St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE FOR RIGHT PROXI HUME

Facility

$6,450.00

Service Code	HCPCS C1713
Hospital Charge Code	64905469
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,772.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,547.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,870.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,225.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,708.75
Rate for Payer: EmblemHealth Commercial	$3,225.00
Rate for Payer: Fidelis Medicare Advantage	$6,772.50
Rate for Payer: Group Health Inc Commercial	$3,225.00
Rate for Payer: Group Health Inc Medicare	$2,257.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,225.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,192.50

PLATE FRAC 2.7MM 4H 35MM

Facility

$417.50

Service Code	HCPCS C1713
Hospital Charge Code	64901225
Hospital Revenue Code	278
Min. Negotiated Rate	$208.75
Max. Negotiated Rate	$208.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$208.75
Rate for Payer: Hamaspik Choice Inc Medicare	$208.75

PLATE FRAC 2.7MM 4H 35MM

Facility

$417.50

Service Code	HCPCS C1713
Hospital Charge Code	64901225
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$438.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$229.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$250.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$208.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$240.06
Rate for Payer: EmblemHealth Commercial	$208.75
Rate for Payer: Fidelis Medicare Advantage	$438.38
Rate for Payer: Group Health Inc Commercial	$208.75
Rate for Payer: Group Health Inc Medicare	$146.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$208.75
Rate for Payer: Hamaspik Choice Inc Medicare	$208.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$271.38

PLATE FRAC 2.7MM 4H 40MM 45 DEG

Facility

$517.50

Service Code	HCPCS C1713
Hospital Charge Code	64901227
Hospital Revenue Code	278
Min. Negotiated Rate	$258.75
Max. Negotiated Rate	$258.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$258.75
Rate for Payer: Hamaspik Choice Inc Medicare	$258.75

PLATE FRAC 2.7MM 4H 40MM 45 DEG

Facility

$517.50

Service Code	HCPCS C1713
Hospital Charge Code	64901227
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$543.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$284.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$310.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$258.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$297.56
Rate for Payer: EmblemHealth Commercial	$258.75
Rate for Payer: Fidelis Medicare Advantage	$543.38
Rate for Payer: Group Health Inc Commercial	$258.75
Rate for Payer: Group Health Inc Medicare	$181.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$258.75
Rate for Payer: Hamaspik Choice Inc Medicare	$258.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$336.38

PLATE FRAC 2.7MM ANG 6H 52MM

Facility

$605.00

Service Code	HCPCS C1713
Hospital Charge Code	64901223
Hospital Revenue Code	278
Min. Negotiated Rate	$302.50
Max. Negotiated Rate	$302.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$302.50
Rate for Payer: Hamaspik Choice Inc Medicare	$302.50

PLATE FRAC 2.7MM ANG 6H 52MM

Facility

$605.00

Service Code	HCPCS C1713
Hospital Charge Code	64901223
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$635.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$332.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$363.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$302.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$347.88
Rate for Payer: EmblemHealth Commercial	$302.50
Rate for Payer: Fidelis Medicare Advantage	$635.25
Rate for Payer: Group Health Inc Commercial	$302.50
Rate for Payer: Group Health Inc Medicare	$211.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$302.50
Rate for Payer: Hamaspik Choice Inc Medicare	$302.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$393.25

PLATE FRACTURE 11 HOLE

Facility

$1,247.00

Service Code	HCPCS C1713
Hospital Charge Code	64906322
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,309.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$685.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$748.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$623.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$717.02
Rate for Payer: EmblemHealth Commercial	$623.50
Rate for Payer: Fidelis Medicare Advantage	$1,309.35
Rate for Payer: Group Health Inc Commercial	$623.50
Rate for Payer: Group Health Inc Medicare	$436.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$623.50
Rate for Payer: Hamaspik Choice Inc Medicare	$623.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$810.55

PLATE FRACTURE 11 HOLE

Facility

$1,247.00

Service Code	HCPCS C1713
Hospital Charge Code	64906322
Hospital Revenue Code	278
Min. Negotiated Rate	$623.50
Max. Negotiated Rate	$623.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$623.50
Rate for Payer: Hamaspik Choice Inc Medicare	$623.50

PLATE FRACTURE 14 HOLE

Facility

$1,078.10

Service Code	HCPCS C1713
Hospital Charge Code	64906771
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,132.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$592.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$646.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$539.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$619.91
Rate for Payer: EmblemHealth Commercial	$539.05
Rate for Payer: Fidelis Medicare Advantage	$1,132.00
Rate for Payer: Group Health Inc Commercial	$539.05
Rate for Payer: Group Health Inc Medicare	$377.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$539.05
Rate for Payer: Hamaspik Choice Inc Medicare	$539.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$700.76

PLATE FRACTURE 14 HOLE

Facility

$1,078.10

Service Code	HCPCS C1713
Hospital Charge Code	64906771
Hospital Revenue Code	278
Min. Negotiated Rate	$539.05
Max. Negotiated Rate	$539.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$539.05
Rate for Payer: Hamaspik Choice Inc Medicare	$539.05

PLATE FRACTURE 4-HOLE MED

Facility

$670.00

Service Code	HCPCS C1713
Hospital Charge Code	64901338
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$703.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$368.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$402.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$335.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$385.25
Rate for Payer: EmblemHealth Commercial	$335.00
Rate for Payer: Fidelis Medicare Advantage	$703.50
Rate for Payer: Group Health Inc Commercial	$335.00
Rate for Payer: Group Health Inc Medicare	$234.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$335.00
Rate for Payer: Hamaspik Choice Inc Medicare	$335.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$435.50

