St. Barnabas Hospital

All Charges

Charge

Type

Price

STR 1.7X8MM SCREW CROSS PIN SLFTP

Facility IP

$110.42

Service Code	HCPCS C1713
Hospital Charge Code	40204680
Hospital Revenue Code	278
Min. Negotiated Rate	$55.21
Max. Negotiated Rate	$55.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.21
Rate for Payer: Hamaspik Choice Inc Medicare	$55.21

STR 1.9X5MM SCR CROSS PIN SLFTP

Facility IP

$98.42

Service Code	HCPCS C1713
Hospital Charge Code	40204674
Hospital Revenue Code	278
Min. Negotiated Rate	$49.21
Max. Negotiated Rate	$49.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.21
Rate for Payer: Hamaspik Choice Inc Medicare	$49.21

STR 1.9X5MM SCR CROSS PIN SLFTP

Facility OP

$98.42

Service Code	HCPCS C1713
Hospital Charge Code	40204674
Hospital Revenue Code	278
Min. Negotiated Rate	$34.45
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$54.13
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	$49.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$56.59
Rate for Payer: Fidelis Medicare Advantage	$103.34
Rate for Payer: Group Health Inc Commercial	$49.21
Rate for Payer: Group Health Inc Medicare	$34.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.21
Rate for Payer: Hamaspik Choice Inc Medicare	$49.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$63.97

STR 2.0 SELF DRIL LK SCR 2.0X6MM

Facility OP

$252.00

Service Code	HCPCS C1713
Hospital Charge Code	40204442
Hospital Revenue Code	278
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$264.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$138.60
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	$126.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.90
Rate for Payer: Fidelis Medicare Advantage	$264.60
Rate for Payer: Group Health Inc Commercial	$126.00
Rate for Payer: Group Health Inc Medicare	$88.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.00
Rate for Payer: Hamaspik Choice Inc Medicare	$126.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$163.80

STR 2.0 SELF DRIL LK SCR 2.0X6MM

Facility IP

$252.00

Service Code	HCPCS C1713
Hospital Charge Code	40204442
Hospital Revenue Code	278
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$126.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.00
Rate for Payer: Hamaspik Choice Inc Medicare	$126.00

STR 2.0 SELF DRL LK SCR 2.0X8MM

Facility OP

$252.00

Service Code	HCPCS C1713
Hospital Charge Code	40204443
Hospital Revenue Code	278
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$264.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$138.60
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	$126.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.90
Rate for Payer: Fidelis Medicare Advantage	$264.60
Rate for Payer: Group Health Inc Commercial	$126.00
Rate for Payer: Group Health Inc Medicare	$88.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.00
Rate for Payer: Hamaspik Choice Inc Medicare	$126.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$163.80

STR 2.0 SELF DRL LK SCR 2.0X8MM

Facility IP

$252.00

Service Code	HCPCS C1713
Hospital Charge Code	40204443
Hospital Revenue Code	278
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$126.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.00
Rate for Payer: Hamaspik Choice Inc Medicare	$126.00

STR 2.0X10MM BN SCREW CR PIN

Facility IP

$85.68

Service Code	HCPCS C1713
Hospital Charge Code	40203436
Hospital Revenue Code	278
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$42.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.84
Rate for Payer: Hamaspik Choice Inc Medicare	$42.84

STR 2.0X10MM BN SCREW CR PIN

Facility OP

$85.68

Service Code	HCPCS C1713
Hospital Charge Code	40203436
Hospital Revenue Code	278
Min. Negotiated Rate	$29.99
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.12
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	$42.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.27
Rate for Payer: Fidelis Medicare Advantage	$89.96
Rate for Payer: Group Health Inc Commercial	$42.84
Rate for Payer: Group Health Inc Medicare	$29.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.84
Rate for Payer: Hamaspik Choice Inc Medicare	$42.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$55.69

STR 2.0X10MM LCK SCREW CR PIN

Facility IP

$156.38

Service Code	HCPCS C1713
Hospital Charge Code	40203435
Hospital Revenue Code	278
Min. Negotiated Rate	$78.19
Max. Negotiated Rate	$78.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.19
Rate for Payer: Hamaspik Choice Inc Medicare	$78.19

STR 2.0X10MM LCK SCREW CR PIN

Facility OP

$156.38

Service Code	HCPCS C1713
Hospital Charge Code	40203435
Hospital Revenue Code	278
Min. Negotiated Rate	$54.73
Max. Negotiated Rate	$164.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.01
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	$78.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$89.92
Rate for Payer: Fidelis Medicare Advantage	$164.20
Rate for Payer: Group Health Inc Commercial	$78.19
Rate for Payer: Group Health Inc Medicare	$54.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.19
Rate for Payer: Hamaspik Choice Inc Medicare	$78.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$101.65

STR 2.0X12MM BN SCREW CR PIN

Facility OP

$85.68

Service Code	HCPCS C1713
Hospital Charge Code	40203434
Hospital Revenue Code	278
Min. Negotiated Rate	$29.99
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.12
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	$42.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.27
Rate for Payer: Fidelis Medicare Advantage	$89.96
Rate for Payer: Group Health Inc Commercial	$42.84
Rate for Payer: Group Health Inc Medicare	$29.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.84
Rate for Payer: Hamaspik Choice Inc Medicare	$42.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$55.69

STR 2.0X12MM BN SCREW CR PIN

Facility IP

$85.68

Service Code	HCPCS C1713
Hospital Charge Code	40203434
Hospital Revenue Code	278
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$42.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.84
Rate for Payer: Hamaspik Choice Inc Medicare	$42.84

