St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SCREW CANNLTD 4.5 X 22MM

Facility

$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 6.5 X 115MM

Facility

$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

$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: Brighton Health Commercial	$268.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$223.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$257.12
Rate for Payer: EmblemHealth Commercial	$223.58
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

$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

$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: Brighton Health Commercial	$134.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$111.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$128.56
Rate for Payer: EmblemHealth Commercial	$111.80
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

$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

$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: Brighton Health Commercial	$690.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$575.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$661.25
Rate for Payer: EmblemHealth Commercial	$575.00
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

$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 CANN SHRT 6.5 X 55MM

Facility

$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: Brighton Health Commercial	$690.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$575.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$661.25
Rate for Payer: EmblemHealth Commercial	$575.00
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 CANNUL 4.0 X 44MM ASNIS

Facility

$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

$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: 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 CANNUL 4X30MM ASNIS

Facility

$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 4X30MM ASNIS

Facility

$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: 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 CANNUL 6.5X75MM ASNIS

Facility

$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: 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 CANNUL 6.5X75MM ASNIS

Facility

$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

$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

SCREW CANNUL 8.0 X 105

Facility

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64905116
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: Brighton Health Commercial	$364.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$303.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$349.46
Rate for Payer: EmblemHealth Commercial	$303.88
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 CANNUL 8.0X85MM ASNIS

Facility

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64905722
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 CANNUL 8.0X85MM ASNIS

Facility

$607.75

Service Code	HCPCS C1713
Hospital Charge Code	64905722
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: Brighton Health Commercial	$364.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$303.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$349.46
Rate for Payer: EmblemHealth Commercial	$303.88
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 CANNUL ASNIS III 4X42MM

Facility

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	64905909
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 CANNUL ASNIS III 4X42MM

Facility

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	64905909
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 CANNULATED

Facility

$237.50

Service Code	HCPCS C1713
Hospital Charge Code	64907325
Hospital Revenue Code	278
Min. Negotiated Rate	$83.12
Max. Negotiated Rate	$249.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$142.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$118.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.56
Rate for Payer: EmblemHealth Commercial	$118.75
Rate for Payer: Fidelis Medicare Advantage	$249.38
Rate for Payer: Group Health Inc Commercial	$118.75
Rate for Payer: Group Health Inc Medicare	$83.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.75
Rate for Payer: Hamaspik Choice Inc Medicare	$118.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.38

SCREW CANNULATED

Facility

$374.00

Service Code	HCPCS C1713
Hospital Charge Code	40201126
Hospital Revenue Code	278
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$392.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$205.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$224.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$187.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$215.05
Rate for Payer: EmblemHealth Commercial	$187.00
Rate for Payer: Fidelis Medicare Advantage	$392.70
Rate for Payer: Group Health Inc Commercial	$187.00
Rate for Payer: Group Health Inc Medicare	$130.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00
Rate for Payer: Hamaspik Choice Inc Medicare	$187.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$243.10

SCREW CANNULATED

Facility

$374.00

Service Code	HCPCS C1713
Hospital Charge Code	40201126
Hospital Revenue Code	278
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$187.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00
Rate for Payer: Hamaspik Choice Inc Medicare	$187.00

SCREW CANNULATED

Facility

$237.50

Service Code	HCPCS C1713
Hospital Charge Code	64907325
Hospital Revenue Code	278
Min. Negotiated Rate	$118.75
Max. Negotiated Rate	$118.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.75
Rate for Payer: Hamaspik Choice Inc Medicare	$118.75

Know your out-of-pocket cost for care.

All Charges