St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

STRY AXSOS LCK SCR 4.0 X 85MM

Facility

$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 NON LCK SCR 3.5X60MM

Facility

$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 3.5X60MM

Facility

$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: Brighton Health Commercial	$301.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$251.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$288.65
Rate for Payer: EmblemHealth Commercial	$251.00
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 3.5X65MM

Facility

$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: Brighton Health Commercial	$48.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.00
Rate for Payer: EmblemHealth Commercial	$40.00
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

$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

$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

$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: Brighton Health Commercial	$96.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$92.00
Rate for Payer: EmblemHealth Commercial	$80.00
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

$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: Brighton Health Commercial	$269.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$224.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$258.06
Rate for Payer: EmblemHealth Commercial	$224.40
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

STRY AXSOS NON LCK SCREW 3.5X30MM

Facility

$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

$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: Brighton Health Commercial	$565.83
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

$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: Brighton Health Commercial	$98.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$82.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$94.30
Rate for Payer: EmblemHealth Commercial	$82.00
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

$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

$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: Brighton Health Commercial	$244.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$203.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.20
Rate for Payer: EmblemHealth Commercial	$203.65
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 BUR HOLE W/TAB COV PLT 14MM

Facility

$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 CAN POLYAX SCR 6.5X40MM

Facility

$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: Brighton Health Commercial	$2,799.35
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: EmblemHealth Commercial	$2,332.79
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

$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

$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: Brighton Health Commercial	$165.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$138.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$158.70
Rate for Payer: EmblemHealth Commercial	$138.00
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 CMF 2 HOLE DOG BONE PLT

Facility

$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 COR SCR NON-LK 2.7MMX14MM

Facility

$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: Brighton Health Commercial	$180.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$172.50
Rate for Payer: EmblemHealth Commercial	$150.00
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 COR SCR NON-LK 2.7MMX14MM

Facility

$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 CORT SCREW NON 2.7MM X 14MM

Facility

$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: Brighton Health Commercial	$180.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$172.50
Rate for Payer: EmblemHealth Commercial	$150.00
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

$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 COUPLIN EXT FIXATION 70241

Facility

$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: Brighton Health Commercial	$358.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$298.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$343.26
Rate for Payer: EmblemHealth Commercial	$298.48
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

$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

$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

Know your out-of-pocket cost for care.

All Charges