St. Barnabas Hospital

All Charges

Charge

Type

Price

SYNTHES SCREW CORTEX TIT S/T 2.0X

Facility OP

$93.38

Service Code	HCPCS C1713
Hospital Charge Code	40205229
Hospital Revenue Code	278
Min. Negotiated Rate	$32.68
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.36
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	$46.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.69
Rate for Payer: Fidelis Medicare Advantage	$98.05
Rate for Payer: Group Health Inc Commercial	$46.69
Rate for Payer: Group Health Inc Medicare	$32.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.69
Rate for Payer: Hamaspik Choice Inc Medicare	$46.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$60.70

SYNTHES SCREW CORTEX TIT S/T 2.0X

Facility IP

$93.38

Service Code	HCPCS C1713
Hospital Charge Code	40205229
Hospital Revenue Code	278
Min. Negotiated Rate	$46.69
Max. Negotiated Rate	$46.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.69
Rate for Payer: Hamaspik Choice Inc Medicare	$46.69

SYNTHES SCREW CORTICAL SLF TAP3.5

Facility OP

$49.00

Service Code	HCPCS C1713
Hospital Charge Code	40206035
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 CORTICAL SLF TAP3.5

Facility IP

$49.00

Service Code	HCPCS C1713
Hospital Charge Code	40206035
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 CRTX ST T8 2.7 56

Facility OP

$56.00

Service Code	HCPCS C1713
Hospital Charge Code	40205932
Hospital Revenue Code	278
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.80
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	$28.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.20
Rate for Payer: Fidelis Medicare Advantage	$58.80
Rate for Payer: Group Health Inc Commercial	$28.00
Rate for Payer: Group Health Inc Medicare	$19.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.00
Rate for Payer: Hamaspik Choice Inc Medicare	$28.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.40

SYNTHES SCREW CRTX ST T8 2.7 56

Facility IP

$56.00

Service Code	HCPCS C1713
Hospital Charge Code	40205932
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$28.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.00
Rate for Payer: Hamaspik Choice Inc Medicare	$28.00

SYNTHES SCREW LOCKING S/T 3.5 SS

Facility OP

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	40205309
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 SCREW LOCKING S/T 3.5 SS

Facility IP

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	40205309
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 SCREW LOCK ST SS 3.5MM

Facility OP

$395.50

Service Code	HCPCS C1713
Hospital Charge Code	40205702
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$415.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$217.52
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	$197.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$227.41
Rate for Payer: Fidelis Medicare Advantage	$415.28
Rate for Payer: Group Health Inc Commercial	$197.75
Rate for Payer: Group Health Inc Medicare	$138.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$197.75
Rate for Payer: Hamaspik Choice Inc Medicare	$197.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$257.08

SYNTHES SCREW LOCK ST SS 3.5MM

Facility IP

$395.50

Service Code	HCPCS C1713
Hospital Charge Code	40205702
Hospital Revenue Code	278
Min. Negotiated Rate	$197.75
Max. Negotiated Rate	$197.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$197.75
Rate for Payer: Hamaspik Choice Inc Medicare	$197.75

SYNTHES SCREW LOCK ST SS 3.5 STR

Facility IP

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	40205311
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 SCREW LOCK ST SS 3.5 STR

Facility OP

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	40205311
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 SCREW LOCK T25 STRDRV 5MM

Facility IP

$643.50

Service Code	HCPCS C1713
Hospital Charge Code	40205774
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 LOCK T25 STRDRV 5MM

Facility OP

$643.50

Service Code	HCPCS C1713
Hospital Charge Code	40205774
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 PARTIAL THREAD

Facility OP

$35.00

Service Code	HCPCS C1713
Hospital Charge Code	40205788
Hospital Revenue Code	278
Min. Negotiated Rate	$12.25
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.25
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	$17.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.12
Rate for Payer: Fidelis Medicare Advantage	$36.75
Rate for Payer: Group Health Inc Commercial	$17.50
Rate for Payer: Group Health Inc Medicare	$12.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.50
Rate for Payer: Hamaspik Choice Inc Medicare	$17.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.75

