St. Barnabas Hospital

All Charges

Charge

Type

Price

STRY LCK 4.0X34MM SCREW

Facility OP

$502.00

Service Code	HCPCS C1713
Hospital Charge Code	40008284
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 LCK 4.0X34MM SCREW

Facility IP

$502.00

Service Code	HCPCS C1713
Hospital Charge Code	40008284
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 LCK 4.0X38MM SCREW

Facility IP

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40008277
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 LCK 4.0X38MM SCREW

Facility OP

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40008277
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

STRYLER APEX PIN 4X90

Facility OP

$215.60

Service Code	HCPCS C1713
Hospital Charge Code	40202746
Hospital Revenue Code	278
Min. Negotiated Rate	$75.46
Max. Negotiated Rate	$226.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$118.58
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	$107.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$123.97
Rate for Payer: Fidelis Medicare Advantage	$226.38
Rate for Payer: Group Health Inc Commercial	$107.80
Rate for Payer: Group Health Inc Medicare	$75.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.80
Rate for Payer: Hamaspik Choice Inc Medicare	$107.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$140.14

STRYLER APEX PIN 4X90

Facility IP

$215.60

Service Code	HCPCS C1713
Hospital Charge Code	40202746
Hospital Revenue Code	278
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$107.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.80
Rate for Payer: Hamaspik Choice Inc Medicare	$107.80

STRY LG SUBOCCIPITAL SKL BASE PLT

Facility IP

$2,009.42

Service Code	HCPCS C1713
Hospital Charge Code	40002791
Hospital Revenue Code	278
Min. Negotiated Rate	$1,004.71
Max. Negotiated Rate	$1,004.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,004.71
Rate for Payer: Hamaspik Choice Inc Medicare	$1,004.71

STRY LG SUBOCCIPITAL SKL BASE PLT

Facility OP

$2,009.42

Service Code	HCPCS C1713
Hospital Charge Code	40002791
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,109.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,105.18
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	$1,004.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,155.42
Rate for Payer: Fidelis Medicare Advantage	$2,109.89
Rate for Payer: Group Health Inc Commercial	$1,004.71
Rate for Payer: Group Health Inc Medicare	$703.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,004.71
Rate for Payer: Hamaspik Choice Inc Medicare	$1,004.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,306.12

STRY LID FOR ASNIS SCR RACK

Facility OP

$170.00

Hospital Charge Code	40204261
Hospital Revenue Code	272
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$136.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$85.00
Rate for Payer: Aetna Government	$85.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$136.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$115.60
Rate for Payer: Group Health Inc Commercial	$85.00
Rate for Payer: Group Health Inc Medicare	$59.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.00
Rate for Payer: Hamaspik Choice Inc Medicare	$85.00

STRY LIGHT PIPE

Facility OP

$741.60

Hospital Charge Code	40004607
Hospital Revenue Code	272
Min. Negotiated Rate	$259.56
Max. Negotiated Rate	$593.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$407.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$370.80
Rate for Payer: Aetna Government	$370.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$593.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$504.29
Rate for Payer: Group Health Inc Commercial	$370.80
Rate for Payer: Group Health Inc Medicare	$259.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$370.80
Rate for Payer: Hamaspik Choice Inc Medicare	$370.80

STRY LOCK 2.7 MM X 14 MM

Facility OP

$450.50

Service Code	HCPCS C1713
Hospital Charge Code	40203440
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$473.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$247.78
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	$225.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$259.04
Rate for Payer: Fidelis Medicare Advantage	$473.02
Rate for Payer: Group Health Inc Commercial	$225.25
Rate for Payer: Group Health Inc Medicare	$157.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.25
Rate for Payer: Hamaspik Choice Inc Medicare	$225.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$292.82

STRY LOCK 2.7 MM X 14 MM

Facility IP

$450.50

Service Code	HCPCS C1713
Hospital Charge Code	40203440
Hospital Revenue Code	278
Min. Negotiated Rate	$225.25
Max. Negotiated Rate	$225.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.25
Rate for Payer: Hamaspik Choice Inc Medicare	$225.25

STRY LOCK 2.7MM X 14MM

Facility IP

$450.50

Service Code	HCPCS C1713
Hospital Charge Code	40204722
Hospital Revenue Code	278
Min. Negotiated Rate	$225.25
Max. Negotiated Rate	$225.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.25
Rate for Payer: Hamaspik Choice Inc Medicare	$225.25

STRY LOCK 2.7MM X 14MM

Facility OP

$450.50

Service Code	HCPCS C1713
Hospital Charge Code	40204722
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$473.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$247.78
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	$225.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$259.04
Rate for Payer: Fidelis Medicare Advantage	$473.02
Rate for Payer: Group Health Inc Commercial	$225.25
Rate for Payer: Group Health Inc Medicare	$157.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.25
Rate for Payer: Hamaspik Choice Inc Medicare	$225.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$292.82

