St. Barnabas Hospital

All Charges

Charge

Type

Price

STRY AXSOS NON LCK SCREW 3.5X30MM

Facility IP

$448.80

Service Code	HCPCS C1713
Hospital Charge Code	40008291
Hospital Revenue Code	278
Min. Negotiated Rate	$224.40
Max. Negotiated Rate	$224.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$224.40
Rate for Payer: Hamaspik Choice Inc Medicare	$224.40

STRY BIT DRILL 2.5MM HOWMED

Facility OP

$754.44

Hospital Charge Code	40204253
Hospital Revenue Code	272
Min. Negotiated Rate	$264.05
Max. Negotiated Rate	$603.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$414.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$377.22
Rate for Payer: Aetna Government	$377.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$603.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$513.02
Rate for Payer: Group Health Inc Commercial	$377.22
Rate for Payer: Group Health Inc Medicare	$264.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$377.22
Rate for Payer: Hamaspik Choice Inc Medicare	$377.22

STRY BUR HOLE S/TAB COV PL 14MM

Facility OP

$164.00

Service Code	HCPCS C1713
Hospital Charge Code	40204204
Hospital Revenue Code	278
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$172.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$90.20
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	$82.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$94.30
Rate for Payer: Fidelis Medicare Advantage	$172.20
Rate for Payer: Group Health Inc Commercial	$82.00
Rate for Payer: Group Health Inc Medicare	$57.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.00
Rate for Payer: Hamaspik Choice Inc Medicare	$82.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$106.60

STRY BUR HOLE S/TAB COV PL 14MM

Facility IP

$164.00

Service Code	HCPCS C1713
Hospital Charge Code	40204204
Hospital Revenue Code	278
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$82.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.00
Rate for Payer: Hamaspik Choice Inc Medicare	$82.00

STRY BUR HOLE W/TAB COV PLT 14MM

Facility IP

$407.30

Service Code	HCPCS C1713
Hospital Charge Code	40204200
Hospital Revenue Code	278
Min. Negotiated Rate	$203.65
Max. Negotiated Rate	$203.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.65
Rate for Payer: Hamaspik Choice Inc Medicare	$203.65

STRY BUR HOLE W/TAB COV PLT 14MM

Facility OP

$407.30

Service Code	HCPCS C1713
Hospital Charge Code	40204200
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$427.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$224.02
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	$203.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.20
Rate for Payer: Fidelis Medicare Advantage	$427.66
Rate for Payer: Group Health Inc Commercial	$203.65
Rate for Payer: Group Health Inc Medicare	$142.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.65
Rate for Payer: Hamaspik Choice Inc Medicare	$203.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$264.74

STRY CAN POLYAX SCR 6.5X40MM

Facility OP

$4,665.58

Service Code	HCPCS C1713
Hospital Charge Code	40008313
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,898.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,566.07
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	$2,332.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,682.71
Rate for Payer: Fidelis Medicare Advantage	$4,898.86
Rate for Payer: Group Health Inc Commercial	$2,332.79
Rate for Payer: Group Health Inc Medicare	$1,632.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,332.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2,332.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,032.63

STRY CAN POLYAX SCR 6.5X40MM

Facility IP

$4,665.58

Service Code	HCPCS C1713
Hospital Charge Code	40008313
Hospital Revenue Code	278
Min. Negotiated Rate	$2,332.79
Max. Negotiated Rate	$2,332.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,332.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2,332.79

STRY CMF 2 HOLE DOG BONE PLT

Facility IP

$276.00

Service Code	HCPCS C1713
Hospital Charge Code	40204224
Hospital Revenue Code	278
Min. Negotiated Rate	$138.00
Max. Negotiated Rate	$138.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.00
Rate for Payer: Hamaspik Choice Inc Medicare	$138.00

STRY CMF 2 HOLE DOG BONE PLT

Facility OP

$276.00

Service Code	HCPCS C1713
Hospital Charge Code	40204224
Hospital Revenue Code	278
Min. Negotiated Rate	$96.60
Max. Negotiated Rate	$289.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$151.80
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	$138.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$158.70
Rate for Payer: Fidelis Medicare Advantage	$289.80
Rate for Payer: Group Health Inc Commercial	$138.00
Rate for Payer: Group Health Inc Medicare	$96.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.00
Rate for Payer: Hamaspik Choice Inc Medicare	$138.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$179.40

STRY COR SCR NON-LK 2.7MMX14MM

Facility IP

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40203438
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00

STRY COR SCR NON-LK 2.7MMX14MM

Facility OP

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40203438
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$315.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
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	$150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$172.50
Rate for Payer: Fidelis Medicare Advantage	$315.00
Rate for Payer: Group Health Inc Commercial	$150.00
Rate for Payer: Group Health Inc Medicare	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$195.00

STRY CORT SCREW NON 2.7MM X 14MM

Facility IP

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40204720
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00

