St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SYNTHES PLATE 8HOLE 3.5X11MM

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	40209435
Hospital Revenue Code	278
Min. Negotiated Rate	$47.25
Max. Negotiated Rate	$141.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$81.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$67.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.62
Rate for Payer: EmblemHealth Commercial	$67.50
Rate for Payer: Fidelis Medicare Advantage	$141.75
Rate for Payer: Group Health Inc Commercial	$67.50
Rate for Payer: Group Health Inc Medicare	$47.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.50
Rate for Payer: Hamaspik Choice Inc Medicare	$67.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$87.75

SYNTHES PLATE 8HOLE 3.5X11MM

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	40209435
Hospital Revenue Code	278
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.50
Rate for Payer: Hamaspik Choice Inc Medicare	$67.50

SYNTHES PLATE L/CALANEAL RGHT

Facility

$1,333.80

Service Code	HCPCS C1713
Hospital Charge Code	40205310
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 PLATE L/CALANEAL RGHT

Facility

$1,333.80

Service Code	HCPCS C1713
Hospital Charge Code	40205310
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 PLATE LCP 9H 3.5X124MM

Facility

$121.50

Service Code	HCPCS C1713
Hospital Charge Code	40209447
Hospital Revenue Code	278
Min. Negotiated Rate	$42.52
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$72.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.86
Rate for Payer: EmblemHealth Commercial	$60.75
Rate for Payer: Fidelis Medicare Advantage	$127.58
Rate for Payer: Group Health Inc Commercial	$60.75
Rate for Payer: Group Health Inc Medicare	$42.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.75
Rate for Payer: Hamaspik Choice Inc Medicare	$60.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$78.98

SYNTHES PLATE LCP 9H 3.5X124MM

Facility

$121.50

Service Code	HCPCS C1713
Hospital Charge Code	40209447
Hospital Revenue Code	278
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.75
Rate for Payer: Hamaspik Choice Inc Medicare	$60.75

SYNTHES PLATE PERI ARTICULAR

Facility

$547.20

Service Code	HCPCS C1713
Hospital Charge Code	40205335
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$574.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$300.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$328.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$273.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$314.64
Rate for Payer: EmblemHealth Commercial	$273.60
Rate for Payer: Fidelis Medicare Advantage	$574.56
Rate for Payer: Group Health Inc Commercial	$273.60
Rate for Payer: Group Health Inc Medicare	$191.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$273.60
Rate for Payer: Hamaspik Choice Inc Medicare	$273.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$355.68

SYNTHES PLATE PERI ARTICULAR

Facility

$547.20

Service Code	HCPCS C1713
Hospital Charge Code	40205335
Hospital Revenue Code	278
Min. Negotiated Rate	$273.60
Max. Negotiated Rate	$273.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$273.60
Rate for Payer: Hamaspik Choice Inc Medicare	$273.60

SYNTHES PLATE PERIARTICULAR P SYS

Facility

$2,800.00

Service Code	HCPCS C1713
Hospital Charge Code	40205341
Hospital Revenue Code	278
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$1,400.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,400.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,400.00

SYNTHES PLATE PERIARTICULAR P SYS

Facility

$2,800.00

Service Code	HCPCS C1713
Hospital Charge Code	40205341
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,940.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,540.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,680.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,610.00
Rate for Payer: EmblemHealth Commercial	$1,400.00
Rate for Payer: Fidelis Medicare Advantage	$2,940.00
Rate for Payer: Group Health Inc Commercial	$1,400.00
Rate for Payer: Group Health Inc Medicare	$980.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,400.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,400.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,820.00

SYNTHES PLT 11 H 3.5MM LCP

Facility

$667.80

Service Code	HCPCS C1776
Hospital Charge Code	40205176
Hospital Revenue Code	278
Min. Negotiated Rate	$233.73
Max. Negotiated Rate	$701.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$367.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$400.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$333.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$383.98
Rate for Payer: EmblemHealth Commercial	$333.90
Rate for Payer: Fidelis Medicare Advantage	$701.19
Rate for Payer: Group Health Inc Commercial	$333.90
Rate for Payer: Group Health Inc Medicare	$233.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$333.90
Rate for Payer: Hamaspik Choice Inc Medicare	$333.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$434.07

SYNTHES PLT 11 H 3.5MM LCP

Facility

$667.80

Service Code	HCPCS C1776
Hospital Charge Code	40205176
Hospital Revenue Code	278
Min. Negotiated Rate	$333.90
Max. Negotiated Rate	$333.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$333.90
Rate for Payer: Hamaspik Choice Inc Medicare	$333.90

