St. Barnabas Hospital

All Charges

Charge

Type

Price

SYNTHES JOINT UNIVERSAL FOR TWO T

Facility IP

$1,172.00

Service Code	HCPCS C1776
Hospital Charge Code	40203346
Hospital Revenue Code	278
Min. Negotiated Rate	$586.00
Max. Negotiated Rate	$586.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$586.00
Rate for Payer: Hamaspik Choice Inc Medicare	$586.00

SYNTHES K-WIRE 1.25MM

Facility IP

$146.00

Service Code	HCPCS C1769
Hospital Charge Code	40205216
Hospital Revenue Code	278
Min. Negotiated Rate	$73.00
Max. Negotiated Rate	$73.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.00
Rate for Payer: Hamaspik Choice Inc Medicare	$73.00

SYNTHES K-WIRE 1.25MM

Facility OP

$146.00

Service Code	HCPCS C1769
Hospital Charge Code	40205216
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$153.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.30
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	$73.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$83.95
Rate for Payer: Fidelis Medicare Advantage	$153.30
Rate for Payer: Group Health Inc Commercial	$73.00
Rate for Payer: Group Health Inc Medicare	$51.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.00
Rate for Payer: Hamaspik Choice Inc Medicare	$73.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$94.90

SYNTHES LCKNG SCREW 7.3MMX85MM

Facility OP

$528.00

Service Code	HCPCS C1713
Hospital Charge Code	40205772
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$554.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$290.40
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	$264.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$303.60
Rate for Payer: Fidelis Medicare Advantage	$554.40
Rate for Payer: Group Health Inc Commercial	$264.00
Rate for Payer: Group Health Inc Medicare	$184.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.00
Rate for Payer: Hamaspik Choice Inc Medicare	$264.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$343.20

SYNTHES LCKNG SCREW 7.3MMX85MM

Facility IP

$528.00

Service Code	HCPCS C1713
Hospital Charge Code	40205772
Hospital Revenue Code	278
Min. Negotiated Rate	$264.00
Max. Negotiated Rate	$264.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.00
Rate for Payer: Hamaspik Choice Inc Medicare	$264.00

SYNTHES LOCKIG SCREW 2.0MMX 10-12

Facility OP

$268.00

Service Code	HCPCS C1713
Hospital Charge Code	40206333
Hospital Revenue Code	278
Min. Negotiated Rate	$93.80
Max. Negotiated Rate	$281.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$147.40
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	$134.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$154.10
Rate for Payer: Fidelis Medicare Advantage	$281.40
Rate for Payer: Group Health Inc Commercial	$134.00
Rate for Payer: Group Health Inc Medicare	$93.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.00
Rate for Payer: Hamaspik Choice Inc Medicare	$134.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$174.20

SYNTHES LOCKIG SCREW 2.0MMX 10-12

Facility IP

$268.00

Service Code	HCPCS C1713
Hospital Charge Code	40206333
Hospital Revenue Code	278
Min. Negotiated Rate	$134.00
Max. Negotiated Rate	$134.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.00
Rate for Payer: Hamaspik Choice Inc Medicare	$134.00

SYNTHES LOCKING SCREW

Facility IP

$304.20

Service Code	HCPCS C1713
Hospital Charge Code	40208149
Hospital Revenue Code	278
Min. Negotiated Rate	$152.10
Max. Negotiated Rate	$152.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.10
Rate for Payer: Hamaspik Choice Inc Medicare	$152.10

SYNTHES LOCKING SCREW

Facility OP

$304.20

Service Code	HCPCS C1713
Hospital Charge Code	40208149
Hospital Revenue Code	278
Min. Negotiated Rate	$106.47
Max. Negotiated Rate	$319.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$167.31
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	$152.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$174.92
Rate for Payer: Fidelis Medicare Advantage	$319.41
Rate for Payer: Group Health Inc Commercial	$152.10
Rate for Payer: Group Health Inc Medicare	$106.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.10
Rate for Payer: Hamaspik Choice Inc Medicare	$152.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$197.73

SYNTHES LOCKING SCREW 2.0

Facility IP

$254.00

Service Code	HCPCS C1713
Hospital Charge Code	40205810
Hospital Revenue Code	278
Min. Negotiated Rate	$127.00
Max. Negotiated Rate	$127.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$127.00
Rate for Payer: Hamaspik Choice Inc Medicare	$127.00

