St. Barnabas Hospital

All Charges

Charge

Type

Price

SYNTHES SCREW 1.5MM TIT C/S 10MM

Facility IP

$101.70

Service Code	HCPCS C1713
Hospital Charge Code	40205617
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

SYNTHES SCREW 1.5MM TIT C/S 10MM

Facility OP

$101.70

Service Code	HCPCS C1713
Hospital Charge Code	40205617
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

SYNTHES SCREW 1.5MM TIT C/S 9MM

Facility OP

$101.70

Service Code	HCPCS C1713
Hospital Charge Code	40205618
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

SYNTHES SCREW 1.5MM TIT C/S 9MM

Facility IP

$101.70

Service Code	HCPCS C1713
Hospital Charge Code	40205618
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

SYNTHES SCREW 1.5MM TIT C S/T8MM

Facility IP

$101.70

Service Code	HCPCS C1713
Hospital Charge Code	40205637
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

SYNTHES SCREW 1.5MM TIT C S/T8MM

Facility OP

$101.70

Service Code	HCPCS C1713
Hospital Charge Code	40205637
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

SYNTHES SCREW 1.5 TIT C S/T 11MM

Facility IP

$78.50

Service Code	HCPCS C1713
Hospital Charge Code	40205577
Hospital Revenue Code	278
Min. Negotiated Rate	$39.25
Max. Negotiated Rate	$39.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.25
Rate for Payer: Hamaspik Choice Inc Medicare	$39.25

SYNTHES SCREW 1.5 TIT C S/T 11MM

Facility OP

$78.50

Service Code	HCPCS C1713
Hospital Charge Code	40205577
Hospital Revenue Code	278
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$43.18
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	$39.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$45.14
Rate for Payer: Fidelis Medicare Advantage	$82.42
Rate for Payer: Group Health Inc Commercial	$39.25
Rate for Payer: Group Health Inc Medicare	$27.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.25
Rate for Payer: Hamaspik Choice Inc Medicare	$39.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$51.02

SYNTHES SCREW 2.7MM CTX S/T

Facility IP

$80.00

Service Code	HCPCS C1713
Hospital Charge Code	40205794
Hospital Revenue Code	278
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$40.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.00
Rate for Payer: Hamaspik Choice Inc Medicare	$40.00

SYNTHES SCREW 2.7MM CTX S/T

Facility OP

$80.00

Service Code	HCPCS C1713
Hospital Charge Code	40205794
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.00
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	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.00
Rate for Payer: Fidelis Medicare Advantage	$84.00
Rate for Payer: Group Health Inc Commercial	$40.00
Rate for Payer: Group Health Inc Medicare	$28.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.00
Rate for Payer: Hamaspik Choice Inc Medicare	$40.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.00

SYNTHES SCREW 3.5 CORTEX S TAP

Facility IP

$34.50

Service Code	HCPCS C1713
Hospital Charge Code	40205517
Hospital Revenue Code	278
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$17.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.25
Rate for Payer: Hamaspik Choice Inc Medicare	$17.25

SYNTHES SCREW 3.5 CORTEX S TAP

Facility OP

$34.50

Service Code	HCPCS C1713
Hospital Charge Code	40205517
Hospital Revenue Code	278
Min. Negotiated Rate	$12.08
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.98
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	$17.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.84
Rate for Payer: Fidelis Medicare Advantage	$36.22
Rate for Payer: Group Health Inc Commercial	$17.25
Rate for Payer: Group Health Inc Medicare	$12.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.25
Rate for Payer: Hamaspik Choice Inc Medicare	$17.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.42

SYNTHES SCREW 3.5MM CORTEX S-TAP

Facility IP

$87.50

Service Code	HCPCS C1713
Hospital Charge Code	40205141
Hospital Revenue Code	278
Min. Negotiated Rate	$43.75
Max. Negotiated Rate	$43.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.75
Rate for Payer: Hamaspik Choice Inc Medicare	$43.75

SYNTHES SCREW 3.5MM CORTEX S-TAP

Facility OP

$87.50

Service Code	HCPCS C1713
Hospital Charge Code	40205141
Hospital Revenue Code	278
Min. Negotiated Rate	$30.62
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.12
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	$43.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$50.31
Rate for Payer: Fidelis Medicare Advantage	$91.88
Rate for Payer: Group Health Inc Commercial	$43.75
Rate for Payer: Group Health Inc Medicare	$30.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.75
Rate for Payer: Hamaspik Choice Inc Medicare	$43.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$56.88

