St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW BONE CANNUL C MV HEADLES

Facility OP

$1,385.00

Service Code	HCPCS C1713
Hospital Charge Code	64904885
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 HEADLES

Facility IP

$1,385.00

Service Code	HCPCS C1713
Hospital Charge Code	64904885
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 S-FIX HEADB

Facility IP

$1,385.00

Service Code	HCPCS C1713
Hospital Charge Code	64904692
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 S-FIX HEADB

Facility OP

$1,385.00

Service Code	HCPCS C1713
Hospital Charge Code	64904692
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 S-FIX HEADC

Facility OP

$1,307.50

Service Code	HCPCS C1713
Hospital Charge Code	64904694
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 S-FIX HEADC

Facility IP

$1,307.50

Service Code	HCPCS C1713
Hospital Charge Code	64904694
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 S-FIX HEADD

Facility IP

$1,385.00

Service Code	HCPCS C1713
Hospital Charge Code	64904775
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 S-FIX HEADD

Facility OP

$1,385.00

Service Code	HCPCS C1713
Hospital Charge Code	64904775
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 HEADLESS 2.5X18

Facility OP

$1,307.50

Service Code	HCPCS C1713
Hospital Charge Code	64905220
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 HEADLESS 2.5X18

Facility IP

$1,307.50

Service Code	HCPCS C1713
Hospital Charge Code	64905220
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 LAG 6.5MM DI1

Facility OP

$503.25

Service Code	HCPCS C1713
Hospital Charge Code	64901333
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$528.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$276.79
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	$251.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$289.37
Rate for Payer: Fidelis Medicare Advantage	$528.41
Rate for Payer: Group Health Inc Commercial	$251.62
Rate for Payer: Group Health Inc Medicare	$176.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.62
Rate for Payer: Hamaspik Choice Inc Medicare	$251.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$327.11

SCREW BONE CANNUL LAG 6.5MM DI1

Facility IP

$503.25

Service Code	HCPCS C1713
Hospital Charge Code	64901333
Hospital Revenue Code	278
Min. Negotiated Rate	$251.62
Max. Negotiated Rate	$251.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.62
Rate for Payer: Hamaspik Choice Inc Medicare	$251.62

SCREW BONE CANNUL LAG 6.5MM DI2

Facility IP

$554.75

Service Code	HCPCS C1713
Hospital Charge Code	64901357
Hospital Revenue Code	278
Min. Negotiated Rate	$277.38
Max. Negotiated Rate	$277.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$277.38
Rate for Payer: Hamaspik Choice Inc Medicare	$277.38

SCREW BONE CANNUL LAG 6.5MM DI2

Facility OP

$554.75

Service Code	HCPCS C1713
Hospital Charge Code	64901357
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$582.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$305.11
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	$277.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$318.98
Rate for Payer: Fidelis Medicare Advantage	$582.49
Rate for Payer: Group Health Inc Commercial	$277.38
Rate for Payer: Group Health Inc Medicare	$194.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$277.38
Rate for Payer: Hamaspik Choice Inc Medicare	$277.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$360.59

SCREW BONE CANNUL LAG 6.5MM DI3

Facility OP

$555.75

Service Code	HCPCS C1713
Hospital Charge Code	64901417
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$583.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$305.66
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	$277.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$319.56
Rate for Payer: Fidelis Medicare Advantage	$583.54
Rate for Payer: Group Health Inc Commercial	$277.88
Rate for Payer: Group Health Inc Medicare	$194.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$277.88
Rate for Payer: Hamaspik Choice Inc Medicare	$277.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$361.24

SCREW BONE CANNUL LAG 6.5MM DI3

Facility IP

$555.75

Service Code	HCPCS C1713
Hospital Charge Code	64901417
Hospital Revenue Code	278
Min. Negotiated Rate	$277.88
Max. Negotiated Rate	$277.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$277.88
Rate for Payer: Hamaspik Choice Inc Medicare	$277.88

