St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW BONE CANNUL LP 6.5MM DIA1

Facility IP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64901775
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 LP 6.5MM DIA1

Facility OP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64901775
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 LP 6.5MM DIA2

Facility IP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64901955
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 LP 6.5MM DIA2

Facility OP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64901955
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 LP 6.5MM DIA3

Facility OP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64902216
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 LP 6.5MM DIA3

Facility IP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64902216
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 LP 6.5MM DIA4

Facility IP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64902271
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 LP 6.5MM DIA4

Facility OP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64902271
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 LP 6.5MM DIA6

Facility OP

$1,228.50

Service Code	HCPCS C1713
Hospital Charge Code	64904893
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,289.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$675.68
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	$614.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$706.39
Rate for Payer: Fidelis Medicare Advantage	$1,289.92
Rate for Payer: Group Health Inc Commercial	$614.25
Rate for Payer: Group Health Inc Medicare	$429.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$614.25
Rate for Payer: Hamaspik Choice Inc Medicare	$614.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$798.52

SCREW BONE CANNUL LP 6.5MM DIA6

Facility IP

$1,228.50

Service Code	HCPCS C1713
Hospital Charge Code	64904893
Hospital Revenue Code	278
Min. Negotiated Rate	$614.25
Max. Negotiated Rate	$614.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$614.25
Rate for Payer: Hamaspik Choice Inc Medicare	$614.25

SCREW BONE CANNUL LP 6MM/3.2MM10

Facility IP

$427.38

Service Code	HCPCS C1713
Hospital Charge Code	64904674
Hospital Revenue Code	278
Min. Negotiated Rate	$213.69
Max. Negotiated Rate	$213.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.69
Rate for Payer: Hamaspik Choice Inc Medicare	$213.69

SCREW BONE CANNUL LP 6MM/3.2MM10

Facility OP

$427.38

Service Code	HCPCS C1713
Hospital Charge Code	64904674
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$448.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$235.06
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	$213.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$245.74
Rate for Payer: Fidelis Medicare Advantage	$448.75
Rate for Payer: Group Health Inc Commercial	$213.69
Rate for Payer: Group Health Inc Medicare	$149.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.69
Rate for Payer: Hamaspik Choice Inc Medicare	$213.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$277.80

SCREW BONE CANNUL LP 6MM/3.2MM11

Facility IP

$427.38

Service Code	HCPCS C1713
Hospital Charge Code	64904768
Hospital Revenue Code	278
Min. Negotiated Rate	$213.69
Max. Negotiated Rate	$213.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.69
Rate for Payer: Hamaspik Choice Inc Medicare	$213.69

SCREW BONE CANNUL LP 6MM/3.2MM11

Facility OP

$427.38

Service Code	HCPCS C1713
Hospital Charge Code	64904768
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$448.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$235.06
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	$213.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$245.74
Rate for Payer: Fidelis Medicare Advantage	$448.75
Rate for Payer: Group Health Inc Commercial	$213.69
Rate for Payer: Group Health Inc Medicare	$149.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.69
Rate for Payer: Hamaspik Choice Inc Medicare	$213.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$277.80

SCREW BONE CANNUL LP 6MM/3.2MM2

Facility IP

$427.38

Service Code	HCPCS C1713
Hospital Charge Code	64903259
Hospital Revenue Code	278
Min. Negotiated Rate	$213.69
Max. Negotiated Rate	$213.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.69
Rate for Payer: Hamaspik Choice Inc Medicare	$213.69

SCREW BONE CANNUL LP 6MM/3.2MM2

Facility OP

$427.38

Service Code	HCPCS C1713
Hospital Charge Code	64903259
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$448.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$235.06
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	$213.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$245.74
Rate for Payer: Fidelis Medicare Advantage	$448.75
Rate for Payer: Group Health Inc Commercial	$213.69
Rate for Payer: Group Health Inc Medicare	$149.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.69
Rate for Payer: Hamaspik Choice Inc Medicare	$213.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$277.80

