St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SCREW RELINE O 8.5X70MM 2S

Facility

$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 RELINE O 8.5X70MM 2S

Facility

$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: Brighton Health Commercial	$2,235.00
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: EmblemHealth Commercial	$1,862.50
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 REL-O 6.5X55MM 2S POLY

Facility

$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: 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 REL-O 6.5X55MM 2S POLY

Facility

$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

$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: Brighton Health Commercial	$136.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$113.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$130.74
Rate for Payer: EmblemHealth Commercial	$113.69
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

$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

$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 12

Facility

$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: Brighton Health Commercial	$519.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$433.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$498.09
Rate for Payer: EmblemHealth Commercial	$433.12
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 16

Facility

$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: Brighton Health Commercial	$519.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$433.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$498.09
Rate for Payer: EmblemHealth Commercial	$433.12
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 16

Facility

$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 RETAINED PLATE

Facility

$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: Brighton Health Commercial	$375.00
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

$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: Brighton Health Commercial	$1,447.50
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: EmblemHealth Commercial	$1,206.25
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 REVISION 5.5 X 25MM

Facility

$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 RONE 3.0 X 16

Facility

$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: Brighton Health Commercial	$315.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$262.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$301.88
Rate for Payer: EmblemHealth Commercial	$262.50
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 RONE 3.0 X 16

Facility

$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 ROS 4.6 X 14

Facility

$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: Brighton Health Commercial	$519.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$433.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$498.09
Rate for Payer: EmblemHealth Commercial	$433.12
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 ROS 4.6 X 14

Facility

$866.25

Service Code	HCPCS C1713
Hospital Charge Code	64904594
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 SCHANZ 4.0X80MM

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	64901166
Hospital Revenue Code	278
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.50
Rate for Payer: Hamaspik Choice Inc Medicare	$67.50

SCREW SCHANZ 4.0X80MM

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	64901166
Hospital Revenue Code	278
Min. Negotiated Rate	$47.25
Max. Negotiated Rate	$141.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$81.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$67.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.62
Rate for Payer: EmblemHealth Commercial	$67.50
Rate for Payer: Fidelis Medicare Advantage	$141.75
Rate for Payer: Group Health Inc Commercial	$67.50
Rate for Payer: Group Health Inc Medicare	$47.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.50
Rate for Payer: Hamaspik Choice Inc Medicare	$67.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$87.75

SCREW SELF DRILL 1.5MM

Facility

$168.05

Service Code	HCPCS C1713
Hospital Charge Code	64904848
Hospital Revenue Code	278
Min. Negotiated Rate	$84.02
Max. Negotiated Rate	$84.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$84.02
Rate for Payer: Hamaspik Choice Inc Medicare	$84.02

SCREW SELF DRILL 1.5MM

Facility

$168.05

Service Code	HCPCS C1713
Hospital Charge Code	64904848
Hospital Revenue Code	278
Min. Negotiated Rate	$58.82
Max. Negotiated Rate	$176.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$92.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$100.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$84.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$96.63
Rate for Payer: EmblemHealth Commercial	$84.02
Rate for Payer: Fidelis Medicare Advantage	$176.45
Rate for Payer: Group Health Inc Commercial	$84.02
Rate for Payer: Group Health Inc Medicare	$58.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$84.02
Rate for Payer: Hamaspik Choice Inc Medicare	$84.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$109.23

SCREW SELF DRILL 1.5X4MM

Facility

$148.25

Service Code	HCPCS C1713
Hospital Charge Code	64901864
Hospital Revenue Code	278
Min. Negotiated Rate	$74.12
Max. Negotiated Rate	$74.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.12
Rate for Payer: Hamaspik Choice Inc Medicare	$74.12

SCREW SELF DRILL 1.5X4MM

Facility

$148.25

Service Code	HCPCS C1713
Hospital Charge Code	64901864
Hospital Revenue Code	278
Min. Negotiated Rate	$51.89
Max. Negotiated Rate	$155.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$81.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$88.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$74.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$85.24
Rate for Payer: EmblemHealth Commercial	$74.12
Rate for Payer: Fidelis Medicare Advantage	$155.66
Rate for Payer: Group Health Inc Commercial	$74.12
Rate for Payer: Group Health Inc Medicare	$51.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.12
Rate for Payer: Hamaspik Choice Inc Medicare	$74.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$96.36

SCREW SELF DRILL 1.7 X 4MM

Facility

$127.33

Service Code	HCPCS C1713
Hospital Charge Code	64904786
Hospital Revenue Code	278
Min. Negotiated Rate	$63.66
Max. Negotiated Rate	$63.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.66
Rate for Payer: Hamaspik Choice Inc Medicare	$63.66

SCREW SELF DRILL 1.7 X 4MM

Facility

$127.33

Service Code	HCPCS C1713
Hospital Charge Code	64904786
Hospital Revenue Code	278
Min. Negotiated Rate	$44.57
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$76.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$63.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$73.21
Rate for Payer: EmblemHealth Commercial	$63.66
Rate for Payer: Fidelis Medicare Advantage	$133.70
Rate for Payer: Group Health Inc Commercial	$63.66
Rate for Payer: Group Health Inc Medicare	$44.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.66
Rate for Payer: Hamaspik Choice Inc Medicare	$63.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$82.76

Know your out-of-pocket cost for care.

All Charges