SCREW BONE CANNUL LAG 6.5MM DI4

Facility OP

$555.75

Service Code	HCPCS C1713
Hospital Charge Code	64901419
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$583.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$305.66
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	$277.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$319.56
Rate for Payer: Fidelis Medicare Advantage	$583.54
Rate for Payer: Group Health Inc Commercial	$277.88
Rate for Payer: Group Health Inc Medicare	$194.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$277.88
Rate for Payer: Hamaspik Choice Inc Medicare	$277.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$361.24

SCREW BONE CANNUL LAG 6.5MM DI4

Facility IP

$555.75

Service Code	HCPCS C1713
Hospital Charge Code	64901419
Hospital Revenue Code	278
Min. Negotiated Rate	$277.88
Max. Negotiated Rate	$277.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$277.88
Rate for Payer: Hamaspik Choice Inc Medicare	$277.88

SCREW BONE CANNUL LAG 6.5MM DI5

Facility OP

$555.75

Service Code	HCPCS C1713
Hospital Charge Code	64901771
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$583.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$305.66
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	$277.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$319.56
Rate for Payer: Fidelis Medicare Advantage	$583.54
Rate for Payer: Group Health Inc Commercial	$277.88
Rate for Payer: Group Health Inc Medicare	$194.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$277.88
Rate for Payer: Hamaspik Choice Inc Medicare	$277.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$361.24

SCREW BONE CANNUL LAG 6.5MM DI5

Facility IP

$555.75

Service Code	HCPCS C1713
Hospital Charge Code	64901771
Hospital Revenue Code	278
Min. Negotiated Rate	$277.88
Max. Negotiated Rate	$277.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$277.88
Rate for Payer: Hamaspik Choice Inc Medicare	$277.88

SCREW BONE CANNUL LAG 6.5MM DI6

Facility OP

$555.75

Service Code	HCPCS C1713
Hospital Charge Code	64904973
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$583.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$305.66
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	$277.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$319.56
Rate for Payer: Fidelis Medicare Advantage	$583.54
Rate for Payer: Group Health Inc Commercial	$277.88
Rate for Payer: Group Health Inc Medicare	$194.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$277.88
Rate for Payer: Hamaspik Choice Inc Medicare	$277.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$361.24

SCREW BONE CANNUL LAG 6.5MM DI6

Facility IP

$555.75

Service Code	HCPCS C1713
Hospital Charge Code	64904973
Hospital Revenue Code	278
Min. Negotiated Rate	$277.88
Max. Negotiated Rate	$277.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$277.88
Rate for Payer: Hamaspik Choice Inc Medicare	$277.88

SCREW BONE CANNUL LAG LP 6.5MM

Facility OP

$555.75

Service Code	HCPCS C1713
Hospital Charge Code	64903791
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$583.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$305.66
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	$277.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$319.56
Rate for Payer: Fidelis Medicare Advantage	$583.54
Rate for Payer: Group Health Inc Commercial	$277.88
Rate for Payer: Group Health Inc Medicare	$194.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$277.88
Rate for Payer: Hamaspik Choice Inc Medicare	$277.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$361.24

SCREW BONE CANNUL LAG LP 6.5MM

Facility IP

$555.75

Service Code	HCPCS C1713
Hospital Charge Code	64903791
Hospital Revenue Code	278
Min. Negotiated Rate	$277.88
Max. Negotiated Rate	$277.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$277.88
Rate for Payer: Hamaspik Choice Inc Medicare	$277.88

SCREW BONE CANNUL LOCKING 5M

Facility OP

$429.00

Service Code	HCPCS C1713
Hospital Charge Code	64902536
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$450.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$235.95
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	$214.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$246.68
Rate for Payer: Fidelis Medicare Advantage	$450.45
Rate for Payer: Group Health Inc Commercial	$214.50
Rate for Payer: Group Health Inc Medicare	$150.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$214.50
Rate for Payer: Hamaspik Choice Inc Medicare	$214.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$278.85

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