St. Barnabas Hospital

All Charges

Charge

Type

Price

COROENT LI 2X11X26MM 4 DEG

Facility OP

$8,237.50

Service Code	HCPCS C1713
Hospital Charge Code	64904872
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$8,649.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,530.62
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	$4,118.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,736.56
Rate for Payer: Fidelis Medicare Advantage	$8,649.38
Rate for Payer: Group Health Inc Commercial	$4,118.75
Rate for Payer: Group Health Inc Medicare	$2,883.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,118.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,118.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,354.38

COROENT LO 10X10X25MM 5 DEG

Facility IP

$10,920.00

Service Code	HCPCS C1713
Hospital Charge Code	64903718
Hospital Revenue Code	278
Min. Negotiated Rate	$5,460.00
Max. Negotiated Rate	$5,460.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,460.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,460.00

COROENT LO 10X10X25MM 5 DEG

Facility OP

$10,920.00

Service Code	HCPCS C1713
Hospital Charge Code	64903718
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$11,466.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,006.00
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	$5,460.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,279.00
Rate for Payer: Fidelis Medicare Advantage	$11,466.00
Rate for Payer: Group Health Inc Commercial	$5,460.00
Rate for Payer: Group Health Inc Medicare	$3,822.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,460.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,460.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,098.00

COROENT LO 10X10X30 5DEG

Facility OP

$10,500.00

Hospital Charge Code	64905999
Hospital Revenue Code	270
Min. Negotiated Rate	$3,675.00
Max. Negotiated Rate	$8,400.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,775.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,250.00
Rate for Payer: Aetna Government	$5,250.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,140.00
Rate for Payer: Group Health Inc Commercial	$5,250.00
Rate for Payer: Group Health Inc Medicare	$3,675.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,250.00

COROENT LO 12X10X25MM

Facility OP

$10,920.00

Service Code	HCPCS C1713
Hospital Charge Code	64903523
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$11,466.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,006.00
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	$5,460.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,279.00
Rate for Payer: Fidelis Medicare Advantage	$11,466.00
Rate for Payer: Group Health Inc Commercial	$5,460.00
Rate for Payer: Group Health Inc Medicare	$3,822.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,460.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,460.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,098.00

COROENT LO 12X10X25MM

Facility IP

$10,920.00

Service Code	HCPCS C1713
Hospital Charge Code	64903523
Hospital Revenue Code	278
Min. Negotiated Rate	$5,460.00
Max. Negotiated Rate	$5,460.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,460.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,460.00

COROENT LO 12X10X30

Facility OP

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	64903927
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$11,025.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,775.00
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	$5,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,037.50
Rate for Payer: Fidelis Medicare Advantage	$11,025.00
Rate for Payer: Group Health Inc Commercial	$5,250.00
Rate for Payer: Group Health Inc Medicare	$3,675.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,825.00

COROENT LO 12X10X30

Facility IP

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	64903927
Hospital Revenue Code	278
Min. Negotiated Rate	$5,250.00
Max. Negotiated Rate	$5,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,250.00

COROENT LO 12X10X40MM 5 DG

Facility OP

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	64904079
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$11,025.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,775.00
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	$5,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,037.50
Rate for Payer: Fidelis Medicare Advantage	$11,025.00
Rate for Payer: Group Health Inc Commercial	$5,250.00
Rate for Payer: Group Health Inc Medicare	$3,675.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,825.00

COROENT LO 12X10X40MM 5 DG

Facility IP

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	64904079
Hospital Revenue Code	278
Min. Negotiated Rate	$5,250.00
Max. Negotiated Rate	$5,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,250.00

COROENTLO 8X10X30 5DEG

Facility IP

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	64903921
Hospital Revenue Code	278
Min. Negotiated Rate	$5,250.00
Max. Negotiated Rate	$5,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,250.00

COROENTLO 8X10X30 5DEG

Facility OP

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	64903921
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$11,025.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,775.00
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	$5,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,037.50
Rate for Payer: Fidelis Medicare Advantage	$11,025.00
Rate for Payer: Group Health Inc Commercial	$5,250.00
Rate for Payer: Group Health Inc Medicare	$3,675.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,825.00

COROENT SI SCREW, 4X12MM SELFT

Facility OP

$917.50

Service Code	HCPCS C1713
Hospital Charge Code	64905277
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$963.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$504.62
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	$458.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$527.56
Rate for Payer: Fidelis Medicare Advantage	$963.38
Rate for Payer: Group Health Inc Commercial	$458.75
Rate for Payer: Group Health Inc Medicare	$321.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$458.75
Rate for Payer: Hamaspik Choice Inc Medicare	$458.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$596.38

