St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SCREW POLY 5.0 X 35

Facility

$4,912.80

Service Code	HCPCS C1713
Hospital Charge Code	64904040
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,158.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,702.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,947.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,456.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,824.86
Rate for Payer: EmblemHealth Commercial	$2,456.40
Rate for Payer: Fidelis Medicare Advantage	$5,158.44
Rate for Payer: Group Health Inc Commercial	$2,456.40
Rate for Payer: Group Health Inc Medicare	$1,719.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,456.40
Rate for Payer: Hamaspik Choice Inc Medicare	$2,456.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,193.32

SCREW POLY 5.0 X 35

Facility

$4,912.80

Service Code	HCPCS C1713
Hospital Charge Code	64904040
Hospital Revenue Code	278
Min. Negotiated Rate	$2,456.40
Max. Negotiated Rate	$2,456.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,456.40
Rate for Payer: Hamaspik Choice Inc Medicare	$2,456.40

SCREW POLYAXIAL 5.5 X 30

Facility

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	64904166
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: Brighton Health Commercial	$2,085.00
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: EmblemHealth Commercial	$1,737.50
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 POLYAXIAL 5.5 X 30

Facility

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	64904166
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 POLYAXIAL 5.5 X 35

Facility

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	64904164
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: Brighton Health Commercial	$2,085.00
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: EmblemHealth Commercial	$1,737.50
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 POLYAXIAL 5.5 X 35

Facility

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	64904164
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 POLYAXIAL 6.5 45

Facility

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	64904157
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: Brighton Health Commercial	$2,085.00
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: EmblemHealth Commercial	$1,737.50
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 POLYAXIAL 6.5 45

Facility

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	64904157
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 POLYAXIAL 6.5 X 35

Facility

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	64904162
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 POLYAXIAL 6.5 X 35

Facility

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	64904162
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: Brighton Health Commercial	$2,085.00
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: EmblemHealth Commercial	$1,737.50
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 POLYAXIAL 6.5 X 40

Facility

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	64904161
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 POLYAXIAL 6.5 X 40

Facility

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	64904161
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: Brighton Health Commercial	$2,085.00
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: EmblemHealth Commercial	$1,737.50
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 POLYAXIAL SRTO 5.0X35MM

Facility

$2,332.79

Service Code	HCPCS C1713
Hospital Charge Code	64906398
Hospital Revenue Code	278
Min. Negotiated Rate	$1,166.40
Max. Negotiated Rate	$1,166.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,166.40
Rate for Payer: Hamaspik Choice Inc Medicare	$1,166.40

SCREW POLYAXIAL SRTO 5.0X35MM

Facility

$2,332.79

Service Code	HCPCS C1713
Hospital Charge Code	64906398
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,449.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,283.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,399.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,166.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,341.35
Rate for Payer: EmblemHealth Commercial	$1,166.40
Rate for Payer: Fidelis Medicare Advantage	$2,449.43
Rate for Payer: Group Health Inc Commercial	$1,166.40
Rate for Payer: Group Health Inc Medicare	$816.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,166.40
Rate for Payer: Hamaspik Choice Inc Medicare	$1,166.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,516.31

SCREW POLYAX SERRATO 6.5X40MM

Facility

$4,665.58

Service Code	HCPCS C1713
Hospital Charge Code	64906684
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 POLYAX SERRATO 6.5X40MM

Facility

$4,665.58

Service Code	HCPCS C1713
Hospital Charge Code	64906684
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: Brighton Health Commercial	$2,799.35
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: EmblemHealth Commercial	$2,332.79
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 POLY LOCK 2.5

Facility

$460.00

Service Code	HCPCS C1713
Hospital Charge Code	64907049
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 POLY LOCK 2.5

Facility

$460.00

Service Code	HCPCS C1713
Hospital Charge Code	64907049
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: Brighton Health Commercial	$276.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$230.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$264.50
Rate for Payer: EmblemHealth Commercial	$230.00
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 POLY NON 3.5

Facility

$380.00

Service Code	HCPCS C1713
Hospital Charge Code	64907468
Hospital Revenue Code	278
Min. Negotiated Rate	$133.00
Max. Negotiated Rate	$399.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$209.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$228.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$190.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$218.50
Rate for Payer: EmblemHealth Commercial	$190.00
Rate for Payer: Fidelis Medicare Advantage	$399.00
Rate for Payer: Group Health Inc Commercial	$190.00
Rate for Payer: Group Health Inc Medicare	$133.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.00
Rate for Payer: Hamaspik Choice Inc Medicare	$190.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$247.00

SCREW POLY NON 3.5

Facility

$380.00

Service Code	HCPCS C1713
Hospital Charge Code	64907468
Hospital Revenue Code	278
Min. Negotiated Rate	$190.00
Max. Negotiated Rate	$190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.00
Rate for Payer: Hamaspik Choice Inc Medicare	$190.00

SCREW POLY SERRATO 5.5X30MM

Facility

$2,332.79

Service Code	HCPCS C1713
Hospital Charge Code	64906402
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,449.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,283.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,399.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,166.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,341.35
Rate for Payer: EmblemHealth Commercial	$1,166.40
Rate for Payer: Fidelis Medicare Advantage	$2,449.43
Rate for Payer: Group Health Inc Commercial	$1,166.40
Rate for Payer: Group Health Inc Medicare	$816.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,166.40
Rate for Payer: Hamaspik Choice Inc Medicare	$1,166.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,516.31

SCREW POLY SERRATO 5.5X30MM

Facility

$2,332.79

Service Code	HCPCS C1713
Hospital Charge Code	64906402
Hospital Revenue Code	278
Min. Negotiated Rate	$1,166.40
Max. Negotiated Rate	$1,166.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,166.40
Rate for Payer: Hamaspik Choice Inc Medicare	$1,166.40

SCREW POLY SERRATO 5.5X35MM

Facility

$2,332.79

Service Code	HCPCS C1713
Hospital Charge Code	64906399
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,449.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,283.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,399.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,166.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,341.35
Rate for Payer: EmblemHealth Commercial	$1,166.40
Rate for Payer: Fidelis Medicare Advantage	$2,449.43
Rate for Payer: Group Health Inc Commercial	$1,166.40
Rate for Payer: Group Health Inc Medicare	$816.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,166.40
Rate for Payer: Hamaspik Choice Inc Medicare	$1,166.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,516.31

SCREW POLY SERRATO 5.5X35MM

Facility

$2,332.79

Service Code	HCPCS C1713
Hospital Charge Code	64906399
Hospital Revenue Code	278
Min. Negotiated Rate	$1,166.40
Max. Negotiated Rate	$1,166.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,166.40
Rate for Payer: Hamaspik Choice Inc Medicare	$1,166.40

SCREW POLY SERRATO 6.0X35MM

Facility

$2,332.79

Service Code	HCPCS C1713
Hospital Charge Code	64906400
Hospital Revenue Code	278
Min. Negotiated Rate	$1,166.40
Max. Negotiated Rate	$1,166.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,166.40
Rate for Payer: Hamaspik Choice Inc Medicare	$1,166.40

Know your out-of-pocket cost for care.

All Charges