PLATE FRACTURE 4-HOLE MED

Facility

$670.00

Service Code	HCPCS C1713
Hospital Charge Code	64901338
Hospital Revenue Code	278
Min. Negotiated Rate	$335.00
Max. Negotiated Rate	$335.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$335.00
Rate for Payer: Hamaspik Choice Inc Medicare	$335.00

PLATE FRACTURE 4 HOLES

Facility

$712.50

Service Code	HCPCS C1713
Hospital Charge Code	64901486
Hospital Revenue Code	278
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$356.25
Rate for Payer: Hamaspik Choice Inc Medicare	$356.25

PLATE FRACTURE 4 HOLES

Facility

$712.50

Service Code	HCPCS C1713
Hospital Charge Code	64901486
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$748.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$391.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$427.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$356.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$409.69
Rate for Payer: EmblemHealth Commercial	$356.25
Rate for Payer: Fidelis Medicare Advantage	$748.12
Rate for Payer: Group Health Inc Commercial	$356.25
Rate for Payer: Group Health Inc Medicare	$249.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$356.25
Rate for Payer: Hamaspik Choice Inc Medicare	$356.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$463.12

PLATE FRACTURE 4H ST W/BAR

Facility

$739.20

Service Code	HCPCS C1713
Hospital Charge Code	64901408
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$776.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$406.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$443.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$369.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$425.04
Rate for Payer: EmblemHealth Commercial	$369.60
Rate for Payer: Fidelis Medicare Advantage	$776.16
Rate for Payer: Group Health Inc Commercial	$369.60
Rate for Payer: Group Health Inc Medicare	$258.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$369.60
Rate for Payer: Hamaspik Choice Inc Medicare	$369.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$480.48

PLATE FRACTURE 4H ST W/BAR

Facility

$739.20

Service Code	HCPCS C1713
Hospital Charge Code	64901408
Hospital Revenue Code	278
Min. Negotiated Rate	$369.60
Max. Negotiated Rate	$369.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$369.60
Rate for Payer: Hamaspik Choice Inc Medicare	$369.60

PLATE FRACTURE 6 HOLES

Facility

$865.60

Service Code	HCPCS C1713
Hospital Charge Code	64901487
Hospital Revenue Code	278
Min. Negotiated Rate	$432.80
Max. Negotiated Rate	$432.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$432.80
Rate for Payer: Hamaspik Choice Inc Medicare	$432.80

PLATE FRACTURE 6 HOLES

Facility

$865.60

Service Code	HCPCS C1713
Hospital Charge Code	64901487
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$908.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$476.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$519.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$432.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$497.72
Rate for Payer: EmblemHealth Commercial	$432.80
Rate for Payer: Fidelis Medicare Advantage	$908.88
Rate for Payer: Group Health Inc Commercial	$432.80
Rate for Payer: Group Health Inc Medicare	$302.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$432.80
Rate for Payer: Hamaspik Choice Inc Medicare	$432.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$562.64

PLATE FRACTURE 6 HOLES W/BAR

Facility

$856.00

Service Code	HCPCS C1713
Hospital Charge Code	40201274
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$898.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$470.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$513.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$428.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$492.20
Rate for Payer: EmblemHealth Commercial	$428.00
Rate for Payer: Fidelis Medicare Advantage	$898.80
Rate for Payer: Group Health Inc Commercial	$428.00
Rate for Payer: Group Health Inc Medicare	$299.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$428.00
Rate for Payer: Hamaspik Choice Inc Medicare	$428.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$556.40

PLATE FRACTURE 6 HOLES W/BAR

Facility

$856.00

Service Code	HCPCS C1713
Hospital Charge Code	40201274
Hospital Revenue Code	278
Min. Negotiated Rate	$428.00
Max. Negotiated Rate	$428.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$428.00
Rate for Payer: Hamaspik Choice Inc Medicare	$428.00

PLATE FRACTURE ANGLE 6 HOLE 140

Facility

$1,294.93

Service Code	HCPCS C1713
Hospital Charge Code	64901496
Hospital Revenue Code	278
Min. Negotiated Rate	$647.46
Max. Negotiated Rate	$647.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$647.46
Rate for Payer: Hamaspik Choice Inc Medicare	$647.46

PLATE FRACTURE ANGLE 6 HOLE 140

Facility

$1,294.93

Service Code	HCPCS C1713
Hospital Charge Code	64901496
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,359.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$712.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$776.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$647.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$744.58
Rate for Payer: EmblemHealth Commercial	$647.46
Rate for Payer: Fidelis Medicare Advantage	$1,359.68
Rate for Payer: Group Health Inc Commercial	$647.46
Rate for Payer: Group Health Inc Medicare	$453.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$647.46
Rate for Payer: Hamaspik Choice Inc Medicare	$647.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$841.70

PLATE FRACTURE C-SHAPED 4 HOLES

Facility

$802.68

Service Code	HCPCS C1713
Hospital Charge Code	64901494
Hospital Revenue Code	278
Min. Negotiated Rate	$401.34
Max. Negotiated Rate	$401.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$401.34
Rate for Payer: Hamaspik Choice Inc Medicare	$401.34

PLATE FRACTURE C-SHAPED 4 HOLES

Facility

$624.00

Service Code	HCPCS C1713
Hospital Charge Code	40201273
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$655.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$343.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$374.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$312.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$358.80
Rate for Payer: EmblemHealth Commercial	$312.00
Rate for Payer: Fidelis Medicare Advantage	$655.20
Rate for Payer: Group Health Inc Commercial	$312.00
Rate for Payer: Group Health Inc Medicare	$218.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$312.00
Rate for Payer: Hamaspik Choice Inc Medicare	$312.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$405.60

Know your out-of-pocket cost for care.

All Charges