St. Barnabas Hospital

All Charges

Charge

Type

Price

STRY APEX PIN 6 X 180MM

Facility IP

$279.50

Service Code	HCPCS C1713
Hospital Charge Code	40204734
Hospital Revenue Code	278
Min. Negotiated Rate	$139.75
Max. Negotiated Rate	$139.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.75
Rate for Payer: Hamaspik Choice Inc Medicare	$139.75

STRY APEX PIN 6 X 180MM

Facility OP

$279.50

Service Code	HCPCS C1713
Hospital Charge Code	40204734
Hospital Revenue Code	278
Min. Negotiated Rate	$97.82
Max. Negotiated Rate	$293.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$153.72
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	$139.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$160.71
Rate for Payer: Fidelis Medicare Advantage	$293.48
Rate for Payer: Group Health Inc Commercial	$139.75
Rate for Payer: Group Health Inc Medicare	$97.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.75
Rate for Payer: Hamaspik Choice Inc Medicare	$139.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$181.68

STRY ASNISIII SCREW 4.0X46MM

Facility OP

$312.00

Service Code	HCPCS C1713
Hospital Charge Code	40008257
Hospital Revenue Code	278
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$327.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$171.60
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	$156.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$179.40
Rate for Payer: Fidelis Medicare Advantage	$327.60
Rate for Payer: Group Health Inc Commercial	$156.00
Rate for Payer: Group Health Inc Medicare	$109.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.00
Rate for Payer: Hamaspik Choice Inc Medicare	$156.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$202.80

STRY ASNISIII SCREW 4.0X46MM

Facility IP

$312.00

Service Code	HCPCS C1713
Hospital Charge Code	40008257
Hospital Revenue Code	278
Min. Negotiated Rate	$156.00
Max. Negotiated Rate	$156.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.00
Rate for Payer: Hamaspik Choice Inc Medicare	$156.00

STRY ASNIS SCR 4.0 X 40MM

Facility OP

$312.00

Service Code	HCPCS C1713
Hospital Charge Code	40203450
Hospital Revenue Code	278
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$327.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$171.60
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	$156.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$179.40
Rate for Payer: Fidelis Medicare Advantage	$327.60
Rate for Payer: Group Health Inc Commercial	$156.00
Rate for Payer: Group Health Inc Medicare	$109.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.00
Rate for Payer: Hamaspik Choice Inc Medicare	$156.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$202.80

STRY ASNIS SCR 4.0 X 40MM

Facility IP

$312.00

Service Code	HCPCS C1713
Hospital Charge Code	40203450
Hospital Revenue Code	278
Min. Negotiated Rate	$156.00
Max. Negotiated Rate	$156.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.00
Rate for Payer: Hamaspik Choice Inc Medicare	$156.00

STRY ASNIS SCREW 4.0 X 40MM

Facility OP

$312.00

Service Code	HCPCS C1713
Hospital Charge Code	40204732
Hospital Revenue Code	278
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$327.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$171.60
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	$156.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$179.40
Rate for Payer: Fidelis Medicare Advantage	$327.60
Rate for Payer: Group Health Inc Commercial	$156.00
Rate for Payer: Group Health Inc Medicare	$109.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.00
Rate for Payer: Hamaspik Choice Inc Medicare	$156.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$202.80

STRY ASNIS SCREW 4.0 X 40MM

Facility IP

$312.00

Service Code	HCPCS C1713
Hospital Charge Code	40204732
Hospital Revenue Code	278
Min. Negotiated Rate	$156.00
Max. Negotiated Rate	$156.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.00
Rate for Payer: Hamaspik Choice Inc Medicare	$156.00

STRY AXSOS 8 HL RT TIBL PLT

Facility OP

$5,248.00

Service Code	HCPCS C1713
Hospital Charge Code	40204234
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,510.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,886.40
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	$2,624.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,017.60
Rate for Payer: Fidelis Medicare Advantage	$5,510.40
Rate for Payer: Group Health Inc Commercial	$2,624.00
Rate for Payer: Group Health Inc Medicare	$1,836.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,624.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,624.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,411.20

STRY AXSOS 8 HL RT TIBL PLT

Facility IP

$5,248.00

Service Code	HCPCS C1713
Hospital Charge Code	40204234
Hospital Revenue Code	278
Min. Negotiated Rate	$2,624.00
Max. Negotiated Rate	$2,624.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,624.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,624.00

STRY AXSOS LCK SCR 4.0 X 30MM

Facility OP

$502.00

Service Code	HCPCS C1713
Hospital Charge Code	40204235
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$527.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$276.10
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	$251.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$288.65
Rate for Payer: Fidelis Medicare Advantage	$527.10
Rate for Payer: Group Health Inc Commercial	$251.00
Rate for Payer: Group Health Inc Medicare	$175.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.00
Rate for Payer: Hamaspik Choice Inc Medicare	$251.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$326.30

STRY AXSOS LCK SCR 4.0 X 30MM

Facility IP

$502.00

Service Code	HCPCS C1713
Hospital Charge Code	40204235
Hospital Revenue Code	278
Min. Negotiated Rate	$251.00
Max. Negotiated Rate	$251.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.00
Rate for Payer: Hamaspik Choice Inc Medicare	$251.00

