St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

6H L PT 8MM ADVC 100D LT STD

Facility

$346.00

Service Code	HCPCS C1713
Hospital Charge Code	40202278
Hospital Revenue Code	278
Min. Negotiated Rate	$121.10
Max. Negotiated Rate	$363.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$190.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$207.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$173.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$198.95
Rate for Payer: EmblemHealth Commercial	$173.00
Rate for Payer: Fidelis Medicare Advantage	$363.30
Rate for Payer: Group Health Inc Commercial	$173.00
Rate for Payer: Group Health Inc Medicare	$121.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$173.00
Rate for Payer: Hamaspik Choice Inc Medicare	$173.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$224.90

6H L PT 8MM ADVC 100D RT STD

Facility

$346.00

Service Code	HCPCS C1713
Hospital Charge Code	40202279
Hospital Revenue Code	278
Min. Negotiated Rate	$173.00
Max. Negotiated Rate	$173.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$173.00
Rate for Payer: Hamaspik Choice Inc Medicare	$173.00

6H L PT 8MM ADVC 100D RT STD

Facility

$346.00

Service Code	HCPCS C1713
Hospital Charge Code	40202279
Hospital Revenue Code	278
Min. Negotiated Rate	$121.10
Max. Negotiated Rate	$363.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$190.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$207.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$173.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$198.95
Rate for Payer: EmblemHealth Commercial	$173.00
Rate for Payer: Fidelis Medicare Advantage	$363.30
Rate for Payer: Group Health Inc Commercial	$173.00
Rate for Payer: Group Health Inc Medicare	$121.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$173.00
Rate for Payer: Hamaspik Choice Inc Medicare	$173.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$224.90

6 HOLE BP NO BAR

Facility

$442.00

Service Code	HCPCS C1713
Hospital Charge Code	40201158
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$464.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$243.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$265.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$221.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$254.15
Rate for Payer: EmblemHealth Commercial	$221.00
Rate for Payer: Fidelis Medicare Advantage	$464.10
Rate for Payer: Group Health Inc Commercial	$221.00
Rate for Payer: Group Health Inc Medicare	$154.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$221.00
Rate for Payer: Hamaspik Choice Inc Medicare	$221.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$287.30

6 HOLE BP NO BAR

Facility

$442.00

Service Code	HCPCS C1713
Hospital Charge Code	40201158
Hospital Revenue Code	278
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$221.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$221.00
Rate for Payer: Hamaspik Choice Inc Medicare	$221.00

6HOLE PLT,12MM ADVMDFC LOC

Facility

$406.00

Service Code	HCPCS C1713
Hospital Charge Code	40201156
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$426.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$223.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$243.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$203.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$233.45
Rate for Payer: EmblemHealth Commercial	$203.00
Rate for Payer: Fidelis Medicare Advantage	$426.30
Rate for Payer: Group Health Inc Commercial	$203.00
Rate for Payer: Group Health Inc Medicare	$142.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.00
Rate for Payer: Hamaspik Choice Inc Medicare	$203.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$263.90

6HOLE PLT,12MM ADVMDFC LOC

Facility

$406.00

Service Code	HCPCS C1713
Hospital Charge Code	40201156
Hospital Revenue Code	278
Min. Negotiated Rate	$203.00
Max. Negotiated Rate	$203.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.00
Rate for Payer: Hamaspik Choice Inc Medicare	$203.00

6HOLE PLT, 8MM ADV MDFC LOC

Facility

$396.00

Service Code	HCPCS C1713
Hospital Charge Code	40201157
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$415.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$217.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$237.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$198.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$227.70
Rate for Payer: EmblemHealth Commercial	$198.00
Rate for Payer: Fidelis Medicare Advantage	$415.80
Rate for Payer: Group Health Inc Commercial	$198.00
Rate for Payer: Group Health Inc Medicare	$138.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$198.00
Rate for Payer: Hamaspik Choice Inc Medicare	$198.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$257.40

6HOLE PLT, 8MM ADV MDFC LOC

Facility

$396.00

Service Code	HCPCS C1713
Hospital Charge Code	40201157
Hospital Revenue Code	278
Min. Negotiated Rate	$198.00
Max. Negotiated Rate	$198.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$198.00
Rate for Payer: Hamaspik Choice Inc Medicare	$198.00