SYNTHES LOCKING SCREW 2.0

Facility OP

$254.00

Service Code	HCPCS C1713
Hospital Charge Code	40205810
Hospital Revenue Code	278
Min. Negotiated Rate	$88.90
Max. Negotiated Rate	$266.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$139.70
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	$127.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$146.05
Rate for Payer: Fidelis Medicare Advantage	$266.70
Rate for Payer: Group Health Inc Commercial	$127.00
Rate for Payer: Group Health Inc Medicare	$88.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$127.00
Rate for Payer: Hamaspik Choice Inc Medicare	$127.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$165.10

SYNTHES LOCKING SCREW 2.7X

Facility IP

$297.00

Service Code	HCPCS C1713
Hospital Charge Code	40200716
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 LOCKING SCREW 2.7X

Facility OP

$297.00

Service Code	HCPCS C1713
Hospital Charge Code	40200716
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 LOCKING SCREW 4.0 X

Facility OP

$148.50

Service Code	HCPCS C1713
Hospital Charge Code	40205700
Hospital Revenue Code	278
Min. Negotiated Rate	$51.98
Max. Negotiated Rate	$155.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$81.68
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	$74.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$85.39
Rate for Payer: Fidelis Medicare Advantage	$155.92
Rate for Payer: Group Health Inc Commercial	$74.25
Rate for Payer: Group Health Inc Medicare	$51.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.25
Rate for Payer: Hamaspik Choice Inc Medicare	$74.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$96.52

SYNTHES LOCKING SCREW 4.0 X

Facility IP

$148.50

Service Code	HCPCS C1713
Hospital Charge Code	40205700
Hospital Revenue Code	278
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$74.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.25
Rate for Payer: Hamaspik Choice Inc Medicare	$74.25

SYNTHES LOCKING SCREW 5.0 X 54MM

Facility OP

$388.00

Service Code	HCPCS C1713
Hospital Charge Code	40206245
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$407.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$213.40
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	$194.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$223.10
Rate for Payer: Fidelis Medicare Advantage	$407.40
Rate for Payer: Group Health Inc Commercial	$194.00
Rate for Payer: Group Health Inc Medicare	$135.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$194.00
Rate for Payer: Hamaspik Choice Inc Medicare	$194.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$252.20

SYNTHES LOCKING SCREW 5.0 X 54MM

Facility IP

$388.00

Service Code	HCPCS C1713
Hospital Charge Code	40206245
Hospital Revenue Code	278
Min. Negotiated Rate	$194.00
Max. Negotiated Rate	$194.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$194.00
Rate for Payer: Hamaspik Choice Inc Medicare	$194.00

SYNTHES L/S 2.7MM X

Facility IP

$297.00

Service Code	HCPCS C1713
Hospital Charge Code	40205793
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 L/S 2.7MM X

Facility OP

$297.00

Service Code	HCPCS C1713
Hospital Charge Code	40205793
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 L/S 5.0X

Facility IP

$464.00

Service Code	HCPCS C1713
Hospital Charge Code	40205946
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 L/S 5.0X

Facility OP

$464.00

Service Code	HCPCS C1713
Hospital Charge Code	40205946
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 L/S 5.0 X 26-38MM

Facility IP

$478.80

Service Code	HCPCS C1713
Hospital Charge Code	40209600
Hospital Revenue Code	278
Min. Negotiated Rate	$239.40
Max. Negotiated Rate	$239.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$239.40
Rate for Payer: Hamaspik Choice Inc Medicare	$239.40

SYNTHES L/S 5.0 X 26-38MM

Facility OP

$478.80

Service Code	HCPCS C1713
Hospital Charge Code	40209600
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$502.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$263.34
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	$239.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$275.31
Rate for Payer: Fidelis Medicare Advantage	$502.74
Rate for Payer: Group Health Inc Commercial	$239.40
Rate for Payer: Group Health Inc Medicare	$167.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$239.40
Rate for Payer: Hamaspik Choice Inc Medicare	$239.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$311.22

SYNTHES MATRIX HOLE BOARD PLATE

Facility IP

$970.00

Service Code	HCPCS C1713
Hospital Charge Code	40206064
Hospital Revenue Code	278
Min. Negotiated Rate	$485.00
Max. Negotiated Rate	$485.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$485.00
Rate for Payer: Hamaspik Choice Inc Medicare	$485.00

SYNTHES MATRIX HOLE BOARD PLATE

Facility OP

$970.00

Service Code	HCPCS C1713
Hospital Charge Code	40206064
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,018.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$533.50
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	$485.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$557.75
Rate for Payer: Fidelis Medicare Advantage	$1,018.50
Rate for Payer: Group Health Inc Commercial	$485.00
Rate for Payer: Group Health Inc Medicare	$339.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$485.00
Rate for Payer: Hamaspik Choice Inc Medicare	$485.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$630.50

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