St. Barnabas Hospital

All Charges

Charge

Type

Price

SYNTHES TI MATRIX 4 H PLT 1.5MM T

Facility IP

$1,410.00

Service Code	HCPCS C1713
Hospital Charge Code	40205825
Hospital Revenue Code	278
Min. Negotiated Rate	$705.00
Max. Negotiated Rate	$705.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$705.00
Rate for Payer: Hamaspik Choice Inc Medicare	$705.00

SYNTHES TI MATRIX 4 H PLT 1.5MM T

Facility OP

$1,410.00

Service Code	HCPCS C1713
Hospital Charge Code	40205825
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,480.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$775.50
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	$705.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$810.75
Rate for Payer: Fidelis Medicare Advantage	$1,480.50
Rate for Payer: Group Health Inc Commercial	$705.00
Rate for Payer: Group Health Inc Medicare	$493.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$705.00
Rate for Payer: Hamaspik Choice Inc Medicare	$705.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$916.50

SYNTHES TIMATRIX 5MM S/D SCRW

Facility IP

$174.00

Service Code	HCPCS C1713
Hospital Charge Code	40206236
Hospital Revenue Code	278
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$87.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.00
Rate for Payer: Hamaspik Choice Inc Medicare	$87.00

SYNTHES TIMATRIX 5MM S/D SCRW

Facility OP

$174.00

Service Code	HCPCS C1713
Hospital Charge Code	40206236
Hospital Revenue Code	278
Min. Negotiated Rate	$60.90
Max. Negotiated Rate	$182.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$95.70
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	$87.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$100.05
Rate for Payer: Fidelis Medicare Advantage	$182.70
Rate for Payer: Group Health Inc Commercial	$87.00
Rate for Payer: Group Health Inc Medicare	$60.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.00
Rate for Payer: Hamaspik Choice Inc Medicare	$87.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$113.10

SYNTHES TIMATRIX 8MM S/D SCRW

Facility OP

$176.00

Service Code	HCPCS C1713
Hospital Charge Code	40206238
Hospital Revenue Code	278
Min. Negotiated Rate	$61.60
Max. Negotiated Rate	$184.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$96.80
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	$88.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$101.20
Rate for Payer: Fidelis Medicare Advantage	$184.80
Rate for Payer: Group Health Inc Commercial	$88.00
Rate for Payer: Group Health Inc Medicare	$61.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$88.00
Rate for Payer: Hamaspik Choice Inc Medicare	$88.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$114.40

SYNTHES TIMATRIX 8MM S/D SCRW

Facility IP

$176.00

Service Code	HCPCS C1713
Hospital Charge Code	40206238
Hospital Revenue Code	278
Min. Negotiated Rate	$88.00
Max. Negotiated Rate	$88.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$88.00
Rate for Payer: Hamaspik Choice Inc Medicare	$88.00

SYNTHES TIMATRIX M/F 12 H .5MM P

Facility IP

$684.00

Service Code	HCPCS C1776
Hospital Charge Code	40205295
Hospital Revenue Code	278
Min. Negotiated Rate	$342.00
Max. Negotiated Rate	$342.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$342.00
Rate for Payer: Hamaspik Choice Inc Medicare	$342.00

SYNTHES TIMATRIX M/F 12 H .5MM P

Facility OP

$684.00

Service Code	HCPCS C1776
Hospital Charge Code	40205295
Hospital Revenue Code	278
Min. Negotiated Rate	$239.40
Max. Negotiated Rate	$718.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$376.20
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	$342.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$393.30
Rate for Payer: Fidelis Medicare Advantage	$718.20
Rate for Payer: Group Health Inc Commercial	$342.00
Rate for Payer: Group Health Inc Medicare	$239.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$342.00
Rate for Payer: Hamaspik Choice Inc Medicare	$342.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$444.60

SYNTHES TI MATRIX M/F 4MM ER SCRW

Facility OP

$174.00

Service Code	HCPCS C1713
Hospital Charge Code	40205428
Hospital Revenue Code	278
Min. Negotiated Rate	$60.90
Max. Negotiated Rate	$182.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$95.70
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	$87.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$100.05
Rate for Payer: Fidelis Medicare Advantage	$182.70
Rate for Payer: Group Health Inc Commercial	$87.00
Rate for Payer: Group Health Inc Medicare	$60.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.00
Rate for Payer: Hamaspik Choice Inc Medicare	$87.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$113.10

SYNTHES TI MATRIX M/F 4MM ER SCRW

Facility IP

$174.00

Service Code	HCPCS C1713
Hospital Charge Code	40205428
Hospital Revenue Code	278
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$87.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.00
Rate for Payer: Hamaspik Choice Inc Medicare	$87.00

SYNTHES TIMATRIX M/F ADAPTION PLT

Facility OP

$1,328.00

Service Code	HCPCS C1713
Hospital Charge Code	40207056
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,394.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$730.40
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	$664.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$763.60
Rate for Payer: Fidelis Medicare Advantage	$1,394.40
Rate for Payer: Group Health Inc Commercial	$664.00
Rate for Payer: Group Health Inc Medicare	$464.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$664.00
Rate for Payer: Hamaspik Choice Inc Medicare	$664.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$863.20

SYNTHES TIMATRIX M/F ADAPTION PLT

Facility IP

$1,328.00

Service Code	HCPCS C1713
Hospital Charge Code	40207056
Hospital Revenue Code	278
Min. Negotiated Rate	$664.00
Max. Negotiated Rate	$664.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$664.00
Rate for Payer: Hamaspik Choice Inc Medicare	$664.00