SCREW BONE CANNUL LP 6MM/3.2MM3

Facility IP

$427.38

Service Code	HCPCS C1713
Hospital Charge Code	64903567
Hospital Revenue Code	278
Min. Negotiated Rate	$213.69
Max. Negotiated Rate	$213.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.69
Rate for Payer: Hamaspik Choice Inc Medicare	$213.69

SCREW BONE CANNUL LP 6MM/3.2MM3

Facility OP

$427.38

Service Code	HCPCS C1713
Hospital Charge Code	64903567
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$448.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$235.06
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	$213.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$245.74
Rate for Payer: Fidelis Medicare Advantage	$448.75
Rate for Payer: Group Health Inc Commercial	$213.69
Rate for Payer: Group Health Inc Medicare	$149.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.69
Rate for Payer: Hamaspik Choice Inc Medicare	$213.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$277.80

SCREW BONE CANNUL LP 6MM/3.2MM4

Facility IP

$427.38

Service Code	HCPCS C1713
Hospital Charge Code	64903593
Hospital Revenue Code	278
Min. Negotiated Rate	$213.69
Max. Negotiated Rate	$213.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.69
Rate for Payer: Hamaspik Choice Inc Medicare	$213.69

SCREW BONE CANNUL LP 6MM/3.2MM4

Facility OP

$427.38

Service Code	HCPCS C1713
Hospital Charge Code	64903593
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$448.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$235.06
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	$213.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$245.74
Rate for Payer: Fidelis Medicare Advantage	$448.75
Rate for Payer: Group Health Inc Commercial	$213.69
Rate for Payer: Group Health Inc Medicare	$149.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.69
Rate for Payer: Hamaspik Choice Inc Medicare	$213.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$277.80

SCREW BONE CANNUL LP 6MM/3.2MM5

Facility IP

$427.38

Service Code	HCPCS C1713
Hospital Charge Code	64903845
Hospital Revenue Code	278
Min. Negotiated Rate	$213.69
Max. Negotiated Rate	$213.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.69
Rate for Payer: Hamaspik Choice Inc Medicare	$213.69

SCREW BONE CANNUL LP 6MM/3.2MM5

Facility OP

$427.38

Service Code	HCPCS C1713
Hospital Charge Code	64903845
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$448.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$235.06
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	$213.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$245.74
Rate for Payer: Fidelis Medicare Advantage	$448.75
Rate for Payer: Group Health Inc Commercial	$213.69
Rate for Payer: Group Health Inc Medicare	$149.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.69
Rate for Payer: Hamaspik Choice Inc Medicare	$213.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$277.80

SCREW BONE CANNUL LP 6MM/3.2MM7

Facility OP

$427.38

Service Code	HCPCS C1713
Hospital Charge Code	64904466
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$448.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$235.06
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	$213.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$245.74
Rate for Payer: Fidelis Medicare Advantage	$448.75
Rate for Payer: Group Health Inc Commercial	$213.69
Rate for Payer: Group Health Inc Medicare	$149.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.69
Rate for Payer: Hamaspik Choice Inc Medicare	$213.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$277.80

SCREW BONE CANNUL LP 6MM/3.2MM7

Facility IP

$427.38

Service Code	HCPCS C1713
Hospital Charge Code	64904466
Hospital Revenue Code	278
Min. Negotiated Rate	$213.69
Max. Negotiated Rate	$213.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.69
Rate for Payer: Hamaspik Choice Inc Medicare	$213.69

SCREW BONE CANNUL LP 6MM/3.2MM8

Facility IP

$427.38

Service Code	HCPCS C1713
Hospital Charge Code	64904560
Hospital Revenue Code	278
Min. Negotiated Rate	$213.69
Max. Negotiated Rate	$213.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.69
Rate for Payer: Hamaspik Choice Inc Medicare	$213.69

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