St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

RECEMENT CROWN

Facility

$75.00

Service Code	HCPCS D2920
Hospital Charge Code	42300610
Hospital Revenue Code	361
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$56.25
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

RECEMENT CROWN

Facility

$75.00

Service Code	HCPCS D2920
Hospital Charge Code	42300610
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

RECEMENT INLAY

Facility

$106.31

Service Code	HCPCS D2910
Hospital Charge Code	42300605
Hospital Revenue Code	361
Min. Negotiated Rate	$53.16
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$79.73
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.16
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

RECEMENT INLAY

Facility

$106.31

Service Code	HCPCS D2910
Hospital Charge Code	42300605
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

RE-CEMENT OR RE-BOND SPACE BILAT

Facility

$47.50

Service Code	HCPCS D1551
Hospital Charge Code	42300713
Hospital Revenue Code	361
Min. Negotiated Rate	$23.75
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$35.62
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

RE-CEMENT OR RE-BOND SPACE BILAT

Facility

$47.50

Service Code	HCPCS D1551
Hospital Charge Code	42300713
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

RE-CEMENT OR RE-BOND SPACE MANDIB

Facility

$47.50

Service Code	HCPCS D1552
Hospital Charge Code	42300714
Hospital Revenue Code	361
Min. Negotiated Rate	$23.75
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$35.62
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

RE-CEMENT OR RE-BOND SPACE MANDIB

Facility

$47.50

Service Code	HCPCS D1552
Hospital Charge Code	42300714
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

RE-CEMENT OR RE-BOND UNILATERAL

Facility

$47.50

Service Code	HCPCS D1553
Hospital Charge Code	42300716
Hospital Revenue Code	361
Min. Negotiated Rate	$23.75
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$35.62
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

RE-CEMENT OR RE-BOND UNILATERAL

Facility

$47.50

Service Code	HCPCS D1553
Hospital Charge Code	42300716
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

RECEMENT SUPP CROWN

Facility

$150.00

Service Code	HCPCS D6092
Hospital Charge Code	42303424
Hospital Revenue Code	361
Min. Negotiated Rate	$29.68
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.68
Rate for Payer: Aetna Government	$29.68
Rate for Payer: Brighton Health Commercial	$112.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

RECEMENT SUPP PART DENTURE

Facility

$200.00

Service Code	HCPCS D6093
Hospital Charge Code	42303425
Hospital Revenue Code	361
Min. Negotiated Rate	$46.64
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$46.64
Rate for Payer: Aetna Government	$46.64
Rate for Payer: Brighton Health Commercial	$150.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$100.00
Rate for Payer: Group Health Inc Medicare	$70.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$100.00

RE-CLOSE SURGICAL OPENING

Facility

$5,272.28

Service Code	HCPCS 13160
Hospital Charge Code	30302051
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,108.87
Rate for Payer: Aetna Government	$2,108.87
Rate for Payer: Affinity Essential Plan 1&2	$1,476.21
Rate for Payer: Affinity Essential Plan 3&4	$1,476.21
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,476.21
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$2,108.87
Rate for Payer: Cash Price	$2,108.87
Rate for Payer: Cash Price	$2,108.87
Rate for Payer: Cash Price	$2,108.87
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,108.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$2,108.87
Rate for Payer: Fidelis Essential Plan Aliesa	$1,792.54
Rate for Payer: Fidelis Essential Plan QHP	$1,876.89
Rate for Payer: Fidelis Medicare Advantage	$2,108.87
Rate for Payer: Fidelis Qualified Health Plan	$1,876.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,636.14
Rate for Payer: Hamaspik Choice Inc Medicare	$2,108.87
Rate for Payer: Healthfirst Medicare Advantage	$1,792.54
Rate for Payer: Healthfirst QHP	$2,108.87
Rate for Payer: Humana Medicare	$2,151.05
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$2,108.87
Rate for Payer: Senior Whole Health Medicare Advantage	$2,108.87
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$2,108.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,108.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,687.10
Rate for Payer: Wellcare Medicare	$2,003.43

RE-CLOSE SURGICAL OPENING

Facility

$5,272.28

Service Code	HCPCS 13160
Hospital Charge Code	30302051
Hospital Revenue Code	510
Rate for Payer: Cash Price	$2,108.87

