St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLT 3.5MM CURVED RECONSTRUCT 12H

Facility

$913.00

Service Code	HCPCS C1713
Hospital Charge Code	40209890
Hospital Revenue Code	278
Min. Negotiated Rate	$456.50
Max. Negotiated Rate	$456.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$456.50
Rate for Payer: Hamaspik Choice Inc Medicare	$456.50

PLT 3.5 RECONSTRUCTION 6H/70MM

Facility

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	40209892
Hospital Revenue Code	278
Min. Negotiated Rate	$325.00
Max. Negotiated Rate	$325.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$325.00

PLT 3.5 RECONSTRUCTION 6H/70MM

Facility

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	40209892
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$682.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$357.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$390.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$325.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$373.75
Rate for Payer: EmblemHealth Commercial	$325.00
Rate for Payer: Fidelis Medicare Advantage	$682.50
Rate for Payer: Group Health Inc Commercial	$325.00
Rate for Payer: Group Health Inc Medicare	$227.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$325.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$422.50

PLT 3.5 RECONSTRUCTION 8H/94MM

Facility

$710.00

Service Code	HCPCS C1713
Hospital Charge Code	40209893
Hospital Revenue Code	278
Min. Negotiated Rate	$355.00
Max. Negotiated Rate	$355.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$355.00
Rate for Payer: Hamaspik Choice Inc Medicare	$355.00

PLT 3.5 RECONSTRUCTION 8H/94MM

Facility

$710.00

Service Code	HCPCS C1713
Hospital Charge Code	40209893
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$745.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$390.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$426.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$355.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$408.25
Rate for Payer: EmblemHealth Commercial	$355.00
Rate for Payer: Fidelis Medicare Advantage	$745.50
Rate for Payer: Group Health Inc Commercial	$355.00
Rate for Payer: Group Health Inc Medicare	$248.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$355.00
Rate for Payer: Hamaspik Choice Inc Medicare	$355.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$461.50

PLT/4-HOLE PREBENT - R

Facility

$733.65

Service Code	HCPCS C1713
Hospital Charge Code	64903285
Hospital Revenue Code	278
Min. Negotiated Rate	$366.82
Max. Negotiated Rate	$366.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.82
Rate for Payer: Hamaspik Choice Inc Medicare	$366.82

PLT/4-HOLE PREBENT - R

Facility

$733.65

Service Code	HCPCS C1713
Hospital Charge Code	64903285
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$770.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$403.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$440.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$366.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$421.85
Rate for Payer: EmblemHealth Commercial	$366.82
Rate for Payer: Fidelis Medicare Advantage	$770.33
Rate for Payer: Group Health Inc Commercial	$366.82
Rate for Payer: Group Health Inc Medicare	$256.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.82
Rate for Payer: Hamaspik Choice Inc Medicare	$366.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$476.87

PLT/4HOLE PREBENT,SHORT,LEFT

Facility

$896.00

Service Code	HCPCS C1713
Hospital Charge Code	40005858
Hospital Revenue Code	278
Min. Negotiated Rate	$448.00
Max. Negotiated Rate	$448.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$448.00
Rate for Payer: Hamaspik Choice Inc Medicare	$448.00

PLT/4HOLE PREBENT,SHORT,LEFT

Facility

$896.00

Service Code	HCPCS C1713
Hospital Charge Code	40005858
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$940.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$492.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$537.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$448.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$515.20
Rate for Payer: EmblemHealth Commercial	$448.00
Rate for Payer: Fidelis Medicare Advantage	$940.80
Rate for Payer: Group Health Inc Commercial	$448.00
Rate for Payer: Group Health Inc Medicare	$313.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$448.00
Rate for Payer: Hamaspik Choice Inc Medicare	$448.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$582.40

PLT 4H RIGHT DISTAL MEDIAL TIBIA

Facility

$2,100.00

Service Code	HCPCS C1713
Hospital Charge Code	40201267
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

PLT 4H RIGHT DISTAL MEDIAL TIBIA

Facility

$2,100.00

Service Code	HCPCS C1713
Hospital Charge Code	40201267
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

PLT 5H LCP

Facility

$532.00

Service Code	HCPCS C1713
Hospital Charge Code	40200077
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$558.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$292.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$319.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$266.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$305.90
Rate for Payer: EmblemHealth Commercial	$266.00
Rate for Payer: Fidelis Medicare Advantage	$558.60
Rate for Payer: Group Health Inc Commercial	$266.00
Rate for Payer: Group Health Inc Medicare	$186.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$266.00
Rate for Payer: Hamaspik Choice Inc Medicare	$266.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$345.80

PLT 5H LCP

Facility

$532.00

Service Code	HCPCS C1713
Hospital Charge Code	40200077
Hospital Revenue Code	278
Min. Negotiated Rate	$266.00
Max. Negotiated Rate	$266.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$266.00
Rate for Payer: Hamaspik Choice Inc Medicare	$266.00