STRY CORT SCREW NON 2.7MM X 14MM

Facility OP

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40204720
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$315.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
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	$150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$172.50
Rate for Payer: Fidelis Medicare Advantage	$315.00
Rate for Payer: Group Health Inc Commercial	$150.00
Rate for Payer: Group Health Inc Medicare	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$195.00

STRY COUPLIN EXT FIXATION 70241

Facility OP

$596.97

Service Code	HCPCS C1713
Hospital Charge Code	40205444
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$626.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$328.33
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	$298.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$343.26
Rate for Payer: Fidelis Medicare Advantage	$626.82
Rate for Payer: Group Health Inc Commercial	$298.48
Rate for Payer: Group Health Inc Medicare	$208.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$298.48
Rate for Payer: Hamaspik Choice Inc Medicare	$298.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$388.03

STRY COUPLIN EXT FIXATION 70241

Facility IP

$596.97

Service Code	HCPCS C1713
Hospital Charge Code	40205444
Hospital Revenue Code	278
Min. Negotiated Rate	$298.48
Max. Negotiated Rate	$298.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$298.48
Rate for Payer: Hamaspik Choice Inc Medicare	$298.48

STRY CRANIAL 2 HOL BONE PLT W/TAB

Facility IP

$292.46

Service Code	HCPCS C1713
Hospital Charge Code	40203401
Hospital Revenue Code	278
Min. Negotiated Rate	$146.23
Max. Negotiated Rate	$146.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.23
Rate for Payer: Hamaspik Choice Inc Medicare	$146.23

STRY CRANIAL 2 HOL BONE PLT W/TAB

Facility OP

$292.46

Service Code	HCPCS C1713
Hospital Charge Code	40203401
Hospital Revenue Code	278
Min. Negotiated Rate	$102.36
Max. Negotiated Rate	$307.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$160.85
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	$146.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$168.16
Rate for Payer: Fidelis Medicare Advantage	$307.08
Rate for Payer: Group Health Inc Commercial	$146.23
Rate for Payer: Group Health Inc Medicare	$102.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.23
Rate for Payer: Hamaspik Choice Inc Medicare	$146.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$190.10

STRY C-SHAP FRACT PLT, 4 HOLES

Facility IP

$611.42

Service Code	HCPCS C1713
Hospital Charge Code	40204715
Hospital Revenue Code	278
Min. Negotiated Rate	$305.71
Max. Negotiated Rate	$305.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$305.71
Rate for Payer: Hamaspik Choice Inc Medicare	$305.71

STRY C-SHAP FRACT PLT, 4 HOLES

Facility OP

$611.42

Service Code	HCPCS C1713
Hospital Charge Code	40204715
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$641.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$336.28
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	$305.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$351.57
Rate for Payer: Fidelis Medicare Advantage	$641.99
Rate for Payer: Group Health Inc Commercial	$305.71
Rate for Payer: Group Health Inc Medicare	$214.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$305.71
Rate for Payer: Hamaspik Choice Inc Medicare	$305.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$397.42

STRY DRILL 2.0X62X13 MM RE PIN

Facility OP

$253.46

Hospital Charge Code	40204212
Hospital Revenue Code	272
Min. Negotiated Rate	$88.71
Max. Negotiated Rate	$202.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$139.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$126.73
Rate for Payer: Aetna Government	$126.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$202.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$172.35
Rate for Payer: Group Health Inc Commercial	$126.73
Rate for Payer: Group Health Inc Medicare	$88.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.73
Rate for Payer: Hamaspik Choice Inc Medicare	$126.73

STRY DRILL BIT 1.9 MM

Facility OP

$150.00

Hospital Charge Code	40203442
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$120.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75.00
Rate for Payer: Aetna Government	$75.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$120.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.00
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

STRY DRILL BIT 1.9MM

Facility OP

$150.00

Hospital Charge Code	40204724
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$120.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75.00
Rate for Payer: Aetna Government	$75.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$120.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.00
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

STRY DRILL BIT 2.0 MM

Facility OP

$530.00

Hospital Charge Code	40203441
Hospital Revenue Code	272
Min. Negotiated Rate	$185.50
Max. Negotiated Rate	$424.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$291.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.00
Rate for Payer: Aetna Government	$265.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$424.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$360.40
Rate for Payer: Group Health Inc Commercial	$265.00
Rate for Payer: Group Health Inc Medicare	$185.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$265.00
Rate for Payer: Hamaspik Choice Inc Medicare	$265.00

STRY DRILL BIT 2.0MM

Facility OP

$530.00

Hospital Charge Code	40204723
Hospital Revenue Code	272
Min. Negotiated Rate	$185.50
Max. Negotiated Rate	$424.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$291.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.00
Rate for Payer: Aetna Government	$265.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$424.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$360.40
Rate for Payer: Group Health Inc Commercial	$265.00
Rate for Payer: Group Health Inc Medicare	$185.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$265.00
Rate for Payer: Hamaspik Choice Inc Medicare	$265.00

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