St. Barnabas Hospital

All Charges

Charge

Type

Price

SYNTHES CORTEX SCREW 1.3MM

Facility OP

$810.00

Service Code	HCPCS C1776
Hospital Charge Code	40205257
Hospital Revenue Code	278
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$850.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$445.50
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	$405.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$465.75
Rate for Payer: Fidelis Medicare Advantage	$850.50
Rate for Payer: Group Health Inc Commercial	$405.00
Rate for Payer: Group Health Inc Medicare	$283.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$405.00
Rate for Payer: Hamaspik Choice Inc Medicare	$405.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$526.50

SYNTHES CORTEX SCREW 1.3MM

Facility IP

$810.00

Service Code	HCPCS C1776
Hospital Charge Code	40205257
Hospital Revenue Code	278
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$405.00
Rate for Payer: Hamaspik Choice Inc Medicare	$405.00

SYNTHES CORTEX SCREW 1.3MMX14MM

Facility OP

$810.00

Service Code	HCPCS C1776
Hospital Charge Code	40205258
Hospital Revenue Code	278
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$850.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$445.50
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	$405.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$465.75
Rate for Payer: Fidelis Medicare Advantage	$850.50
Rate for Payer: Group Health Inc Commercial	$405.00
Rate for Payer: Group Health Inc Medicare	$283.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$405.00
Rate for Payer: Hamaspik Choice Inc Medicare	$405.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$526.50

SYNTHES CORTEX SCREW 1.3MMX14MM

Facility IP

$810.00

Service Code	HCPCS C1776
Hospital Charge Code	40205258
Hospital Revenue Code	278
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$405.00
Rate for Payer: Hamaspik Choice Inc Medicare	$405.00

SYNTHES CORTEX SCREW 2.4 X

Facility IP

$114.75

Service Code	HCPCS C1713
Hospital Charge Code	40205680
Hospital Revenue Code	278
Min. Negotiated Rate	$57.38
Max. Negotiated Rate	$57.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.38
Rate for Payer: Hamaspik Choice Inc Medicare	$57.38

SYNTHES CORTEX SCREW 2.4 X

Facility OP

$114.75

Service Code	HCPCS C1713
Hospital Charge Code	40205680
Hospital Revenue Code	278
Min. Negotiated Rate	$40.16
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$63.11
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	$57.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.98
Rate for Payer: Fidelis Medicare Advantage	$120.49
Rate for Payer: Group Health Inc Commercial	$57.38
Rate for Payer: Group Health Inc Medicare	$40.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.38
Rate for Payer: Hamaspik Choice Inc Medicare	$57.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$74.59

SYNTHES CORTEX SCREW 4.5 X

Facility OP

$64.38

Service Code	HCPCS C1713
Hospital Charge Code	40205688
Hospital Revenue Code	278
Min. Negotiated Rate	$22.53
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.41
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	$32.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.02
Rate for Payer: Fidelis Medicare Advantage	$67.60
Rate for Payer: Group Health Inc Commercial	$32.19
Rate for Payer: Group Health Inc Medicare	$22.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.19
Rate for Payer: Hamaspik Choice Inc Medicare	$32.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$41.85

SYNTHES CORTEX SCREW 4.5 X

Facility IP

$64.38

Service Code	HCPCS C1713
Hospital Charge Code	40205688
Hospital Revenue Code	278
Min. Negotiated Rate	$32.19
Max. Negotiated Rate	$32.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.19
Rate for Payer: Hamaspik Choice Inc Medicare	$32.19

SYNTHES CORTEX SCRW 1.3MMX10MM

Facility IP

$810.00

Service Code	HCPCS C1776
Hospital Charge Code	40205256
Hospital Revenue Code	278
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$405.00
Rate for Payer: Hamaspik Choice Inc Medicare	$405.00

SYNTHES CORTEX SCRW 1.3MMX10MM

Facility OP

$810.00

Service Code	HCPCS C1776
Hospital Charge Code	40205256
Hospital Revenue Code	278
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$850.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$445.50
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	$405.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$465.75
Rate for Payer: Fidelis Medicare Advantage	$850.50
Rate for Payer: Group Health Inc Commercial	$405.00
Rate for Payer: Group Health Inc Medicare	$283.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$405.00
Rate for Payer: Hamaspik Choice Inc Medicare	$405.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$526.50

SYNTHES CORTEX TIT 2.4

Facility OP

$166.50

Service Code	HCPCS C1776
Hospital Charge Code	40205209
Hospital Revenue Code	278
Min. Negotiated Rate	$58.28
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.58
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	$83.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.74
Rate for Payer: Fidelis Medicare Advantage	$174.82
Rate for Payer: Group Health Inc Commercial	$83.25
Rate for Payer: Group Health Inc Medicare	$58.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.25
Rate for Payer: Hamaspik Choice Inc Medicare	$83.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$108.22

SYNTHES CORTEX TIT 2.4

Facility IP

$166.50

Service Code	HCPCS C1776
Hospital Charge Code	40205209
Hospital Revenue Code	278
Min. Negotiated Rate	$83.25
Max. Negotiated Rate	$83.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.25
Rate for Payer: Hamaspik Choice Inc Medicare	$83.25