SYNTHES SCREW PARTIAL THREAD

Facility IP

$35.00

Service Code	HCPCS C1713
Hospital Charge Code	40205788
Hospital Revenue Code	278
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.50
Rate for Payer: Hamaspik Choice Inc Medicare	$17.50

SYNTHES SCREW SCHANZ TI 5.0/80

Facility OP

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40205722
Hospital Revenue Code	278
Min. Negotiated Rate	$100.10
Max. Negotiated Rate	$300.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.30
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	$143.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$164.45
Rate for Payer: Fidelis Medicare Advantage	$300.30
Rate for Payer: Group Health Inc Commercial	$143.00
Rate for Payer: Group Health Inc Medicare	$100.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.90

SYNTHES SCREW SCHANZ TI 5.0/80

Facility IP

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40205722
Hospital Revenue Code	278
Min. Negotiated Rate	$143.00
Max. Negotiated Rate	$143.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00

SYNTHES SCRW 1.5MM TIT CORT/SLF

Facility OP

$79.00

Service Code	HCPCS C1713
Hospital Charge Code	40207040
Hospital Revenue Code	278
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$43.45
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	$39.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$45.42
Rate for Payer: Fidelis Medicare Advantage	$82.95
Rate for Payer: Group Health Inc Commercial	$39.50
Rate for Payer: Group Health Inc Medicare	$27.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.50
Rate for Payer: Hamaspik Choice Inc Medicare	$39.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$51.35

SYNTHES SCRW 1.5MM TIT CORT/SLF

Facility IP

$79.00

Service Code	HCPCS C1713
Hospital Charge Code	40207040
Hospital Revenue Code	278
Min. Negotiated Rate	$39.50
Max. Negotiated Rate	$39.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.50
Rate for Payer: Hamaspik Choice Inc Medicare	$39.50

SYNTHES SCRW 2.7MM CRTX S-TAP

Facility OP

$81.50

Service Code	HCPCS C1776
Hospital Charge Code	40205203
Hospital Revenue Code	278
Min. Negotiated Rate	$28.52
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.82
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	$40.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.86
Rate for Payer: Fidelis Medicare Advantage	$85.58
Rate for Payer: Group Health Inc Commercial	$40.75
Rate for Payer: Group Health Inc Medicare	$28.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.75
Rate for Payer: Hamaspik Choice Inc Medicare	$40.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.98

SYNTHES SCRW 2.7MM CRTX S-TAP

Facility IP

$81.50

Service Code	HCPCS C1776
Hospital Charge Code	40205203
Hospital Revenue Code	278
Min. Negotiated Rate	$40.75
Max. Negotiated Rate	$40.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.75
Rate for Payer: Hamaspik Choice Inc Medicare	$40.75

SYNTHES SCRW 3.5MMCORTEX S-TP45MM

Facility IP

$51.00

Service Code	HCPCS C1713
Hospital Charge Code	40205518
Hospital Revenue Code	278
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$25.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.50
Rate for Payer: Hamaspik Choice Inc Medicare	$25.50

SYNTHES SCRW 3.5MMCORTEX S-TP45MM

Facility OP

$51.00

Service Code	HCPCS C1713
Hospital Charge Code	40205518
Hospital Revenue Code	278
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.05
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	$25.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.32
Rate for Payer: Fidelis Medicare Advantage	$53.55
Rate for Payer: Group Health Inc Commercial	$25.50
Rate for Payer: Group Health Inc Medicare	$17.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.50
Rate for Payer: Hamaspik Choice Inc Medicare	$25.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$33.15

SYNTHES SCRW 3.5MM CORT S-TAP40MM

Facility OP

$46.00

Service Code	HCPCS C1776
Hospital Charge Code	40205121
Hospital Revenue Code	278
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.30
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	$23.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.45
Rate for Payer: Fidelis Medicare Advantage	$48.30
Rate for Payer: Group Health Inc Commercial	$23.00
Rate for Payer: Group Health Inc Medicare	$16.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.00
Rate for Payer: Hamaspik Choice Inc Medicare	$23.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.90

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