St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW BONE CANNUL 8MM DIA 40MM

Facility IP

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	64902761
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 60MM

Facility OP

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	64902458
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 60MM

Facility IP

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	64902458
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 90

Facility IP

$604.20

Service Code	HCPCS C1713
Hospital Charge Code	64902881
Hospital Revenue Code	278
Min. Negotiated Rate	$302.10
Max. Negotiated Rate	$302.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$302.10
Rate for Payer: Hamaspik Choice Inc Medicare	$302.10

SCREW BONE CANNUL 90

Facility OP

$604.20

Service Code	HCPCS C1713
Hospital Charge Code	64902881
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$634.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$332.31
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	$302.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$347.42
Rate for Payer: Fidelis Medicare Advantage	$634.41
Rate for Payer: Group Health Inc Commercial	$302.10
Rate for Payer: Group Health Inc Medicare	$211.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$302.10
Rate for Payer: Hamaspik Choice Inc Medicare	$302.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$392.73

SCREW BONE CANNUL C 2.5MM DI

Facility OP

$1,310.00

Service Code	HCPCS C1713
Hospital Charge Code	64904790
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,375.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$720.50
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	$655.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$753.25
Rate for Payer: Fidelis Medicare Advantage	$1,375.50
Rate for Payer: Group Health Inc Commercial	$655.00
Rate for Payer: Group Health Inc Medicare	$458.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$655.00
Rate for Payer: Hamaspik Choice Inc Medicare	$655.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$851.50

SCREW BONE CANNUL C 2.5MM DI

Facility IP

$1,310.00

Service Code	HCPCS C1713
Hospital Charge Code	64904790
Hospital Revenue Code	278
Min. Negotiated Rate	$655.00
Max. Negotiated Rate	$655.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$655.00
Rate for Payer: Hamaspik Choice Inc Medicare	$655.00

SCREW BONE CANNUL C 2.5MM DIA

Facility OP

$1,385.00

Service Code	HCPCS C1713
Hospital Charge Code	64904641
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,454.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$761.75
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	$692.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$796.38
Rate for Payer: Fidelis Medicare Advantage	$1,454.25
Rate for Payer: Group Health Inc Commercial	$692.50
Rate for Payer: Group Health Inc Medicare	$484.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$692.50
Rate for Payer: Hamaspik Choice Inc Medicare	$692.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$900.25

SCREW BONE CANNUL C 2.5MM DIA

Facility IP

$1,385.00

Service Code	HCPCS C1713
Hospital Charge Code	64904641
Hospital Revenue Code	278
Min. Negotiated Rate	$692.50
Max. Negotiated Rate	$692.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$692.50
Rate for Payer: Hamaspik Choice Inc Medicare	$692.50

SCREW BONE CANNUL C 3.2MM/4.1MB

Facility IP

$804.38

Service Code	HCPCS C1713
Hospital Charge Code	64902305
Hospital Revenue Code	278
Min. Negotiated Rate	$402.19
Max. Negotiated Rate	$402.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$402.19
Rate for Payer: Hamaspik Choice Inc Medicare	$402.19

SCREW BONE CANNUL C 3.2MM/4.1MB

Facility OP

$804.38

Service Code	HCPCS C1713
Hospital Charge Code	64902305
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$844.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$442.41
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	$402.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$462.52
Rate for Payer: Fidelis Medicare Advantage	$844.60
Rate for Payer: Group Health Inc Commercial	$402.19
Rate for Payer: Group Health Inc Medicare	$281.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$402.19
Rate for Payer: Hamaspik Choice Inc Medicare	$402.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$522.85

SCREW BONE CANNUL C 3.5MM DIA

Facility IP

$1,307.50

Service Code	HCPCS C1713
Hospital Charge Code	64904574
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 BONE CANNUL C 3.5MM DIA

Facility OP

$1,307.50

Service Code	HCPCS C1713
Hospital Charge Code	64904574
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 BONE CANNUL C C-FIX 3.5M

Facility IP

$1,385.00

Service Code	HCPCS C1713
Hospital Charge Code	64904777
Hospital Revenue Code	278
Min. Negotiated Rate	$692.50
Max. Negotiated Rate	$692.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$692.50
Rate for Payer: Hamaspik Choice Inc Medicare	$692.50