RECON FULL MAND PLT

Facility

$2,694.00

Service Code	HCPCS C1713
Hospital Charge Code	40201297
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,828.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,481.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,616.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,347.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,549.05
Rate for Payer: EmblemHealth Commercial	$1,347.00
Rate for Payer: Fidelis Medicare Advantage	$2,828.70
Rate for Payer: Group Health Inc Commercial	$1,347.00
Rate for Payer: Group Health Inc Medicare	$942.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,347.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,347.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,751.10

RECON FULL MAND PLT

Facility

$2,694.00

Service Code	HCPCS C1713
Hospital Charge Code	40201297
Hospital Revenue Code	278
Min. Negotiated Rate	$1,347.00
Max. Negotiated Rate	$1,347.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,347.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,347.00

RECON HEMI MAND PLT LFT 6X17

Facility

$2,600.00

Service Code	HCPCS C1713
Hospital Charge Code	40201302
Hospital Revenue Code	278
Min. Negotiated Rate	$1,300.00
Max. Negotiated Rate	$1,300.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,300.00

RECON HEMI MAND PLT LFT 6X17

Facility

$2,600.00

Service Code	HCPCS C1713
Hospital Charge Code	40201302
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,730.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,430.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,560.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,495.00
Rate for Payer: EmblemHealth Commercial	$1,300.00
Rate for Payer: Fidelis Medicare Advantage	$2,730.00
Rate for Payer: Group Health Inc Commercial	$1,300.00
Rate for Payer: Group Health Inc Medicare	$910.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,300.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,690.00

RECON HEMI PLATE,6X17, LFT 17 DEG

Facility

$2,600.00

Service Code	HCPCS C1713
Hospital Charge Code	40201305
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,730.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,430.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,560.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,495.00
Rate for Payer: EmblemHealth Commercial	$1,300.00
Rate for Payer: Fidelis Medicare Advantage	$2,730.00
Rate for Payer: Group Health Inc Commercial	$1,300.00
Rate for Payer: Group Health Inc Medicare	$910.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,300.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,690.00

RECON HEMI PLATE,6X17, LFT 17 DEG

Facility

$2,600.00

Service Code	HCPCS C1713
Hospital Charge Code	40201305
Hospital Revenue Code	278
Min. Negotiated Rate	$1,300.00
Max. Negotiated Rate	$1,300.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,300.00

RECON HEMI PLATE,6X17,RGHT 17 DEG

Facility

$2,600.00

Service Code	HCPCS C1713
Hospital Charge Code	40201306
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,730.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,430.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,560.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,495.00
Rate for Payer: EmblemHealth Commercial	$1,300.00
Rate for Payer: Fidelis Medicare Advantage	$2,730.00
Rate for Payer: Group Health Inc Commercial	$1,300.00
Rate for Payer: Group Health Inc Medicare	$910.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,300.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,690.00

RECON HEMI PLATE,6X17,RGHT 17 DEG

Facility

$2,600.00

Service Code	HCPCS C1713
Hospital Charge Code	40201306
Hospital Revenue Code	278
Min. Negotiated Rate	$1,300.00
Max. Negotiated Rate	$1,300.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,300.00

RECON NAIL

Facility

$2,840.50

Service Code	HCPCS C1713
Hospital Charge Code	40201415
Hospital Revenue Code	278
Min. Negotiated Rate	$1,420.25
Max. Negotiated Rate	$1,420.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,420.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,420.25

RECON NAIL

Facility

$2,840.50

Service Code	HCPCS C1713
Hospital Charge Code	40201415
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,982.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,562.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,704.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,420.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,633.29
Rate for Payer: EmblemHealth Commercial	$1,420.25
Rate for Payer: Fidelis Medicare Advantage	$2,982.52
Rate for Payer: Group Health Inc Commercial	$1,420.25
Rate for Payer: Group Health Inc Medicare	$994.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,420.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,420.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,846.32

RECON NAIL, LEFT

Facility

$2,840.00

Service Code	HCPCS C1713
Hospital Charge Code	40200744
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,982.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,562.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,704.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,420.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,633.00
Rate for Payer: EmblemHealth Commercial	$1,420.00
Rate for Payer: Fidelis Medicare Advantage	$2,982.00
Rate for Payer: Group Health Inc Commercial	$1,420.00
Rate for Payer: Group Health Inc Medicare	$994.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,420.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,846.00

Know your out-of-pocket cost for care.

All Charges