St. Barnabas Hospital

All Charges

Charge

Type

Price

SYNTHES 1.5MM TIT 6-H STGHT PLATE

Facility IP

$329.40

Service Code	HCPCS C1713
Hospital Charge Code	40205608
Hospital Revenue Code	278
Min. Negotiated Rate	$164.70
Max. Negotiated Rate	$164.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$164.70
Rate for Payer: Hamaspik Choice Inc Medicare	$164.70

SYNTHES 1.5 TIT ST 12 HOLE PLATE

Facility IP

$454.72

Service Code	HCPCS C1713
Hospital Charge Code	40205544
Hospital Revenue Code	278
Min. Negotiated Rate	$227.36
Max. Negotiated Rate	$227.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$227.36
Rate for Payer: Hamaspik Choice Inc Medicare	$227.36

SYNTHES 1.5 TIT ST 12 HOLE PLATE

Facility OP

$454.72

Service Code	HCPCS C1713
Hospital Charge Code	40205544
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$477.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$250.10
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	$227.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$261.46
Rate for Payer: Fidelis Medicare Advantage	$477.46
Rate for Payer: Group Health Inc Commercial	$227.36
Rate for Payer: Group Health Inc Medicare	$159.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$227.36
Rate for Payer: Hamaspik Choice Inc Medicare	$227.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$295.57

SYNTHES 16MM HEADLESS COMP SCRW

Facility IP

$764.00

Service Code	HCPCS C1713
Hospital Charge Code	40205436
Hospital Revenue Code	278
Min. Negotiated Rate	$382.00
Max. Negotiated Rate	$382.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$382.00
Rate for Payer: Hamaspik Choice Inc Medicare	$382.00

SYNTHES 16MM HEADLESS COMP SCRW

Facility OP

$764.00

Service Code	HCPCS C1713
Hospital Charge Code	40205436
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$802.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$420.20
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	$382.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$439.30
Rate for Payer: Fidelis Medicare Advantage	$802.20
Rate for Payer: Group Health Inc Commercial	$382.00
Rate for Payer: Group Health Inc Medicare	$267.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$382.00
Rate for Payer: Hamaspik Choice Inc Medicare	$382.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$496.60

SYNTHES 2.0 MATRIX MANDIBLE X6MM

Facility OP

$143.00

Service Code	HCPCS C1713
Hospital Charge Code	40208150
Hospital Revenue Code	278
Min. Negotiated Rate	$50.05
Max. Negotiated Rate	$150.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.65
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	$71.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$82.22
Rate for Payer: Fidelis Medicare Advantage	$150.15
Rate for Payer: Group Health Inc Commercial	$71.50
Rate for Payer: Group Health Inc Medicare	$50.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.50
Rate for Payer: Hamaspik Choice Inc Medicare	$71.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$92.95

SYNTHES 2.0 MATRIX MANDIBLE X6MM

Facility IP

$143.00

Service Code	HCPCS C1713
Hospital Charge Code	40208150
Hospital Revenue Code	278
Min. Negotiated Rate	$71.50
Max. Negotiated Rate	$71.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.50
Rate for Payer: Hamaspik Choice Inc Medicare	$71.50

SYNTHES 2.0 TI MATRIX MAND SCRW

Facility IP

$126.00

Service Code	HCPCS C1713
Hospital Charge Code	40207053
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$63.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.00
Rate for Payer: Hamaspik Choice Inc Medicare	$63.00

SYNTHES 2.0 TI MATRIX MAND SCRW

Facility OP

$126.00

Service Code	HCPCS C1713
Hospital Charge Code	40207053
Hospital Revenue Code	278
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$69.30
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	$63.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$72.45
Rate for Payer: Fidelis Medicare Advantage	$132.30
Rate for Payer: Group Health Inc Commercial	$63.00
Rate for Payer: Group Health Inc Medicare	$44.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.00
Rate for Payer: Hamaspik Choice Inc Medicare	$63.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$81.90

SYNTHES 2.0X 12 HOLE TI MATRIX P

Facility IP

$1,972.00

Service Code	HCPCS C1713
Hospital Charge Code	40206334
Hospital Revenue Code	278
Min. Negotiated Rate	$986.00
Max. Negotiated Rate	$986.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$986.00
Rate for Payer: Hamaspik Choice Inc Medicare	$986.00

SYNTHES 2.0X 12 HOLE TI MATRIX P

Facility OP

$1,972.00

Service Code	HCPCS C1713
Hospital Charge Code	40206334
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,070.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,084.60
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	$986.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,133.90
Rate for Payer: Fidelis Medicare Advantage	$2,070.60
Rate for Payer: Group Health Inc Commercial	$986.00
Rate for Payer: Group Health Inc Medicare	$690.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$986.00
Rate for Payer: Hamaspik Choice Inc Medicare	$986.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,281.80

SYNTHES 2.0X230MM GUIDEWIRE

Facility IP

$80.54

Service Code	HCPCS C1769
Hospital Charge Code	40205665
Hospital Revenue Code	278
Min. Negotiated Rate	$40.27
Max. Negotiated Rate	$40.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.27
Rate for Payer: Hamaspik Choice Inc Medicare	$40.27

SYNTHES 2.0X230MM GUIDEWIRE

Facility OP

$80.54

Service Code	HCPCS C1769
Hospital Charge Code	40205665
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$84.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.31
Rate for Payer: Fidelis Medicare Advantage	$84.57
Rate for Payer: Group Health Inc Commercial	$40.27
Rate for Payer: Group Health Inc Medicare	$28.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.27
Rate for Payer: Hamaspik Choice Inc Medicare	$40.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.35

