St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SYNTHES 2.7/3.5 LCP FIBULAR 7H P

Facility

$1,602.00

Service Code	HCPCS C1713
Hospital Charge Code	40205196
Hospital Revenue Code	278
Min. Negotiated Rate	$801.00
Max. Negotiated Rate	$801.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$801.00
Rate for Payer: Hamaspik Choice Inc Medicare	$801.00

SYNTHES 2.7/3.5 LCP FIBULAR 7H P

Facility

$1,602.00

Service Code	HCPCS C1713
Hospital Charge Code	40205196
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,682.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$881.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$961.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$801.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$921.15
Rate for Payer: EmblemHealth Commercial	$801.00
Rate for Payer: Fidelis Medicare Advantage	$1,682.10
Rate for Payer: Group Health Inc Commercial	$801.00
Rate for Payer: Group Health Inc Medicare	$560.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$801.00
Rate for Payer: Hamaspik Choice Inc Medicare	$801.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,041.30

SYNTHES 2.7MM LOCKING SCREW 14MM

Facility

$255.60

Service Code	HCPCS C1713
Hospital Charge Code	40205198
Hospital Revenue Code	278
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$127.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$127.80
Rate for Payer: Hamaspik Choice Inc Medicare	$127.80

SYNTHES 2.7MM LOCKING SCREW 14MM

Facility

$255.60

Service Code	HCPCS C1713
Hospital Charge Code	40205198
Hospital Revenue Code	278
Min. Negotiated Rate	$89.46
Max. Negotiated Rate	$268.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$140.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$153.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$127.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$146.97
Rate for Payer: EmblemHealth Commercial	$127.80
Rate for Payer: Fidelis Medicare Advantage	$268.38
Rate for Payer: Group Health Inc Commercial	$127.80
Rate for Payer: Group Health Inc Medicare	$89.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$127.80
Rate for Payer: Hamaspik Choice Inc Medicare	$127.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$166.14

SYNTHES 2.7MM LOCKING SCREW 16MM

Facility

$244.80

Service Code	HCPCS C1713
Hospital Charge Code	40205197
Hospital Revenue Code	278
Min. Negotiated Rate	$85.68
Max. Negotiated Rate	$257.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$134.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$146.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$122.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$140.76
Rate for Payer: EmblemHealth Commercial	$122.40
Rate for Payer: Fidelis Medicare Advantage	$257.04
Rate for Payer: Group Health Inc Commercial	$122.40
Rate for Payer: Group Health Inc Medicare	$85.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$122.40
Rate for Payer: Hamaspik Choice Inc Medicare	$122.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$159.12

SYNTHES 2.7MM LOCKING SCREW 16MM

Facility

$244.80

Service Code	HCPCS C1713
Hospital Charge Code	40205197
Hospital Revenue Code	278
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$122.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$122.40
Rate for Payer: Hamaspik Choice Inc Medicare	$122.40

SYNTHES 2.7MM L/S 18MM

Facility

$217.80

Service Code	HCPCS C1713
Hospital Charge Code	40205923
Hospital Revenue Code	278
Min. Negotiated Rate	$76.23
Max. Negotiated Rate	$228.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$119.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$130.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$108.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$125.24
Rate for Payer: EmblemHealth Commercial	$108.90
Rate for Payer: Fidelis Medicare Advantage	$228.69
Rate for Payer: Group Health Inc Commercial	$108.90
Rate for Payer: Group Health Inc Medicare	$76.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$108.90
Rate for Payer: Hamaspik Choice Inc Medicare	$108.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$141.57

SYNTHES 2.7MM L/S 18MM

Facility

$217.80

Service Code	HCPCS C1713
Hospital Charge Code	40205923
Hospital Revenue Code	278
Min. Negotiated Rate	$108.90
Max. Negotiated Rate	$108.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$108.90
Rate for Payer: Hamaspik Choice Inc Medicare	$108.90

SYNTHES 3.5 1/3 TUBULAR LCP

Facility

$499.50

Service Code	HCPCS C1713
Hospital Charge Code	40205708
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$524.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$274.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$299.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$249.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$287.21
Rate for Payer: EmblemHealth Commercial	$249.75
Rate for Payer: Fidelis Medicare Advantage	$524.48
Rate for Payer: Group Health Inc Commercial	$249.75
Rate for Payer: Group Health Inc Medicare	$174.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$249.75
Rate for Payer: Hamaspik Choice Inc Medicare	$249.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$324.68

SYNTHES 3.5 1/3 TUBULAR LCP

Facility

$499.50

Service Code	HCPCS C1713
Hospital Charge Code	40205708
Hospital Revenue Code	278
Min. Negotiated Rate	$249.75
Max. Negotiated Rate	$249.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$249.75
Rate for Payer: Hamaspik Choice Inc Medicare	$249.75

SYNTHES 3.5MM 6-H LCP P TIB PLATE

Facility

$3,085.20

Service Code	HCPCS C1713
Hospital Charge Code	40205689
Hospital Revenue Code	278
Min. Negotiated Rate	$1,542.60
Max. Negotiated Rate	$1,542.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,542.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,542.60

SYNTHES 3.5MM 6-H LCP P TIB PLATE

Facility

$3,085.20

Service Code	HCPCS C1713
Hospital Charge Code	40205689
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,239.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,696.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,851.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,542.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,773.99
Rate for Payer: EmblemHealth Commercial	$1,542.60
Rate for Payer: Fidelis Medicare Advantage	$3,239.46
Rate for Payer: Group Health Inc Commercial	$1,542.60
Rate for Payer: Group Health Inc Medicare	$1,079.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,542.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,542.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,005.38