SYNTHES PLT 2.7 LFT HUM LCP 8H

Facility

$862.20

Service Code	HCPCS C1713
Hospital Charge Code	40205916
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$905.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$474.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$517.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$431.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$495.76
Rate for Payer: EmblemHealth Commercial	$431.10
Rate for Payer: Fidelis Medicare Advantage	$905.31
Rate for Payer: Group Health Inc Commercial	$431.10
Rate for Payer: Group Health Inc Medicare	$301.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$431.10
Rate for Payer: Hamaspik Choice Inc Medicare	$431.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$560.43

SYNTHES PLT 2.7 LFT HUM LCP 8H

Facility

$862.20

Service Code	HCPCS C1713
Hospital Charge Code	40205916
Hospital Revenue Code	278
Min. Negotiated Rate	$431.10
Max. Negotiated Rate	$431.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$431.10
Rate for Payer: Hamaspik Choice Inc Medicare	$431.10

SYNTHES PLT3.5 LCP P/L 241.273

Facility

$2,295.00

Service Code	HCPCS C1713
Hospital Charge Code	40205918
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,409.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,262.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,377.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,147.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,319.62
Rate for Payer: EmblemHealth Commercial	$1,147.50
Rate for Payer: Fidelis Medicare Advantage	$2,409.75
Rate for Payer: Group Health Inc Commercial	$1,147.50
Rate for Payer: Group Health Inc Medicare	$803.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,147.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,147.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,491.75

SYNTHES PLT3.5 LCP P/L 241.273

Facility

$2,295.00

Service Code	HCPCS C1713
Hospital Charge Code	40205918
Hospital Revenue Code	278
Min. Negotiated Rate	$1,147.50
Max. Negotiated Rate	$1,147.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,147.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,147.50

SYNTHES PLT 4.5 LCP 12-H RT

Facility

$3,920.00

Service Code	HCPCS C1713
Hospital Charge Code	40205773
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,116.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,156.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,352.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,960.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,254.00
Rate for Payer: EmblemHealth Commercial	$1,960.00
Rate for Payer: Fidelis Medicare Advantage	$4,116.00
Rate for Payer: Group Health Inc Commercial	$1,960.00
Rate for Payer: Group Health Inc Medicare	$1,372.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,960.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,960.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,548.00

SYNTHES PLT 4.5 LCP 12-H RT

Facility

$3,920.00

Service Code	HCPCS C1713
Hospital Charge Code	40205773
Hospital Revenue Code	278
Min. Negotiated Rate	$1,960.00
Max. Negotiated Rate	$1,960.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,960.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,960.00

SYNTHES PLT 4.5MM N 7 H 124MM

Facility

$295.20

Service Code	HCPCS C1776
Hospital Charge Code	40205278
Hospital Revenue Code	278
Min. Negotiated Rate	$147.60
Max. Negotiated Rate	$147.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$147.60
Rate for Payer: Hamaspik Choice Inc Medicare	$147.60

SYNTHES PLT 4.5MM N 7 H 124MM

Facility

$295.20

Service Code	HCPCS C1776
Hospital Charge Code	40205278
Hospital Revenue Code	278
Min. Negotiated Rate	$103.32
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$162.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$177.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$169.74
Rate for Payer: EmblemHealth Commercial	$147.60
Rate for Payer: Fidelis Medicare Advantage	$309.96
Rate for Payer: Group Health Inc Commercial	$147.60
Rate for Payer: Group Health Inc Medicare	$103.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$147.60
Rate for Payer: Hamaspik Choice Inc Medicare	$147.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$191.88

SYNTHES PLT LC-DCP 6H 3.5MM

Facility

$210.00

Service Code	HCPCS C1713
Hospital Charge Code	40205131
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.00
Rate for Payer: Hamaspik Choice Inc Medicare	$105.00

SYNTHES PLT LC-DCP 6H 3.5MM

Facility

$210.00

Service Code	HCPCS C1713
Hospital Charge Code	40205131
Hospital Revenue Code	278
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$220.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$115.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$126.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$105.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$120.75
Rate for Payer: EmblemHealth Commercial	$105.00
Rate for Payer: Fidelis Medicare Advantage	$220.50
Rate for Payer: Group Health Inc Commercial	$105.00
Rate for Payer: Group Health Inc Medicare	$73.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.00
Rate for Payer: Hamaspik Choice Inc Medicare	$105.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$136.50

SYNTHES PLT LCP 5H

Facility

$2,133.00

Service Code	HCPCS C1713
Hospital Charge Code	40205917
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 PLT LCP 5H

Facility

$2,133.00

Service Code	HCPCS C1713
Hospital Charge Code	40205917
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 S/B CORTICAL S/T 2X

Facility

$79.50

Service Code	HCPCS C1713
Hospital Charge Code	40205776
Hospital Revenue Code	278
Min. Negotiated Rate	$39.75
Max. Negotiated Rate	$39.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.75
Rate for Payer: Hamaspik Choice Inc Medicare	$39.75

Know your out-of-pocket cost for care.

All Charges