St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW CANN 6.5 X 55MM

Facility IP

$1,644.00

Service Code	HCPCS C1713
Hospital Charge Code	64906805
Hospital Revenue Code	278
Min. Negotiated Rate	$822.00
Max. Negotiated Rate	$822.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$822.00
Rate for Payer: Hamaspik Choice Inc Medicare	$822.00

SCREW CANN 6.5 X 55MM

Facility OP

$1,644.00

Service Code	HCPCS C1713
Hospital Charge Code	64906805
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,726.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$904.20
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	$822.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$945.30
Rate for Payer: Fidelis Medicare Advantage	$1,726.20
Rate for Payer: Group Health Inc Commercial	$822.00
Rate for Payer: Group Health Inc Medicare	$575.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$822.00
Rate for Payer: Hamaspik Choice Inc Medicare	$822.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,068.60

SCREW CANN F/T 3.5

Facility IP

$306.00

Service Code	HCPCS C1776
Hospital Charge Code	40208116
Hospital Revenue Code	278
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$153.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$153.00
Rate for Payer: Hamaspik Choice Inc Medicare	$153.00

SCREW CANN F/T 3.5

Facility OP

$306.00

Service Code	HCPCS C1776
Hospital Charge Code	40208116
Hospital Revenue Code	278
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$168.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$153.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$175.95
Rate for Payer: Fidelis Medicare Advantage	$321.30
Rate for Payer: Group Health Inc Commercial	$153.00
Rate for Payer: Group Health Inc Medicare	$107.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$153.00
Rate for Payer: Hamaspik Choice Inc Medicare	$153.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$198.90

SCREW, CANN HEAD 3.5X28MM

Facility OP

$467.38

Service Code	HCPCS C1713
Hospital Charge Code	40004420
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$490.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$257.06
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	$233.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$268.74
Rate for Payer: Fidelis Medicare Advantage	$490.75
Rate for Payer: Group Health Inc Commercial	$233.69
Rate for Payer: Group Health Inc Medicare	$163.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$233.69
Rate for Payer: Hamaspik Choice Inc Medicare	$233.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$303.80

SCREW, CANN HEAD 3.5X28MM

Facility IP

$467.38

Service Code	HCPCS C1713
Hospital Charge Code	40004420
Hospital Revenue Code	278
Min. Negotiated Rate	$233.69
Max. Negotiated Rate	$233.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$233.69
Rate for Payer: Hamaspik Choice Inc Medicare	$233.69

SCREW CANN INT W/DISP

Facility OP

$287.50

Service Code	HCPCS C1713
Hospital Charge Code	64907433
Hospital Revenue Code	278
Min. Negotiated Rate	$100.62
Max. Negotiated Rate	$301.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$158.12
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	$143.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$165.31
Rate for Payer: Fidelis Medicare Advantage	$301.88
Rate for Payer: Group Health Inc Commercial	$143.75
Rate for Payer: Group Health Inc Medicare	$100.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.75
Rate for Payer: Hamaspik Choice Inc Medicare	$143.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$186.88

SCREW CANN INT W/DISP

Facility IP

$287.50

Service Code	HCPCS C1713
Hospital Charge Code	64907433
Hospital Revenue Code	278
Min. Negotiated Rate	$143.75
Max. Negotiated Rate	$143.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.75
Rate for Payer: Hamaspik Choice Inc Medicare	$143.75

SCREW CANNLTD 4.5 X 22MM

Facility IP

$92.80

Service Code	HCPCS C1713
Hospital Charge Code	64907017
Hospital Revenue Code	278
Min. Negotiated Rate	$46.40
Max. Negotiated Rate	$46.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.40
Rate for Payer: Hamaspik Choice Inc Medicare	$46.40

SCREW CANNLTD 4.5 X 22MM

Facility OP

$92.80

Service Code	HCPCS C1713
Hospital Charge Code	64907017
Hospital Revenue Code	278
Min. Negotiated Rate	$32.48
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.04
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	$46.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.36
Rate for Payer: Fidelis Medicare Advantage	$97.44
Rate for Payer: Group Health Inc Commercial	$46.40
Rate for Payer: Group Health Inc Medicare	$32.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.40
Rate for Payer: Hamaspik Choice Inc Medicare	$46.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$60.32