PLT/6 HL STRT W/BAR MA LCK

Facility

$1,841.10

Service Code	HCPCS C1713
Hospital Charge Code	64903287
Hospital Revenue Code	278
Min. Negotiated Rate	$920.55
Max. Negotiated Rate	$920.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$920.55
Rate for Payer: Hamaspik Choice Inc Medicare	$920.55

PLT/6 HL STRT W/BAR MA LCK

Facility

$1,841.10

Service Code	HCPCS C1713
Hospital Charge Code	64903287
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,933.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,012.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,104.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$920.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,058.63
Rate for Payer: EmblemHealth Commercial	$920.55
Rate for Payer: Fidelis Medicare Advantage	$1,933.16
Rate for Payer: Group Health Inc Commercial	$920.55
Rate for Payer: Group Health Inc Medicare	$644.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$920.55
Rate for Payer: Hamaspik Choice Inc Medicare	$920.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,196.72

PLT 6H RIGHT PROXIMAL FEMUR

Facility

$2,596.00

Service Code	HCPCS C1713
Hospital Charge Code	40200078
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,725.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,427.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,557.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,298.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,492.70
Rate for Payer: EmblemHealth Commercial	$1,298.00
Rate for Payer: Fidelis Medicare Advantage	$2,725.80
Rate for Payer: Group Health Inc Commercial	$1,298.00
Rate for Payer: Group Health Inc Medicare	$908.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,298.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,298.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,687.40

PLT 6H RIGHT PROXIMAL FEMUR

Facility

$2,596.00

Service Code	HCPCS C1713
Hospital Charge Code	40200078
Hospital Revenue Code	278
Min. Negotiated Rate	$1,298.00
Max. Negotiated Rate	$1,298.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,298.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,298.00

PLT 8H 4.5X206MM SS LCP

Facility

$2,410.00

Service Code	HCPCS C1713
Hospital Charge Code	40200079
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,530.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,325.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,446.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,205.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,385.75
Rate for Payer: EmblemHealth Commercial	$1,205.00
Rate for Payer: Fidelis Medicare Advantage	$2,530.50
Rate for Payer: Group Health Inc Commercial	$1,205.00
Rate for Payer: Group Health Inc Medicare	$843.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,205.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,205.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,566.50

PLT 8H 4.5X206MM SS LCP

Facility

$2,410.00

Service Code	HCPCS C1713
Hospital Charge Code	40200079
Hospital Revenue Code	278
Min. Negotiated Rate	$1,205.00
Max. Negotiated Rate	$1,205.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,205.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,205.00

PLT BARREL DHS 5H 135

Facility

$968.00

Service Code	HCPCS C1713
Hospital Charge Code	40200081
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,016.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$532.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$580.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$484.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$556.60
Rate for Payer: EmblemHealth Commercial	$484.00
Rate for Payer: Fidelis Medicare Advantage	$1,016.40
Rate for Payer: Group Health Inc Commercial	$484.00
Rate for Payer: Group Health Inc Medicare	$338.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$484.00
Rate for Payer: Hamaspik Choice Inc Medicare	$484.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$629.20

PLT BARREL DHS 5H 135

Facility

$968.00

Service Code	HCPCS C1713
Hospital Charge Code	40200081
Hospital Revenue Code	278
Min. Negotiated Rate	$484.00
Max. Negotiated Rate	$484.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$484.00
Rate for Payer: Hamaspik Choice Inc Medicare	$484.00

PLT CONDYLAR LCP 8H LFT 4.5MM

Facility

$2,604.00

Service Code	HCPCS C1713
Hospital Charge Code	40200084
Hospital Revenue Code	278
Min. Negotiated Rate	$1,302.00
Max. Negotiated Rate	$1,302.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,302.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,302.00

PLT CONDYLAR LCP 8H LFT 4.5MM

Facility

$2,604.00

Service Code	HCPCS C1713
Hospital Charge Code	40200084
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,734.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,432.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,562.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,302.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,497.30
Rate for Payer: EmblemHealth Commercial	$1,302.00
Rate for Payer: Fidelis Medicare Advantage	$2,734.20
Rate for Payer: Group Health Inc Commercial	$1,302.00
Rate for Payer: Group Health Inc Medicare	$911.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,302.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,302.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,692.60

PLT DHS 135 2H/46MM ING BARREL

Facility

$925.20

Service Code	HCPCS C1713
Hospital Charge Code	40209981
Hospital Revenue Code	278
Min. Negotiated Rate	$462.60
Max. Negotiated Rate	$462.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$462.60
Rate for Payer: Hamaspik Choice Inc Medicare	$462.60

PLT DHS 135 2H/46MM ING BARREL

Facility

$925.20

Service Code	HCPCS C1713
Hospital Charge Code	40209981
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$971.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$508.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$555.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$462.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$531.99
Rate for Payer: EmblemHealth Commercial	$462.60
Rate for Payer: Fidelis Medicare Advantage	$971.46
Rate for Payer: Group Health Inc Commercial	$462.60
Rate for Payer: Group Health Inc Medicare	$323.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$462.60
Rate for Payer: Hamaspik Choice Inc Medicare	$462.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$601.38

Know your out-of-pocket cost for care.

All Charges