St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE FRACTURE C-SHAPED 4 HOLES

Facility

$624.00

Service Code	HCPCS C1713
Hospital Charge Code	40201273
Hospital Revenue Code	278
Min. Negotiated Rate	$312.00
Max. Negotiated Rate	$312.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$312.00
Rate for Payer: Hamaspik Choice Inc Medicare	$312.00

PLATE FRACTURE C-SHAPED 4 HOLES

Facility

$802.68

Service Code	HCPCS C1713
Hospital Charge Code	64901494
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$842.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$441.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$481.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$401.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$461.54
Rate for Payer: EmblemHealth Commercial	$401.34
Rate for Payer: Fidelis Medicare Advantage	$842.81
Rate for Payer: Group Health Inc Commercial	$401.34
Rate for Payer: Group Health Inc Medicare	$280.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$401.34
Rate for Payer: Hamaspik Choice Inc Medicare	$401.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$521.74

PLATE FRACTURE STRAIGHT

Facility

$2,498.68

Service Code	HCPCS C1713
Hospital Charge Code	64904108
Hospital Revenue Code	278
Min. Negotiated Rate	$1,249.34
Max. Negotiated Rate	$1,249.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,249.34
Rate for Payer: Hamaspik Choice Inc Medicare	$1,249.34

PLATE FRACTURE STRAIGHT

Facility

$2,498.68

Service Code	HCPCS C1713
Hospital Charge Code	64904108
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,623.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,374.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,499.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,249.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,436.74
Rate for Payer: EmblemHealth Commercial	$1,249.34
Rate for Payer: Fidelis Medicare Advantage	$2,623.61
Rate for Payer: Group Health Inc Commercial	$1,249.34
Rate for Payer: Group Health Inc Medicare	$874.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,249.34
Rate for Payer: Hamaspik Choice Inc Medicare	$1,249.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,624.14

PLATE FRAG PROTEAN PRT-FSP

Facility

$2,100.00

Service Code	HCPCS C1713
Hospital Charge Code	64906933
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,205.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,155.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,260.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,050.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,207.50
Rate for Payer: EmblemHealth Commercial	$1,050.00
Rate for Payer: Fidelis Medicare Advantage	$2,205.00
Rate for Payer: Group Health Inc Commercial	$1,050.00
Rate for Payer: Group Health Inc Medicare	$735.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,050.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,365.00

PLATE FRAG PROTEAN PRT-FSP

Facility

$2,100.00

Service Code	HCPCS C1713
Hospital Charge Code	64906933
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,050.00

PLATE FUSION STRGHT 120M

Facility

$2,018.75

Service Code	HCPCS C1713
Hospital Charge Code	64906227
Hospital Revenue Code	278
Min. Negotiated Rate	$1,009.38
Max. Negotiated Rate	$1,009.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,009.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1,009.38

PLATE FUSION STRGHT 120M

Facility

$2,018.75

Service Code	HCPCS C1713
Hospital Charge Code	64906227
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,119.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,110.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,211.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,009.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,160.78
Rate for Payer: EmblemHealth Commercial	$1,009.38
Rate for Payer: Fidelis Medicare Advantage	$2,119.69
Rate for Payer: Group Health Inc Commercial	$1,009.38
Rate for Payer: Group Health Inc Medicare	$706.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,009.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1,009.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,312.19

PLATE GAP SMALL LOW PROFILE

Facility

$623.28

Service Code	HCPCS C1713
Hospital Charge Code	64901874
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$654.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$373.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$311.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$358.39
Rate for Payer: EmblemHealth Commercial	$311.64
Rate for Payer: Fidelis Medicare Advantage	$654.44
Rate for Payer: Group Health Inc Commercial	$311.64
Rate for Payer: Group Health Inc Medicare	$218.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$311.64
Rate for Payer: Hamaspik Choice Inc Medicare	$311.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$405.13

PLATE GAP SMALL LOW PROFILE

Facility

$623.28

Service Code	HCPCS C1713
Hospital Charge Code	64901874
Hospital Revenue Code	278
Min. Negotiated Rate	$311.64
Max. Negotiated Rate	$311.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$311.64
Rate for Payer: Hamaspik Choice Inc Medicare	$311.64

PLATE GAP UN3 6HOLE, LG

Facility

$294.79

Service Code	HCPCS C1713
Hospital Charge Code	64906287
Hospital Revenue Code	278
Min. Negotiated Rate	$103.18
Max. Negotiated Rate	$309.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$162.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$176.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$169.50
Rate for Payer: EmblemHealth Commercial	$147.40
Rate for Payer: Fidelis Medicare Advantage	$309.53
Rate for Payer: Group Health Inc Commercial	$147.40
Rate for Payer: Group Health Inc Medicare	$103.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$147.40
Rate for Payer: Hamaspik Choice Inc Medicare	$147.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$191.61

PLATE GAP UN3 6HOLE, LG

Facility

$294.79

Service Code	HCPCS C1713
Hospital Charge Code	64906287
Hospital Revenue Code	278
Min. Negotiated Rate	$147.40
Max. Negotiated Rate	$147.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$147.40
Rate for Payer: Hamaspik Choice Inc Medicare	$147.40

PLATE GEMINUS D-RAD 3HOLE

Facility

$2,090.00

Service Code	HCPCS C1713
Hospital Charge Code	64906898
Hospital Revenue Code	278
Min. Negotiated Rate	$1,045.00
Max. Negotiated Rate	$1,045.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,045.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,045.00

