St. Barnabas Hospital

All Charges

Charge

Type

Price

SCREW CANNULATED 8.0 X 100

Facility OP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64903200
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 CANNULATED 8.0 X 100

Facility IP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64903200
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 CANNULATED 8.0 X 110

Facility OP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64902884
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 CANNULATED 8.0 X 110

Facility IP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64902884
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 CANNULATED 8.0 X 75MM

Facility OP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64902474
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 CANNULATED 8.0 X 75MM

Facility IP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64902474
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 CANNULATED PT 6.5X105MM

Facility OP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64902624
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 CANNULATED PT 6.5X105MM

Facility IP

$614.25

Service Code	HCPCS C1713
Hospital Charge Code	64902624
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 CANNULATED ST SS 7.3

Facility IP

$456.00

Service Code	HCPCS C1713
Hospital Charge Code	40205125
Hospital Revenue Code	278
Min. Negotiated Rate	$228.00
Max. Negotiated Rate	$228.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$228.00
Rate for Payer: Hamaspik Choice Inc Medicare	$228.00

SCREW CANNULATED ST SS 7.3

Facility OP

$456.00

Service Code	HCPCS C1713
Hospital Charge Code	40205125
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$478.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$250.80
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	$228.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$262.20
Rate for Payer: Fidelis Medicare Advantage	$478.80
Rate for Payer: Group Health Inc Commercial	$228.00
Rate for Payer: Group Health Inc Medicare	$159.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$228.00
Rate for Payer: Hamaspik Choice Inc Medicare	$228.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$296.40

SCREW CANNULATED ST SS 7.3X130MM

Facility OP

$340.00

Service Code	HCPCS C1713
Hospital Charge Code	40200156
Hospital Revenue Code	278
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$357.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$187.00
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	$170.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$195.50
Rate for Payer: Fidelis Medicare Advantage	$357.00
Rate for Payer: Group Health Inc Commercial	$170.00
Rate for Payer: Group Health Inc Medicare	$119.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$170.00
Rate for Payer: Hamaspik Choice Inc Medicare	$170.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$221.00

SCREW CANNULATED ST SS 7.3X130MM

Facility IP

$340.00

Service Code	HCPCS C1713
Hospital Charge Code	40200156
Hospital Revenue Code	278
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$170.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$170.00
Rate for Payer: Hamaspik Choice Inc Medicare	$170.00

SCREW CANNULTD ASNIX III SS 8X100

Facility OP

$486.20

Service Code	HCPCS C1713
Hospital Charge Code	40006563
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$510.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$267.41
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	$243.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$279.56
Rate for Payer: Fidelis Medicare Advantage	$510.51
Rate for Payer: Group Health Inc Commercial	$243.10
Rate for Payer: Group Health Inc Medicare	$170.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.10
Rate for Payer: Hamaspik Choice Inc Medicare	$243.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$316.03

SCREW CANNULTD ASNIX III SS 8X100

Facility IP

$486.20

Service Code	HCPCS C1713
Hospital Charge Code	40006563
Hospital Revenue Code	278
Min. Negotiated Rate	$243.10
Max. Negotiated Rate	$243.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.10
Rate for Payer: Hamaspik Choice Inc Medicare	$243.10

SCREW CANNUL TI ASN III 4X48MM

Facility IP

$156.00

Service Code	HCPCS C1713
Hospital Charge Code	64906250
Hospital Revenue Code	278
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$78.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.00
Rate for Payer: Hamaspik Choice Inc Medicare	$78.00

SCREW CANNUL TI ASN III 4X48MM

Facility OP

$156.00

Service Code	HCPCS C1713
Hospital Charge Code	64906250
Hospital Revenue Code	278
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$163.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.80
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	$78.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$89.70
Rate for Payer: Fidelis Medicare Advantage	$163.80
Rate for Payer: Group Health Inc Commercial	$78.00
Rate for Payer: Group Health Inc Medicare	$54.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.00
Rate for Payer: Hamaspik Choice Inc Medicare	$78.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$101.40

SCREW CANULL 8.0 X 115

Facility OP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64905138
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 CANULL 8.0 X 115

Facility IP

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64905138
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 CANULTD SS 6.5 X 75MM

Facility OP

$447.18

Service Code	HCPCS C1713
Hospital Charge Code	64906575
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$469.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$245.95
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	$223.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$257.13
Rate for Payer: Fidelis Medicare Advantage	$469.54
Rate for Payer: Group Health Inc Commercial	$223.59
Rate for Payer: Group Health Inc Medicare	$156.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$223.59
Rate for Payer: Hamaspik Choice Inc Medicare	$223.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$290.67

SCREW CANULTD SS 6.5 X 75MM

Facility IP

$447.18

Service Code	HCPCS C1713
Hospital Charge Code	64906575
Hospital Revenue Code	278
Min. Negotiated Rate	$223.59
Max. Negotiated Rate	$223.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$223.59
Rate for Payer: Hamaspik Choice Inc Medicare	$223.59

SCREW CANULTD SS 6.5 X 85MM

Facility OP

$447.18

Service Code	HCPCS C1713
Hospital Charge Code	64906576
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$469.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$245.95
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	$223.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$257.13
Rate for Payer: Fidelis Medicare Advantage	$469.54
Rate for Payer: Group Health Inc Commercial	$223.59
Rate for Payer: Group Health Inc Medicare	$156.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$223.59
Rate for Payer: Hamaspik Choice Inc Medicare	$223.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$290.67

SCREW CANULTD SS 6.5 X 85MM

Facility IP

$447.18

Service Code	HCPCS C1713
Hospital Charge Code	64906576
Hospital Revenue Code	278
Min. Negotiated Rate	$223.59
Max. Negotiated Rate	$223.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$223.59
Rate for Payer: Hamaspik Choice Inc Medicare	$223.59

SCREW CENTRAL 6.5 X 25MM

Facility OP

$187.50

Service Code	HCPCS C1713
Hospital Charge Code	64906968
Hospital Revenue Code	278
Min. Negotiated Rate	$65.62
Max. Negotiated Rate	$196.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$103.12
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	$93.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$107.81
Rate for Payer: Fidelis Medicare Advantage	$196.88
Rate for Payer: Group Health Inc Commercial	$93.75
Rate for Payer: Group Health Inc Medicare	$65.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$93.75
Rate for Payer: Hamaspik Choice Inc Medicare	$93.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$121.88

SCREW CENTRAL 6.5 X 25MM

Facility IP

$187.50

Service Code	HCPCS C1713
Hospital Charge Code	64906968
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$93.75
Rate for Payer: Hamaspik Choice Inc Medicare	$93.75

SCREW CENTRAL SHLDR REV

Facility OP

$187.50

Service Code	HCPCS C1713
Hospital Charge Code	64907002
Hospital Revenue Code	278
Min. Negotiated Rate	$65.62
Max. Negotiated Rate	$196.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$103.12
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	$93.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$107.81
Rate for Payer: Fidelis Medicare Advantage	$196.88
Rate for Payer: Group Health Inc Commercial	$93.75
Rate for Payer: Group Health Inc Medicare	$65.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$93.75
Rate for Payer: Hamaspik Choice Inc Medicare	$93.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$121.88

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