SYNTHES SCREW 3.5MM CORTEX S-TP34

Facility OP

$49.00

Service Code	HCPCS C1713
Hospital Charge Code	40205359
Hospital Revenue Code	278
Min. Negotiated Rate	$17.15
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.95
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	$24.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.18
Rate for Payer: Fidelis Medicare Advantage	$51.45
Rate for Payer: Group Health Inc Commercial	$24.50
Rate for Payer: Group Health Inc Medicare	$17.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.50
Rate for Payer: Hamaspik Choice Inc Medicare	$24.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.85

SYNTHES SCREW 3.5MM CORTEX S-TP34

Facility IP

$49.00

Service Code	HCPCS C1713
Hospital Charge Code	40205359
Hospital Revenue Code	278
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$24.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.50
Rate for Payer: Hamaspik Choice Inc Medicare	$24.50

SYNTHES SCREW 3.5MM CRTX S-TP40MM

Facility OP

$46.50

Service Code	HCPCS C1713
Hospital Charge Code	40205360
Hospital Revenue Code	278
Min. Negotiated Rate	$16.28
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.58
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	$23.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.74
Rate for Payer: Fidelis Medicare Advantage	$48.82
Rate for Payer: Group Health Inc Commercial	$23.25
Rate for Payer: Group Health Inc Medicare	$16.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.25
Rate for Payer: Hamaspik Choice Inc Medicare	$23.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.22

SYNTHES SCREW 3.5MM CRTX S-TP40MM

Facility IP

$46.50

Service Code	HCPCS C1713
Hospital Charge Code	40205360
Hospital Revenue Code	278
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$23.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.25
Rate for Payer: Hamaspik Choice Inc Medicare	$23.25

SYNTHES SCREW 4MM CAN BONE F/T

Facility IP

$36.00

Service Code	HCPCS C1713
Hospital Charge Code	40207060
Hospital Revenue Code	278
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$18.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.00
Rate for Payer: Hamaspik Choice Inc Medicare	$18.00

SYNTHES SCREW 4MM CAN BONE F/T

Facility OP

$36.00

Service Code	HCPCS C1713
Hospital Charge Code	40207060
Hospital Revenue Code	278
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.80
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	$18.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.70
Rate for Payer: Fidelis Medicare Advantage	$37.80
Rate for Payer: Group Health Inc Commercial	$18.00
Rate for Payer: Group Health Inc Medicare	$12.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.00
Rate for Payer: Hamaspik Choice Inc Medicare	$18.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.40

SYNTHES SCREW B CAN 4.0X10

Facility IP

$35.50

Service Code	HCPCS C1776
Hospital Charge Code	40205122
Hospital Revenue Code	278
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$17.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.75
Rate for Payer: Hamaspik Choice Inc Medicare	$17.75

SYNTHES SCREW B CAN 4.0X10

Facility OP

$35.50

Service Code	HCPCS C1776
Hospital Charge Code	40205122
Hospital Revenue Code	278
Min. Negotiated Rate	$12.42
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.52
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	$17.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.41
Rate for Payer: Fidelis Medicare Advantage	$37.28
Rate for Payer: Group Health Inc Commercial	$17.75
Rate for Payer: Group Health Inc Medicare	$12.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.75
Rate for Payer: Hamaspik Choice Inc Medicare	$17.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.08

SYNTHES SCREW BONE CANCEL 35MM SS

Facility IP

$33.50

Service Code	HCPCS C1713
Hospital Charge Code	40205789
Hospital Revenue Code	278
Min. Negotiated Rate	$16.75
Max. Negotiated Rate	$16.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.75
Rate for Payer: Hamaspik Choice Inc Medicare	$16.75

SYNTHES SCREW BONE CANCEL 35MM SS

Facility OP

$33.50

Service Code	HCPCS C1713
Hospital Charge Code	40205789
Hospital Revenue Code	278
Min. Negotiated Rate	$11.72
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.42
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	$16.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.26
Rate for Payer: Fidelis Medicare Advantage	$35.18
Rate for Payer: Group Health Inc Commercial	$16.75
Rate for Payer: Group Health Inc Medicare	$11.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.75
Rate for Payer: Hamaspik Choice Inc Medicare	$16.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.78

SYNTHES SCREW BONE CANCELLOUS 4.0

Facility IP

$34.00

Service Code	HCPCS C1713
Hospital Charge Code	40206036
Hospital Revenue Code	278
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$17.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17.00

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