St. Barnabas Hospital

All Charges

Charge

Type

Price

STRY 2.0X12MM BONE SCREW CRSS PIN

Facility IP

$85.68

Service Code	HCPCS C1713
Hospital Charge Code	40204716
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

STRY 2.0X12MM LCKNG SCR CROSS PIN

Facility OP

$156.44

Service Code	HCPCS C1713
Hospital Charge Code	40203424
Hospital Revenue Code	278
Min. Negotiated Rate	$54.75
Max. Negotiated Rate	$164.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.04
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	$78.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$89.95
Rate for Payer: Fidelis Medicare Advantage	$164.26
Rate for Payer: Group Health Inc Commercial	$78.22
Rate for Payer: Group Health Inc Medicare	$54.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.22
Rate for Payer: Hamaspik Choice Inc Medicare	$78.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$101.69

STRY 2.0X12MM LCKNG SCR CROSS PIN

Facility IP

$156.44

Service Code	HCPCS C1713
Hospital Charge Code	40203424
Hospital Revenue Code	278
Min. Negotiated Rate	$78.22
Max. Negotiated Rate	$78.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.22
Rate for Payer: Hamaspik Choice Inc Medicare	$78.22

STRY 2.0X14MM LCKNG SCR CROSS PIN

Facility IP

$156.44

Service Code	HCPCS C1713
Hospital Charge Code	40203412
Hospital Revenue Code	278
Min. Negotiated Rate	$78.22
Max. Negotiated Rate	$78.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.22
Rate for Payer: Hamaspik Choice Inc Medicare	$78.22

STRY 2.0X14MM LCKNG SCR CROSS PIN

Facility OP

$156.44

Service Code	HCPCS C1713
Hospital Charge Code	40203412
Hospital Revenue Code	278
Min. Negotiated Rate	$54.75
Max. Negotiated Rate	$164.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.04
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	$78.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$89.95
Rate for Payer: Fidelis Medicare Advantage	$164.26
Rate for Payer: Group Health Inc Commercial	$78.22
Rate for Payer: Group Health Inc Medicare	$54.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.22
Rate for Payer: Hamaspik Choice Inc Medicare	$78.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$101.69

STRY 22MM AVIATOR PLT

Facility IP

$4,582.50

Service Code	HCPCS C1713
Hospital Charge Code	40001792
Hospital Revenue Code	278
Min. Negotiated Rate	$2,291.25
Max. Negotiated Rate	$2,291.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,291.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,291.25

STRY 22MM AVIATOR PLT

Facility OP

$4,582.50

Service Code	HCPCS C1713
Hospital Charge Code	40001792
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,811.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,520.38
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	$2,291.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,634.94
Rate for Payer: Fidelis Medicare Advantage	$4,811.62
Rate for Payer: Group Health Inc Commercial	$2,291.25
Rate for Payer: Group Health Inc Medicare	$1,603.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,291.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,291.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,978.62

STRY 2.3MM 2 X 4 HOLES 3DLK PLT

Facility OP

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	40203444
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$887.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$464.75
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	$422.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$485.88
Rate for Payer: Fidelis Medicare Advantage	$887.25
Rate for Payer: Group Health Inc Commercial	$422.50
Rate for Payer: Group Health Inc Medicare	$295.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$422.50
Rate for Payer: Hamaspik Choice Inc Medicare	$422.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$549.25

STRY 2.3MM 2 X 4 HOLES 3DLK PLT

Facility IP

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	40203444
Hospital Revenue Code	278
Min. Negotiated Rate	$422.50
Max. Negotiated Rate	$422.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$422.50
Rate for Payer: Hamaspik Choice Inc Medicare	$422.50

STRY 2.3MM 2X4HOLES 3DLOCKING PLT

Facility IP

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	40204726
Hospital Revenue Code	278
Min. Negotiated Rate	$422.50
Max. Negotiated Rate	$422.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$422.50
Rate for Payer: Hamaspik Choice Inc Medicare	$422.50

STRY 2.3MM 2X4HOLES 3DLOCKING PLT

Facility OP

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	40204726
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$887.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$464.75
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	$422.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$485.88
Rate for Payer: Fidelis Medicare Advantage	$887.25
Rate for Payer: Group Health Inc Commercial	$422.50
Rate for Payer: Group Health Inc Medicare	$295.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$422.50
Rate for Payer: Hamaspik Choice Inc Medicare	$422.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$549.25

STRY 2.3X10MM BN SCREW CR PIN

Facility IP

$104.94

Service Code	HCPCS C1713
Hospital Charge Code	40203431
Hospital Revenue Code	278
Min. Negotiated Rate	$52.47
Max. Negotiated Rate	$52.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.47
Rate for Payer: Hamaspik Choice Inc Medicare	$52.47

STRY 2.3X10MM BN SCREW CR PIN

Facility OP

$104.94

Service Code	HCPCS C1713
Hospital Charge Code	40203431
Hospital Revenue Code	278
Min. Negotiated Rate	$36.73
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.72
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	$52.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$60.34
Rate for Payer: Fidelis Medicare Advantage	$110.19
Rate for Payer: Group Health Inc Commercial	$52.47
Rate for Payer: Group Health Inc Medicare	$36.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.47
Rate for Payer: Hamaspik Choice Inc Medicare	$52.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$68.21

STRY 2.3X10MM NB SCREW CROSS PIN

Facility IP

$104.94

Service Code	HCPCS C1713
Hospital Charge Code	40204713
Hospital Revenue Code	278
Min. Negotiated Rate	$52.47
Max. Negotiated Rate	$52.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.47
Rate for Payer: Hamaspik Choice Inc Medicare	$52.47

