St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SYNTHES 5.0X32MM LCK SCRW

Facility

$464.00

Service Code	HCPCS C1713
Hospital Charge Code	40205384
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$487.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$255.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$278.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$232.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$266.80
Rate for Payer: EmblemHealth Commercial	$232.00
Rate for Payer: Fidelis Medicare Advantage	$487.20
Rate for Payer: Group Health Inc Commercial	$232.00
Rate for Payer: Group Health Inc Medicare	$162.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$232.00
Rate for Payer: Hamaspik Choice Inc Medicare	$232.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$301.60

SYNTHES 5.0X LOCKING

Facility

$464.00

Service Code	HCPCS C1713
Hospital Charge Code	40205664
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

SYNTHES 5.0X LOCKING

Facility

$464.00

Service Code	HCPCS C1713
Hospital Charge Code	40205664
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$487.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$255.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$278.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$232.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$266.80
Rate for Payer: EmblemHealth Commercial	$232.00
Rate for Payer: Fidelis Medicare Advantage	$487.20
Rate for Payer: Group Health Inc Commercial	$232.00
Rate for Payer: Group Health Inc Medicare	$162.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$232.00
Rate for Payer: Hamaspik Choice Inc Medicare	$232.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$301.60

SYNTHES .5MM SQ /BOXPLATE

Facility

$558.00

Service Code	HCPCS C1713
Hospital Charge Code	40205306
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$585.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$334.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$279.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$320.85
Rate for Payer: EmblemHealth Commercial	$279.00
Rate for Payer: Fidelis Medicare Advantage	$585.90
Rate for Payer: Group Health Inc Commercial	$279.00
Rate for Payer: Group Health Inc Medicare	$195.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$279.00
Rate for Payer: Hamaspik Choice Inc Medicare	$279.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$362.70

SYNTHES .5MM SQ /BOXPLATE

Facility

$558.00

Service Code	HCPCS C1713
Hospital Charge Code	40205306
Hospital Revenue Code	278
Min. Negotiated Rate	$279.00
Max. Negotiated Rate	$279.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$279.00
Rate for Payer: Hamaspik Choice Inc Medicare	$279.00

SYNTHES .5MM X PLT 4 HOLES

Facility

$548.00

Service Code	HCPCS C1713
Hospital Charge Code	40205290
Hospital Revenue Code	278
Min. Negotiated Rate	$274.00
Max. Negotiated Rate	$274.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$274.00
Rate for Payer: Hamaspik Choice Inc Medicare	$274.00

SYNTHES .5MM X PLT 4 HOLES

Facility

$548.00

Service Code	HCPCS C1713
Hospital Charge Code	40205290
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$575.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$301.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$328.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$274.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$315.10
Rate for Payer: EmblemHealth Commercial	$274.00
Rate for Payer: Fidelis Medicare Advantage	$575.40
Rate for Payer: Group Health Inc Commercial	$274.00
Rate for Payer: Group Health Inc Medicare	$191.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$274.00
Rate for Payer: Hamaspik Choice Inc Medicare	$274.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$356.20

SYNTHES 6H BROAD PLATE 2.0MM

Facility

$2,020.00

Service Code	HCPCS C1713
Hospital Charge Code	40209624
Hospital Revenue Code	278
Min. Negotiated Rate	$1,010.00
Max. Negotiated Rate	$1,010.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,010.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,010.00

SYNTHES 6H BROAD PLATE 2.0MM

Facility

$2,020.00

Service Code	HCPCS C1713
Hospital Charge Code	40209624
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,121.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,111.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,212.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,010.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,161.50
Rate for Payer: EmblemHealth Commercial	$1,010.00
Rate for Payer: Fidelis Medicare Advantage	$2,121.00
Rate for Payer: Group Health Inc Commercial	$1,010.00
Rate for Payer: Group Health Inc Medicare	$707.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,010.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,010.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,313.00

SYNTHES 8 HOLE TITANIUM T- PLATE

Facility

$542.00

Service Code	HCPCS C1713
Hospital Charge Code	40205762
Hospital Revenue Code	278
Min. Negotiated Rate	$271.00
Max. Negotiated Rate	$271.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$271.00
Rate for Payer: Hamaspik Choice Inc Medicare	$271.00

SYNTHES 8 HOLE TITANIUM T- PLATE

Facility

$542.00

Service Code	HCPCS C1713
Hospital Charge Code	40205762
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$569.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$298.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$325.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$311.65
Rate for Payer: EmblemHealth Commercial	$271.00
Rate for Payer: Fidelis Medicare Advantage	$569.10
Rate for Payer: Group Health Inc Commercial	$271.00
Rate for Payer: Group Health Inc Medicare	$189.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$271.00
Rate for Payer: Hamaspik Choice Inc Medicare	$271.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$352.30

SYNTHES 9MM TI CANN HUMERAL NAIL

Facility

$4,006.80

Service Code	HCPCS C1713
Hospital Charge Code	40205694
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,207.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,203.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,404.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,003.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,303.91
Rate for Payer: EmblemHealth Commercial	$2,003.40
Rate for Payer: Fidelis Medicare Advantage	$4,207.14
Rate for Payer: Group Health Inc Commercial	$2,003.40
Rate for Payer: Group Health Inc Medicare	$1,402.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,003.40
Rate for Payer: Hamaspik Choice Inc Medicare	$2,003.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,604.42

SYNTHES 9MM TI CANN HUMERAL NAIL

Facility

$4,006.80

Service Code	HCPCS C1713
Hospital Charge Code	40205694
Hospital Revenue Code	278
Min. Negotiated Rate	$2,003.40
Max. Negotiated Rate	$2,003.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,003.40
Rate for Payer: Hamaspik Choice Inc Medicare	$2,003.40