PLATE GEMINUS D-RAD 3HOLE

Facility

$2,090.00

Service Code	HCPCS C1713
Hospital Charge Code	64906898
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,194.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,149.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,254.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,045.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,201.75
Rate for Payer: EmblemHealth Commercial	$1,045.00
Rate for Payer: Fidelis Medicare Advantage	$2,194.50
Rate for Payer: Group Health Inc Commercial	$1,045.00
Rate for Payer: Group Health Inc Medicare	$731.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,045.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,045.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,358.50

PLATE GEMINUS HOOK

Facility

$1,300.00

Service Code	HCPCS C1713
Hospital Charge Code	64907322
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,365.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$715.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$780.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$650.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$747.50
Rate for Payer: EmblemHealth Commercial	$650.00
Rate for Payer: Fidelis Medicare Advantage	$1,365.00
Rate for Payer: Group Health Inc Commercial	$650.00
Rate for Payer: Group Health Inc Medicare	$455.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$650.00
Rate for Payer: Hamaspik Choice Inc Medicare	$650.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$845.00

PLATE GEMINUS HOOK

Facility

$1,300.00

Service Code	HCPCS C1713
Hospital Charge Code	64907322
Hospital Revenue Code	278
Min. Negotiated Rate	$650.00
Max. Negotiated Rate	$650.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$650.00
Rate for Payer: Hamaspik Choice Inc Medicare	$650.00

PLATE GEM NRW-GMN

Facility

$6,875.00

Service Code	HCPCS C1713
Hospital Charge Code	64907459
Hospital Revenue Code	278
Min. Negotiated Rate	$3,437.50
Max. Negotiated Rate	$3,437.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,437.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,437.50

PLATE GEM NRW-GMN

Facility

$6,875.00

Service Code	HCPCS C1713
Hospital Charge Code	64907459
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$7,218.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,781.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,125.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,437.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,953.12
Rate for Payer: EmblemHealth Commercial	$3,437.50
Rate for Payer: Fidelis Medicare Advantage	$7,218.75
Rate for Payer: Group Health Inc Commercial	$3,437.50
Rate for Payer: Group Health Inc Medicare	$2,406.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,437.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,437.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,468.75

PLATE, GENIO

Facility

$509.48

Service Code	HCPCS C1713
Hospital Charge Code	64905716
Hospital Revenue Code	278
Min. Negotiated Rate	$254.74
Max. Negotiated Rate	$254.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$254.74
Rate for Payer: Hamaspik Choice Inc Medicare	$254.74

PLATE, GENIO

Facility

$509.48

Service Code	HCPCS C1713
Hospital Charge Code	64905716
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$534.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$280.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$305.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$254.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$292.95
Rate for Payer: EmblemHealth Commercial	$254.74
Rate for Payer: Fidelis Medicare Advantage	$534.95
Rate for Payer: Group Health Inc Commercial	$254.74
Rate for Payer: Group Health Inc Medicare	$178.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$254.74
Rate for Payer: Hamaspik Choice Inc Medicare	$254.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$331.16

PLATE G II RIGHT NON BASE

Facility

$3,935.25

Service Code	HCPCS C1713
Hospital Charge Code	64904623
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,132.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,164.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,361.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,967.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,262.77
Rate for Payer: EmblemHealth Commercial	$1,967.62
Rate for Payer: Fidelis Medicare Advantage	$4,132.01
Rate for Payer: Group Health Inc Commercial	$1,967.62
Rate for Payer: Group Health Inc Medicare	$1,377.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,967.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,967.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,557.91

PLATE G II RIGHT NON BASE

Facility

$3,935.25

Service Code	HCPCS C1713
Hospital Charge Code	64904623
Hospital Revenue Code	278
Min. Negotiated Rate	$1,967.62
Max. Negotiated Rate	$1,967.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,967.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,967.62

PLATE GOLD DOG BONE

Facility

$213.28

Service Code	HCPCS C1713
Hospital Charge Code	64903212
Hospital Revenue Code	278
Min. Negotiated Rate	$106.64
Max. Negotiated Rate	$106.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$106.64
Rate for Payer: Hamaspik Choice Inc Medicare	$106.64

PLATE GOLD DOG BONE

Facility

$213.28

Service Code	HCPCS C1713
Hospital Charge Code	64903212
Hospital Revenue Code	278
Min. Negotiated Rate	$74.65
Max. Negotiated Rate	$223.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$117.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$127.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$106.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$122.64
Rate for Payer: EmblemHealth Commercial	$106.64
Rate for Payer: Fidelis Medicare Advantage	$223.94
Rate for Payer: Group Health Inc Commercial	$106.64
Rate for Payer: Group Health Inc Medicare	$74.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$106.64
Rate for Payer: Hamaspik Choice Inc Medicare	$106.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$138.63

PLATE GRIP CABLE

Facility

$3,416.25

Service Code	HCPCS C1776
Hospital Charge Code	64907230
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,587.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,878.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,049.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,708.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,964.34
Rate for Payer: EmblemHealth Commercial	$1,708.12
Rate for Payer: Fidelis Medicare Advantage	$3,587.06
Rate for Payer: Group Health Inc Commercial	$1,708.12
Rate for Payer: Group Health Inc Medicare	$1,195.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,708.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,708.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,220.56

Know your out-of-pocket cost for care.

All Charges