St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SCREW BONE CANNUL LP 3MM 12MM

Facility

$450.13

Service Code	HCPCS C1713
Hospital Charge Code	64902317
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$472.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$247.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$270.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$225.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$258.82
Rate for Payer: EmblemHealth Commercial	$225.06
Rate for Payer: Fidelis Medicare Advantage	$472.64
Rate for Payer: Group Health Inc Commercial	$225.06
Rate for Payer: Group Health Inc Medicare	$157.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.06
Rate for Payer: Hamaspik Choice Inc Medicare	$225.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$292.58

SCREW BONE CANNUL LP 3MM 12MM

Facility

$450.13

Service Code	HCPCS C1713
Hospital Charge Code	64902317
Hospital Revenue Code	278
Min. Negotiated Rate	$225.06
Max. Negotiated Rate	$225.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.06
Rate for Payer: Hamaspik Choice Inc Medicare	$225.06

SCREW BONE CANNUL LP 3MM 13MM

Facility

$514.50

Service Code	HCPCS C1713
Hospital Charge Code	64902314
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$540.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$282.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$308.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$257.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$295.84
Rate for Payer: EmblemHealth Commercial	$257.25
Rate for Payer: Fidelis Medicare Advantage	$540.22
Rate for Payer: Group Health Inc Commercial	$257.25
Rate for Payer: Group Health Inc Medicare	$180.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$257.25
Rate for Payer: Hamaspik Choice Inc Medicare	$257.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$334.42

SCREW BONE CANNUL LP 3MM 13MM

Facility

$514.50

Service Code	HCPCS C1713
Hospital Charge Code	64902314
Hospital Revenue Code	278
Min. Negotiated Rate	$257.25
Max. Negotiated Rate	$257.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$257.25
Rate for Payer: Hamaspik Choice Inc Medicare	$257.25

SCREW BONE CANNUL LP 3MM 15MM

Facility

$450.13

Service Code	HCPCS C1713
Hospital Charge Code	64902059
Hospital Revenue Code	278
Min. Negotiated Rate	$225.06
Max. Negotiated Rate	$225.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.06
Rate for Payer: Hamaspik Choice Inc Medicare	$225.06

SCREW BONE CANNUL LP 3MM 15MM

Facility

$450.13

Service Code	HCPCS C1713
Hospital Charge Code	64902059
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$472.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$247.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$270.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$225.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$258.82
Rate for Payer: EmblemHealth Commercial	$225.06
Rate for Payer: Fidelis Medicare Advantage	$472.64
Rate for Payer: Group Health Inc Commercial	$225.06
Rate for Payer: Group Health Inc Medicare	$157.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.06
Rate for Payer: Hamaspik Choice Inc Medicare	$225.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$292.58

SCREW BONE CANNUL LP 3MM 17MM

Facility

$450.13

Service Code	HCPCS C1713
Hospital Charge Code	64902027
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$472.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$247.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$270.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$225.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$258.82
Rate for Payer: EmblemHealth Commercial	$225.06
Rate for Payer: Fidelis Medicare Advantage	$472.64
Rate for Payer: Group Health Inc Commercial	$225.06
Rate for Payer: Group Health Inc Medicare	$157.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.06
Rate for Payer: Hamaspik Choice Inc Medicare	$225.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$292.58

SCREW BONE CANNUL LP 3MM 17MM

Facility

$450.13

Service Code	HCPCS C1713
Hospital Charge Code	64902027
Hospital Revenue Code	278
Min. Negotiated Rate	$225.06
Max. Negotiated Rate	$225.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.06
Rate for Payer: Hamaspik Choice Inc Medicare	$225.06

SCREW BONE CANNUL LP 3MM 19MM

Facility

$450.13

Service Code	HCPCS C1713
Hospital Charge Code	64902419
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$472.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$247.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$270.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$225.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$258.82
Rate for Payer: EmblemHealth Commercial	$225.06
Rate for Payer: Fidelis Medicare Advantage	$472.64
Rate for Payer: Group Health Inc Commercial	$225.06
Rate for Payer: Group Health Inc Medicare	$157.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.06
Rate for Payer: Hamaspik Choice Inc Medicare	$225.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$292.58

SCREW BONE CANNUL LP 3MM 19MM

Facility

$450.13

Service Code	HCPCS C1713
Hospital Charge Code	64902419
Hospital Revenue Code	278
Min. Negotiated Rate	$225.06
Max. Negotiated Rate	$225.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.06
Rate for Payer: Hamaspik Choice Inc Medicare	$225.06

SCREW BONE CANNUL LP 3MM 28MM

Facility

$450.13

Service Code	HCPCS C1713
Hospital Charge Code	64902145
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$472.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$247.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$270.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$225.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$258.82
Rate for Payer: EmblemHealth Commercial	$225.06
Rate for Payer: Fidelis Medicare Advantage	$472.64
Rate for Payer: Group Health Inc Commercial	$225.06
Rate for Payer: Group Health Inc Medicare	$157.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.06
Rate for Payer: Hamaspik Choice Inc Medicare	$225.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$292.58

SCREW BONE CANNUL LP 3MM 28MM

Facility

$450.13

Service Code	HCPCS C1713
Hospital Charge Code	64902145
Hospital Revenue Code	278
Min. Negotiated Rate	$225.06
Max. Negotiated Rate	$225.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.06
Rate for Payer: Hamaspik Choice Inc Medicare	$225.06

SCREW BONE CANNUL LP 3MM 30MM

Facility

$450.13

Service Code	HCPCS C1713
Hospital Charge Code	64902029
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$472.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$247.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$270.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$225.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$258.82
Rate for Payer: EmblemHealth Commercial	$225.06
Rate for Payer: Fidelis Medicare Advantage	$472.64
Rate for Payer: Group Health Inc Commercial	$225.06
Rate for Payer: Group Health Inc Medicare	$157.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.06
Rate for Payer: Hamaspik Choice Inc Medicare	$225.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$292.58

SCREW BONE CANNUL LP 3MM 30MM

Facility

$450.13

Service Code	HCPCS C1713
Hospital Charge Code	64902029
Hospital Revenue Code	278
Min. Negotiated Rate	$225.06
Max. Negotiated Rate	$225.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.06
Rate for Payer: Hamaspik Choice Inc Medicare	$225.06

SCREW BONE CANNUL LP 5MM/2.5MM

Facility

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	64903103
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: Brighton Health Commercial	$234.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$195.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$224.25
Rate for Payer: EmblemHealth Commercial	$195.00
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 BONE CANNUL LP 5MM/2.5MM

Facility

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	64903103
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 BONE CANNUL LP 6.5MM DIA1

Facility

$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: Brighton Health Commercial	$368.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$307.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$353.19
Rate for Payer: EmblemHealth Commercial	$307.12
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 DIA1

Facility

$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 DIA2

Facility

$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: Brighton Health Commercial	$368.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$307.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$353.19
Rate for Payer: EmblemHealth Commercial	$307.12
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

$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 DIA3

Facility

$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: Brighton Health Commercial	$368.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$307.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$353.19
Rate for Payer: EmblemHealth Commercial	$307.12
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

$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

$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: Brighton Health Commercial	$368.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$307.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$353.19
Rate for Payer: EmblemHealth Commercial	$307.12
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 DIA4

Facility

$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 DIA6

Facility

$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

Know your out-of-pocket cost for care.

All Charges