St. Barnabas Hospital

All Charges

Charge

Type

Price

SYNTHES SCREW BONE CANCELLOUS 4.0

Facility OP

$34.00

Service Code	HCPCS C1713
Hospital Charge Code	40206036
Hospital Revenue Code	278
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.70
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	$17.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.55
Rate for Payer: Fidelis Medicare Advantage	$35.70
Rate for Payer: Group Health Inc Commercial	$17.00
Rate for Payer: Group Health Inc Medicare	$11.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.10

SYNTHES SCREW CANN LCK 2.7

Facility IP

$406.38

Service Code	HCPCS C1713
Hospital Charge Code	40205769
Hospital Revenue Code	278
Min. Negotiated Rate	$203.19
Max. Negotiated Rate	$203.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.19
Rate for Payer: Hamaspik Choice Inc Medicare	$203.19

SYNTHES SCREW CANN LCK 2.7

Facility OP

$406.38

Service Code	HCPCS C1713
Hospital Charge Code	40205769
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$426.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$223.51
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	$203.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$233.67
Rate for Payer: Fidelis Medicare Advantage	$426.70
Rate for Payer: Group Health Inc Commercial	$203.19
Rate for Payer: Group Health Inc Medicare	$142.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.19
Rate for Payer: Hamaspik Choice Inc Medicare	$203.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$264.15

SYNTHES SCREW CANN LCK 4.0X

Facility OP

$643.50

Service Code	HCPCS C1713
Hospital Charge Code	40205768
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$675.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$353.92
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	$321.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$370.01
Rate for Payer: Fidelis Medicare Advantage	$675.68
Rate for Payer: Group Health Inc Commercial	$321.75
Rate for Payer: Group Health Inc Medicare	$225.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$321.75
Rate for Payer: Hamaspik Choice Inc Medicare	$321.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$418.28

SYNTHES SCREW CANN LCK 4.0X

Facility IP

$643.50

Service Code	HCPCS C1713
Hospital Charge Code	40205768
Hospital Revenue Code	278
Min. Negotiated Rate	$321.75
Max. Negotiated Rate	$321.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$321.75
Rate for Payer: Hamaspik Choice Inc Medicare	$321.75

SYNTHES SCREW CANN LCK 5.0

Facility IP

$604.33

Service Code	HCPCS C1713
Hospital Charge Code	40205753
Hospital Revenue Code	278
Min. Negotiated Rate	$302.16
Max. Negotiated Rate	$302.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$302.16
Rate for Payer: Hamaspik Choice Inc Medicare	$302.16

SYNTHES SCREW CANN LCK 5.0

Facility OP

$604.33

Service Code	HCPCS C1713
Hospital Charge Code	40205753
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$634.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$332.38
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	$302.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$347.49
Rate for Payer: Fidelis Medicare Advantage	$634.55
Rate for Payer: Group Health Inc Commercial	$302.16
Rate for Payer: Group Health Inc Medicare	$211.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$302.16
Rate for Payer: Hamaspik Choice Inc Medicare	$302.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$392.81

SYNTHES SCREW CANN P/T 3.5X44MM

Facility OP

$306.00

Service Code	HCPCS C1713
Hospital Charge Code	40205621
Hospital Revenue Code	278
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$321.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$168.30
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	$153.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$175.95
Rate for Payer: Fidelis Medicare Advantage	$321.30
Rate for Payer: Group Health Inc Commercial	$153.00
Rate for Payer: Group Health Inc Medicare	$107.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$153.00
Rate for Payer: Hamaspik Choice Inc Medicare	$153.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$198.90

SYNTHES SCREW CANN P/T 3.5X44MM

Facility IP

$306.00

Service Code	HCPCS C1713
Hospital Charge Code	40205621
Hospital Revenue Code	278
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$153.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$153.00
Rate for Payer: Hamaspik Choice Inc Medicare	$153.00

SYNTHES SCREW CANNULATED 207.634

Facility IP

$381.55

Service Code	HCPCS C1713
Hospital Charge Code	40205470
Hospital Revenue Code	278
Min. Negotiated Rate	$190.78
Max. Negotiated Rate	$190.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.78
Rate for Payer: Hamaspik Choice Inc Medicare	$190.78

SYNTHES SCREW CANNULATED 207.634

Facility OP

$381.55

Service Code	HCPCS C1713
Hospital Charge Code	40205470
Hospital Revenue Code	278
Min. Negotiated Rate	$133.54
Max. Negotiated Rate	$400.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$209.85
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	$190.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$219.39
Rate for Payer: Fidelis Medicare Advantage	$400.63
Rate for Payer: Group Health Inc Commercial	$190.78
Rate for Payer: Group Health Inc Medicare	$133.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.78
Rate for Payer: Hamaspik Choice Inc Medicare	$190.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$248.01

SYNTHES SCREW CANNULATED 207.738

Facility IP

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	40205432
Hospital Revenue Code	278
Min. Negotiated Rate	$155.00
Max. Negotiated Rate	$155.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$155.00
Rate for Payer: Hamaspik Choice Inc Medicare	$155.00

SYNTHES SCREW CANNULATED 207.738

Facility OP

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	40205432
Hospital Revenue Code	278
Min. Negotiated Rate	$108.50
Max. Negotiated Rate	$325.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$170.50
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	$155.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$178.25
Rate for Payer: Fidelis Medicare Advantage	$325.50
Rate for Payer: Group Health Inc Commercial	$155.00
Rate for Payer: Group Health Inc Medicare	$108.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$155.00
Rate for Payer: Hamaspik Choice Inc Medicare	$155.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$201.50

