St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW BONE CANNUL 6.5MM DIA 85 A

Facility IP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64902912
Hospital Revenue Code	278
Min. Negotiated Rate	$307.12
Max. Negotiated Rate	$307.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$307.12
Rate for Payer: Hamaspik Choice Inc Medicare	$307.12

SCREW BONE CANNUL 6.5MM DIA 85 A

Facility OP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64902912
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$644.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$337.84
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	$307.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$353.19
Rate for Payer: Fidelis Medicare Advantage	$644.96
Rate for Payer: Group Health Inc Commercial	$307.12
Rate for Payer: Group Health Inc Medicare	$214.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$307.12
Rate for Payer: Hamaspik Choice Inc Medicare	$307.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$399.26

SCREW BONE CANNUL 6.5MM DIA 85 B

Facility OP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64903333
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$644.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$337.84
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	$307.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$353.19
Rate for Payer: Fidelis Medicare Advantage	$644.96
Rate for Payer: Group Health Inc Commercial	$307.12
Rate for Payer: Group Health Inc Medicare	$214.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$307.12
Rate for Payer: Hamaspik Choice Inc Medicare	$307.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$399.26

SCREW BONE CANNUL 6.5MM DIA 85 B

Facility IP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64903333
Hospital Revenue Code	278
Min. Negotiated Rate	$307.12
Max. Negotiated Rate	$307.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$307.12
Rate for Payer: Hamaspik Choice Inc Medicare	$307.12

SCREW BONE CANNUL 6.5MM DIA 90

Facility IP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64902544
Hospital Revenue Code	278
Min. Negotiated Rate	$307.12
Max. Negotiated Rate	$307.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$307.12
Rate for Payer: Hamaspik Choice Inc Medicare	$307.12

SCREW BONE CANNUL 6.5MM DIA 90

Facility OP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64902544
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$644.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$337.84
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	$307.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$353.19
Rate for Payer: Fidelis Medicare Advantage	$644.96
Rate for Payer: Group Health Inc Commercial	$307.12
Rate for Payer: Group Health Inc Medicare	$214.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$307.12
Rate for Payer: Hamaspik Choice Inc Medicare	$307.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$399.26

SCREW BONE CANNUL 6.5MM DIA 95

Facility IP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64901957
Hospital Revenue Code	278
Min. Negotiated Rate	$307.12
Max. Negotiated Rate	$307.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$307.12
Rate for Payer: Hamaspik Choice Inc Medicare	$307.12

SCREW BONE CANNUL 6.5MM DIA 95

Facility OP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64901957
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$644.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$337.84
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	$307.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$353.19
Rate for Payer: Fidelis Medicare Advantage	$644.96
Rate for Payer: Group Health Inc Commercial	$307.12
Rate for Payer: Group Health Inc Medicare	$214.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$307.12
Rate for Payer: Hamaspik Choice Inc Medicare	$307.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$399.26

SCREW BONE CANNUL 6.5X60MM

Facility IP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64905607
Hospital Revenue Code	278
Min. Negotiated Rate	$307.12
Max. Negotiated Rate	$307.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$307.12
Rate for Payer: Hamaspik Choice Inc Medicare	$307.12

SCREW BONE CANNUL 6.5X60MM

Facility OP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64905607
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$644.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$337.84
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	$307.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$353.19
Rate for Payer: Fidelis Medicare Advantage	$644.96
Rate for Payer: Group Health Inc Commercial	$307.12
Rate for Payer: Group Health Inc Medicare	$214.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$307.12
Rate for Payer: Hamaspik Choice Inc Medicare	$307.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$399.26

SCREW BONE CANNUL 8.0X110MM

Facility IP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64905592
Hospital Revenue Code	278
Min. Negotiated Rate	$303.88
Max. Negotiated Rate	$303.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$303.88
Rate for Payer: Hamaspik Choice Inc Medicare	$303.88

SCREW BONE CANNUL 8.0X110MM

Facility OP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64905592
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$638.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$334.26
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	$303.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$349.46
Rate for Payer: Fidelis Medicare Advantage	$638.14
Rate for Payer: Group Health Inc Commercial	$303.88
Rate for Payer: Group Health Inc Medicare	$212.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$303.88
Rate for Payer: Hamaspik Choice Inc Medicare	$303.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$395.04