COROENT SI SCREW, 4X12MM SELFT

Facility IP

$917.50

Service Code	HCPCS C1713
Hospital Charge Code	64905277
Hospital Revenue Code	278
Min. Negotiated Rate	$458.75
Max. Negotiated Rate	$458.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$458.75
Rate for Payer: Hamaspik Choice Inc Medicare	$458.75

COROENT SI SCREW, 4X14MM SELFT

Facility OP

$917.50

Service Code	HCPCS C1713
Hospital Charge Code	64905276
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$963.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$504.62
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	$458.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$527.56
Rate for Payer: Fidelis Medicare Advantage	$963.38
Rate for Payer: Group Health Inc Commercial	$458.75
Rate for Payer: Group Health Inc Medicare	$321.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$458.75
Rate for Payer: Hamaspik Choice Inc Medicare	$458.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$596.38

COROENT SI SCREW, 4X14MM SELFT

Facility IP

$917.50

Service Code	HCPCS C1713
Hospital Charge Code	64905276
Hospital Revenue Code	278
Min. Negotiated Rate	$458.75
Max. Negotiated Rate	$458.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$458.75
Rate for Payer: Hamaspik Choice Inc Medicare	$458.75

COROENT SMALL, 7X13X15MM LORDO

Facility OP

$4,142.50

Service Code	HCPCS C1713
Hospital Charge Code	64905574
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,349.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,278.38
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	$2,071.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,381.94
Rate for Payer: Fidelis Medicare Advantage	$4,349.62
Rate for Payer: Group Health Inc Commercial	$2,071.25
Rate for Payer: Group Health Inc Medicare	$1,449.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,071.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,071.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,692.62

COROENT SMALL, 7X13X15MM LORDO

Facility IP

$4,142.50

Service Code	HCPCS C1713
Hospital Charge Code	64905574
Hospital Revenue Code	278
Min. Negotiated Rate	$2,071.25
Max. Negotiated Rate	$2,071.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,071.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,071.25

COROENT SMALL, 8X13X15MM LORDO

Facility OP

$4,142.50

Service Code	HCPCS C1713
Hospital Charge Code	64905572
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,349.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,278.38
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	$2,071.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,381.94
Rate for Payer: Fidelis Medicare Advantage	$4,349.62
Rate for Payer: Group Health Inc Commercial	$2,071.25
Rate for Payer: Group Health Inc Medicare	$1,449.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,071.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,071.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,692.62

COROENT SMALL, 8X13X15MM LORDO

Facility IP

$4,142.50

Service Code	HCPCS C1713
Hospital Charge Code	64905572
Hospital Revenue Code	278
Min. Negotiated Rate	$2,071.25
Max. Negotiated Rate	$2,071.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,071.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,071.25

COROENT SM CONTOUR, M6

Facility IP

$4,142.50

Service Code	HCPCS C1713
Hospital Charge Code	64905423
Hospital Revenue Code	278
Min. Negotiated Rate	$2,071.25
Max. Negotiated Rate	$2,071.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,071.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,071.25

COROENT SM CONTOUR, M6

Facility OP

$4,142.50

Service Code	HCPCS C1713
Hospital Charge Code	64905423
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,349.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,278.38
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	$2,071.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,381.94
Rate for Payer: Fidelis Medicare Advantage	$4,349.62
Rate for Payer: Group Health Inc Commercial	$2,071.25
Rate for Payer: Group Health Inc Medicare	$1,449.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,071.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,071.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,692.62

COROENT SM INTERLOCK 7X17X14 7

Facility OP

$7,105.00

Service Code	HCPCS C1713
Hospital Charge Code	64905274
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$7,460.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,907.75
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	$3,552.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,085.38
Rate for Payer: Fidelis Medicare Advantage	$7,460.25
Rate for Payer: Group Health Inc Commercial	$3,552.50
Rate for Payer: Group Health Inc Medicare	$2,486.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,552.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,552.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,618.25

COROENT SM INTERLOCK 7X17X14 7

Facility IP

$7,105.00

Service Code	HCPCS C1713
Hospital Charge Code	64905274
Hospital Revenue Code	278
Min. Negotiated Rate	$3,552.50
Max. Negotiated Rate	$3,552.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,552.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,552.50

COROENT SM INTERLOCK 8X17X14 7

Facility IP

$7,105.00

Service Code	HCPCS C1713
Hospital Charge Code	64905275
Hospital Revenue Code	278
Min. Negotiated Rate	$3,552.50
Max. Negotiated Rate	$3,552.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,552.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,552.50

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