STR 2.0X14MM BONE SCREW CROSS PIN

Facility IP

$104.62

Service Code	HCPCS C1713
Hospital Charge Code	40204687
Hospital Revenue Code	278
Min. Negotiated Rate	$52.31
Max. Negotiated Rate	$52.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.31
Rate for Payer: Hamaspik Choice Inc Medicare	$52.31

STR 2.0X14MM BONE SCREW CROSS PIN

Facility OP

$104.62

Service Code	HCPCS C1713
Hospital Charge Code	40204687
Hospital Revenue Code	278
Min. Negotiated Rate	$36.62
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.54
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	$52.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$60.16
Rate for Payer: Fidelis Medicare Advantage	$109.85
Rate for Payer: Group Health Inc Commercial	$52.31
Rate for Payer: Group Health Inc Medicare	$36.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.31
Rate for Payer: Hamaspik Choice Inc Medicare	$52.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$68.00

STR 2.0X16MM BONE SCREW CROSS PIN

Facility IP

$104.62

Service Code	HCPCS C1713
Hospital Charge Code	40204688
Hospital Revenue Code	278
Min. Negotiated Rate	$52.31
Max. Negotiated Rate	$52.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.31
Rate for Payer: Hamaspik Choice Inc Medicare	$52.31

STR 2.0X16MM BONE SCREW CROSS PIN

Facility OP

$104.62

Service Code	HCPCS C1713
Hospital Charge Code	40204688
Hospital Revenue Code	278
Min. Negotiated Rate	$36.62
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.54
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	$52.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$60.16
Rate for Payer: Fidelis Medicare Advantage	$109.85
Rate for Payer: Group Health Inc Commercial	$52.31
Rate for Payer: Group Health Inc Medicare	$36.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.31
Rate for Payer: Hamaspik Choice Inc Medicare	$52.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$68.00

STR 2.0X4MM BONE SCREW CROSS PIN

Facility IP

$104.62

Service Code	HCPCS C1713
Hospital Charge Code	40204685
Hospital Revenue Code	278
Min. Negotiated Rate	$52.31
Max. Negotiated Rate	$52.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.31
Rate for Payer: Hamaspik Choice Inc Medicare	$52.31

STR 2.0X4MM BONE SCREW CROSS PIN

Facility OP

$104.62

Service Code	HCPCS C1713
Hospital Charge Code	40204685
Hospital Revenue Code	278
Min. Negotiated Rate	$36.62
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.54
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	$52.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$60.16
Rate for Payer: Fidelis Medicare Advantage	$109.85
Rate for Payer: Group Health Inc Commercial	$52.31
Rate for Payer: Group Health Inc Medicare	$36.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.31
Rate for Payer: Hamaspik Choice Inc Medicare	$52.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$68.00

STR 2.0X4MM LCKNG SCREW CROSS PIN

Facility OP

$197.74

Service Code	HCPCS C1713
Hospital Charge Code	40204684
Hospital Revenue Code	278
Min. Negotiated Rate	$69.21
Max. Negotiated Rate	$207.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$108.76
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	$98.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$113.70
Rate for Payer: Fidelis Medicare Advantage	$207.63
Rate for Payer: Group Health Inc Commercial	$98.87
Rate for Payer: Group Health Inc Medicare	$69.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$98.87
Rate for Payer: Hamaspik Choice Inc Medicare	$98.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$128.53

STR 2.0X4MM LCKNG SCREW CROSS PIN

Facility IP

$197.74

Service Code	HCPCS C1713
Hospital Charge Code	40204684
Hospital Revenue Code	278
Min. Negotiated Rate	$98.87
Max. Negotiated Rate	$98.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$98.87
Rate for Payer: Hamaspik Choice Inc Medicare	$98.87

STR 2.0X4MM LOCK CROSS PIN

Facility IP

$156.38

Service Code	HCPCS C1713
Hospital Charge Code	40204445
Hospital Revenue Code	278
Min. Negotiated Rate	$78.19
Max. Negotiated Rate	$78.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.19
Rate for Payer: Hamaspik Choice Inc Medicare	$78.19

STR 2.0X4MM LOCK CROSS PIN

Facility OP

$156.38

Service Code	HCPCS C1713
Hospital Charge Code	40204445
Hospital Revenue Code	278
Min. Negotiated Rate	$54.73
Max. Negotiated Rate	$164.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.01
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	$78.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$89.92
Rate for Payer: Fidelis Medicare Advantage	$164.20
Rate for Payer: Group Health Inc Commercial	$78.19
Rate for Payer: Group Health Inc Medicare	$54.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.19
Rate for Payer: Hamaspik Choice Inc Medicare	$78.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$101.65

STR 2.0X5MM LCKNG SCREW CROSS PIN

Facility IP

$191.74

Service Code	HCPCS C1713
Hospital Charge Code	40204683
Hospital Revenue Code	278
Min. Negotiated Rate	$95.87
Max. Negotiated Rate	$95.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.87
Rate for Payer: Hamaspik Choice Inc Medicare	$95.87

STR 2.0X5MM LCKNG SCREW CROSS PIN

Facility OP

$191.74

Service Code	HCPCS C1713
Hospital Charge Code	40204683
Hospital Revenue Code	278
Min. Negotiated Rate	$67.11
Max. Negotiated Rate	$201.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$105.46
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	$95.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$110.25
Rate for Payer: Fidelis Medicare Advantage	$201.33
Rate for Payer: Group Health Inc Commercial	$95.87
Rate for Payer: Group Health Inc Medicare	$67.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.87
Rate for Payer: Hamaspik Choice Inc Medicare	$95.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$124.63

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