SCREW BONE CANNUL 8.0X115MM

Facility IP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64905593
Hospital Revenue Code	278
Min. Negotiated Rate	$303.88
Max. Negotiated Rate	$303.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$303.88
Rate for Payer: Hamaspik Choice Inc Medicare	$303.88

SCREW BONE CANNUL 8.0X115MM

Facility OP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64905593
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$638.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$334.26
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	$303.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$349.46
Rate for Payer: Fidelis Medicare Advantage	$638.14
Rate for Payer: Group Health Inc Commercial	$303.88
Rate for Payer: Group Health Inc Medicare	$212.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$303.88
Rate for Payer: Hamaspik Choice Inc Medicare	$303.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$395.04

SCREW BONE CANNUL 8.0X120MM

Facility IP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64905595
Hospital Revenue Code	278
Min. Negotiated Rate	$303.88
Max. Negotiated Rate	$303.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$303.88
Rate for Payer: Hamaspik Choice Inc Medicare	$303.88

SCREW BONE CANNUL 8.0X120MM

Facility OP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64905595
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$638.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$334.26
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	$303.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$349.46
Rate for Payer: Fidelis Medicare Advantage	$638.14
Rate for Payer: Group Health Inc Commercial	$303.88
Rate for Payer: Group Health Inc Medicare	$212.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$303.88
Rate for Payer: Hamaspik Choice Inc Medicare	$303.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$395.04

SCREW BONE CANNUL 8.0X40MM

Facility IP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64905834
Hospital Revenue Code	278
Min. Negotiated Rate	$303.88
Max. Negotiated Rate	$303.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$303.88
Rate for Payer: Hamaspik Choice Inc Medicare	$303.88

SCREW BONE CANNUL 8.0X40MM

Facility OP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64905834
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$638.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$334.26
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	$303.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$349.46
Rate for Payer: Fidelis Medicare Advantage	$638.14
Rate for Payer: Group Health Inc Commercial	$303.88
Rate for Payer: Group Health Inc Medicare	$212.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$303.88
Rate for Payer: Hamaspik Choice Inc Medicare	$303.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$395.04

SCREW BONE CANNUL 8.0 X 8.0

Facility IP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64905369
Hospital Revenue Code	278
Min. Negotiated Rate	$303.88
Max. Negotiated Rate	$303.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$303.88
Rate for Payer: Hamaspik Choice Inc Medicare	$303.88

SCREW BONE CANNUL 8.0 X 8.0

Facility OP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64905369
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$638.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$334.26
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	$303.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$349.46
Rate for Payer: Fidelis Medicare Advantage	$638.14
Rate for Payer: Group Health Inc Commercial	$303.88
Rate for Payer: Group Health Inc Medicare	$212.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$303.88
Rate for Payer: Hamaspik Choice Inc Medicare	$303.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$395.04

SCREW BONE CANNUL 8MM DIA 34MM

Facility OP

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	64902507
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$409.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$214.50
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	$195.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$224.25
Rate for Payer: Fidelis Medicare Advantage	$409.50
Rate for Payer: Group Health Inc Commercial	$195.00
Rate for Payer: Group Health Inc Medicare	$136.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$195.00
Rate for Payer: Hamaspik Choice Inc Medicare	$195.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$253.50

SCREW BONE CANNUL 8MM DIA 34MM

Facility IP

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	64902507
Hospital Revenue Code	278
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$195.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$195.00
Rate for Payer: Hamaspik Choice Inc Medicare	$195.00

SCREW BONE CANNUL 8MM DIA 38MM

Facility IP

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	64904685
Hospital Revenue Code	278
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$195.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$195.00
Rate for Payer: Hamaspik Choice Inc Medicare	$195.00

SCREW BONE CANNUL 8MM DIA 38MM

Facility OP

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	64904685
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$409.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$214.50
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	$195.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$224.25
Rate for Payer: Fidelis Medicare Advantage	$409.50
Rate for Payer: Group Health Inc Commercial	$195.00
Rate for Payer: Group Health Inc Medicare	$136.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$195.00
Rate for Payer: Hamaspik Choice Inc Medicare	$195.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$253.50

SCREW BONE CANNUL 8MM DIA 40MM

Facility OP

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	64902761
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$409.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$214.50
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	$195.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$224.25
Rate for Payer: Fidelis Medicare Advantage	$409.50
Rate for Payer: Group Health Inc Commercial	$195.00
Rate for Payer: Group Health Inc Medicare	$136.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$195.00
Rate for Payer: Hamaspik Choice Inc Medicare	$195.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$253.50

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