St. Barnabas Hospital

All Charges

Charge

Type

Price

STRY SCR LCK 2.7 X 24MM

Facility IP

$450.00

Service Code	HCPCS C1713
Hospital Charge Code	40204249
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 44MM

Facility IP

$450.00

Service Code	HCPCS C1713
Hospital Charge Code	40204246
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 44MM

Facility OP

$450.00

Service Code	HCPCS C1713
Hospital Charge Code	40204246
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 LG 6.5X70MM

Facility IP

$4,665.58

Service Code	HCPCS C1713
Hospital Charge Code	40008317
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 SCR LG 6.5X70MM

Facility OP

$4,665.58

Service Code	HCPCS C1713
Hospital Charge Code	40008317
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 SCR UN III AXS SCREW 1.5X5MM

Facility IP

$164.00

Service Code	HCPCS C1713
Hospital Charge Code	40203408
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 SCR UN III AXS SCREW 1.5X5MM

Facility OP

$164.00

Service Code	HCPCS C1713
Hospital Charge Code	40203408
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 SCRW ASNIS MICR 3.0X16MM CAN

Facility IP

$399.84

Service Code	HCPCS C1713
Hospital Charge Code	40204263
Hospital Revenue Code	278
Min. Negotiated Rate	$199.92
Max. Negotiated Rate	$199.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$199.92
Rate for Payer: Hamaspik Choice Inc Medicare	$199.92

STRY SCRW ASNIS MICR 3.0X16MM CAN

Facility OP

$399.84

Service Code	HCPCS C1713
Hospital Charge Code	40204263
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$419.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$219.91
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	$199.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$229.91
Rate for Payer: Fidelis Medicare Advantage	$419.83
Rate for Payer: Group Health Inc Commercial	$199.92
Rate for Payer: Group Health Inc Medicare	$139.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$199.92
Rate for Payer: Hamaspik Choice Inc Medicare	$199.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$259.90

STRY SCRW BONE 3.5 X 14MM

Facility OP

$104.00

Service Code	HCPCS C1776
Hospital Charge Code	40208007
Hospital Revenue Code	278
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.80
Rate for Payer: Fidelis Medicare Advantage	$109.20
Rate for Payer: Group Health Inc Commercial	$52.00
Rate for Payer: Group Health Inc Medicare	$36.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.00
Rate for Payer: Hamaspik Choice Inc Medicare	$52.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$67.60

STRY SCRW BONE 3.5 X 14MM

Facility IP

$104.00

Service Code	HCPCS C1776
Hospital Charge Code	40208007
Hospital Revenue Code	278
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$52.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.00
Rate for Payer: Hamaspik Choice Inc Medicare	$52.00

STRY SCRW BONE 3.5 X16MM

Facility OP

$104.00

Service Code	HCPCS C1776
Hospital Charge Code	40208008
Hospital Revenue Code	278
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.80
Rate for Payer: Fidelis Medicare Advantage	$109.20
Rate for Payer: Group Health Inc Commercial	$52.00
Rate for Payer: Group Health Inc Medicare	$36.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.00
Rate for Payer: Hamaspik Choice Inc Medicare	$52.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$67.60

STRY SCRW BONE 3.5 X16MM

Facility IP

$104.00

Service Code	HCPCS C1776
Hospital Charge Code	40208008
Hospital Revenue Code	278
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$52.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.00
Rate for Payer: Hamaspik Choice Inc Medicare	$52.00

STRY SELF-DRILL HALF PIN 5X50 MM

Facility OP

$370.00

Service Code	HCPCS C1713
Hospital Charge Code	40204221
Hospital Revenue Code	278
Min. Negotiated Rate	$129.50
Max. Negotiated Rate	$388.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$203.50
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	$185.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$212.75
Rate for Payer: Fidelis Medicare Advantage	$388.50
Rate for Payer: Group Health Inc Commercial	$185.00
Rate for Payer: Group Health Inc Medicare	$129.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.00
Rate for Payer: Hamaspik Choice Inc Medicare	$185.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$240.50

STRY SELF-DRILL HALF PIN 5X50 MM

Facility IP

$370.00

Service Code	HCPCS C1713
Hospital Charge Code	40204221
Hospital Revenue Code	278
Min. Negotiated Rate	$185.00
Max. Negotiated Rate	$185.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.00
Rate for Payer: Hamaspik Choice Inc Medicare	$185.00

STRY SER POLYAX 6.5X30MM

Facility IP

$4,665.58

Service Code	HCPCS C1713
Hospital Charge Code	40008316
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 SER POLYAX 6.5X30MM

Facility OP

$4,665.58

Service Code	HCPCS C1713
Hospital Charge Code	40008316
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 SER POLYAX 6.5X35MM

Facility IP

$4,665.58

Service Code	HCPCS C1713
Hospital Charge Code	40008315
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 SER POLYAX 6.5X35MM

Facility OP

$4,665.58

Service Code	HCPCS C1713
Hospital Charge Code	40008315
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 SPINE 3.5MM TAP

Facility OP

$1,025.80

Service Code	HCPCS C1713
Hospital Charge Code	40204254
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,077.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$564.19
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	$512.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$589.84
Rate for Payer: Fidelis Medicare Advantage	$1,077.09
Rate for Payer: Group Health Inc Commercial	$512.90
Rate for Payer: Group Health Inc Medicare	$359.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$512.90
Rate for Payer: Hamaspik Choice Inc Medicare	$512.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$666.77

STRY SPINE 3.5MM TAP

Facility IP

$1,025.80

Service Code	HCPCS C1713
Hospital Charge Code	40204254
Hospital Revenue Code	278
Min. Negotiated Rate	$512.90
Max. Negotiated Rate	$512.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$512.90
Rate for Payer: Hamaspik Choice Inc Medicare	$512.90

STRY SPINE 5.5 TAP

Facility OP

$720.16

Service Code	HCPCS C1713
Hospital Charge Code	40003441
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$756.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$396.09
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	$360.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$414.09
Rate for Payer: Fidelis Medicare Advantage	$756.17
Rate for Payer: Group Health Inc Commercial	$360.08
Rate for Payer: Group Health Inc Medicare	$252.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$360.08
Rate for Payer: Hamaspik Choice Inc Medicare	$360.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$468.10

STRY SPINE 5.5 TAP

Facility IP

$720.16

Service Code	HCPCS C1713
Hospital Charge Code	40003441
Hospital Revenue Code	278
Min. Negotiated Rate	$360.08
Max. Negotiated Rate	$360.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$360.08
Rate for Payer: Hamaspik Choice Inc Medicare	$360.08

STRY SRT INTERM VOLAR PL LT

Facility IP

$3,204.00

Service Code	HCPCS C1713
Hospital Charge Code	40204207
Hospital Revenue Code	278
Min. Negotiated Rate	$1,602.00
Max. Negotiated Rate	$1,602.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,602.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,602.00

STRY SRT INTERM VOLAR PL LT

Facility OP

$3,204.00

Service Code	HCPCS C1713
Hospital Charge Code	40204207
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,364.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,762.20
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	$1,602.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,842.30
Rate for Payer: Fidelis Medicare Advantage	$3,364.20
Rate for Payer: Group Health Inc Commercial	$1,602.00
Rate for Payer: Group Health Inc Medicare	$1,121.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,602.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,602.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,082.60

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