SYNTHES 3.5MM LCP DISTAL TIB PLT

Facility

$2,133.00

Service Code	HCPCS C1713
Hospital Charge Code	40205673
Hospital Revenue Code	278
Min. Negotiated Rate	$1,066.50
Max. Negotiated Rate	$1,066.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,066.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,066.50

SYNTHES 3.5MM LCP DISTAL TIB PLT

Facility

$2,133.00

Service Code	HCPCS C1713
Hospital Charge Code	40205673
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,239.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,173.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,279.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,066.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,226.48
Rate for Payer: EmblemHealth Commercial	$1,066.50
Rate for Payer: Fidelis Medicare Advantage	$2,239.65
Rate for Payer: Group Health Inc Commercial	$1,066.50
Rate for Payer: Group Health Inc Medicare	$746.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,066.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,066.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,386.45

SYNTHES 3.5MM T-HANDLE

Facility

$504.00

Hospital Charge Code	40205812
Hospital Revenue Code	270
Min. Negotiated Rate	$176.40
Max. Negotiated Rate	$403.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$277.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$252.00
Rate for Payer: Aetna Government	$252.00
Rate for Payer: Brighton Health Commercial	$378.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$403.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$342.72
Rate for Payer: Group Health Inc Commercial	$252.00
Rate for Payer: Group Health Inc Medicare	$176.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$252.00
Rate for Payer: Hamaspik Choice Inc Medicare	$252.00

SYNTHES 3.5X 34MM LOCKING SCREW

Facility

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	40205190
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 3.5X 34MM LOCKING SCREW

Facility

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	40205190
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: Brighton Health Commercial	$162.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$135.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$155.25
Rate for Payer: EmblemHealth Commercial	$135.00
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 4.0X LCP SCREW

Facility

$297.00

Service Code	HCPCS C1713
Hospital Charge Code	40205663
Hospital Revenue Code	278
Min. Negotiated Rate	$148.50
Max. Negotiated Rate	$148.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.50
Rate for Payer: Hamaspik Choice Inc Medicare	$148.50

SYNTHES 4.0X LCP SCREW

Facility

$297.00

Service Code	HCPCS C1713
Hospital Charge Code	40205663
Hospital Revenue Code	278
Min. Negotiated Rate	$103.95
Max. Negotiated Rate	$311.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$163.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$178.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$148.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.78
Rate for Payer: EmblemHealth Commercial	$148.50
Rate for Payer: Fidelis Medicare Advantage	$311.85
Rate for Payer: Group Health Inc Commercial	$148.50
Rate for Payer: Group Health Inc Medicare	$103.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.50
Rate for Payer: Hamaspik Choice Inc Medicare	$148.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$193.05

SYNTHES 4.5 DRILL BIT

Facility

$136.50

Hospital Charge Code	40205709
Hospital Revenue Code	270
Min. Negotiated Rate	$47.78
Max. Negotiated Rate	$109.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$75.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$68.25
Rate for Payer: Aetna Government	$68.25
Rate for Payer: Brighton Health Commercial	$102.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$109.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$92.82
Rate for Payer: Group Health Inc Commercial	$68.25
Rate for Payer: Group Health Inc Medicare	$47.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.25
Rate for Payer: Hamaspik Choice Inc Medicare	$68.25

SYNTHES 4.5 LCP NARROW PLATE

Facility

$1,108.00

Service Code	HCPCS C1713
Hospital Charge Code	40205706
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,163.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$609.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$664.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$554.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$637.10
Rate for Payer: EmblemHealth Commercial	$554.00
Rate for Payer: Fidelis Medicare Advantage	$1,163.40
Rate for Payer: Group Health Inc Commercial	$554.00
Rate for Payer: Group Health Inc Medicare	$387.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$554.00
Rate for Payer: Hamaspik Choice Inc Medicare	$554.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$720.20

SYNTHES 4.5 LCP NARROW PLATE

Facility

$1,108.00

Service Code	HCPCS C1713
Hospital Charge Code	40205706
Hospital Revenue Code	278
Min. Negotiated Rate	$554.00
Max. Negotiated Rate	$554.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$554.00
Rate for Payer: Hamaspik Choice Inc Medicare	$554.00

SYNTHES 5.0X200MM S/D SHANZ SCREW

Facility

$1,333.80

Service Code	HCPCS C1713
Hospital Charge Code	40205191
Hospital Revenue Code	278
Min. Negotiated Rate	$666.90
Max. Negotiated Rate	$666.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$666.90
Rate for Payer: Hamaspik Choice Inc Medicare	$666.90

SYNTHES 5.0X200MM S/D SHANZ SCREW

Facility

$1,333.80

Service Code	HCPCS C1713
Hospital Charge Code	40205191
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,400.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$733.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$800.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$666.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$766.94
Rate for Payer: EmblemHealth Commercial	$666.90
Rate for Payer: Fidelis Medicare Advantage	$1,400.49
Rate for Payer: Group Health Inc Commercial	$666.90
Rate for Payer: Group Health Inc Medicare	$466.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$666.90
Rate for Payer: Hamaspik Choice Inc Medicare	$666.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$866.97

SYNTHES 5.0X32MM LCK SCRW

Facility

$464.00

Service Code	HCPCS C1713
Hospital Charge Code	40205384
Hospital Revenue Code	278
Min. Negotiated Rate	$232.00
Max. Negotiated Rate	$232.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$232.00
Rate for Payer: Hamaspik Choice Inc Medicare	$232.00

Know your out-of-pocket cost for care.

All Charges