St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLT LOCKING CALCANEAL SHORT LEFT

Facility

$1,232.00

Service Code	HCPCS C1713
Hospital Charge Code	40200096
Hospital Revenue Code	278
Min. Negotiated Rate	$616.00
Max. Negotiated Rate	$616.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$616.00
Rate for Payer: Hamaspik Choice Inc Medicare	$616.00

PLT/MANIBULAR FRAC 6 HOLE 15MM

Facility

$2,310.00

Service Code	HCPCS C1713
Hospital Charge Code	64904939
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,425.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,270.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,386.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,155.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,328.25
Rate for Payer: EmblemHealth Commercial	$1,155.00
Rate for Payer: Fidelis Medicare Advantage	$2,425.50
Rate for Payer: Group Health Inc Commercial	$1,155.00
Rate for Payer: Group Health Inc Medicare	$808.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,155.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,155.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,501.50

PLT/MANIBULAR FRAC 6 HOLE 15MM

Facility

$2,310.00

Service Code	HCPCS C1713
Hospital Charge Code	64904939
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$1,155.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,155.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,155.00

PLT/MINI 4 HOLE WB 1.5

Facility

$1,486.00

Service Code	HCPCS C1713
Hospital Charge Code	64903277
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,560.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$817.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$891.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$743.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$854.45
Rate for Payer: EmblemHealth Commercial	$743.00
Rate for Payer: Fidelis Medicare Advantage	$1,560.30
Rate for Payer: Group Health Inc Commercial	$743.00
Rate for Payer: Group Health Inc Medicare	$520.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$743.00
Rate for Payer: Hamaspik Choice Inc Medicare	$743.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$965.90

PLT/MINI 4 HOLE WB 1.5

Facility

$1,486.00

Service Code	HCPCS C1713
Hospital Charge Code	64903277
Hospital Revenue Code	278
Min. Negotiated Rate	$743.00
Max. Negotiated Rate	$743.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$743.00
Rate for Payer: Hamaspik Choice Inc Medicare	$743.00

PLT PROXIMAL LATERAL LOCK PLT 2H

Facility

$1,908.20

Service Code	HCPCS C1713
Hospital Charge Code	40209944
Hospital Revenue Code	278
Min. Negotiated Rate	$954.10
Max. Negotiated Rate	$954.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.10
Rate for Payer: Hamaspik Choice Inc Medicare	$954.10

PLT PROXIMAL LATERAL LOCK PLT 2H

Facility

$1,908.20

Service Code	HCPCS C1713
Hospital Charge Code	40209944
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,003.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,049.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,144.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$954.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,097.22
Rate for Payer: EmblemHealth Commercial	$954.10
Rate for Payer: Fidelis Medicare Advantage	$2,003.61
Rate for Payer: Group Health Inc Commercial	$954.10
Rate for Payer: Group Health Inc Medicare	$667.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.10
Rate for Payer: Hamaspik Choice Inc Medicare	$954.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,240.33

PLT PROXIMAL TIBIA LISS 13H RT

Facility

$2,754.00

Service Code	HCPCS C1713
Hospital Charge Code	40200098
Hospital Revenue Code	278
Min. Negotiated Rate	$1,377.00
Max. Negotiated Rate	$1,377.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,377.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,377.00

PLT PROXIMAL TIBIA LISS 13H RT

Facility

$2,754.00

Service Code	HCPCS C1713
Hospital Charge Code	40200098
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,891.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,514.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,652.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,377.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,583.55
Rate for Payer: EmblemHealth Commercial	$1,377.00
Rate for Payer: Fidelis Medicare Advantage	$2,891.70
Rate for Payer: Group Health Inc Commercial	$1,377.00
Rate for Payer: Group Health Inc Medicare	$963.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,377.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,377.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,790.10

PLT RECON HEMI MAND LFT 6X17

Facility

$3,002.18

Service Code	HCPCS C1713
Hospital Charge Code	64901526
Hospital Revenue Code	278
Min. Negotiated Rate	$1,501.09
Max. Negotiated Rate	$1,501.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,501.09
Rate for Payer: Hamaspik Choice Inc Medicare	$1,501.09

PLT RECON HEMI MAND LFT 6X17

Facility

$3,002.18

Service Code	HCPCS C1713
Hospital Charge Code	64901526
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,152.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,651.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,801.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,501.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,726.25
Rate for Payer: EmblemHealth Commercial	$1,501.09
Rate for Payer: Fidelis Medicare Advantage	$3,152.29
Rate for Payer: Group Health Inc Commercial	$1,501.09
Rate for Payer: Group Health Inc Medicare	$1,050.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,501.09
Rate for Payer: Hamaspik Choice Inc Medicare	$1,501.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,951.42

PLT RECONSTRUCTION 9H 3.5X106MM

Facility

$728.00

Service Code	HCPCS C1713
Hospital Charge Code	40200099
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$764.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$400.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$436.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$364.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$418.60
Rate for Payer: EmblemHealth Commercial	$364.00
Rate for Payer: Fidelis Medicare Advantage	$764.40
Rate for Payer: Group Health Inc Commercial	$364.00
Rate for Payer: Group Health Inc Medicare	$254.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$364.00
Rate for Payer: Hamaspik Choice Inc Medicare	$364.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$473.20