SYNTHES TIMATRIX M/F SCREW S/T

Facility IP

$180.00

Service Code	HCPCS C1713
Hospital Charge Code	40207043
Hospital Revenue Code	278
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.00
Rate for Payer: Hamaspik Choice Inc Medicare	$90.00

SYNTHES TIMATRIX M/F SCREW S/T

Facility OP

$180.00

Service Code	HCPCS C1713
Hospital Charge Code	40207043
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$189.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$99.00
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	$90.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$103.50
Rate for Payer: Fidelis Medicare Advantage	$189.00
Rate for Payer: Group Health Inc Commercial	$90.00
Rate for Payer: Group Health Inc Medicare	$63.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.00
Rate for Payer: Hamaspik Choice Inc Medicare	$90.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$117.00

SYNTHES TI M/F 20 H ADAPTION

Facility OP

$1,328.00

Service Code	HCPCS C1713
Hospital Charge Code	40205815
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,394.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$730.40
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	$664.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$763.60
Rate for Payer: Fidelis Medicare Advantage	$1,394.40
Rate for Payer: Group Health Inc Commercial	$664.00
Rate for Payer: Group Health Inc Medicare	$464.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$664.00
Rate for Payer: Hamaspik Choice Inc Medicare	$664.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$863.20

SYNTHES TI M/F 20 H ADAPTION

Facility IP

$1,328.00

Service Code	HCPCS C1713
Hospital Charge Code	40205815
Hospital Revenue Code	278
Min. Negotiated Rate	$664.00
Max. Negotiated Rate	$664.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$664.00
Rate for Payer: Hamaspik Choice Inc Medicare	$664.00

SYNTHES TIMTX 4H MALL2X2PLT 1.0MM

Facility OP

$680.00

Service Code	HCPCS C1776
Hospital Charge Code	40207052
Hospital Revenue Code	278
Min. Negotiated Rate	$238.00
Max. Negotiated Rate	$714.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$374.00
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	$340.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$391.00
Rate for Payer: Fidelis Medicare Advantage	$714.00
Rate for Payer: Group Health Inc Commercial	$340.00
Rate for Payer: Group Health Inc Medicare	$238.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$340.00
Rate for Payer: Hamaspik Choice Inc Medicare	$340.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$442.00

SYNTHES TIMTX 4H MALL2X2PLT 1.0MM

Facility IP

$680.00

Service Code	HCPCS C1776
Hospital Charge Code	40207052
Hospital Revenue Code	278
Min. Negotiated Rate	$340.00
Max. Negotiated Rate	$340.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$340.00
Rate for Payer: Hamaspik Choice Inc Medicare	$340.00

SYNTHES VA PLATE

Facility IP

$2,079.00

Service Code	HCPCS C1713
Hospital Charge Code	40205696
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$1,039.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,039.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,039.50

SYNTHES VA PLATE

Facility OP

$2,079.00

Service Code	HCPCS C1713
Hospital Charge Code	40205696
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,182.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,143.45
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	$1,039.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,195.42
Rate for Payer: Fidelis Medicare Advantage	$2,182.95
Rate for Payer: Group Health Inc Commercial	$1,039.50
Rate for Payer: Group Health Inc Medicare	$727.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,039.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,039.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,351.35

SYNTHES WIRE CERCLAGE

Facility OP

$96.00

Hospital Charge Code	40205286
Hospital Revenue Code	270
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$76.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$48.00
Rate for Payer: Aetna Government	$48.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$76.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.28
Rate for Payer: Group Health Inc Commercial	$48.00
Rate for Payer: Group Health Inc Medicare	$33.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.00
Rate for Payer: Hamaspik Choice Inc Medicare	$48.00

SYNTHES WIRE CERCLAGE 291.06

Facility IP

$155.70

Service Code	HCPCS C1713
Hospital Charge Code	40205213
Hospital Revenue Code	278
Min. Negotiated Rate	$77.85
Max. Negotiated Rate	$77.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.85
Rate for Payer: Hamaspik Choice Inc Medicare	$77.85

SYNTHES WIRE CERCLAGE 291.06

Facility OP

$155.70

Service Code	HCPCS C1713
Hospital Charge Code	40205213
Hospital Revenue Code	278
Min. Negotiated Rate	$54.50
Max. Negotiated Rate	$163.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.64
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	$77.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$89.53
Rate for Payer: Fidelis Medicare Advantage	$163.48
Rate for Payer: Group Health Inc Commercial	$77.85
Rate for Payer: Group Health Inc Medicare	$54.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.85
Rate for Payer: Hamaspik Choice Inc Medicare	$77.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$101.20

SYNTHES WIRE CERCLAGE W/EYE291.01

Facility IP

$155.70

Service Code	HCPCS C1713
Hospital Charge Code	40205211
Hospital Revenue Code	278
Min. Negotiated Rate	$77.85
Max. Negotiated Rate	$77.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.85
Rate for Payer: Hamaspik Choice Inc Medicare	$77.85

SYNTHES WIRE CERCLAGE W/EYE291.01

Facility OP

$155.70

Service Code	HCPCS C1713
Hospital Charge Code	40205211
Hospital Revenue Code	278
Min. Negotiated Rate	$54.50
Max. Negotiated Rate	$163.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.64
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	$77.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$89.53
Rate for Payer: Fidelis Medicare Advantage	$163.48
Rate for Payer: Group Health Inc Commercial	$77.85
Rate for Payer: Group Health Inc Medicare	$54.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.85
Rate for Payer: Hamaspik Choice Inc Medicare	$77.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$101.20

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