St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

.75MM 9-LOCH STEINH LPLT LNKS 1

Facility

$580.00

Service Code	HCPCS C1713
Hospital Charge Code	40209751
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$609.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$319.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$348.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$290.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$333.50
Rate for Payer: EmblemHealth Commercial	$290.00
Rate for Payer: Fidelis Medicare Advantage	$609.00
Rate for Payer: Group Health Inc Commercial	$290.00
Rate for Payer: Group Health Inc Medicare	$203.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$290.00
Rate for Payer: Hamaspik Choice Inc Medicare	$290.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$377.00

.75MM 9-LOCH STEINH LPLT LNKS 1

Facility

$580.00

Service Code	HCPCS C1713
Hospital Charge Code	40209751
Hospital Revenue Code	278
Min. Negotiated Rate	$290.00
Max. Negotiated Rate	$290.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$290.00
Rate for Payer: Hamaspik Choice Inc Medicare	$290.00

.75MM MP PLATE LOCKING L RIGHT

Facility

$580.00

Service Code	HCPCS C1713
Hospital Charge Code	40209746
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$609.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$319.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$348.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$290.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$333.50
Rate for Payer: EmblemHealth Commercial	$290.00
Rate for Payer: Fidelis Medicare Advantage	$609.00
Rate for Payer: Group Health Inc Commercial	$290.00
Rate for Payer: Group Health Inc Medicare	$203.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$290.00
Rate for Payer: Hamaspik Choice Inc Medicare	$290.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$377.00

.75MM MP PLATE LOCKING L RIGHT

Facility

$580.00

Service Code	HCPCS C1713
Hospital Charge Code	40209746
Hospital Revenue Code	278
Min. Negotiated Rate	$290.00
Max. Negotiated Rate	$290.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$290.00
Rate for Payer: Hamaspik Choice Inc Medicare	$290.00

7-8 REGIONS

Facility

$164.83

Service Code	HCPCS 98928
Hospital Charge Code	30305016
Hospital Revenue Code	530
Rate for Payer: Cash Price	$30.00

7-8 REGIONS

Facility

$164.83

Service Code	HCPCS 98928
Hospital Charge Code	30305016
Hospital Revenue Code	530
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$131.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$90.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.00
Rate for Payer: Aetna Government	$30.00
Rate for Payer: Affinity Essential Plan 1&2	$21.00
Rate for Payer: Affinity Essential Plan 3&4	$21.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$21.00
Rate for Payer: Brighton Health Commercial	$123.62
Rate for Payer: Cash Price	$30.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$30.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$131.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$112.08
Rate for Payer: Elderplan Medicare Advantage	$30.00
Rate for Payer: EmblemHealth Commercial	$30.00
Rate for Payer: Fidelis Essential Plan Aliesa	$25.50
Rate for Payer: Fidelis Essential Plan QHP	$26.70
Rate for Payer: Fidelis Medicare Advantage	$30.00
Rate for Payer: Fidelis Qualified Health Plan	$26.70
Rate for Payer: Group Health Inc Commercial	$30.00
Rate for Payer: Group Health Inc Medicare	$30.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.42
Rate for Payer: Hamaspik Choice Inc Medicare	$30.00
Rate for Payer: Healthfirst Medicare Advantage	$25.50
Rate for Payer: Healthfirst QHP	$30.00
Rate for Payer: Humana Medicare	$30.60
Rate for Payer: Senior Whole Health Medicare Advantage	$30.00
Rate for Payer: United Healthcare Medicare Advantage	$30.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24.00
Rate for Payer: Wellcare Medicare	$28.50

7H DOUBLE Y PLATE UPFC MALLEABLE

Facility

$292.00

Service Code	HCPCS C1713
Hospital Charge Code	40200560
Hospital Revenue Code	278
Min. Negotiated Rate	$102.20
Max. Negotiated Rate	$306.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$160.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$175.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$146.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$167.90
Rate for Payer: EmblemHealth Commercial	$146.00
Rate for Payer: Fidelis Medicare Advantage	$306.60
Rate for Payer: Group Health Inc Commercial	$146.00
Rate for Payer: Group Health Inc Medicare	$102.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.00
Rate for Payer: Hamaspik Choice Inc Medicare	$146.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$189.80

