St. Barnabas Hospital

All Charges

Charge

Type

Price

SYN POR HO FEM COM SZ14

Facility OP

$9,329.50

Service Code	HCPCS C1713
Hospital Charge Code	64905232
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$9,795.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,131.22
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	$4,664.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,364.46
Rate for Payer: Fidelis Medicare Advantage	$9,795.98
Rate for Payer: Group Health Inc Commercial	$4,664.75
Rate for Payer: Group Health Inc Medicare	$3,265.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,664.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,664.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,064.18

SYN POR HO FEM COM SZ14

Facility IP

$9,329.50

Service Code	HCPCS C1713
Hospital Charge Code	64905232
Hospital Revenue Code	278
Min. Negotiated Rate	$4,664.75
Max. Negotiated Rate	$4,664.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,664.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,664.75

SYN SCRW 1.5 TIT C S/T 8MM

Facility OP

$101.70

Service Code	HCPCS C1713
Hospital Charge Code	40205255
Hospital Revenue Code	278
Min. Negotiated Rate	$35.60
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.94
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	$50.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.48
Rate for Payer: Fidelis Medicare Advantage	$106.78
Rate for Payer: Group Health Inc Commercial	$50.85
Rate for Payer: Group Health Inc Medicare	$35.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.85
Rate for Payer: Hamaspik Choice Inc Medicare	$50.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.10

SYN SCRW 1.5 TIT C S/T 8MM

Facility IP

$101.70

Service Code	HCPCS C1713
Hospital Charge Code	40205255
Hospital Revenue Code	278
Min. Negotiated Rate	$50.85
Max. Negotiated Rate	$50.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.85
Rate for Payer: Hamaspik Choice Inc Medicare	$50.85

SYN SCRW 2.7MM COR TI S-TAP 14MM

Facility OP

$81.50

Service Code	HCPCS C1776
Hospital Charge Code	40205106
Hospital Revenue Code	278
Min. Negotiated Rate	$28.52
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.82
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	$40.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.86
Rate for Payer: Fidelis Medicare Advantage	$85.58
Rate for Payer: Group Health Inc Commercial	$40.75
Rate for Payer: Group Health Inc Medicare	$28.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.75
Rate for Payer: Hamaspik Choice Inc Medicare	$40.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.98

SYN SCRW 2.7MM COR TI S-TAP 14MM

Facility IP

$81.50

Service Code	HCPCS C1776
Hospital Charge Code	40205106
Hospital Revenue Code	278
Min. Negotiated Rate	$40.75
Max. Negotiated Rate	$40.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.75
Rate for Payer: Hamaspik Choice Inc Medicare	$40.75

SYNTHE CMF PLATE 2.4MM LCKNG SCRW

Facility IP

$288.00

Service Code	HCPCS C1776
Hospital Charge Code	40205186
Hospital Revenue Code	278
Min. Negotiated Rate	$144.00
Max. Negotiated Rate	$144.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$144.00
Rate for Payer: Hamaspik Choice Inc Medicare	$144.00

SYNTHE CMF PLATE 2.4MM LCKNG SCRW

Facility OP

$288.00

Service Code	HCPCS C1776
Hospital Charge Code	40205186
Hospital Revenue Code	278
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$158.40
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	$144.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$165.60
Rate for Payer: Fidelis Medicare Advantage	$302.40
Rate for Payer: Group Health Inc Commercial	$144.00
Rate for Payer: Group Health Inc Medicare	$100.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$144.00
Rate for Payer: Hamaspik Choice Inc Medicare	$144.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$187.20

SYNTHES 0.4MM THICK MATRIX PLT

Facility OP

$3,294.00

Service Code	HCPCS C1713
Hospital Charge Code	40206222
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,458.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,811.70
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	$1,647.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,894.05
Rate for Payer: Fidelis Medicare Advantage	$3,458.70
Rate for Payer: Group Health Inc Commercial	$1,647.00
Rate for Payer: Group Health Inc Medicare	$1,152.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,647.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,647.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,141.10

SYNTHES 0.4MM THICK MATRIX PLT

Facility IP

$3,294.00

Service Code	HCPCS C1713
Hospital Charge Code	40206222
Hospital Revenue Code	278
Min. Negotiated Rate	$1,647.00
Max. Negotiated Rate	$1,647.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,647.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,647.00

SYNTHES 0.7MM 7 HOLE L-PLATE

Facility OP

$614.00

Service Code	HCPCS C1713
Hospital Charge Code	40205811
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$644.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$337.70
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	$307.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$353.05
Rate for Payer: Fidelis Medicare Advantage	$644.70
Rate for Payer: Group Health Inc Commercial	$307.00
Rate for Payer: Group Health Inc Medicare	$214.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$307.00
Rate for Payer: Hamaspik Choice Inc Medicare	$307.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$399.10

SYNTHES 0.7MM 7 HOLE L-PLATE

Facility IP

$614.00

Service Code	HCPCS C1713
Hospital Charge Code	40205811
Hospital Revenue Code	278
Min. Negotiated Rate	$307.00
Max. Negotiated Rate	$307.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$307.00
Rate for Payer: Hamaspik Choice Inc Medicare	$307.00

