St. Barnabas Hospital

All Charges

Charge

Type

Price

SYNTHES SCRW 3.5MM CORT S-TAP40MM

Facility IP

$46.00

Service Code	HCPCS C1776
Hospital Charge Code	40205121
Hospital Revenue Code	278
Min. Negotiated Rate	$23.00
Max. Negotiated Rate	$23.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.00
Rate for Payer: Hamaspik Choice Inc Medicare	$23.00

SYNTHES SCRW 3.5MM CRTX S-TAP26MM

Facility IP

$47.04

Service Code	HCPCS C1776
Hospital Charge Code	40206034
Hospital Revenue Code	278
Min. Negotiated Rate	$23.52
Max. Negotiated Rate	$23.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.52
Rate for Payer: Hamaspik Choice Inc Medicare	$23.52

SYNTHES SCRW 3.5MM CRTX S-TAP26MM

Facility OP

$47.04

Service Code	HCPCS C1776
Hospital Charge Code	40206034
Hospital Revenue Code	278
Min. Negotiated Rate	$16.46
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.87
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	$23.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.05
Rate for Payer: Fidelis Medicare Advantage	$49.39
Rate for Payer: Group Health Inc Commercial	$23.52
Rate for Payer: Group Health Inc Medicare	$16.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.52
Rate for Payer: Hamaspik Choice Inc Medicare	$23.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.58

SYNTHES SCRW BN CORTICAL S/T 2X10

Facility IP

$86.50

Service Code	HCPCS C1713
Hospital Charge Code	40205638
Hospital Revenue Code	278
Min. Negotiated Rate	$43.25
Max. Negotiated Rate	$43.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.25
Rate for Payer: Hamaspik Choice Inc Medicare	$43.25

SYNTHES SCRW BN CORTICAL S/T 2X10

Facility OP

$86.50

Service Code	HCPCS C1713
Hospital Charge Code	40205638
Hospital Revenue Code	278
Min. Negotiated Rate	$30.28
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.58
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	$43.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.74
Rate for Payer: Fidelis Medicare Advantage	$90.82
Rate for Payer: Group Health Inc Commercial	$43.25
Rate for Payer: Group Health Inc Medicare	$30.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.25
Rate for Payer: Hamaspik Choice Inc Medicare	$43.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$56.22

SYNTHES SCRW CANN PT TH3.5X42MM

Facility IP

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40205515
Hospital Revenue Code	278
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$148.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00

SYNTHES SCRW CANN PT TH3.5X42MM

Facility OP

$296.00

Service Code	HCPCS C1713
Hospital Charge Code	40205515
Hospital Revenue Code	278
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$310.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$162.80
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	$148.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.20
Rate for Payer: Fidelis Medicare Advantage	$310.80
Rate for Payer: Group Health Inc Commercial	$148.00
Rate for Payer: Group Health Inc Medicare	$103.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$192.40

SYNTHES SCRW CORTEX TIT 2.7X24

Facility OP

$82.50

Service Code	HCPCS C1713
Hospital Charge Code	40208168
Hospital Revenue Code	278
Min. Negotiated Rate	$28.88
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.38
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	$41.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.44
Rate for Payer: Fidelis Medicare Advantage	$86.62
Rate for Payer: Group Health Inc Commercial	$41.25
Rate for Payer: Group Health Inc Medicare	$28.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.25
Rate for Payer: Hamaspik Choice Inc Medicare	$41.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$53.62

SYNTHES SCRW CORTEX TIT 2.7X24

Facility IP

$82.50

Service Code	HCPCS C1713
Hospital Charge Code	40208168
Hospital Revenue Code	278
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.25
Rate for Payer: Hamaspik Choice Inc Medicare	$41.25

SYNTHES SCRW CORT SLF TAPPING

Facility IP

$75.13

Service Code	HCPCS C1776
Hospital Charge Code	40207050
Hospital Revenue Code	278
Min. Negotiated Rate	$37.56
Max. Negotiated Rate	$37.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.56
Rate for Payer: Hamaspik Choice Inc Medicare	$37.56

SYNTHES SCRW CORT SLF TAPPING

Facility OP

$75.13

Service Code	HCPCS C1776
Hospital Charge Code	40207050
Hospital Revenue Code	278
Min. Negotiated Rate	$26.30
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.32
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	$37.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.20
Rate for Payer: Fidelis Medicare Advantage	$78.89
Rate for Payer: Group Health Inc Commercial	$37.56
Rate for Payer: Group Health Inc Medicare	$26.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.56
Rate for Payer: Hamaspik Choice Inc Medicare	$37.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$48.83

SYNTHES SCRW CORT S/T 3.5X30MM

Facility OP

$50.00

Service Code	HCPCS C1713
Hospital Charge Code	40205519
Hospital Revenue Code	278
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.50
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	$25.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.75
Rate for Payer: Fidelis Medicare Advantage	$52.50
Rate for Payer: Group Health Inc Commercial	$25.00
Rate for Payer: Group Health Inc Medicare	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$32.50

SYNTHES SCRW CORT S/T 3.5X30MM

Facility IP

$50.00

Service Code	HCPCS C1713
Hospital Charge Code	40205519
Hospital Revenue Code	278
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$25.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00