6 HOLE RIGHT PROX LOCKING PLATE

Facility

$1,910.00

Service Code	HCPCS C1713
Hospital Charge Code	40201152
Hospital Revenue Code	278
Min. Negotiated Rate	$955.00
Max. Negotiated Rate	$955.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$955.00
Rate for Payer: Hamaspik Choice Inc Medicare	$955.00

6 HOLE RIGHT PROX LOCKING PLATE

Facility

$1,910.00

Service Code	HCPCS C1713
Hospital Charge Code	40201152
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,005.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,050.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,146.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$955.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,098.25
Rate for Payer: EmblemHealth Commercial	$955.00
Rate for Payer: Fidelis Medicare Advantage	$2,005.50
Rate for Payer: Group Health Inc Commercial	$955.00
Rate for Payer: Group Health Inc Medicare	$668.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$955.00
Rate for Payer: Hamaspik Choice Inc Medicare	$955.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,241.50

6HOLE RIGHT PROX LOCKING PLATE

Facility

$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

6HOLE RIGHT PROX LOCKING PLATE

Facility

$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: Brighton Health Commercial	$1,050.00
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: EmblemHealth Commercial	$875.00
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

6 HOLE SAGITTAL SPLIT PLATE

Facility

$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: Brighton Health Commercial	$319.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$266.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$306.26
Rate for Payer: EmblemHealth Commercial	$266.31
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

6 HOLE SAGITTAL SPLIT PLATE

Facility

$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

6HOLE START PLTE W/BAR,MAND,LOCK

Facility

$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

$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: Brighton Health Commercial	$250.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$209.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$240.35
Rate for Payer: EmblemHealth Commercial	$209.00
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

$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: Brighton Health Commercial	$1,178.40
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: EmblemHealth Commercial	$982.00
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

6H PLATE

Facility

$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

6-MINUTE WALK

Facility

$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: Affinity Essential Plan 1&2	$107.73
Rate for Payer: Affinity Essential Plan 3&4	$107.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$47.88
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: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$107.73
Rate for Payer: United Healthcare Essential Plan 3&4	$52.67
Rate for Payer: United Healthcare Medicaid	$47.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$47.88
Rate for Payer: Wellcare Medicare	$55.00

6 MIN WALK TEST

Facility

$330.23

Service Code	HCPCS 94618 TC
Hospital Charge Code	30301329
Hospital Revenue Code	460
Rate for Payer: Cash Price	$147.72

6 MIN WALK TEST

Facility

$330.23

Service Code	HCPCS 94618 TC
Hospital Charge Code	30301329
Hospital Revenue Code	460
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$264.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$181.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$147.72
Rate for Payer: Aetna Government	$147.72
Rate for Payer: Affinity Essential Plan 1&2	$103.40
Rate for Payer: Affinity Essential Plan 3&4	$103.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$103.40
Rate for Payer: Brighton Health Commercial	$247.67
Rate for Payer: Cash Price	$147.72
Rate for Payer: Cash Price	$147.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$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: Elderplan Medicare Advantage	$147.72
Rate for Payer: EmblemHealth Commercial	$147.72
Rate for Payer: Fidelis Essential Plan Aliesa	$125.56
Rate for Payer: Fidelis Essential Plan QHP	$131.47
Rate for Payer: Fidelis Medicare Advantage	$147.72
Rate for Payer: Fidelis Qualified Health Plan	$131.47
Rate for Payer: Group Health Inc Commercial	$147.72
Rate for Payer: Group Health Inc Medicare	$147.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.12
Rate for Payer: Hamaspik Choice Inc Medicare	$147.72
Rate for Payer: Healthfirst Medicare Advantage	$125.56
Rate for Payer: Healthfirst QHP	$147.72
Rate for Payer: Humana Medicare	$150.67
Rate for Payer: Senior Whole Health Medicare Advantage	$147.72
Rate for Payer: United Healthcare Commercial	$165.12
Rate for Payer: United Healthcare Medicare Advantage	$147.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$147.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$118.18
Rate for Payer: Wellcare Medicare	$140.33

6MM PRE-DRILLING ASSEMBLY-LONG

Facility

$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: Brighton Health Commercial	$182.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$152.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$174.80
Rate for Payer: EmblemHealth Commercial	$152.00
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

6MM PRE-DRILLING ASSEMBLY-LONG

Facility

$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

6X2H 3D PLATE UPPER FC MALLEABLE

Facility

$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

Know your out-of-pocket cost for care.

All Charges