STRY AXSOS LCK SCR 4.0 X 75MM

Facility OP

$502.00

Service Code	HCPCS C1713
Hospital Charge Code	40204236
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$527.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$276.10
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	$251.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$288.65
Rate for Payer: Fidelis Medicare Advantage	$527.10
Rate for Payer: Group Health Inc Commercial	$251.00
Rate for Payer: Group Health Inc Medicare	$175.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.00
Rate for Payer: Hamaspik Choice Inc Medicare	$251.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$326.30

STRY AXSOS LCK SCR 4.0 X 75MM

Facility IP

$502.00

Service Code	HCPCS C1713
Hospital Charge Code	40204236
Hospital Revenue Code	278
Min. Negotiated Rate	$251.00
Max. Negotiated Rate	$251.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.00
Rate for Payer: Hamaspik Choice Inc Medicare	$251.00

STRY AXSOS LCK SCR 4.0 X 80MM

Facility IP

$502.00

Service Code	HCPCS C1713
Hospital Charge Code	40204237
Hospital Revenue Code	278
Min. Negotiated Rate	$251.00
Max. Negotiated Rate	$251.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.00
Rate for Payer: Hamaspik Choice Inc Medicare	$251.00

STRY AXSOS LCK SCR 4.0 X 80MM

Facility OP

$502.00

Service Code	HCPCS C1713
Hospital Charge Code	40204237
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$527.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$276.10
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	$251.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$288.65
Rate for Payer: Fidelis Medicare Advantage	$527.10
Rate for Payer: Group Health Inc Commercial	$251.00
Rate for Payer: Group Health Inc Medicare	$175.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.00
Rate for Payer: Hamaspik Choice Inc Medicare	$251.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$326.30

STRY AXSOS LCK SCR 4.0 X 85MM

Facility IP

$502.00

Service Code	HCPCS C1713
Hospital Charge Code	40204238
Hospital Revenue Code	278
Min. Negotiated Rate	$251.00
Max. Negotiated Rate	$251.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.00
Rate for Payer: Hamaspik Choice Inc Medicare	$251.00

STRY AXSOS LCK SCR 4.0 X 85MM

Facility OP

$502.00

Service Code	HCPCS C1713
Hospital Charge Code	40204238
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$527.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$276.10
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	$251.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$288.65
Rate for Payer: Fidelis Medicare Advantage	$527.10
Rate for Payer: Group Health Inc Commercial	$251.00
Rate for Payer: Group Health Inc Medicare	$175.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.00
Rate for Payer: Hamaspik Choice Inc Medicare	$251.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$326.30

STRY AXSOS NON LCK SCR 3.5X60MM

Facility OP

$502.00

Service Code	HCPCS C1713
Hospital Charge Code	40204239
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$527.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$276.10
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	$251.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$288.65
Rate for Payer: Fidelis Medicare Advantage	$527.10
Rate for Payer: Group Health Inc Commercial	$251.00
Rate for Payer: Group Health Inc Medicare	$175.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.00
Rate for Payer: Hamaspik Choice Inc Medicare	$251.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$326.30

STRY AXSOS NON LCK SCR 3.5X60MM

Facility IP

$502.00

Service Code	HCPCS C1713
Hospital Charge Code	40204239
Hospital Revenue Code	278
Min. Negotiated Rate	$251.00
Max. Negotiated Rate	$251.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.00
Rate for Payer: Hamaspik Choice Inc Medicare	$251.00

STRY AXSOS NON LCK SCR 3.5X65MM

Facility OP

$80.00

Service Code	HCPCS C1713
Hospital Charge Code	40204240
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.00
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	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.00
Rate for Payer: Fidelis Medicare Advantage	$84.00
Rate for Payer: Group Health Inc Commercial	$40.00
Rate for Payer: Group Health Inc Medicare	$28.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.00
Rate for Payer: Hamaspik Choice Inc Medicare	$40.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.00

STRY AXSOS NON LCK SCR 3.5X65MM

Facility IP

$80.00

Service Code	HCPCS C1713
Hospital Charge Code	40204240
Hospital Revenue Code	278
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$40.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.00
Rate for Payer: Hamaspik Choice Inc Medicare	$40.00

STRY AXSOS NON LCK SCR 3.5X80MM

Facility IP

$160.00

Service Code	HCPCS C1713
Hospital Charge Code	40204241
Hospital Revenue Code	278
Min. Negotiated Rate	$80.00
Max. Negotiated Rate	$80.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.00
Rate for Payer: Hamaspik Choice Inc Medicare	$80.00

STRY AXSOS NON LCK SCR 3.5X80MM

Facility OP

$160.00

Service Code	HCPCS C1713
Hospital Charge Code	40204241
Hospital Revenue Code	278
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$168.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$88.00
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	$80.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$92.00
Rate for Payer: Fidelis Medicare Advantage	$168.00
Rate for Payer: Group Health Inc Commercial	$80.00
Rate for Payer: Group Health Inc Medicare	$56.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.00
Rate for Payer: Hamaspik Choice Inc Medicare	$80.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$104.00

STRY AXSOS NON LCK SCREW 3.5X30MM

Facility OP

$448.80

Service Code	HCPCS C1713
Hospital Charge Code	40008291
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$471.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$246.84
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	$224.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$258.06
Rate for Payer: Fidelis Medicare Advantage	$471.24
Rate for Payer: Group Health Inc Commercial	$224.40
Rate for Payer: Group Health Inc Medicare	$157.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$224.40
Rate for Payer: Hamaspik Choice Inc Medicare	$224.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$291.72

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