7H DOUBLE Y PLATE UPFC MALLEABLE

Facility

$292.00

Service Code	HCPCS C1713
Hospital Charge Code	40200560
Hospital Revenue Code	278
Min. Negotiated Rate	$146.00
Max. Negotiated Rate	$146.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.00
Rate for Payer: Hamaspik Choice Inc Medicare	$146.00

7 HOLE DOUBLE Y PLATE UPPERFACE

Facility

$292.00

Service Code	HCPCS C1713
Hospital Charge Code	40201164
Hospital Revenue Code	278
Min. Negotiated Rate	$102.20
Max. Negotiated Rate	$306.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$160.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$175.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$146.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$167.90
Rate for Payer: EmblemHealth Commercial	$146.00
Rate for Payer: Fidelis Medicare Advantage	$306.60
Rate for Payer: Group Health Inc Commercial	$146.00
Rate for Payer: Group Health Inc Medicare	$102.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.00
Rate for Payer: Hamaspik Choice Inc Medicare	$146.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$189.80

7 HOLE DOUBLE Y PLATE UPPERFACE

Facility

$292.00

Service Code	HCPCS C1713
Hospital Charge Code	40201164
Hospital Revenue Code	278
Min. Negotiated Rate	$146.00
Max. Negotiated Rate	$146.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.00
Rate for Payer: Hamaspik Choice Inc Medicare	$146.00

7HOLE DOUBLE Y PLT UPFC MLBL

Facility

$324.00

Service Code	HCPCS C1713
Hospital Charge Code	40201169
Hospital Revenue Code	278
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$340.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$178.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$194.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$162.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$186.30
Rate for Payer: EmblemHealth Commercial	$162.00
Rate for Payer: Fidelis Medicare Advantage	$340.20
Rate for Payer: Group Health Inc Commercial	$162.00
Rate for Payer: Group Health Inc Medicare	$113.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.00
Rate for Payer: Hamaspik Choice Inc Medicare	$162.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$210.60

7HOLE DOUBLE Y PLT UPFC MLBL

Facility

$324.00

Service Code	HCPCS C1713
Hospital Charge Code	40201169
Hospital Revenue Code	278
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$162.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.00
Rate for Payer: Hamaspik Choice Inc Medicare	$162.00

7HOLE NARROW T-PLATE

Facility

$1,796.00

Service Code	HCPCS C1713
Hospital Charge Code	40209947
Hospital Revenue Code	278
Min. Negotiated Rate	$898.00
Max. Negotiated Rate	$898.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$898.00
Rate for Payer: Hamaspik Choice Inc Medicare	$898.00

7HOLE NARROW T-PLATE

Facility

$1,796.00

Service Code	HCPCS C1713
Hospital Charge Code	40209947
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,885.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$987.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,077.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$898.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,032.70
Rate for Payer: EmblemHealth Commercial	$898.00
Rate for Payer: Fidelis Medicare Advantage	$1,885.80
Rate for Payer: Group Health Inc Commercial	$898.00
Rate for Payer: Group Health Inc Medicare	$628.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$898.00
Rate for Payer: Hamaspik Choice Inc Medicare	$898.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,167.40

7HOLE NARROW T-PLATE

Facility

$1,558.00

Service Code	HCPCS C1713
Hospital Charge Code	40201106
Hospital Revenue Code	278
Min. Negotiated Rate	$779.00
Max. Negotiated Rate	$779.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$779.00
Rate for Payer: Hamaspik Choice Inc Medicare	$779.00

7HOLE NARROW T-PLATE

Facility

$1,558.00

Service Code	HCPCS C1713
Hospital Charge Code	40201106
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,635.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$856.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$934.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$779.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$895.85
Rate for Payer: EmblemHealth Commercial	$779.00
Rate for Payer: Fidelis Medicare Advantage	$1,635.90
Rate for Payer: Group Health Inc Commercial	$779.00
Rate for Payer: Group Health Inc Medicare	$545.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$779.00
Rate for Payer: Hamaspik Choice Inc Medicare	$779.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,012.70