SCREW BONE CANNUL C C-FIX 3.5M

Facility OP

$1,385.00

Service Code	HCPCS C1713
Hospital Charge Code	64904777
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,454.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$761.75
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	$692.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$796.38
Rate for Payer: Fidelis Medicare Advantage	$1,454.25
Rate for Payer: Group Health Inc Commercial	$692.50
Rate for Payer: Group Health Inc Medicare	$484.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$692.50
Rate for Payer: Hamaspik Choice Inc Medicare	$692.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$900.25

SCREW BONE CANNUL C C-FIX HEADA

Facility IP

$998.33

Service Code	HCPCS C1713
Hospital Charge Code	64904006
Hospital Revenue Code	278
Min. Negotiated Rate	$499.16
Max. Negotiated Rate	$499.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$499.16
Rate for Payer: Hamaspik Choice Inc Medicare	$499.16

SCREW BONE CANNUL C C-FIX HEADA

Facility OP

$998.33

Service Code	HCPCS C1713
Hospital Charge Code	64904006
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,048.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$549.08
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	$499.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$574.04
Rate for Payer: Fidelis Medicare Advantage	$1,048.25
Rate for Payer: Group Health Inc Commercial	$499.16
Rate for Payer: Group Health Inc Medicare	$349.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$499.16
Rate for Payer: Hamaspik Choice Inc Medicare	$499.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$648.91

SCREW BONE CANNUL C C-FIX HEADB

Facility OP

$1,078.70

Service Code	HCPCS C1713
Hospital Charge Code	64904008
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,132.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$593.28
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	$539.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$620.25
Rate for Payer: Fidelis Medicare Advantage	$1,132.64
Rate for Payer: Group Health Inc Commercial	$539.35
Rate for Payer: Group Health Inc Medicare	$377.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$539.35
Rate for Payer: Hamaspik Choice Inc Medicare	$539.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$701.16

SCREW BONE CANNUL C C-FIX HEADB

Facility IP

$1,078.70

Service Code	HCPCS C1713
Hospital Charge Code	64904008
Hospital Revenue Code	278
Min. Negotiated Rate	$539.35
Max. Negotiated Rate	$539.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$539.35
Rate for Payer: Hamaspik Choice Inc Medicare	$539.35

SCREW BONE CANNUL C C-FIX HEADC

Facility OP

$1,385.00

Service Code	HCPCS C1713
Hospital Charge Code	64904883
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,454.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$761.75
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	$692.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$796.38
Rate for Payer: Fidelis Medicare Advantage	$1,454.25
Rate for Payer: Group Health Inc Commercial	$692.50
Rate for Payer: Group Health Inc Medicare	$484.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$692.50
Rate for Payer: Hamaspik Choice Inc Medicare	$692.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$900.25

SCREW BONE CANNUL C C-FIX HEADC

Facility IP

$1,385.00

Service Code	HCPCS C1713
Hospital Charge Code	64904883
Hospital Revenue Code	278
Min. Negotiated Rate	$692.50
Max. Negotiated Rate	$692.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$692.50
Rate for Payer: Hamaspik Choice Inc Medicare	$692.50

SCREW BONE CANNUL C C-FIX HEADD

Facility OP

$1,307.50

Service Code	HCPCS C1713
Hospital Charge Code	64904928
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 BONE CANNUL C C-FIX HEADD

Facility IP

$1,307.50

Service Code	HCPCS C1713
Hospital Charge Code	64904928
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 BONE CANNUL C MV 4MM DIA

Facility OP

$1,385.00

Service Code	HCPCS C1713
Hospital Charge Code	64904887
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,454.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$761.75
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	$692.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$796.38
Rate for Payer: Fidelis Medicare Advantage	$1,454.25
Rate for Payer: Group Health Inc Commercial	$692.50
Rate for Payer: Group Health Inc Medicare	$484.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$692.50
Rate for Payer: Hamaspik Choice Inc Medicare	$692.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$900.25

SCREW BONE CANNUL C MV 4MM DIA

Facility IP

$1,385.00

Service Code	HCPCS C1713
Hospital Charge Code	64904887
Hospital Revenue Code	278
Min. Negotiated Rate	$692.50
Max. Negotiated Rate	$692.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$692.50
Rate for Payer: Hamaspik Choice Inc Medicare	$692.50

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