SCREW CANNLTD 6.5 X 115MM

Facility IP

$447.16

Service Code	HCPCS C1713
Hospital Charge Code	64906881
Hospital Revenue Code	278
Min. Negotiated Rate	$223.58
Max. Negotiated Rate	$223.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$223.58
Rate for Payer: Hamaspik Choice Inc Medicare	$223.58

SCREW CANNLTD 6.5 X 115MM

Facility OP

$447.16

Service Code	HCPCS C1713
Hospital Charge Code	64906881
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$469.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$245.94
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	$223.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$257.12
Rate for Payer: Fidelis Medicare Advantage	$469.52
Rate for Payer: Group Health Inc Commercial	$223.58
Rate for Payer: Group Health Inc Medicare	$156.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$223.58
Rate for Payer: Hamaspik Choice Inc Medicare	$223.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$290.65

SCREW CANNLTD SS 6.5 X 110MM

Facility IP

$223.59

Service Code	HCPCS C1713
Hospital Charge Code	64906387
Hospital Revenue Code	278
Min. Negotiated Rate	$111.80
Max. Negotiated Rate	$111.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.80
Rate for Payer: Hamaspik Choice Inc Medicare	$111.80

SCREW CANNLTD SS 6.5 X 110MM

Facility OP

$223.59

Service Code	HCPCS C1713
Hospital Charge Code	64906387
Hospital Revenue Code	278
Min. Negotiated Rate	$78.26
Max. Negotiated Rate	$234.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$122.97
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	$111.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$128.56
Rate for Payer: Fidelis Medicare Advantage	$234.77
Rate for Payer: Group Health Inc Commercial	$111.80
Rate for Payer: Group Health Inc Medicare	$78.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.80
Rate for Payer: Hamaspik Choice Inc Medicare	$111.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$145.33

SCREW CANN SHRT 6.5 X 45MM

Facility IP

$1,150.00

Service Code	HCPCS C1713
Hospital Charge Code	64906844
Hospital Revenue Code	278
Min. Negotiated Rate	$575.00
Max. Negotiated Rate	$575.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00

SCREW CANN SHRT 6.5 X 45MM

Facility OP

$1,150.00

Service Code	HCPCS C1713
Hospital Charge Code	64906844
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,207.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$632.50
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	$575.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$661.25
Rate for Payer: Fidelis Medicare Advantage	$1,207.50
Rate for Payer: Group Health Inc Commercial	$575.00
Rate for Payer: Group Health Inc Medicare	$402.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$747.50

SCREW CANN SHRT 6.5 X 55MM

Facility OP

$1,150.00

Service Code	HCPCS C1713
Hospital Charge Code	64906845
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,207.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$632.50
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	$575.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$661.25
Rate for Payer: Fidelis Medicare Advantage	$1,207.50
Rate for Payer: Group Health Inc Commercial	$575.00
Rate for Payer: Group Health Inc Medicare	$402.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$747.50

SCREW CANN SHRT 6.5 X 55MM

Facility IP

$1,150.00

Service Code	HCPCS C1713
Hospital Charge Code	64906845
Hospital Revenue Code	278
Min. Negotiated Rate	$575.00
Max. Negotiated Rate	$575.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00

SCREW CANNUL 4.0 X 44MM ASNIS

Facility IP

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	64905727
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 CANNUL 4.0 X 44MM ASNIS

Facility OP

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	64905727
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 CANNUL 4X30MM ASNIS

Facility OP

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	64905719
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 CANNUL 4X30MM ASNIS

Facility IP

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	64905719
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 CANNUL 6.5X75MM ASNIS

Facility OP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64905721
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 CANNUL 6.5X75MM ASNIS

Facility IP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64905721
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 CANNUL 8.0 X 105

Facility IP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64905116
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

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