St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLT DHS 135 2H LNG BARREL

Facility

$926.00

Service Code	HCPCS C1713
Hospital Charge Code	40200086
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$972.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$509.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$555.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$463.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$532.45
Rate for Payer: EmblemHealth Commercial	$463.00
Rate for Payer: Fidelis Medicare Advantage	$972.30
Rate for Payer: Group Health Inc Commercial	$463.00
Rate for Payer: Group Health Inc Medicare	$324.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$463.00
Rate for Payer: Hamaspik Choice Inc Medicare	$463.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$601.90

PLT DHS 135 2H LNG BARREL

Facility

$926.00

Service Code	HCPCS C1713
Hospital Charge Code	40200086
Hospital Revenue Code	278
Min. Negotiated Rate	$463.00
Max. Negotiated Rate	$463.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$463.00
Rate for Payer: Hamaspik Choice Inc Medicare	$463.00

PLT DHS STD BRL 135 DEG 4H

Facility

$754.00

Service Code	HCPCS C1713
Hospital Charge Code	40200088
Hospital Revenue Code	278
Min. Negotiated Rate	$377.00
Max. Negotiated Rate	$377.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$377.00
Rate for Payer: Hamaspik Choice Inc Medicare	$377.00

PLT DHS STD BRL 135 DEG 4H

Facility

$754.00

Service Code	HCPCS C1713
Hospital Charge Code	40200088
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$791.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$414.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$452.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$377.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$433.55
Rate for Payer: EmblemHealth Commercial	$377.00
Rate for Payer: Fidelis Medicare Advantage	$791.70
Rate for Payer: Group Health Inc Commercial	$377.00
Rate for Payer: Group Health Inc Medicare	$263.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$377.00
Rate for Payer: Hamaspik Choice Inc Medicare	$377.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$490.10

PLT DISTAL RADIUS UNIVER NARROW

Facility

$796.00

Service Code	HCPCS C1713
Hospital Charge Code	40200089
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$835.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$437.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$477.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$398.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$457.70
Rate for Payer: EmblemHealth Commercial	$398.00
Rate for Payer: Fidelis Medicare Advantage	$835.80
Rate for Payer: Group Health Inc Commercial	$398.00
Rate for Payer: Group Health Inc Medicare	$278.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$398.00
Rate for Payer: Hamaspik Choice Inc Medicare	$398.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$517.40

PLT DISTAL RADIUS UNIVER NARROW

Facility

$796.00

Service Code	HCPCS C1713
Hospital Charge Code	40200089
Hospital Revenue Code	278
Min. Negotiated Rate	$398.00
Max. Negotiated Rate	$398.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$398.00
Rate for Payer: Hamaspik Choice Inc Medicare	$398.00

PLTE 10 HLE LFT DISTL MEDIL TIBIA

Facility

$2,100.00

Service Code	HCPCS C1713
Hospital Charge Code	40201265
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

PLTE 10 HLE LFT DISTL MEDIL TIBIA

Facility

$2,100.00

Service Code	HCPCS C1713
Hospital Charge Code	40201265
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

PLTE 6 RGHT DISTL ANTERO LATERAL

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	40201269
Hospital Revenue Code	278
Min. Negotiated Rate	$1,000.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00

PLTE 6 RGHT DISTL ANTERO LATERAL

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	40201269
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,100.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,100.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,200.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,150.00
Rate for Payer: EmblemHealth Commercial	$1,000.00
Rate for Payer: Fidelis Medicare Advantage	$2,100.00
Rate for Payer: Group Health Inc Commercial	$1,000.00
Rate for Payer: Group Health Inc Medicare	$700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,300.00

PLTE BONE 246MM 8HOLE-00223200302

Facility

$1,208.00

Service Code	HCPCS C1713
Hospital Charge Code	64906410
Hospital Revenue Code	278
Min. Negotiated Rate	$604.00
Max. Negotiated Rate	$604.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$604.00
Rate for Payer: Hamaspik Choice Inc Medicare	$604.00

PLTE BONE 246MM 8HOLE-00223200302

Facility

$1,208.00

Service Code	HCPCS C1713
Hospital Charge Code	64906410
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,268.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$664.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$724.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$604.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$694.60
Rate for Payer: EmblemHealth Commercial	$604.00
Rate for Payer: Fidelis Medicare Advantage	$1,268.40
Rate for Payer: Group Health Inc Commercial	$604.00
Rate for Payer: Group Health Inc Medicare	$422.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$604.00
Rate for Payer: Hamaspik Choice Inc Medicare	$604.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$785.20