SYNTHES SCRW CTX ST T8 2.7

Facility IP

$68.84

Service Code	HCPCS C1713
Hospital Charge Code	40205922
Hospital Revenue Code	278
Min. Negotiated Rate	$34.42
Max. Negotiated Rate	$34.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.42
Rate for Payer: Hamaspik Choice Inc Medicare	$34.42

SYNTHES SCRW CTX ST T8 2.7

Facility OP

$68.84

Service Code	HCPCS C1713
Hospital Charge Code	40205922
Hospital Revenue Code	278
Min. Negotiated Rate	$24.09
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.86
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	$34.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.58
Rate for Payer: Fidelis Medicare Advantage	$72.28
Rate for Payer: Group Health Inc Commercial	$34.42
Rate for Payer: Group Health Inc Medicare	$24.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.42
Rate for Payer: Hamaspik Choice Inc Medicare	$34.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$44.75

SYNTHES SEMI TUBULAR PALTE

Facility IP

$162.00

Service Code	HCPCS C1713
Hospital Charge Code	40205686
Hospital Revenue Code	278
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$81.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.00
Rate for Payer: Hamaspik Choice Inc Medicare	$81.00

SYNTHES SEMI TUBULAR PALTE

Facility OP

$162.00

Service Code	HCPCS C1713
Hospital Charge Code	40205686
Hospital Revenue Code	278
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$170.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.10
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	$81.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.15
Rate for Payer: Fidelis Medicare Advantage	$170.10
Rate for Payer: Group Health Inc Commercial	$81.00
Rate for Payer: Group Health Inc Medicare	$56.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.00
Rate for Payer: Hamaspik Choice Inc Medicare	$81.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.30

SYNTHES S/L ST SS 3.5

Facility OP

$202.00

Service Code	HCPCS C1713
Hospital Charge Code	40205934
Hospital Revenue Code	278
Min. Negotiated Rate	$70.70
Max. Negotiated Rate	$212.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$111.10
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	$101.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$116.15
Rate for Payer: Fidelis Medicare Advantage	$212.10
Rate for Payer: Group Health Inc Commercial	$101.00
Rate for Payer: Group Health Inc Medicare	$70.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$101.00
Rate for Payer: Hamaspik Choice Inc Medicare	$101.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$131.30

SYNTHES S/L ST SS 3.5

Facility IP

$202.00

Service Code	HCPCS C1713
Hospital Charge Code	40205934
Hospital Revenue Code	278
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$101.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$101.00
Rate for Payer: Hamaspik Choice Inc Medicare	$101.00

SYNTHES S/L ST SS 3.5 S/D

Facility IP

$257.40

Service Code	HCPCS C1713
Hospital Charge Code	40205924
Hospital Revenue Code	278
Min. Negotiated Rate	$128.70
Max. Negotiated Rate	$128.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$128.70
Rate for Payer: Hamaspik Choice Inc Medicare	$128.70

SYNTHES S/L ST SS 3.5 S/D

Facility OP

$257.40

Service Code	HCPCS C1713
Hospital Charge Code	40205924
Hospital Revenue Code	278
Min. Negotiated Rate	$90.09
Max. Negotiated Rate	$270.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$141.57
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	$128.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$148.00
Rate for Payer: Fidelis Medicare Advantage	$270.27
Rate for Payer: Group Health Inc Commercial	$128.70
Rate for Payer: Group Health Inc Medicare	$90.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$128.70
Rate for Payer: Hamaspik Choice Inc Medicare	$128.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$167.31

SYNTHES S/L ST SS 3.5 STR-DR 173

Facility OP

$173.00

Service Code	HCPCS C1713
Hospital Charge Code	40205933
Hospital Revenue Code	278
Min. Negotiated Rate	$60.55
Max. Negotiated Rate	$181.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$95.15
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	$86.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$99.48
Rate for Payer: Fidelis Medicare Advantage	$181.65
Rate for Payer: Group Health Inc Commercial	$86.50
Rate for Payer: Group Health Inc Medicare	$60.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.50
Rate for Payer: Hamaspik Choice Inc Medicare	$86.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$112.45

SYNTHES S/L ST SS 3.5 STR-DR 173

Facility IP

$173.00

Service Code	HCPCS C1713
Hospital Charge Code	40205933
Hospital Revenue Code	278
Min. Negotiated Rate	$86.50
Max. Negotiated Rate	$86.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.50
Rate for Payer: Hamaspik Choice Inc Medicare	$86.50

SYNTHES SPIRAL BLADE

Facility IP

$1,350.00

Service Code	HCPCS C1713
Hospital Charge Code	40209603
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$675.00
Rate for Payer: Hamaspik Choice Inc Medicare	$675.00

SYNTHES SPIRAL BLADE

Facility OP

$1,350.00

Service Code	HCPCS C1713
Hospital Charge Code	40209603
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,417.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$742.50
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	$675.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$776.25
Rate for Payer: Fidelis Medicare Advantage	$1,417.50
Rate for Payer: Group Health Inc Commercial	$675.00
Rate for Payer: Group Health Inc Medicare	$472.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$675.00
Rate for Payer: Hamaspik Choice Inc Medicare	$675.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$877.50

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