SYNTHES 2.4 M/MANDIBLE B ER SCRW

Facility OP

$194.00

Service Code	HCPCS C1713
Hospital Charge Code	40205839
Hospital Revenue Code	278
Min. Negotiated Rate	$67.90
Max. Negotiated Rate	$203.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$106.70
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	$97.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$111.55
Rate for Payer: Fidelis Medicare Advantage	$203.70
Rate for Payer: Group Health Inc Commercial	$97.00
Rate for Payer: Group Health Inc Medicare	$67.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$97.00
Rate for Payer: Hamaspik Choice Inc Medicare	$97.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$126.10

SYNTHES 2.4 M/MANDIBLE B ER SCRW

Facility IP

$194.00

Service Code	HCPCS C1713
Hospital Charge Code	40205839
Hospital Revenue Code	278
Min. Negotiated Rate	$97.00
Max. Negotiated Rate	$97.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$97.00
Rate for Payer: Hamaspik Choice Inc Medicare	$97.00

SYNTHES 2.4MMX23H LCKNG RECON PLT

Facility IP

$81.00

Service Code	HCPCS C1713
Hospital Charge Code	40205284
Hospital Revenue Code	278
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.50
Rate for Payer: Hamaspik Choice Inc Medicare	$40.50

SYNTHES 2.4MMX23H LCKNG RECON PLT

Facility OP

$81.00

Service Code	HCPCS C1713
Hospital Charge Code	40205284
Hospital Revenue Code	278
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.55
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	$40.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.58
Rate for Payer: Fidelis Medicare Advantage	$85.05
Rate for Payer: Group Health Inc Commercial	$40.50
Rate for Payer: Group Health Inc Medicare	$28.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.50
Rate for Payer: Hamaspik Choice Inc Medicare	$40.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.65

SYNTHES 2.7/3.5 LCP D FIB 3H PLT

Facility OP

$1,516.00

Service Code	HCPCS C1713
Hospital Charge Code	40205695
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,591.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$833.80
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	$758.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$871.70
Rate for Payer: Fidelis Medicare Advantage	$1,591.80
Rate for Payer: Group Health Inc Commercial	$758.00
Rate for Payer: Group Health Inc Medicare	$530.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$758.00
Rate for Payer: Hamaspik Choice Inc Medicare	$758.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$985.40

SYNTHES 2.7/3.5 LCP D FIB 3H PLT

Facility IP

$1,516.00

Service Code	HCPCS C1713
Hospital Charge Code	40205695
Hospital Revenue Code	278
Min. Negotiated Rate	$758.00
Max. Negotiated Rate	$758.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$758.00
Rate for Payer: Hamaspik Choice Inc Medicare	$758.00

SYNTHES 2.7/3.5 LCP FIBULAR 5H

Facility IP

$1,558.00

Service Code	HCPCS C1713
Hospital Charge Code	40205195
Hospital Revenue Code	278
Min. Negotiated Rate	$779.00
Max. Negotiated Rate	$779.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$779.00
Rate for Payer: Hamaspik Choice Inc Medicare	$779.00

SYNTHES 2.7/3.5 LCP FIBULAR 5H

Facility OP

$1,558.00

Service Code	HCPCS C1713
Hospital Charge Code	40205195
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,635.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$856.90
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	$779.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$895.85
Rate for Payer: Fidelis Medicare Advantage	$1,635.90
Rate for Payer: Group Health Inc Commercial	$779.00
Rate for Payer: Group Health Inc Medicare	$545.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$779.00
Rate for Payer: Hamaspik Choice Inc Medicare	$779.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,012.70

SYNTHES 2.7/3.5 LCP FIBULAR 7H P

Facility OP

$1,602.00

Service Code	HCPCS C1713
Hospital Charge Code	40205196
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,682.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$881.10
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	$801.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$921.15
Rate for Payer: Fidelis Medicare Advantage	$1,682.10
Rate for Payer: Group Health Inc Commercial	$801.00
Rate for Payer: Group Health Inc Medicare	$560.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$801.00
Rate for Payer: Hamaspik Choice Inc Medicare	$801.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,041.30

SYNTHES 2.7/3.5 LCP FIBULAR 7H P

Facility IP

$1,602.00

Service Code	HCPCS C1713
Hospital Charge Code	40205196
Hospital Revenue Code	278
Min. Negotiated Rate	$801.00
Max. Negotiated Rate	$801.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$801.00
Rate for Payer: Hamaspik Choice Inc Medicare	$801.00

SYNTHES 2.7MM LOCKING SCREW 14MM

Facility IP

$255.60

Service Code	HCPCS C1713
Hospital Charge Code	40205198
Hospital Revenue Code	278
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$127.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$127.80
Rate for Payer: Hamaspik Choice Inc Medicare	$127.80

SYNTHES 2.7MM LOCKING SCREW 14MM

Facility OP

$255.60

Service Code	HCPCS C1713
Hospital Charge Code	40205198
Hospital Revenue Code	278
Min. Negotiated Rate	$89.46
Max. Negotiated Rate	$268.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$140.58
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	$127.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$146.97
Rate for Payer: Fidelis Medicare Advantage	$268.38
Rate for Payer: Group Health Inc Commercial	$127.80
Rate for Payer: Group Health Inc Medicare	$89.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$127.80
Rate for Payer: Hamaspik Choice Inc Medicare	$127.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$166.14

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