St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLT TIBIA RIGHT 9H

Facility

$2,976.00

Service Code	HCPCS C1713
Hospital Charge Code	40200108
Hospital Revenue Code	278
Min. Negotiated Rate	$1,488.00
Max. Negotiated Rate	$1,488.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,488.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,488.00

PLT TIBIA RIGHT 9H

Facility

$2,976.00

Service Code	HCPCS C1713
Hospital Charge Code	40200108
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,124.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,636.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,785.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,488.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,711.20
Rate for Payer: EmblemHealth Commercial	$1,488.00
Rate for Payer: Fidelis Medicare Advantage	$3,124.80
Rate for Payer: Group Health Inc Commercial	$1,488.00
Rate for Payer: Group Health Inc Medicare	$1,041.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,488.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,488.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,934.40

PLT T RT ANG 7H 3.5X87MM SS

Facility

$874.00

Service Code	HCPCS C1713
Hospital Charge Code	40200103
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$917.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$480.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$524.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$437.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$502.55
Rate for Payer: EmblemHealth Commercial	$437.00
Rate for Payer: Fidelis Medicare Advantage	$917.70
Rate for Payer: Group Health Inc Commercial	$437.00
Rate for Payer: Group Health Inc Medicare	$305.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$437.00
Rate for Payer: Hamaspik Choice Inc Medicare	$437.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$568.10

PLT T RT ANG 7H 3.5X87MM SS

Facility

$874.00

Service Code	HCPCS C1713
Hospital Charge Code	40200103
Hospital Revenue Code	278
Min. Negotiated Rate	$437.00
Max. Negotiated Rate	$437.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$437.00
Rate for Payer: Hamaspik Choice Inc Medicare	$437.00

PLT TUBULAR 1/3

Facility

$140.00

Service Code	HCPCS C1713
Hospital Charge Code	40200109
Hospital Revenue Code	278
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$70.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.00
Rate for Payer: Hamaspik Choice Inc Medicare	$70.00

PLT TUBULAR 1/3

Facility

$140.00

Service Code	HCPCS C1713
Hospital Charge Code	40200109
Hospital Revenue Code	278
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$147.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$77.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$84.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$80.50
Rate for Payer: EmblemHealth Commercial	$70.00
Rate for Payer: Fidelis Medicare Advantage	$147.00
Rate for Payer: Group Health Inc Commercial	$70.00
Rate for Payer: Group Health Inc Medicare	$49.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.00
Rate for Payer: Hamaspik Choice Inc Medicare	$70.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$91.00

PLT TUBULAR 1/3 10H 121MM

Facility

$350.00

Service Code	HCPCS C1713
Hospital Charge Code	40209393
Hospital Revenue Code	278
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$367.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$175.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.25
Rate for Payer: EmblemHealth Commercial	$175.00
Rate for Payer: Fidelis Medicare Advantage	$367.50
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$227.50

PLT TUBULAR 1/3 10H 121MM

Facility

$350.00

Service Code	HCPCS C1713
Hospital Charge Code	40209393
Hospital Revenue Code	278
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

PLT TUBULAR 1/3 COL LCP 8H 93MM

Facility

$350.00

Service Code	HCPCS C1713
Hospital Charge Code	40200111
Hospital Revenue Code	278
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

PLT TUBULAR 1/3 COL LCP 8H 93MM

Facility

$350.00

Service Code	HCPCS C1713
Hospital Charge Code	40200111
Hospital Revenue Code	278
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$367.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$175.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.25
Rate for Payer: EmblemHealth Commercial	$175.00
Rate for Payer: Fidelis Medicare Advantage	$367.50
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$227.50

PLT TUBULAR 1/3 LCP 6H 69MM

Facility

$240.00

Service Code	HCPCS C1713
Hospital Charge Code	40200110
Hospital Revenue Code	278
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.00
Rate for Payer: Hamaspik Choice Inc Medicare	$120.00

PLT TUBULAR 1/3 LCP 6H 69MM

Facility

$240.00

Service Code	HCPCS C1713
Hospital Charge Code	40200110
Hospital Revenue Code	278
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$252.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$144.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$120.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$138.00
Rate for Payer: EmblemHealth Commercial	$120.00
Rate for Payer: Fidelis Medicare Advantage	$252.00
Rate for Payer: Group Health Inc Commercial	$120.00
Rate for Payer: Group Health Inc Medicare	$84.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.00
Rate for Payer: Hamaspik Choice Inc Medicare	$120.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$156.00

PLT TUBULAR 1/3WCOLLRLCP 7H 81MM

Facility

$293.40

Service Code	HCPCS C1713
Hospital Charge Code	40209405
Hospital Revenue Code	278
Min. Negotiated Rate	$146.70
Max. Negotiated Rate	$146.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.70
Rate for Payer: Hamaspik Choice Inc Medicare	$146.70

PLT TUBULAR 1/3WCOLLRLCP 7H 81MM

Facility

$293.40

Service Code	HCPCS C1713
Hospital Charge Code	40209405
Hospital Revenue Code	278
Min. Negotiated Rate	$102.69
Max. Negotiated Rate	$308.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$161.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$176.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$146.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$168.70
Rate for Payer: EmblemHealth Commercial	$146.70
Rate for Payer: Fidelis Medicare Advantage	$308.07
Rate for Payer: Group Health Inc Commercial	$146.70
Rate for Payer: Group Health Inc Medicare	$102.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.70
Rate for Payer: Hamaspik Choice Inc Medicare	$146.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$190.71