STRY 2.3X10MM NB SCREW CROSS PIN

Facility OP

$104.94

Service Code	HCPCS C1713
Hospital Charge Code	40204713
Hospital Revenue Code	278
Min. Negotiated Rate	$36.73
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.72
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	$52.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$60.34
Rate for Payer: Fidelis Medicare Advantage	$110.19
Rate for Payer: Group Health Inc Commercial	$52.47
Rate for Payer: Group Health Inc Medicare	$36.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.47
Rate for Payer: Hamaspik Choice Inc Medicare	$52.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$68.21

STRY 2 HL RIGID DOGBNE PL T

Facility IP

$185.52

Service Code	HCPCS C1713
Hospital Charge Code	40204210
Hospital Revenue Code	278
Min. Negotiated Rate	$92.76
Max. Negotiated Rate	$92.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.76
Rate for Payer: Hamaspik Choice Inc Medicare	$92.76

STRY 2 HL RIGID DOGBNE PL T

Facility OP

$185.52

Service Code	HCPCS C1713
Hospital Charge Code	40204210
Hospital Revenue Code	278
Min. Negotiated Rate	$64.93
Max. Negotiated Rate	$194.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$102.04
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	$92.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$106.67
Rate for Payer: Fidelis Medicare Advantage	$194.80
Rate for Payer: Group Health Inc Commercial	$92.76
Rate for Payer: Group Health Inc Medicare	$64.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.76
Rate for Payer: Hamaspik Choice Inc Medicare	$92.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$120.59

STRY 2 HOLE RIGID DOGBNE PLT

Facility IP

$185.52

Service Code	HCPCS C1713
Hospital Charge Code	40204214
Hospital Revenue Code	278
Min. Negotiated Rate	$92.76
Max. Negotiated Rate	$92.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.76
Rate for Payer: Hamaspik Choice Inc Medicare	$92.76

STRY 2 HOLE RIGID DOGBNE PLT

Facility OP

$185.52

Service Code	HCPCS C1713
Hospital Charge Code	40204214
Hospital Revenue Code	278
Min. Negotiated Rate	$64.93
Max. Negotiated Rate	$194.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$102.04
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	$92.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$106.67
Rate for Payer: Fidelis Medicare Advantage	$194.80
Rate for Payer: Group Health Inc Commercial	$92.76
Rate for Payer: Group Health Inc Medicare	$64.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.76
Rate for Payer: Hamaspik Choice Inc Medicare	$92.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$120.59

STRY 3.0MM ASN MCR CN DR BT 2.1MM

Facility OP

$325.00

Hospital Charge Code	40204264
Hospital Revenue Code	272
Min. Negotiated Rate	$113.75
Max. Negotiated Rate	$260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$178.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$162.50
Rate for Payer: Aetna Government	$162.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$260.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$221.00
Rate for Payer: Group Health Inc Commercial	$162.50
Rate for Payer: Group Health Inc Medicare	$113.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.50
Rate for Payer: Hamaspik Choice Inc Medicare	$162.50

STRY 3.5 NON LK SCREW

Facility IP

$308.00

Service Code	HCPCS C1713
Hospital Charge Code	40008259
Hospital Revenue Code	278
Min. Negotiated Rate	$154.00
Max. Negotiated Rate	$154.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$154.00
Rate for Payer: Hamaspik Choice Inc Medicare	$154.00

STRY 3.5 NON LK SCREW

Facility OP

$308.00

Service Code	HCPCS C1713
Hospital Charge Code	40008259
Hospital Revenue Code	278
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$323.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$169.40
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	$154.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$177.10
Rate for Payer: Fidelis Medicare Advantage	$323.40
Rate for Payer: Group Health Inc Commercial	$154.00
Rate for Payer: Group Health Inc Medicare	$107.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$154.00
Rate for Payer: Hamaspik Choice Inc Medicare	$154.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$200.20

STRY 3.5 X 20MM HEADLESS SCREW

Facility IP

$1,046.00

Service Code	HCPCS C1713
Hospital Charge Code	40004605
Hospital Revenue Code	278
Min. Negotiated Rate	$523.00
Max. Negotiated Rate	$523.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$523.00
Rate for Payer: Hamaspik Choice Inc Medicare	$523.00

STRY 3.5 X 20MM HEADLESS SCREW

Facility OP

$1,046.00

Service Code	HCPCS C1713
Hospital Charge Code	40004605
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,098.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$575.30
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	$523.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$601.45
Rate for Payer: Fidelis Medicare Advantage	$1,098.30
Rate for Payer: Group Health Inc Commercial	$523.00
Rate for Payer: Group Health Inc Medicare	$366.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$523.00
Rate for Payer: Hamaspik Choice Inc Medicare	$523.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$679.90

STRY 4 HL PLT LONG SPAN

Facility OP

$163.90

Service Code	HCPCS C1713
Hospital Charge Code	40204444
Hospital Revenue Code	278
Min. Negotiated Rate	$57.36
Max. Negotiated Rate	$172.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$90.14
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	$81.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$94.24
Rate for Payer: Fidelis Medicare Advantage	$172.10
Rate for Payer: Group Health Inc Commercial	$81.95
Rate for Payer: Group Health Inc Medicare	$57.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.95
Rate for Payer: Hamaspik Choice Inc Medicare	$81.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$106.54

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