St. Barnabas Hospital

All Charges

Charge

Type

Price

STRY SCR 1.7X3MM CRS PIN SLF DRL

Facility IP

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	40204251
Hospital Revenue Code	278
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$50.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00

STRY SCR 1.7X3MM CRS PIN SLF DRL

Facility OP

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	40204251
Hospital Revenue Code	278
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.00
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	$50.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.50
Rate for Payer: Fidelis Medicare Advantage	$105.00
Rate for Payer: Group Health Inc Commercial	$50.00
Rate for Payer: Group Health Inc Medicare	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.00

STRYSCR/2.0X14MM LCKNG CR PIN

Facility OP

$156.44

Service Code	HCPCS C1713
Hospital Charge Code	40204448
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

STRYSCR/2.0X14MM LCKNG CR PIN

Facility IP

$156.44

Service Code	HCPCS C1713
Hospital Charge Code	40204448
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 SCR 2.7 X 18MM

Facility IP

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	40204245
Hospital Revenue Code	278
Min. Negotiated Rate	$250.00
Max. Negotiated Rate	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

STRY SCR 2.7 X 18MM

Facility OP

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	40204245
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
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	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$287.50
Rate for Payer: Fidelis Medicare Advantage	$525.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$325.00

STRY SCR 2.7 X 50MM

Facility IP

$510.00

Service Code	HCPCS C1713
Hospital Charge Code	40204243
Hospital Revenue Code	278
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$255.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$255.00
Rate for Payer: Hamaspik Choice Inc Medicare	$255.00

STRY SCR 2.7 X 50MM

Facility OP

$510.00

Service Code	HCPCS C1713
Hospital Charge Code	40204243
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$535.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$280.50
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	$255.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$293.25
Rate for Payer: Fidelis Medicare Advantage	$535.50
Rate for Payer: Group Health Inc Commercial	$255.00
Rate for Payer: Group Health Inc Medicare	$178.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$255.00
Rate for Payer: Hamaspik Choice Inc Medicare	$255.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$331.50

STRY SCR 2.7 X 55 MM

Facility IP

$510.00

Service Code	HCPCS C1713
Hospital Charge Code	40204242
Hospital Revenue Code	278
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$255.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$255.00
Rate for Payer: Hamaspik Choice Inc Medicare	$255.00

STRY SCR 2.7 X 55 MM

Facility OP

$510.00

Service Code	HCPCS C1713
Hospital Charge Code	40204242
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$535.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$280.50
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	$255.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$293.25
Rate for Payer: Fidelis Medicare Advantage	$535.50
Rate for Payer: Group Health Inc Commercial	$255.00
Rate for Payer: Group Health Inc Medicare	$178.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$255.00
Rate for Payer: Hamaspik Choice Inc Medicare	$255.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$331.50

STRY SCREW CORT ST 3.5 X 12MM

Facility IP

$44.00

Service Code	HCPCS C1713
Hospital Charge Code	40004612
Hospital Revenue Code	278
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$22.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.00
Rate for Payer: Hamaspik Choice Inc Medicare	$22.00

STRY SCREW CORT ST 3.5 X 12MM

Facility OP

$44.00

Service Code	HCPCS C1713
Hospital Charge Code	40004612
Hospital Revenue Code	278
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.20
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	$22.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.30
Rate for Payer: Fidelis Medicare Advantage	$46.20
Rate for Payer: Group Health Inc Commercial	$22.00
Rate for Payer: Group Health Inc Medicare	$15.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.00
Rate for Payer: Hamaspik Choice Inc Medicare	$22.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.60

STRY SCREW LCK 2.7X14MM

Facility IP

$320.00

Service Code	HCPCS C1713
Hospital Charge Code	40008286
Hospital Revenue Code	278
Min. Negotiated Rate	$160.00
Max. Negotiated Rate	$160.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00