PLT VARIABLE ANG 4H VHS

Facility

$912.00

Service Code	HCPCS C1713
Hospital Charge Code	40202323
Hospital Revenue Code	278
Min. Negotiated Rate	$456.00
Max. Negotiated Rate	$456.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$456.00
Rate for Payer: Hamaspik Choice Inc Medicare	$456.00

PLT VARIABLE ANG 4H VHS

Facility

$912.00

Service Code	HCPCS C1713
Hospital Charge Code	40202323
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$957.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$501.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$547.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$456.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$524.40
Rate for Payer: EmblemHealth Commercial	$456.00
Rate for Payer: Fidelis Medicare Advantage	$957.60
Rate for Payer: Group Health Inc Commercial	$456.00
Rate for Payer: Group Health Inc Medicare	$319.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$456.00
Rate for Payer: Hamaspik Choice Inc Medicare	$456.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$592.80

PLUG BONE

Facility

$407.75

Service Code	HCPCS C1776
Hospital Charge Code	64907300
Hospital Revenue Code	278
Min. Negotiated Rate	$142.71
Max. Negotiated Rate	$428.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$224.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$244.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$203.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.46
Rate for Payer: EmblemHealth Commercial	$203.88
Rate for Payer: Fidelis Medicare Advantage	$428.14
Rate for Payer: Group Health Inc Commercial	$203.88
Rate for Payer: Group Health Inc Medicare	$142.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.88
Rate for Payer: Hamaspik Choice Inc Medicare	$203.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$265.04

PLUG BONE

Facility

$407.75

Service Code	HCPCS C1776
Hospital Charge Code	64907300
Hospital Revenue Code	278
Min. Negotiated Rate	$203.88
Max. Negotiated Rate	$203.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.88
Rate for Payer: Hamaspik Choice Inc Medicare	$203.88

PLUG BONE CEMENT CABLE 5MM DIA

Facility

$118.75

Service Code	HCPCS C1713
Hospital Charge Code	64903880
Hospital Revenue Code	278
Min. Negotiated Rate	$41.56
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$65.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$71.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$59.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.28
Rate for Payer: EmblemHealth Commercial	$59.38
Rate for Payer: Fidelis Medicare Advantage	$124.69
Rate for Payer: Group Health Inc Commercial	$59.38
Rate for Payer: Group Health Inc Medicare	$41.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.38
Rate for Payer: Hamaspik Choice Inc Medicare	$59.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$77.19

PLUG BONE CEMENT CABLE 5MM DIA

Facility

$118.75

Service Code	HCPCS C1713
Hospital Charge Code	64903880
Hospital Revenue Code	278
Min. Negotiated Rate	$59.38
Max. Negotiated Rate	$59.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.38
Rate for Payer: Hamaspik Choice Inc Medicare	$59.38

PLUG CABLE 5.0MM

Facility

$608.00

Hospital Charge Code	64906904
Hospital Revenue Code	270
Min. Negotiated Rate	$212.80
Max. Negotiated Rate	$486.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$334.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$304.00
Rate for Payer: Aetna Government	$304.00
Rate for Payer: Brighton Health Commercial	$456.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$486.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$413.44
Rate for Payer: Group Health Inc Commercial	$304.00
Rate for Payer: Group Health Inc Medicare	$212.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$304.00
Rate for Payer: Hamaspik Choice Inc Medicare	$304.00

PLUG DOME HOLE

Facility

$385.00

Service Code	HCPCS C1776
Hospital Charge Code	64907314
Hospital Revenue Code	278
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$192.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$192.50
Rate for Payer: Hamaspik Choice Inc Medicare	$192.50

PLUG DOME HOLE

Facility

$385.00

Service Code	HCPCS C1776
Hospital Charge Code	64907314
Hospital Revenue Code	278
Min. Negotiated Rate	$134.75
Max. Negotiated Rate	$404.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$211.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$231.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$192.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$221.38
Rate for Payer: EmblemHealth Commercial	$192.50
Rate for Payer: Fidelis Medicare Advantage	$404.25
Rate for Payer: Group Health Inc Commercial	$192.50
Rate for Payer: Group Health Inc Medicare	$134.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$192.50
Rate for Payer: Hamaspik Choice Inc Medicare	$192.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$250.25

PLUGH LIGHT PERFIX XL 1.5X2

Facility

$987.50

Hospital Charge Code	64904946
Hospital Revenue Code	270
Min. Negotiated Rate	$345.62
Max. Negotiated Rate	$790.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$543.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$493.75
Rate for Payer: Aetna Government	$493.75
Rate for Payer: Brighton Health Commercial	$740.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$790.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$671.50
Rate for Payer: Group Health Inc Commercial	$493.75
Rate for Payer: Group Health Inc Medicare	$345.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$493.75
Rate for Payer: Hamaspik Choice Inc Medicare	$493.75

PLUG LIGHT PERFIX LG 1.6X1.9

Facility

$860.00

Service Code	HCPCS C1781
Hospital Charge Code	64905927
Hospital Revenue Code	278
Min. Negotiated Rate	$430.00
Max. Negotiated Rate	$430.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00

Know your out-of-pocket cost for care.

All Charges