St. Barnabas Hospital

All Charges

Charge

Type

Price

SYNTHES 2.7MM LOCKING SCREW 16MM

Facility IP

$244.80

Service Code	HCPCS C1713
Hospital Charge Code	40205197
Hospital Revenue Code	278
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$122.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$122.40
Rate for Payer: Hamaspik Choice Inc Medicare	$122.40

SYNTHES 2.7MM LOCKING SCREW 16MM

Facility OP

$244.80

Service Code	HCPCS C1713
Hospital Charge Code	40205197
Hospital Revenue Code	278
Min. Negotiated Rate	$85.68
Max. Negotiated Rate	$257.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$134.64
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	$122.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$140.76
Rate for Payer: Fidelis Medicare Advantage	$257.04
Rate for Payer: Group Health Inc Commercial	$122.40
Rate for Payer: Group Health Inc Medicare	$85.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$122.40
Rate for Payer: Hamaspik Choice Inc Medicare	$122.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$159.12

SYNTHES 2.7MM L/S 18MM

Facility OP

$217.80

Service Code	HCPCS C1713
Hospital Charge Code	40205923
Hospital Revenue Code	278
Min. Negotiated Rate	$76.23
Max. Negotiated Rate	$228.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$119.79
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	$108.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$125.24
Rate for Payer: Fidelis Medicare Advantage	$228.69
Rate for Payer: Group Health Inc Commercial	$108.90
Rate for Payer: Group Health Inc Medicare	$76.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$108.90
Rate for Payer: Hamaspik Choice Inc Medicare	$108.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$141.57

SYNTHES 2.7MM L/S 18MM

Facility IP

$217.80

Service Code	HCPCS C1713
Hospital Charge Code	40205923
Hospital Revenue Code	278
Min. Negotiated Rate	$108.90
Max. Negotiated Rate	$108.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$108.90
Rate for Payer: Hamaspik Choice Inc Medicare	$108.90

SYNTHES 3.5 1/3 TUBULAR LCP

Facility OP

$499.50

Service Code	HCPCS C1713
Hospital Charge Code	40205708
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$524.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$274.72
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	$249.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$287.21
Rate for Payer: Fidelis Medicare Advantage	$524.48
Rate for Payer: Group Health Inc Commercial	$249.75
Rate for Payer: Group Health Inc Medicare	$174.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$249.75
Rate for Payer: Hamaspik Choice Inc Medicare	$249.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$324.68

SYNTHES 3.5 1/3 TUBULAR LCP

Facility IP

$499.50

Service Code	HCPCS C1713
Hospital Charge Code	40205708
Hospital Revenue Code	278
Min. Negotiated Rate	$249.75
Max. Negotiated Rate	$249.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$249.75
Rate for Payer: Hamaspik Choice Inc Medicare	$249.75

SYNTHES 3.5MM 6-H LCP P TIB PLATE

Facility IP

$3,085.20

Service Code	HCPCS C1713
Hospital Charge Code	40205689
Hospital Revenue Code	278
Min. Negotiated Rate	$1,542.60
Max. Negotiated Rate	$1,542.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,542.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,542.60

SYNTHES 3.5MM 6-H LCP P TIB PLATE

Facility OP

$3,085.20

Service Code	HCPCS C1713
Hospital Charge Code	40205689
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,239.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,696.86
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	$1,542.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,773.99
Rate for Payer: Fidelis Medicare Advantage	$3,239.46
Rate for Payer: Group Health Inc Commercial	$1,542.60
Rate for Payer: Group Health Inc Medicare	$1,079.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,542.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,542.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,005.38

SYNTHES 3.5MM LCP DISTAL TIB PLT

Facility OP

$2,133.00

Service Code	HCPCS C1713
Hospital Charge Code	40205673
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,239.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,173.15
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	$1,066.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,226.48
Rate for Payer: Fidelis Medicare Advantage	$2,239.65
Rate for Payer: Group Health Inc Commercial	$1,066.50
Rate for Payer: Group Health Inc Medicare	$746.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,066.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,066.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,386.45

SYNTHES 3.5MM LCP DISTAL TIB PLT

Facility IP

$2,133.00

Service Code	HCPCS C1713
Hospital Charge Code	40205673
Hospital Revenue Code	278
Min. Negotiated Rate	$1,066.50
Max. Negotiated Rate	$1,066.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,066.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,066.50

SYNTHES 3.5MM T-HANDLE

Facility OP

$504.00

Hospital Charge Code	40205812
Hospital Revenue Code	270
Min. Negotiated Rate	$176.40
Max. Negotiated Rate	$403.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$277.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$252.00
Rate for Payer: Aetna Government	$252.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$403.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$342.72
Rate for Payer: Group Health Inc Commercial	$252.00
Rate for Payer: Group Health Inc Medicare	$176.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$252.00
Rate for Payer: Hamaspik Choice Inc Medicare	$252.00

SYNTHES 3.5X 34MM LOCKING SCREW

Facility OP

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	40205190
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$283.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$148.50
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	$135.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$155.25
Rate for Payer: Fidelis Medicare Advantage	$283.50
Rate for Payer: Group Health Inc Commercial	$135.00
Rate for Payer: Group Health Inc Medicare	$94.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$135.00
Rate for Payer: Hamaspik Choice Inc Medicare	$135.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$175.50

SYNTHES 3.5X 34MM LOCKING SCREW

Facility IP

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	40205190
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$135.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$135.00
Rate for Payer: Hamaspik Choice Inc Medicare	$135.00