SYNTHES ADAPTION P 20 H .4MM THCK

Facility

$1,240.00

Service Code	HCPCS C1776
Hospital Charge Code	40205308
Hospital Revenue Code	278
Min. Negotiated Rate	$620.00
Max. Negotiated Rate	$620.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$620.00
Rate for Payer: Hamaspik Choice Inc Medicare	$620.00

SYNTHES ADAPTION P 20 H .4MM THCK

Facility

$1,240.00

Service Code	HCPCS C1776
Hospital Charge Code	40205308
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,302.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$682.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$744.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$620.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$713.00
Rate for Payer: EmblemHealth Commercial	$620.00
Rate for Payer: Fidelis Medicare Advantage	$1,302.00
Rate for Payer: Group Health Inc Commercial	$620.00
Rate for Payer: Group Health Inc Medicare	$434.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$620.00
Rate for Payer: Hamaspik Choice Inc Medicare	$620.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$806.00

SYNTHES BENDING PLATE

Facility

$137.00

Service Code	HCPCS C1713
Hospital Charge Code	40209623
Hospital Revenue Code	278
Min. Negotiated Rate	$68.50
Max. Negotiated Rate	$68.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.50
Rate for Payer: Hamaspik Choice Inc Medicare	$68.50

SYNTHES BENDING PLATE

Facility

$137.00

Service Code	HCPCS C1713
Hospital Charge Code	40209623
Hospital Revenue Code	278
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$143.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$75.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$82.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$68.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$78.78
Rate for Payer: EmblemHealth Commercial	$68.50
Rate for Payer: Fidelis Medicare Advantage	$143.85
Rate for Payer: Group Health Inc Commercial	$68.50
Rate for Payer: Group Health Inc Medicare	$47.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.50
Rate for Payer: Hamaspik Choice Inc Medicare	$68.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$89.05

SYNTHES CLAMP ADJUSTABLE SYNTHES

Facility

$640.00

Service Code	HCPCS C1713
Hospital Charge Code	40203344
Hospital Revenue Code	278
Min. Negotiated Rate	$320.00
Max. Negotiated Rate	$320.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$320.00
Rate for Payer: Hamaspik Choice Inc Medicare	$320.00

SYNTHES CLAMP ADJUSTABLE SYNTHES

Facility

$640.00

Hospital Charge Code	40009327
Hospital Revenue Code	272
Min. Negotiated Rate	$224.00
Max. Negotiated Rate	$512.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$352.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$320.00
Rate for Payer: Aetna Government	$320.00
Rate for Payer: Brighton Health Commercial	$480.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$512.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$435.20
Rate for Payer: Group Health Inc Commercial	$320.00
Rate for Payer: Group Health Inc Medicare	$224.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$320.00
Rate for Payer: Hamaspik Choice Inc Medicare	$320.00

SYNTHES CLAMP ADJUSTABLE SYNTHES

Facility

$640.00

Service Code	HCPCS C1713
Hospital Charge Code	40203344
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$672.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$352.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$384.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$320.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$368.00
Rate for Payer: EmblemHealth Commercial	$320.00
Rate for Payer: Fidelis Medicare Advantage	$672.00
Rate for Payer: Group Health Inc Commercial	$320.00
Rate for Payer: Group Health Inc Medicare	$224.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$320.00
Rate for Payer: Hamaspik Choice Inc Medicare	$320.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$416.00

SYNTHES CLAMP MULTI-PIN 6 POSIT M

Facility

$1,196.00

Service Code	HCPCS C1713
Hospital Charge Code	40203345
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,255.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$657.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$717.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$598.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$687.70
Rate for Payer: EmblemHealth Commercial	$598.00
Rate for Payer: Fidelis Medicare Advantage	$1,255.80
Rate for Payer: Group Health Inc Commercial	$598.00
Rate for Payer: Group Health Inc Medicare	$418.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$598.00
Rate for Payer: Hamaspik Choice Inc Medicare	$598.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$777.40

SYNTHES CLAMP MULTI-PIN 6 POSIT M

Facility

$1,196.00

Service Code	HCPCS C1713
Hospital Charge Code	40203345
Hospital Revenue Code	278
Min. Negotiated Rate	$598.00
Max. Negotiated Rate	$598.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$598.00
Rate for Payer: Hamaspik Choice Inc Medicare	$598.00

SYNTHES CLAMP MULTI-PIN 6 POSIT M

Facility

$1,196.00

Hospital Charge Code	40009328
Hospital Revenue Code	272
Min. Negotiated Rate	$418.60
Max. Negotiated Rate	$956.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$657.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$598.00
Rate for Payer: Aetna Government	$598.00
Rate for Payer: Brighton Health Commercial	$897.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$956.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$813.28
Rate for Payer: Group Health Inc Commercial	$598.00
Rate for Payer: Group Health Inc Medicare	$418.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$598.00
Rate for Payer: Hamaspik Choice Inc Medicare	$598.00

SYNTHES CMF SCRW TIT N S/D 4MML/P

Facility

$675.00

Service Code	HCPCS C1713
Hospital Charge Code	40205379
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$337.50
Rate for Payer: Hamaspik Choice Inc Medicare	$337.50

SYNTHES CMF SCRW TIT N S/D 4MML/P

Facility

$675.00

Service Code	HCPCS C1713
Hospital Charge Code	40205379
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$708.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$371.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$405.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$337.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$388.12
Rate for Payer: EmblemHealth Commercial	$337.50
Rate for Payer: Fidelis Medicare Advantage	$708.75
Rate for Payer: Group Health Inc Commercial	$337.50
Rate for Payer: Group Health Inc Medicare	$236.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$337.50
Rate for Payer: Hamaspik Choice Inc Medicare	$337.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$438.75

Know your out-of-pocket cost for care.

All Charges