PLT FRAGMENT 12H 3.5X163MM SS

Facility

$766.80

Service Code	HCPCS C1713
Hospital Charge Code	40200090
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$805.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$460.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$383.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$440.91
Rate for Payer: EmblemHealth Commercial	$383.40
Rate for Payer: Fidelis Medicare Advantage	$805.14
Rate for Payer: Group Health Inc Commercial	$383.40
Rate for Payer: Group Health Inc Medicare	$268.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.40
Rate for Payer: Hamaspik Choice Inc Medicare	$383.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$498.42

PLT FRAGMENT 12H 3.5X163MM SS

Facility

$766.80

Service Code	HCPCS C1713
Hospital Charge Code	40200090
Hospital Revenue Code	278
Min. Negotiated Rate	$383.40
Max. Negotiated Rate	$383.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.40
Rate for Payer: Hamaspik Choice Inc Medicare	$383.40

PLT L 6H 12MM ADVC 100D LT STD

Facility

$43.78

Service Code	HCPCS C1713
Hospital Charge Code	64901576
Hospital Revenue Code	278
Min. Negotiated Rate	$21.89
Max. Negotiated Rate	$21.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.89
Rate for Payer: Hamaspik Choice Inc Medicare	$21.89

PLT L 6H 12MM ADVC 100D LT STD

Facility

$43.78

Service Code	HCPCS C1713
Hospital Charge Code	64901576
Hospital Revenue Code	278
Min. Negotiated Rate	$15.32
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$26.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.17
Rate for Payer: EmblemHealth Commercial	$21.89
Rate for Payer: Fidelis Medicare Advantage	$45.97
Rate for Payer: Group Health Inc Commercial	$21.89
Rate for Payer: Group Health Inc Medicare	$15.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.89
Rate for Payer: Hamaspik Choice Inc Medicare	$21.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.46

PLT LC-DCP 6H 3.5MM

Facility

$210.00

Service Code	HCPCS C1713
Hospital Charge Code	40200091
Hospital Revenue Code	278
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$220.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$115.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$126.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$105.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$120.75
Rate for Payer: EmblemHealth Commercial	$105.00
Rate for Payer: Fidelis Medicare Advantage	$220.50
Rate for Payer: Group Health Inc Commercial	$105.00
Rate for Payer: Group Health Inc Medicare	$73.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.00
Rate for Payer: Hamaspik Choice Inc Medicare	$105.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$136.50

PLT LC-DCP 6H 3.5MM

Facility

$210.00

Service Code	HCPCS C1713
Hospital Charge Code	40200091
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.00
Rate for Payer: Hamaspik Choice Inc Medicare	$105.00

PLT LC-DCP 7H 3.5MM

Facility

$288.00

Service Code	HCPCS C1713
Hospital Charge Code	40200092
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

PLT LC-DCP 7H 3.5MM

Facility

$288.00

Service Code	HCPCS C1713
Hospital Charge Code	40200092
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

PLT LC-DCP 8H 3.5X111MM

Facility

$668.00

Service Code	HCPCS C1713
Hospital Charge Code	40209995
Hospital Revenue Code	278
Min. Negotiated Rate	$334.00
Max. Negotiated Rate	$334.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$334.00

PLT LC-DCP 8H 3.5X111MM

Facility

$668.00

Service Code	HCPCS C1713
Hospital Charge Code	40209995
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$701.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$367.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$400.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$334.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$384.10
Rate for Payer: EmblemHealth Commercial	$334.00
Rate for Payer: Fidelis Medicare Advantage	$701.40
Rate for Payer: Group Health Inc Commercial	$334.00
Rate for Payer: Group Health Inc Medicare	$233.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$334.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$434.20

PLT LCP 9H 3.5X124MM

Facility

$600.00

Service Code	HCPCS C1713
Hospital Charge Code	40200094
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$300.00

PLT LCP 9H 3.5X124MM

Facility

$600.00

Service Code	HCPCS C1713
Hospital Charge Code	40200094
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$630.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$330.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$360.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$345.00
Rate for Payer: EmblemHealth Commercial	$300.00
Rate for Payer: Fidelis Medicare Advantage	$630.00
Rate for Payer: Group Health Inc Commercial	$300.00
Rate for Payer: Group Health Inc Medicare	$210.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$300.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$390.00

PLT LOCKING CALCANEAL SHORT LEFT

Facility

$1,232.00

Service Code	HCPCS C1713
Hospital Charge Code	40200096
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,293.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$677.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$739.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$616.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$708.40
Rate for Payer: EmblemHealth Commercial	$616.00
Rate for Payer: Fidelis Medicare Advantage	$1,293.60
Rate for Payer: Group Health Inc Commercial	$616.00
Rate for Payer: Group Health Inc Medicare	$431.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$616.00
Rate for Payer: Hamaspik Choice Inc Medicare	$616.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$800.80

Know your out-of-pocket cost for care.

All Charges