SYNTHES 4.0X LCP SCREW

Facility IP

$297.00

Service Code	HCPCS C1713
Hospital Charge Code	40205663
Hospital Revenue Code	278
Min. Negotiated Rate	$148.50
Max. Negotiated Rate	$148.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.50
Rate for Payer: Hamaspik Choice Inc Medicare	$148.50

SYNTHES 4.0X LCP SCREW

Facility OP

$297.00

Service Code	HCPCS C1713
Hospital Charge Code	40205663
Hospital Revenue Code	278
Min. Negotiated Rate	$103.95
Max. Negotiated Rate	$311.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$163.35
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	$148.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.78
Rate for Payer: Fidelis Medicare Advantage	$311.85
Rate for Payer: Group Health Inc Commercial	$148.50
Rate for Payer: Group Health Inc Medicare	$103.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.50
Rate for Payer: Hamaspik Choice Inc Medicare	$148.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$193.05

SYNTHES 4.5 DRILL BIT

Facility OP

$136.50

Hospital Charge Code	40205709
Hospital Revenue Code	270
Min. Negotiated Rate	$47.78
Max. Negotiated Rate	$109.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$75.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$68.25
Rate for Payer: Aetna Government	$68.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$109.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$92.82
Rate for Payer: Group Health Inc Commercial	$68.25
Rate for Payer: Group Health Inc Medicare	$47.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.25
Rate for Payer: Hamaspik Choice Inc Medicare	$68.25

SYNTHES 4.5 LCP NARROW PLATE

Facility OP

$1,108.00

Service Code	HCPCS C1713
Hospital Charge Code	40205706
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,163.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$609.40
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	$554.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$637.10
Rate for Payer: Fidelis Medicare Advantage	$1,163.40
Rate for Payer: Group Health Inc Commercial	$554.00
Rate for Payer: Group Health Inc Medicare	$387.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$554.00
Rate for Payer: Hamaspik Choice Inc Medicare	$554.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$720.20

SYNTHES 4.5 LCP NARROW PLATE

Facility IP

$1,108.00

Service Code	HCPCS C1713
Hospital Charge Code	40205706
Hospital Revenue Code	278
Min. Negotiated Rate	$554.00
Max. Negotiated Rate	$554.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$554.00
Rate for Payer: Hamaspik Choice Inc Medicare	$554.00

SYNTHES 5.0X200MM S/D SHANZ SCREW

Facility OP

$1,333.80

Service Code	HCPCS C1713
Hospital Charge Code	40205191
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,400.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$733.59
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	$666.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$766.94
Rate for Payer: Fidelis Medicare Advantage	$1,400.49
Rate for Payer: Group Health Inc Commercial	$666.90
Rate for Payer: Group Health Inc Medicare	$466.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$666.90
Rate for Payer: Hamaspik Choice Inc Medicare	$666.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$866.97

SYNTHES 5.0X200MM S/D SHANZ SCREW

Facility IP

$1,333.80

Service Code	HCPCS C1713
Hospital Charge Code	40205191
Hospital Revenue Code	278
Min. Negotiated Rate	$666.90
Max. Negotiated Rate	$666.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$666.90
Rate for Payer: Hamaspik Choice Inc Medicare	$666.90

SYNTHES 5.0X32MM LCK SCRW

Facility IP

$464.00

Service Code	HCPCS C1713
Hospital Charge Code	40205384
Hospital Revenue Code	278
Min. Negotiated Rate	$232.00
Max. Negotiated Rate	$232.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$232.00
Rate for Payer: Hamaspik Choice Inc Medicare	$232.00

SYNTHES 5.0X32MM LCK SCRW

Facility OP

$464.00

Service Code	HCPCS C1713
Hospital Charge Code	40205384
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$487.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$255.20
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	$232.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$266.80
Rate for Payer: Fidelis Medicare Advantage	$487.20
Rate for Payer: Group Health Inc Commercial	$232.00
Rate for Payer: Group Health Inc Medicare	$162.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$232.00
Rate for Payer: Hamaspik Choice Inc Medicare	$232.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$301.60

SYNTHES 5.0X LOCKING

Facility OP

$464.00

Service Code	HCPCS C1713
Hospital Charge Code	40205664
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$487.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$255.20
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	$232.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$266.80
Rate for Payer: Fidelis Medicare Advantage	$487.20
Rate for Payer: Group Health Inc Commercial	$232.00
Rate for Payer: Group Health Inc Medicare	$162.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$232.00
Rate for Payer: Hamaspik Choice Inc Medicare	$232.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$301.60

SYNTHES 5.0X LOCKING

Facility IP

$464.00

Service Code	HCPCS C1713
Hospital Charge Code	40205664
Hospital Revenue Code	278
Min. Negotiated Rate	$232.00
Max. Negotiated Rate	$232.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$232.00
Rate for Payer: Hamaspik Choice Inc Medicare	$232.00

SYNTHES .5MM SQ /BOXPLATE

Facility OP

$558.00

Service Code	HCPCS C1713
Hospital Charge Code	40205306
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$585.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.90
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	$279.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$320.85
Rate for Payer: Fidelis Medicare Advantage	$585.90
Rate for Payer: Group Health Inc Commercial	$279.00
Rate for Payer: Group Health Inc Medicare	$195.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$279.00
Rate for Payer: Hamaspik Choice Inc Medicare	$279.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$362.70

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