STRY SCREW LCK 2.7X14MM

Facility OP

$320.00

Service Code	HCPCS C1713
Hospital Charge Code	40008286
Hospital Revenue Code	278
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$336.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$176.00
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	$160.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.00
Rate for Payer: Fidelis Medicare Advantage	$336.00
Rate for Payer: Group Health Inc Commercial	$160.00
Rate for Payer: Group Health Inc Medicare	$112.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$208.00

STRY SCREW LOCK 2.7X14MM

Facility IP

$320.00

Service Code	HCPCS C1713
Hospital Charge Code	40008275
Hospital Revenue Code	278
Min. Negotiated Rate	$160.00
Max. Negotiated Rate	$160.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00

STRY SCREW LOCK 2.7X14MM

Facility OP

$320.00

Service Code	HCPCS C1713
Hospital Charge Code	40008275
Hospital Revenue Code	278
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$336.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$176.00
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	$160.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.00
Rate for Payer: Fidelis Medicare Advantage	$336.00
Rate for Payer: Group Health Inc Commercial	$160.00
Rate for Payer: Group Health Inc Medicare	$112.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$208.00

STRY SCREW NON-LCK 2.7X34MM

Facility OP

$320.00

Service Code	HCPCS C1713
Hospital Charge Code	40008285
Hospital Revenue Code	278
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$336.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$176.00
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	$160.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.00
Rate for Payer: Fidelis Medicare Advantage	$336.00
Rate for Payer: Group Health Inc Commercial	$160.00
Rate for Payer: Group Health Inc Medicare	$112.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$208.00

STRY SCREW NON-LCK 2.7X34MM

Facility IP

$320.00

Service Code	HCPCS C1713
Hospital Charge Code	40008285
Hospital Revenue Code	278
Min. Negotiated Rate	$160.00
Max. Negotiated Rate	$160.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00

STRY SCREW NON-LCK 3.5X40MM

Facility IP

$320.00

Service Code	HCPCS C1713
Hospital Charge Code	40008260
Hospital Revenue Code	278
Min. Negotiated Rate	$160.00
Max. Negotiated Rate	$160.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00

STRY SCREW NON-LCK 3.5X40MM

Facility OP

$320.00

Service Code	HCPCS C1713
Hospital Charge Code	40008260
Hospital Revenue Code	278
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$336.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$176.00
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	$160.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.00
Rate for Payer: Fidelis Medicare Advantage	$336.00
Rate for Payer: Group Health Inc Commercial	$160.00
Rate for Payer: Group Health Inc Medicare	$112.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$208.00

STRY SCR LCK 2.7 X 20MM

Facility OP

$450.00

Service Code	HCPCS C1713
Hospital Charge Code	40204247
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$472.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$247.50
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	$225.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$258.75
Rate for Payer: Fidelis Medicare Advantage	$472.50
Rate for Payer: Group Health Inc Commercial	$225.00
Rate for Payer: Group Health Inc Medicare	$157.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$225.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$292.50

STRY SCR LCK 2.7 X 20MM

Facility IP

$450.00

Service Code	HCPCS C1713
Hospital Charge Code	40204247
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$225.00

STRY SCR LCK 2.7 X 22MM

Facility OP

$450.00

Service Code	HCPCS C1713
Hospital Charge Code	40204248
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$472.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$247.50
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	$225.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$258.75
Rate for Payer: Fidelis Medicare Advantage	$472.50
Rate for Payer: Group Health Inc Commercial	$225.00
Rate for Payer: Group Health Inc Medicare	$157.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$225.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$292.50

STRY SCR LCK 2.7 X 22MM

Facility IP

$450.00

Service Code	HCPCS C1713
Hospital Charge Code	40204248
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$225.00

STRY SCR LCK 2.7 X 24MM

Facility OP

$450.00

Service Code	HCPCS C1713
Hospital Charge Code	40204249
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$472.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$247.50
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	$225.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$258.75
Rate for Payer: Fidelis Medicare Advantage	$472.50
Rate for Payer: Group Health Inc Commercial	$225.00
Rate for Payer: Group Health Inc Medicare	$157.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$225.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$292.50

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