7 HOLE PLT UPPERFACE

Facility

$288.00

Service Code	HCPCS C1713
Hospital Charge Code	40201166
Hospital Revenue Code	278
Min. Negotiated Rate	$144.00
Max. Negotiated Rate	$144.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$144.00
Rate for Payer: Hamaspik Choice Inc Medicare	$144.00

7 HOLE PLT UPPERFACE

Facility

$288.00

Service Code	HCPCS C1713
Hospital Charge Code	40201166
Hospital Revenue Code	278
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$302.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$158.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$172.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$144.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$165.60
Rate for Payer: EmblemHealth Commercial	$144.00
Rate for Payer: Fidelis Medicare Advantage	$302.40
Rate for Payer: Group Health Inc Commercial	$144.00
Rate for Payer: Group Health Inc Medicare	$100.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$144.00
Rate for Payer: Hamaspik Choice Inc Medicare	$144.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$187.20

7MM T-WRENCH

Facility

$172.00

Hospital Charge Code	40200639
Hospital Revenue Code	270
Min. Negotiated Rate	$60.20
Max. Negotiated Rate	$137.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$86.00
Rate for Payer: Aetna Government	$86.00
Rate for Payer: Brighton Health Commercial	$129.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$137.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$116.96
Rate for Payer: Group Health Inc Commercial	$86.00
Rate for Payer: Group Health Inc Medicare	$60.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.00
Rate for Payer: Hamaspik Choice Inc Medicare	$86.00

7+TOTAL VISISTS, ROUTINE OB

Facility

$2,174.40

Service Code	HCPCS 59426
Hospital Charge Code	30301247
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,195.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$754.76
Rate for Payer: Aetna Government	$754.76
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,087.20
Rate for Payer: Hamaspik Choice Inc Medicare	$1,087.20
Rate for Payer: United Healthcare Commercial	$222.00

8H LATERAL FEMUR LOCKING PLATE

Facility

$1,816.00

Service Code	HCPCS C1713
Hospital Charge Code	40200561
Hospital Revenue Code	278
Min. Negotiated Rate	$908.00
Max. Negotiated Rate	$908.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$908.00
Rate for Payer: Hamaspik Choice Inc Medicare	$908.00

8H LATERAL FEMUR LOCKING PLATE

Facility

$1,816.00

Service Code	HCPCS C1713
Hospital Charge Code	40200561
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,906.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$998.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,089.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$908.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,044.20
Rate for Payer: EmblemHealth Commercial	$908.00
Rate for Payer: Fidelis Medicare Advantage	$1,906.80
Rate for Payer: Group Health Inc Commercial	$908.00
Rate for Payer: Group Health Inc Medicare	$635.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$908.00
Rate for Payer: Hamaspik Choice Inc Medicare	$908.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,180.40

8HOLE L PLT 90D LFT UPPERFACE

Facility

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40201178
Hospital Revenue Code	278
Min. Negotiated Rate	$98.70
Max. Negotiated Rate	$296.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$155.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$169.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$141.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$162.15
Rate for Payer: EmblemHealth Commercial	$141.00
Rate for Payer: Fidelis Medicare Advantage	$296.10
Rate for Payer: Group Health Inc Commercial	$141.00
Rate for Payer: Group Health Inc Medicare	$98.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.00
Rate for Payer: Hamaspik Choice Inc Medicare	$141.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$183.30

8HOLE L PLT 90D LFT UPPERFACE

Facility

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40201178
Hospital Revenue Code	278
Min. Negotiated Rate	$141.00
Max. Negotiated Rate	$141.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.00
Rate for Payer: Hamaspik Choice Inc Medicare	$141.00

8HOLE L PLTE 90D LEFT UPPERFACE

Facility

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40201172
Hospital Revenue Code	278
Min. Negotiated Rate	$141.00
Max. Negotiated Rate	$141.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.00
Rate for Payer: Hamaspik Choice Inc Medicare	$141.00

Know your out-of-pocket cost for care.

All Charges