STRY LOCK SCREW 22 X 2.3 MM

Facility OP

$196.00

Service Code	HCPCS C1713
Hospital Charge Code	40203445
Hospital Revenue Code	278
Min. Negotiated Rate	$68.60
Max. Negotiated Rate	$205.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$107.80
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	$98.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$112.70
Rate for Payer: Fidelis Medicare Advantage	$205.80
Rate for Payer: Group Health Inc Commercial	$98.00
Rate for Payer: Group Health Inc Medicare	$68.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$98.00
Rate for Payer: Hamaspik Choice Inc Medicare	$98.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$127.40

STRY LOCK SCREW 22 X 2.3 MM

Facility IP

$196.00

Service Code	HCPCS C1713
Hospital Charge Code	40203445
Hospital Revenue Code	278
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$98.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$98.00
Rate for Payer: Hamaspik Choice Inc Medicare	$98.00

STRY LOCK SCREW 22 X 2.3MM

Facility IP

$196.00

Service Code	HCPCS C1713
Hospital Charge Code	40204727
Hospital Revenue Code	278
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$98.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$98.00
Rate for Payer: Hamaspik Choice Inc Medicare	$98.00

STRY LOCK SCREW 22 X 2.3MM

Facility OP

$196.00

Service Code	HCPCS C1713
Hospital Charge Code	40204727
Hospital Revenue Code	278
Min. Negotiated Rate	$68.60
Max. Negotiated Rate	$205.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$107.80
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	$98.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$112.70
Rate for Payer: Fidelis Medicare Advantage	$205.80
Rate for Payer: Group Health Inc Commercial	$98.00
Rate for Payer: Group Health Inc Medicare	$68.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$98.00
Rate for Payer: Hamaspik Choice Inc Medicare	$98.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$127.40

STRY LOCK SCREW 24 X 2.3 MM

Facility IP

$196.00

Service Code	HCPCS C1713
Hospital Charge Code	40203447
Hospital Revenue Code	278
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$98.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$98.00
Rate for Payer: Hamaspik Choice Inc Medicare	$98.00

STRY LOCK SCREW 24 X 2.3 MM

Facility OP

$196.00

Service Code	HCPCS C1713
Hospital Charge Code	40203447
Hospital Revenue Code	278
Min. Negotiated Rate	$68.60
Max. Negotiated Rate	$205.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$107.80
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	$98.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$112.70
Rate for Payer: Fidelis Medicare Advantage	$205.80
Rate for Payer: Group Health Inc Commercial	$98.00
Rate for Payer: Group Health Inc Medicare	$68.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$98.00
Rate for Payer: Hamaspik Choice Inc Medicare	$98.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$127.40

STRY LOCK SCREW 24 X 2.3MM

Facility IP

$196.00

Service Code	HCPCS C1713
Hospital Charge Code	40204729
Hospital Revenue Code	278
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$98.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$98.00
Rate for Payer: Hamaspik Choice Inc Medicare	$98.00

STRY LOCK SCREW 24 X 2.3MM

Facility OP

$196.00

Service Code	HCPCS C1713
Hospital Charge Code	40204729
Hospital Revenue Code	278
Min. Negotiated Rate	$68.60
Max. Negotiated Rate	$205.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$107.80
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	$98.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$112.70
Rate for Payer: Fidelis Medicare Advantage	$205.80
Rate for Payer: Group Health Inc Commercial	$98.00
Rate for Payer: Group Health Inc Medicare	$68.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$98.00
Rate for Payer: Hamaspik Choice Inc Medicare	$98.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$127.40

STRY LOCK SCREW 26 X 2.3 MM

Facility IP

$196.00

Service Code	HCPCS C1713
Hospital Charge Code	40203446
Hospital Revenue Code	278
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$98.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$98.00
Rate for Payer: Hamaspik Choice Inc Medicare	$98.00

STRY LOCK SCREW 26 X 2.3 MM

Facility OP

$196.00

Service Code	HCPCS C1713
Hospital Charge Code	40203446
Hospital Revenue Code	278
Min. Negotiated Rate	$68.60
Max. Negotiated Rate	$205.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$107.80
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	$98.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$112.70
Rate for Payer: Fidelis Medicare Advantage	$205.80
Rate for Payer: Group Health Inc Commercial	$98.00
Rate for Payer: Group Health Inc Medicare	$68.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$98.00
Rate for Payer: Hamaspik Choice Inc Medicare	$98.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$127.40

STRY LOCK SCREW 26 X 2.3MM

Facility IP

$196.00

Service Code	HCPCS C1713
Hospital Charge Code	40204728
Hospital Revenue Code	278
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$98.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$98.00
Rate for Payer: Hamaspik Choice Inc Medicare	$98.00

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