St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW BONE CANNUL LP 8MM DIA 7C

Facility OP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64903958
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 LP 8MM DIA 7C

Facility IP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64903958
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 LP 8MM DIA 7D

Facility IP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64904613
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 LP 8MM DIA 7D

Facility OP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64904613
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 LP 8MM DIA 8

Facility OP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64903960
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 LP 8MM DIA 8

Facility IP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64903960
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 LP 8MM DIA 9A

Facility IP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64903956
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 LP 8MM DIA 9A

Facility OP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64903956
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 LP 8MM DIA 9B

Facility OP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64904612
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 LP 8MM DIA 9B

Facility IP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64904612
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 COMPRESSION LOW-PRO

Facility OP

$157.50

Service Code	HCPCS C1713
Hospital Charge Code	64902793
Hospital Revenue Code	278
Min. Negotiated Rate	$55.12
Max. Negotiated Rate	$165.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.62
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	$78.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$90.56
Rate for Payer: Fidelis Medicare Advantage	$165.38
Rate for Payer: Group Health Inc Commercial	$78.75
Rate for Payer: Group Health Inc Medicare	$55.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.75
Rate for Payer: Hamaspik Choice Inc Medicare	$78.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$102.38

SCREW BONE COMPRESSION LOW-PRO

Facility IP

$157.50

Service Code	HCPCS C1713
Hospital Charge Code	64902793
Hospital Revenue Code	278
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$78.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.75
Rate for Payer: Hamaspik Choice Inc Medicare	$78.75

SCREW BONE CORT 5.0MM X 36MM

Facility IP

$496.00

Service Code	HCPCS C1713
Hospital Charge Code	40007506
Hospital Revenue Code	278
Min. Negotiated Rate	$248.00
Max. Negotiated Rate	$248.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$248.00
Rate for Payer: Hamaspik Choice Inc Medicare	$248.00

SCREW BONE CORT 5.0MM X 36MM

Facility IP

$620.00

Service Code	HCPCS C1713
Hospital Charge Code	64905499
Hospital Revenue Code	278
Min. Negotiated Rate	$310.00
Max. Negotiated Rate	$310.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$310.00
Rate for Payer: Hamaspik Choice Inc Medicare	$310.00

SCREW BONE CORT 5.0MM X 36MM

Facility OP

$620.00

Service Code	HCPCS C1713
Hospital Charge Code	64905499
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$651.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$341.00
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	$310.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$356.50
Rate for Payer: Fidelis Medicare Advantage	$651.00
Rate for Payer: Group Health Inc Commercial	$310.00
Rate for Payer: Group Health Inc Medicare	$217.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$310.00
Rate for Payer: Hamaspik Choice Inc Medicare	$310.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$403.00

SCREW BONE CORT 5.0MM X 36MM

Facility OP

$496.00

Service Code	HCPCS C1713
Hospital Charge Code	40007506
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$520.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$272.80
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	$248.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$285.20
Rate for Payer: Fidelis Medicare Advantage	$520.80
Rate for Payer: Group Health Inc Commercial	$248.00
Rate for Payer: Group Health Inc Medicare	$173.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$248.00
Rate for Payer: Hamaspik Choice Inc Medicare	$248.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$322.40

SCREW BONE CORT 5.0MMX36MM

Facility OP

$496.00

Service Code	HCPCS C1713
Hospital Charge Code	40204587
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$520.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$272.80
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	$248.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$285.20
Rate for Payer: Fidelis Medicare Advantage	$520.80
Rate for Payer: Group Health Inc Commercial	$248.00
Rate for Payer: Group Health Inc Medicare	$173.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$248.00
Rate for Payer: Hamaspik Choice Inc Medicare	$248.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$322.40

SCREW BONE CORT 5.0MMX36MM

Facility IP

$496.00

Service Code	HCPCS C1713
Hospital Charge Code	40204587
Hospital Revenue Code	278
Min. Negotiated Rate	$248.00
Max. Negotiated Rate	$248.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$248.00
Rate for Payer: Hamaspik Choice Inc Medicare	$248.00

SCREW BONE CORTICAL 5.0X38MM

Facility IP

$620.00

Service Code	HCPCS C1713
Hospital Charge Code	64905652
Hospital Revenue Code	278
Min. Negotiated Rate	$310.00
Max. Negotiated Rate	$310.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$310.00
Rate for Payer: Hamaspik Choice Inc Medicare	$310.00

SCREW BONE CORTICAL 5.0X38MM

Facility OP

$620.00

Service Code	HCPCS C1713
Hospital Charge Code	64905652
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$651.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$341.00
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	$310.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$356.50
Rate for Payer: Fidelis Medicare Advantage	$651.00
Rate for Payer: Group Health Inc Commercial	$310.00
Rate for Payer: Group Health Inc Medicare	$217.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$310.00
Rate for Payer: Hamaspik Choice Inc Medicare	$310.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$403.00

SCREW BONE CROSS PIN 2.0X14MM

Facility OP

$107.10

Service Code	HCPCS C1713
Hospital Charge Code	64901502
Hospital Revenue Code	278
Min. Negotiated Rate	$37.48
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.90
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	$53.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$61.58
Rate for Payer: Fidelis Medicare Advantage	$112.46
Rate for Payer: Group Health Inc Commercial	$53.55
Rate for Payer: Group Health Inc Medicare	$37.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.55
Rate for Payer: Hamaspik Choice Inc Medicare	$53.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$69.62

SCREW BONE CROSS PIN 2.0X14MM

Facility IP

$107.10

Service Code	HCPCS C1713
Hospital Charge Code	64901502
Hospital Revenue Code	278
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$53.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.55
Rate for Payer: Hamaspik Choice Inc Medicare	$53.55

SCREW BONE CROSS PIN 2.0X16MM

Facility IP

$107.10

Service Code	HCPCS C1713
Hospital Charge Code	64901504
Hospital Revenue Code	278
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$53.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.55
Rate for Payer: Hamaspik Choice Inc Medicare	$53.55

SCREW BONE CROSS PIN 2.0X16MM

Facility OP

$107.10

Service Code	HCPCS C1713
Hospital Charge Code	64901504
Hospital Revenue Code	278
Min. Negotiated Rate	$37.48
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.90
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	$53.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$61.58
Rate for Payer: Fidelis Medicare Advantage	$112.46
Rate for Payer: Group Health Inc Commercial	$53.55
Rate for Payer: Group Health Inc Medicare	$37.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.55
Rate for Payer: Hamaspik Choice Inc Medicare	$53.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$69.62

SCREW BONE CROSS PIN 2.3X14MM

Facility IP

$131.18

Service Code	HCPCS C1713
Hospital Charge Code	64901478
Hospital Revenue Code	278
Min. Negotiated Rate	$65.59
Max. Negotiated Rate	$65.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.59
Rate for Payer: Hamaspik Choice Inc Medicare	$65.59

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