SYNTHES D/B 1.1MM J-L

Facility OP

$153.00

Hospital Charge Code	40205426
Hospital Revenue Code	270
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$122.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$84.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$76.50
Rate for Payer: Aetna Government	$76.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$122.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$104.04
Rate for Payer: Group Health Inc Commercial	$76.50
Rate for Payer: Group Health Inc Medicare	$53.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.50
Rate for Payer: Hamaspik Choice Inc Medicare	$76.50

SYNTHES DRILL BIT 1.1MM

Facility OP

$153.00

Hospital Charge Code	40205135
Hospital Revenue Code	270
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$122.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$84.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$76.50
Rate for Payer: Aetna Government	$76.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$122.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$104.04
Rate for Payer: Group Health Inc Commercial	$76.50
Rate for Payer: Group Health Inc Medicare	$53.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.50
Rate for Payer: Hamaspik Choice Inc Medicare	$76.50

SYNTHES DRILL BIT 1.3MM

Facility OP

$170.00

Hospital Charge Code	40205632
Hospital Revenue Code	270
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$136.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$85.00
Rate for Payer: Aetna Government	$85.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$136.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$115.60
Rate for Payer: Group Health Inc Commercial	$85.00
Rate for Payer: Group Health Inc Medicare	$59.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.00
Rate for Payer: Hamaspik Choice Inc Medicare	$85.00

SYNTHES END CAP 5MM

Facility IP

$477.00

Service Code	HCPCS C1776
Hospital Charge Code	40206080
Hospital Revenue Code	278
Min. Negotiated Rate	$238.50
Max. Negotiated Rate	$238.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$238.50
Rate for Payer: Hamaspik Choice Inc Medicare	$238.50

SYNTHES END CAP 5MM

Facility OP

$477.00

Service Code	HCPCS C1776
Hospital Charge Code	40206080
Hospital Revenue Code	278
Min. Negotiated Rate	$166.95
Max. Negotiated Rate	$500.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$262.35
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	$238.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$274.28
Rate for Payer: Fidelis Medicare Advantage	$500.85
Rate for Payer: Group Health Inc Commercial	$238.50
Rate for Payer: Group Health Inc Medicare	$166.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$238.50
Rate for Payer: Hamaspik Choice Inc Medicare	$238.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$310.05

SYNTHES FIXATION NAIL 10ML/170MM

Facility IP

$2,788.20

Service Code	HCPCS C1713
Hospital Charge Code	40205945
Hospital Revenue Code	278
Min. Negotiated Rate	$1,394.10
Max. Negotiated Rate	$1,394.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,394.10
Rate for Payer: Hamaspik Choice Inc Medicare	$1,394.10

SYNTHES FIXATION NAIL 10ML/170MM

Facility OP

$2,788.20

Service Code	HCPCS C1713
Hospital Charge Code	40205945
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,927.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,533.51
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	$1,394.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,603.22
Rate for Payer: Fidelis Medicare Advantage	$2,927.61
Rate for Payer: Group Health Inc Commercial	$1,394.10
Rate for Payer: Group Health Inc Medicare	$975.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,394.10
Rate for Payer: Hamaspik Choice Inc Medicare	$1,394.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,812.33

SYNTHES GUIDEWIRE 2.0X230MM

Facility OP

$80.54

Service Code	HCPCS C1769
Hospital Charge Code	40205703
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 GUIDEWIRE 2.0X230MM

Facility IP

$80.54

Service Code	HCPCS C1769
Hospital Charge Code	40205703
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 H PLT 11 H 0.5MM THICK

Facility IP

$558.00

Service Code	HCPCS C1776
Hospital Charge Code	40205300
Hospital Revenue Code	278
Min. Negotiated Rate	$279.00
Max. Negotiated Rate	$279.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$279.00
Rate for Payer: Hamaspik Choice Inc Medicare	$279.00

SYNTHES H PLT 11 H 0.5MM THICK

Facility OP

$558.00

Service Code	HCPCS C1776
Hospital Charge Code	40205300
Hospital Revenue Code	278
Min. Negotiated Rate	$195.30
Max. Negotiated Rate	$585.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.90
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	$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

SYNTHES JOINT UNIVERSAL FOR TWO T

Facility OP

$1,172.00

Service Code	HCPCS C1776
Hospital Charge Code	40203346
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,230.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$644.60
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	$586.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$673.90
Rate for Payer: Fidelis Medicare Advantage	$1,230.60
Rate for Payer: Group Health Inc Commercial	$586.00
Rate for Payer: Group Health Inc Medicare	$410.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$586.00
Rate for Payer: Hamaspik Choice Inc Medicare	$586.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$761.80

SYNTHES JOINT UNIVERSAL FOR TWO T

Facility OP

$1,172.00

Hospital Charge Code	40009329
Hospital Revenue Code	272
Min. Negotiated Rate	$410.20
Max. Negotiated Rate	$937.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$644.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$586.00
Rate for Payer: Aetna Government	$586.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$937.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$796.96
Rate for Payer: Group Health Inc Commercial	$586.00
Rate for Payer: Group Health Inc Medicare	$410.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$586.00
Rate for Payer: Hamaspik Choice Inc Medicare	$586.00

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