Rate	$527.50
Max. Negotiated Rate	$527.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$527.50
Rate for Payer: Hamaspik Choice Inc Medicare	$527.50

SCREW VARIABLE 4.2 X 12

Facility IP

$938.75

Service Code	HCPCS C1713
Hospital Charge Code	64904025
Hospital Revenue Code	278
Min. Negotiated Rate	$469.38
Max. Negotiated Rate	$469.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$469.38
Rate for Payer: Hamaspik Choice Inc Medicare	$469.38

SCREW VARIABLE 4.2 X 12

Facility OP

$938.75

Service Code	HCPCS C1713
Hospital Charge Code	64904025
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$985.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$516.31
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	$469.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$539.78
Rate for Payer: Fidelis Medicare Advantage	$985.69
Rate for Payer: Group Health Inc Commercial	$469.38
Rate for Payer: Group Health Inc Medicare	$328.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$469.38
Rate for Payer: Hamaspik Choice Inc Medicare	$469.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$610.19

SCREW VARIABLE 4.2 X 14

Facility OP

$938.75

Service Code	HCPCS C1713
Hospital Charge Code	64904022
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$985.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$516.31
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	$469.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$539.78
Rate for Payer: Fidelis Medicare Advantage	$985.69
Rate for Payer: Group Health Inc Commercial	$469.38
Rate for Payer: Group Health Inc Medicare	$328.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$469.38
Rate for Payer: Hamaspik Choice Inc Medicare	$469.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$610.19

SCREW VARIABLE 4.2 X 14

Facility IP

$938.75

Service Code	HCPCS C1713
Hospital Charge Code	64904022
Hospital Revenue Code	278
Min. Negotiated Rate	$469.38
Max. Negotiated Rate	$469.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$469.38
Rate for Payer: Hamaspik Choice Inc Medicare	$469.38

SCREW VARIABLE DRILLING 4.2 X 16

Facility IP

$938.75

Service Code	HCPCS C1713
Hospital Charge Code	64904013
Hospital Revenue Code	278
Min. Negotiated Rate	$469.38
Max. Negotiated Rate	$469.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$469.38
Rate for Payer: Hamaspik Choice Inc Medicare	$469.38

SCREW VARIABLE DRILLING 4.2 X 16

Facility OP

$938.75

Service Code	HCPCS C1713
Hospital Charge Code	64904013
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$985.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$516.31
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	$469.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$539.78
Rate for Payer: Fidelis Medicare Advantage	$985.69
Rate for Payer: Group Health Inc Commercial	$469.38
Rate for Payer: Group Health Inc Medicare	$328.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$469.38
Rate for Payer: Hamaspik Choice Inc Medicare	$469.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$610.19

SCREW VENTED

Facility IP

$737.50

Service Code	HCPCS C1713
Hospital Charge Code	64907196
Hospital Revenue Code	278
Min. Negotiated Rate	$368.75
Max. Negotiated Rate	$368.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$368.75
Rate for Payer: Hamaspik Choice Inc Medicare	$368.75

SCREW VENTED

Facility OP

$737.50

Service Code	HCPCS C1713
Hospital Charge Code	64907196
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$774.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$405.62
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	$368.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$424.06
Rate for Payer: Fidelis Medicare Advantage	$774.38
Rate for Payer: Group Health Inc Commercial	$368.75
Rate for Payer: Group Health Inc Medicare	$258.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$368.75
Rate for Payer: Hamaspik Choice Inc Medicare	$368.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$479.38

SCREW VENTED 30MM

Facility IP

$737.50

Service Code	HCPCS C1713
Hospital Charge Code	64907111
Hospital Revenue Code	278
Min. Negotiated Rate	$368.75
Max. Negotiated Rate	$368.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$368.75
Rate for Payer: Hamaspik Choice Inc Medicare	$368.75

SCREW VENTED 30MM

Facility OP

$737.50

Service Code	HCPCS C1713
Hospital Charge Code	64907111
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$774.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$405.62
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	$368.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$424.06
Rate for Payer: Fidelis Medicare Advantage	$774.38
Rate for Payer: Group Health Inc Commercial	$368.75
Rate for Payer: Group Health Inc Medicare	$258.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$368.75
Rate for Payer: Hamaspik Choice Inc Medicare	$368.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$479.38

SCREW VENTED 9X20MM BC IF

Facility IP

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	64906335
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00

SCREW VENTED 9X20MM BC IF

Facility OP

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	64906335
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$315.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
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	$150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$172.50
Rate for Payer: Fidelis Medicare Advantage	$315.00
Rate for Payer: Group Health Inc Commercial	$150.00
Rate for Payer: Group Health Inc Medicare	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$195.00

SCREW VENTED BC 9X30MM

Facility IP

$422.00

Service Code	HCPCS C1713
Hospital Charge Code	64906360
Hospital Revenue Code	278
Min. Negotiated Rate	$211.00
Max. Negotiated Rate	$211.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$211.00
Rate for Payer: Hamaspik Choice Inc Medicare	$211.00

SCREW VENTED BC 9X30MM

Facility OP

$422.00

Service Code	HCPCS C1713
Hospital Charge Code	64906360
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$443.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$232.10
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	$211.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$242.65
Rate for Payer: Fidelis Medicare Advantage	$443.10
Rate for Payer: Group Health Inc Commercial	$211.00
Rate for Payer: Group Health Inc Medicare	$147.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$211.00
Rate for Payer: Hamaspik Choice Inc Medicare	$211.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$274.30

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