SYNTHES SCREW CANNULATED 207.746

Facility OP

$320.00

Service Code	HCPCS C1713
Hospital Charge Code	40205431
Hospital Revenue Code	278
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$336.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$176.00
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	$160.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.00
Rate for Payer: Fidelis Medicare Advantage	$336.00
Rate for Payer: Group Health Inc Commercial	$160.00
Rate for Payer: Group Health Inc Medicare	$112.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$208.00

SYNTHES SCREW CANNULATED 207.746

Facility IP

$320.00

Service Code	HCPCS C1713
Hospital Charge Code	40205431
Hospital Revenue Code	278
Min. Negotiated Rate	$160.00
Max. Negotiated Rate	$160.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00

SYNTHES SCREW CANNULATED 4.0X42MM

Facility IP

$346.00

Service Code	HCPCS C1713
Hospital Charge Code	40205468
Hospital Revenue Code	278
Min. Negotiated Rate	$173.00
Max. Negotiated Rate	$173.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$173.00
Rate for Payer: Hamaspik Choice Inc Medicare	$173.00

SYNTHES SCREW CANNULATED 4.0X42MM

Facility OP

$346.00

Service Code	HCPCS C1713
Hospital Charge Code	40205468
Hospital Revenue Code	278
Min. Negotiated Rate	$121.10
Max. Negotiated Rate	$363.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$190.30
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	$173.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$198.95
Rate for Payer: Fidelis Medicare Advantage	$363.30
Rate for Payer: Group Health Inc Commercial	$173.00
Rate for Payer: Group Health Inc Medicare	$121.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$173.00
Rate for Payer: Hamaspik Choice Inc Medicare	$173.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$224.90

SYNTHES SCREW CORTEX S/T 4.5X

Facility OP

$45.00

Service Code	HCPCS C1713
Hospital Charge Code	40205770
Hospital Revenue Code	278
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.75
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	$22.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.88
Rate for Payer: Fidelis Medicare Advantage	$47.25
Rate for Payer: Group Health Inc Commercial	$22.50
Rate for Payer: Group Health Inc Medicare	$15.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.50
Rate for Payer: Hamaspik Choice Inc Medicare	$22.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.25

SYNTHES SCREW CORTEX S/T 4.5X

Facility IP

$45.00

Service Code	HCPCS C1713
Hospital Charge Code	40205770
Hospital Revenue Code	278
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.50
Rate for Payer: Hamaspik Choice Inc Medicare	$22.50

SYNTHES SCREW CORTEX ST SS 4.5X

Facility IP

$67.35

Service Code	HCPCS C1713
Hospital Charge Code	40205771
Hospital Revenue Code	278
Min. Negotiated Rate	$33.68
Max. Negotiated Rate	$33.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.68
Rate for Payer: Hamaspik Choice Inc Medicare	$33.68

SYNTHES SCREW CORTEX ST SS 4.5X

Facility OP

$67.35

Service Code	HCPCS C1713
Hospital Charge Code	40205771
Hospital Revenue Code	278
Min. Negotiated Rate	$23.57
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.04
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	$33.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$38.73
Rate for Payer: Fidelis Medicare Advantage	$70.72
Rate for Payer: Group Health Inc Commercial	$33.68
Rate for Payer: Group Health Inc Medicare	$23.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.68
Rate for Payer: Hamaspik Choice Inc Medicare	$33.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$43.78

SYNTHES SCREW CORTEX ST SS 4.5X38

Facility OP

$41.50

Service Code	HCPCS C1713
Hospital Charge Code	40205775
Hospital Revenue Code	278
Min. Negotiated Rate	$14.52
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.82
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	$20.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.86
Rate for Payer: Fidelis Medicare Advantage	$43.58
Rate for Payer: Group Health Inc Commercial	$20.75
Rate for Payer: Group Health Inc Medicare	$14.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.75
Rate for Payer: Hamaspik Choice Inc Medicare	$20.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.98

SYNTHES SCREW CORTEX ST SS 4.5X38

Facility IP

$41.50

Service Code	HCPCS C1713
Hospital Charge Code	40205775
Hospital Revenue Code	278
Min. Negotiated Rate	$20.75
Max. Negotiated Rate	$20.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.75
Rate for Payer: Hamaspik Choice Inc Medicare	$20.75

SYNTHES SCREW CORTEX ST T8 2.7 75

Facility OP

$75.60

Service Code	HCPCS C1713
Hospital Charge Code	40205938
Hospital Revenue Code	278
Min. Negotiated Rate	$26.46
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.58
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	$37.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.47
Rate for Payer: Fidelis Medicare Advantage	$79.38
Rate for Payer: Group Health Inc Commercial	$37.80
Rate for Payer: Group Health Inc Medicare	$26.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.80
Rate for Payer: Hamaspik Choice Inc Medicare	$37.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$49.14

SYNTHES SCREW CORTEX ST T8 2.7 75

Facility IP

$75.60

Service Code	HCPCS C1713
Hospital Charge Code	40205938
Hospital Revenue Code	278
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$37.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.80
Rate for Payer: Hamaspik Choice Inc Medicare	$37.80

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