PLT RECONSTRUCTION 9H 3.5X106MM

Facility

$728.00

Service Code	HCPCS C1713
Hospital Charge Code	40200099
Hospital Revenue Code	278
Min. Negotiated Rate	$364.00
Max. Negotiated Rate	$364.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$364.00
Rate for Payer: Hamaspik Choice Inc Medicare	$364.00

PLT SHRT BRL 135DEG 4H 78MM

Facility

$754.00

Service Code	HCPCS C1713
Hospital Charge Code	40200100
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 SHRT BRL 135DEG 4H 78MM

Facility

$754.00

Service Code	HCPCS C1713
Hospital Charge Code	40200100
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 T 4 HOLE

Facility

$620.20

Service Code	HCPCS C1713
Hospital Charge Code	40200102
Hospital Revenue Code	278
Min. Negotiated Rate	$310.10
Max. Negotiated Rate	$310.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$310.10
Rate for Payer: Hamaspik Choice Inc Medicare	$310.10

PLT T 4 HOLE

Facility

$620.20

Service Code	HCPCS C1713
Hospital Charge Code	40200102
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$651.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$341.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$372.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$310.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$356.62
Rate for Payer: EmblemHealth Commercial	$310.10
Rate for Payer: Fidelis Medicare Advantage	$651.21
Rate for Payer: Group Health Inc Commercial	$310.10
Rate for Payer: Group Health Inc Medicare	$217.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$310.10
Rate for Payer: Hamaspik Choice Inc Medicare	$310.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$403.13

PLT TIBIA LT 9H

Facility

$2,550.00

Service Code	HCPCS C1713
Hospital Charge Code	40200104
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$1,275.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,275.00

PLT TIBIA LT 9H

Facility

$2,550.00

Service Code	HCPCS C1713
Hospital Charge Code	40200104
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,677.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,402.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,530.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,275.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,466.25
Rate for Payer: EmblemHealth Commercial	$1,275.00
Rate for Payer: Fidelis Medicare Advantage	$2,677.50
Rate for Payer: Group Health Inc Commercial	$1,275.00
Rate for Payer: Group Health Inc Medicare	$892.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,275.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,657.50

PLT TIBIA PROX 4H 4X5X82MM RIGHT

Facility

$2,449.80

Service Code	HCPCS C1713
Hospital Charge Code	40200105
Hospital Revenue Code	278
Min. Negotiated Rate	$1,224.90
Max. Negotiated Rate	$1,224.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,224.90
Rate for Payer: Hamaspik Choice Inc Medicare	$1,224.90

PLT TIBIA PROX 4H 4X5X82MM RIGHT

Facility

$2,449.80

Service Code	HCPCS C1713
Hospital Charge Code	40200105
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,572.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,347.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,469.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,224.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,408.64
Rate for Payer: EmblemHealth Commercial	$1,224.90
Rate for Payer: Fidelis Medicare Advantage	$2,572.29
Rate for Payer: Group Health Inc Commercial	$1,224.90
Rate for Payer: Group Health Inc Medicare	$857.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,224.90
Rate for Payer: Hamaspik Choice Inc Medicare	$1,224.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,592.37

PLT TIBIA PROX 4H LFT 4.5X82MM

Facility

$2,360.00

Service Code	HCPCS C1713
Hospital Charge Code	40200106
Hospital Revenue Code	278
Min. Negotiated Rate	$1,180.00
Max. Negotiated Rate	$1,180.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,180.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,180.00

PLT TIBIA PROX 4H LFT 4.5X82MM

Facility

$2,360.00

Service Code	HCPCS C1713
Hospital Charge Code	40200106
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,478.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,298.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,416.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,180.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,357.00
Rate for Payer: EmblemHealth Commercial	$1,180.00
Rate for Payer: Fidelis Medicare Advantage	$2,478.00
Rate for Payer: Group Health Inc Commercial	$1,180.00
Rate for Payer: Group Health Inc Medicare	$826.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,180.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,180.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,534.00

PLT TIBIA PROX 6H RT 4.5X118MM

Facility

$2,756.00

Service Code	HCPCS C1713
Hospital Charge Code	40200107
Hospital Revenue Code	278
Min. Negotiated Rate	$1,378.00
Max. Negotiated Rate	$1,378.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,378.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,378.00

PLT TIBIA PROX 6H RT 4.5X118MM

Facility

$2,756.00

Service Code	HCPCS C1713
Hospital Charge Code	40200107
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,893.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,515.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,653.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,378.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,584.70
Rate for Payer: EmblemHealth Commercial	$1,378.00
Rate for Payer: Fidelis Medicare Advantage	$2,893.80
Rate for Payer: Group Health Inc Commercial	$1,378.00
Rate for Payer: Group Health Inc Medicare	$964.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,378.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,378.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,791.40

Know your out-of-pocket cost for care.

All Charges