SYNTHES 1.0MM X7MM SCREW CORTEX

Facility OP

$166.00

Service Code	HCPCS C1713
Hospital Charge Code	40206228
Hospital Revenue Code	278
Min. Negotiated Rate	$58.10
Max. Negotiated Rate	$174.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.30
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	$83.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.45
Rate for Payer: Fidelis Medicare Advantage	$174.30
Rate for Payer: Group Health Inc Commercial	$83.00
Rate for Payer: Group Health Inc Medicare	$58.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.00
Rate for Payer: Hamaspik Choice Inc Medicare	$83.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$107.90

SYNTHES 1.0MM X7MM SCREW CORTEX

Facility IP

$166.00

Service Code	HCPCS C1713
Hospital Charge Code	40206228
Hospital Revenue Code	278
Min. Negotiated Rate	$83.00
Max. Negotiated Rate	$83.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.00
Rate for Payer: Hamaspik Choice Inc Medicare	$83.00

SYNTHES 1.25MM 4HOLE

Facility OP

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	40206336
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,050.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$550.00
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	$500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$575.00
Rate for Payer: Fidelis Medicare Advantage	$1,050.00
Rate for Payer: Group Health Inc Commercial	$500.00
Rate for Payer: Group Health Inc Medicare	$350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$650.00

SYNTHES 1.25MM 4HOLE

Facility IP

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	40206336
Hospital Revenue Code	278
Min. Negotiated Rate	$500.00
Max. Negotiated Rate	$500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$500.00

SYNTHES 12 HOLE PLATE

Facility OP

$364.00

Service Code	HCPCS C1713
Hospital Charge Code	40209367
Hospital Revenue Code	278
Min. Negotiated Rate	$127.40
Max. Negotiated Rate	$382.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$200.20
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	$182.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$209.30
Rate for Payer: Fidelis Medicare Advantage	$382.20
Rate for Payer: Group Health Inc Commercial	$182.00
Rate for Payer: Group Health Inc Medicare	$127.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.00
Rate for Payer: Hamaspik Choice Inc Medicare	$182.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$236.60

SYNTHES 12 HOLE PLATE

Facility IP

$364.00

Service Code	HCPCS C1713
Hospital Charge Code	40209367
Hospital Revenue Code	278
Min. Negotiated Rate	$182.00
Max. Negotiated Rate	$182.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.00
Rate for Payer: Hamaspik Choice Inc Medicare	$182.00

SYNTHES 14H 4.5LCP PROXIMAL TIBIA

Facility IP

$3,562.00

Service Code	HCPCS C1776
Hospital Charge Code	40205707
Hospital Revenue Code	278
Min. Negotiated Rate	$1,781.00
Max. Negotiated Rate	$1,781.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,781.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,781.00

SYNTHES 14H 4.5LCP PROXIMAL TIBIA

Facility OP

$3,562.00

Service Code	HCPCS C1776
Hospital Charge Code	40205707
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,740.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,959.10
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	$1,781.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,048.15
Rate for Payer: Fidelis Medicare Advantage	$3,740.10
Rate for Payer: Group Health Inc Commercial	$1,781.00
Rate for Payer: Group Health Inc Medicare	$1,246.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,781.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,781.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,315.30

SYNTHES 1.5MM 4 HOLE PLATE

Facility IP

$1,258.00

Service Code	HCPCS C1713
Hospital Charge Code	40205809
Hospital Revenue Code	278
Min. Negotiated Rate	$629.00
Max. Negotiated Rate	$629.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$629.00
Rate for Payer: Hamaspik Choice Inc Medicare	$629.00

SYNTHES 1.5MM 4 HOLE PLATE

Facility OP

$1,258.00

Service Code	HCPCS C1713
Hospital Charge Code	40205809
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,320.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$691.90
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	$629.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$723.35
Rate for Payer: Fidelis Medicare Advantage	$1,320.90
Rate for Payer: Group Health Inc Commercial	$629.00
Rate for Payer: Group Health Inc Medicare	$440.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$629.00
Rate for Payer: Hamaspik Choice Inc Medicare	$629.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$817.70

SYNTHES 1.5MM EXTENDED H-PLATE

Facility IP

$488.00

Service Code	HCPCS C1713
Hospital Charge Code	40205633
Hospital Revenue Code	278
Min. Negotiated Rate	$244.00
Max. Negotiated Rate	$244.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$244.00
Rate for Payer: Hamaspik Choice Inc Medicare	$244.00

SYNTHES 1.5MM EXTENDED H-PLATE

Facility OP

$488.00

Service Code	HCPCS C1713
Hospital Charge Code	40205633
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$512.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$268.40
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	$244.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$280.60
Rate for Payer: Fidelis Medicare Advantage	$512.40
Rate for Payer: Group Health Inc Commercial	$244.00
Rate for Payer: Group Health Inc Medicare	$170.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$244.00
Rate for Payer: Hamaspik Choice Inc Medicare	$244.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$317.20

SYNTHES 1.5MM TIT 6-H STGHT PLATE

Facility OP

$329.40

Service Code	HCPCS C1713
Hospital Charge Code	40205608
Hospital Revenue Code	278
Min. Negotiated Rate	$115.29
Max. Negotiated Rate	$345.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$181.17
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	$164.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$189.40
Rate for Payer: Fidelis Medicare Advantage	$345.87
Rate for Payer: Group Health Inc Commercial	$164.70
Rate for Payer: Group Health Inc Medicare	$115.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$164.70
Rate for Payer: Hamaspik Choice Inc Medicare	$164.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$214.11

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