St. Barnabas Hospital

All Charges

Charge

Type

Price

6HOLE RIGHT PROX LOCKING PLATE

Facility OP

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	40209953
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,837.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$962.50
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	$875.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,006.25
Rate for Payer: Fidelis Medicare Advantage	$1,837.50
Rate for Payer: Group Health Inc Commercial	$875.00
Rate for Payer: Group Health Inc Medicare	$612.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$875.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,137.50

6HOLE RIGHT PROX LOCKING PLATE

Facility IP

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	40209953
Hospital Revenue Code	278
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$875.00

6 HOLE SAGITTAL SPLIT PLATE

Facility IP

$532.62

Service Code	HCPCS C1713
Hospital Charge Code	40204682
Hospital Revenue Code	278
Min. Negotiated Rate	$266.31
Max. Negotiated Rate	$266.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$266.31
Rate for Payer: Hamaspik Choice Inc Medicare	$266.31

6 HOLE SAGITTAL SPLIT PLATE

Facility OP

$532.62

Service Code	HCPCS C1713
Hospital Charge Code	40204682
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$559.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$292.94
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	$266.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$306.26
Rate for Payer: Fidelis Medicare Advantage	$559.25
Rate for Payer: Group Health Inc Commercial	$266.31
Rate for Payer: Group Health Inc Medicare	$186.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$266.31
Rate for Payer: Hamaspik Choice Inc Medicare	$266.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$346.20

6HOLE START PLTE W/BAR,MAND,LOCK

Facility IP

$418.00

Service Code	HCPCS C1713
Hospital Charge Code	40201153
Hospital Revenue Code	278
Min. Negotiated Rate	$209.00
Max. Negotiated Rate	$209.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.00
Rate for Payer: Hamaspik Choice Inc Medicare	$209.00

6HOLE START PLTE W/BAR,MAND,LOCK

Facility OP

$418.00

Service Code	HCPCS C1713
Hospital Charge Code	40201153
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$438.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$229.90
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	$209.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$240.35
Rate for Payer: Fidelis Medicare Advantage	$438.90
Rate for Payer: Group Health Inc Commercial	$209.00
Rate for Payer: Group Health Inc Medicare	$146.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.00
Rate for Payer: Hamaspik Choice Inc Medicare	$209.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$271.70

6H PLATE

Facility IP

$1,964.00

Service Code	HCPCS C1713
Hospital Charge Code	40202280
Hospital Revenue Code	278
Min. Negotiated Rate	$982.00
Max. Negotiated Rate	$982.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$982.00
Rate for Payer: Hamaspik Choice Inc Medicare	$982.00

6H PLATE

Facility OP

$1,964.00

Service Code	HCPCS C1713
Hospital Charge Code	40202280
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,062.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,080.20
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	$982.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,129.30
Rate for Payer: Fidelis Medicare Advantage	$2,062.20
Rate for Payer: Group Health Inc Commercial	$982.00
Rate for Payer: Group Health Inc Medicare	$687.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$982.00
Rate for Payer: Hamaspik Choice Inc Medicare	$982.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,276.60

6-MINUTE WALK

Facility OP

$88.03

Service Code	HCPCS 97116
Hospital Charge Code	41701001
Hospital Revenue Code	420
Min. Negotiated Rate	$16.96
Max. Negotiated Rate	$4,788.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.96
Rate for Payer: Aetna Government	$16.96
Rate for Payer: Amida Care Medicaid	$47.88
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.95
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4,788.00
Rate for Payer: Fidelis Essential Plan Aliesa	$47.88
Rate for Payer: Fidelis Essential Plan QHP	$47.88
Rate for Payer: Fidelis Qualified Health Plan	$50.27
Rate for Payer: Group Health Inc Commercial	$44.02
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.88
Rate for Payer: Hamaspik Choice Inc Medicare	$44.02
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$47.88
Rate for Payer: Healthfirst Essential Plan	$107.73
Rate for Payer: Healthfirst QHP	$47.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$47.88
Rate for Payer: SOMOS Essential	$107.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$47.88
Rate for Payer: Wellcare Medicare	$55.00

6 MIN WALK TEST

Facility OP

$330.23

Service Code	HCPCS 94618 TC
Hospital Charge Code	30301329
Hospital Revenue Code	460
Min. Negotiated Rate	$13.28
Max. Negotiated Rate	$264.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$181.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$165.12
Rate for Payer: Aetna Government	$165.12
Rate for Payer: Cash Price	$147.72
Rate for Payer: Cash Price	$147.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$264.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$224.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$13.28
Rate for Payer: Group Health Inc Commercial	$165.12
Rate for Payer: Group Health Inc Medicare	$115.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.12
Rate for Payer: Hamaspik Choice Inc Medicare	$165.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$14.75

6MM PRE-DRILLING ASSEMBLY-LONG

Facility IP

$304.00

Service Code	HCPCS C1713
Hospital Charge Code	40200559
Hospital Revenue Code	278
Min. Negotiated Rate	$152.00
Max. Negotiated Rate	$152.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.00
Rate for Payer: Hamaspik Choice Inc Medicare	$152.00

6MM PRE-DRILLING ASSEMBLY-LONG

Facility OP

$304.00

Service Code	HCPCS C1713
Hospital Charge Code	40200559
Hospital Revenue Code	278
Min. Negotiated Rate	$106.40
Max. Negotiated Rate	$319.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$167.20
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	$152.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$174.80
Rate for Payer: Fidelis Medicare Advantage	$319.20
Rate for Payer: Group Health Inc Commercial	$152.00
Rate for Payer: Group Health Inc Medicare	$106.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.00
Rate for Payer: Hamaspik Choice Inc Medicare	$152.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$197.60

6X2H 3D PLATE UPPER FC MALLEABLE

Facility IP

$676.00

Service Code	HCPCS C1713
Hospital Charge Code	40200556
Hospital Revenue Code	278
Min. Negotiated Rate	$338.00
Max. Negotiated Rate	$338.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$338.00
Rate for Payer: Hamaspik Choice Inc Medicare	$338.00

6X2H 3D PLATE UPPER FC MALLEABLE

Facility OP

$676.00

Service Code	HCPCS C1713
Hospital Charge Code	40200556
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$709.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$371.80
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	$338.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$388.70
Rate for Payer: Fidelis Medicare Advantage	$709.80
Rate for Payer: Group Health Inc Commercial	$338.00
Rate for Payer: Group Health Inc Medicare	$236.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$338.00
Rate for Payer: Hamaspik Choice Inc Medicare	$338.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$439.40

6X2 HOLE 3D PLTE UPPERFACE

Facility OP

$636.00

Service Code	HCPCS C1713
Hospital Charge Code	40201154
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$667.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$349.80
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	$318.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$365.70
Rate for Payer: Fidelis Medicare Advantage	$667.80
Rate for Payer: Group Health Inc Commercial	$318.00
Rate for Payer: Group Health Inc Medicare	$222.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$318.00
Rate for Payer: Hamaspik Choice Inc Medicare	$318.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$413.40

6X2 HOLE 3D PLTE UPPERFACE

Facility IP

$636.00

Service Code	HCPCS C1713
Hospital Charge Code	40201154
Hospital Revenue Code	278
Min. Negotiated Rate	$318.00
Max. Negotiated Rate	$318.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$318.00
Rate for Payer: Hamaspik Choice Inc Medicare	$318.00

6X2 HOLE 3D PLT UPPERFACE

Facility IP

$636.00

Service Code	HCPCS C1713
Hospital Charge Code	40201159
Hospital Revenue Code	278
Min. Negotiated Rate	$318.00
Max. Negotiated Rate	$318.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$318.00
Rate for Payer: Hamaspik Choice Inc Medicare	$318.00

6X2 HOLE 3D PLT UPPERFACE

Facility OP

$636.00

Service Code	HCPCS C1713
Hospital Charge Code	40201159
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$667.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$349.80
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	$318.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$365.70
Rate for Payer: Fidelis Medicare Advantage	$667.80
Rate for Payer: Group Health Inc Commercial	$318.00
Rate for Payer: Group Health Inc Medicare	$222.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$318.00
Rate for Payer: Hamaspik Choice Inc Medicare	$318.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$413.40

6X2 HOLE 3D PLT UPPER FC MALLBL

Facility IP

$1,560.00

Service Code	HCPCS C1713
Hospital Charge Code	40201160
Hospital Revenue Code	278
Min. Negotiated Rate	$780.00
Max. Negotiated Rate	$780.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$780.00
Rate for Payer: Hamaspik Choice Inc Medicare	$780.00

6X2 HOLE 3D PLT UPPER FC MALLBL

Facility OP

$1,560.00

Service Code	HCPCS C1713
Hospital Charge Code	40201160
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,638.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$858.00
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	$780.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$897.00
Rate for Payer: Fidelis Medicare Advantage	$1,638.00
Rate for Payer: Group Health Inc Commercial	$780.00
Rate for Payer: Group Health Inc Medicare	$546.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$780.00
Rate for Payer: Hamaspik Choice Inc Medicare	$780.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,014.00

6X6H 3D PLATE UPPER FC MALLEABLE

Facility IP

$676.00

Service Code	HCPCS C1713
Hospital Charge Code	40200557
Hospital Revenue Code	278
Min. Negotiated Rate	$338.00
Max. Negotiated Rate	$338.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$338.00
Rate for Payer: Hamaspik Choice Inc Medicare	$338.00

6X6H 3D PLATE UPPER FC MALLEABLE

Facility OP

$676.00

Service Code	HCPCS C1713
Hospital Charge Code	40200557
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$709.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$371.80
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	$338.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$388.70
Rate for Payer: Fidelis Medicare Advantage	$709.80
Rate for Payer: Group Health Inc Commercial	$338.00
Rate for Payer: Group Health Inc Medicare	$236.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$338.00
Rate for Payer: Hamaspik Choice Inc Medicare	$338.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$439.40

6X6 HOLE 3D PLTE UPPERFACE

Facility IP

$1,508.00

Service Code	HCPCS C1713
Hospital Charge Code	40201155
Hospital Revenue Code	278
Min. Negotiated Rate	$754.00
Max. Negotiated Rate	$754.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$754.00
Rate for Payer: Hamaspik Choice Inc Medicare	$754.00

6X6 HOLE 3D PLTE UPPERFACE

Facility OP

$1,508.00

Service Code	HCPCS C1713
Hospital Charge Code	40201155
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,583.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$829.40
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	$754.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$867.10
Rate for Payer: Fidelis Medicare Advantage	$1,583.40
Rate for Payer: Group Health Inc Commercial	$754.00
Rate for Payer: Group Health Inc Medicare	$527.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$754.00
Rate for Payer: Hamaspik Choice Inc Medicare	$754.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$980.20

6X6HOLE 3D PLT UPPERFACE

Facility OP

$1,508.00

Service Code	HCPCS C1713
Hospital Charge Code	40201161
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,583.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$829.40
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	$754.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$867.10
Rate for Payer: Fidelis Medicare Advantage	$1,583.40
Rate for Payer: Group Health Inc Commercial	$754.00
Rate for Payer: Group Health Inc Medicare	$527.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$754.00
Rate for Payer: Hamaspik Choice Inc Medicare	$754.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$980.20

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