St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

8HOLE L PLTE 90D LEFT UPPERFACE

Facility

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40201172
Hospital Revenue Code	278
Min. Negotiated Rate	$141.00
Max. Negotiated Rate	$141.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.00
Rate for Payer: Hamaspik Choice Inc Medicare	$141.00

8HOLE L PLTE 90D RIGHT UPPERFACE

Facility

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40201173
Hospital Revenue Code	278
Min. Negotiated Rate	$98.70
Max. Negotiated Rate	$296.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$155.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$169.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$141.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$162.15
Rate for Payer: EmblemHealth Commercial	$141.00
Rate for Payer: Fidelis Medicare Advantage	$296.10
Rate for Payer: Group Health Inc Commercial	$141.00
Rate for Payer: Group Health Inc Medicare	$98.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.00
Rate for Payer: Hamaspik Choice Inc Medicare	$141.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$183.30

8HOLE L PLTE 90D RIGHT UPPERFACE

Facility

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40201173
Hospital Revenue Code	278
Min. Negotiated Rate	$141.00
Max. Negotiated Rate	$141.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.00
Rate for Payer: Hamaspik Choice Inc Medicare	$141.00

8HOLE PLATE,MIDFACE

Facility

$428.00

Service Code	HCPCS C1713
Hospital Charge Code	40201174
Hospital Revenue Code	278
Min. Negotiated Rate	$214.00
Max. Negotiated Rate	$214.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$214.00
Rate for Payer: Hamaspik Choice Inc Medicare	$214.00

8HOLE PLATE,MIDFACE

Facility

$428.00

Service Code	HCPCS C1713
Hospital Charge Code	40201174
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$449.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$235.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$256.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$214.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$246.10
Rate for Payer: EmblemHealth Commercial	$214.00
Rate for Payer: Fidelis Medicare Advantage	$449.40
Rate for Payer: Group Health Inc Commercial	$214.00
Rate for Payer: Group Health Inc Medicare	$149.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$214.00
Rate for Payer: Hamaspik Choice Inc Medicare	$214.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$278.20

8HOLE Y PLATE.MIDFACE LOCKING

Facility

$448.00

Service Code	HCPCS C1713
Hospital Charge Code	40201177
Hospital Revenue Code	278
Min. Negotiated Rate	$224.00
Max. Negotiated Rate	$224.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$224.00
Rate for Payer: Hamaspik Choice Inc Medicare	$224.00

8HOLE Y PLATE.MIDFACE LOCKING

Facility

$448.00

Service Code	HCPCS C1713
Hospital Charge Code	40201177
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$470.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$246.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$268.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$224.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$257.60
Rate for Payer: EmblemHealth Commercial	$224.00
Rate for Payer: Fidelis Medicare Advantage	$470.40
Rate for Payer: Group Health Inc Commercial	$224.00
Rate for Payer: Group Health Inc Medicare	$156.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$224.00
Rate for Payer: Hamaspik Choice Inc Medicare	$224.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$291.20

8H RGHT CLAVICLE PLATE

Facility

$1,764.00

Service Code	HCPCS C1713
Hospital Charge Code	40200115
Hospital Revenue Code	278
Min. Negotiated Rate	$882.00
Max. Negotiated Rate	$882.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$882.00
Rate for Payer: Hamaspik Choice Inc Medicare	$882.00

8H RGHT CLAVICLE PLATE

Facility

$1,764.00

Service Code	HCPCS C1713
Hospital Charge Code	40200115
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,852.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$970.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,058.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$882.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,014.30
Rate for Payer: EmblemHealth Commercial	$882.00
Rate for Payer: Fidelis Medicare Advantage	$1,852.20
Rate for Payer: Group Health Inc Commercial	$882.00
Rate for Payer: Group Health Inc Medicare	$617.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$882.00
Rate for Payer: Hamaspik Choice Inc Medicare	$882.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,146.60

8MM THREADED POST W/13MM NUT

Facility

$170.00

Service Code	HCPCS C1713
Hospital Charge Code	40200563
Hospital Revenue Code	278
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$178.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$102.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$85.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$97.75
Rate for Payer: EmblemHealth Commercial	$85.00
Rate for Payer: Fidelis Medicare Advantage	$178.50
Rate for Payer: Group Health Inc Commercial	$85.00
Rate for Payer: Group Health Inc Medicare	$59.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.00
Rate for Payer: Hamaspik Choice Inc Medicare	$85.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$110.50

8MM THREADED POST W/13MM NUT

Facility

$170.00

Service Code	HCPCS C1713
Hospital Charge Code	40200563
Hospital Revenue Code	278
Min. Negotiated Rate	$85.00
Max. Negotiated Rate	$85.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.00
Rate for Payer: Hamaspik Choice Inc Medicare	$85.00

8x10 Bioclusive Dressing

Facility

$18.07

Hospital Charge Code	40200011
Hospital Revenue Code	270
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$14.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.04
Rate for Payer: Aetna Government	$9.04
Rate for Payer: Brighton Health Commercial	$13.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.29
Rate for Payer: Group Health Inc Commercial	$9.04
Rate for Payer: Group Health Inc Medicare	$6.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.04
Rate for Payer: Hamaspik Choice Inc Medicare	$9.04

8X28MM LEFT NAIL

Facility

$5,100.00

Service Code	HCPCS C1713
Hospital Charge Code	40203555
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,355.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,805.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,060.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,550.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,932.50
Rate for Payer: EmblemHealth Commercial	$2,550.00
Rate for Payer: Fidelis Medicare Advantage	$5,355.00
Rate for Payer: Group Health Inc Commercial	$2,550.00
Rate for Payer: Group Health Inc Medicare	$1,785.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,550.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,315.00

8X28MM LEFT NAIL

Facility

$5,100.00

Service Code	HCPCS C1713
Hospital Charge Code	40203555
Hospital Revenue Code	278
Min. Negotiated Rate	$2,550.00
Max. Negotiated Rate	$2,550.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,550.00

8X345MM T2 TIBIAL NAIL STANDARD

Facility

$2,209.20

Service Code	HCPCS C1713
Hospital Charge Code	40200562
Hospital Revenue Code	278
Min. Negotiated Rate	$1,104.60
Max. Negotiated Rate	$1,104.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,104.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,104.60

8X345MM T2 TIBIAL NAIL STANDARD

Facility

$2,209.20

Service Code	HCPCS C1713
Hospital Charge Code	40200562
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,319.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,215.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,325.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,104.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,270.29
Rate for Payer: EmblemHealth Commercial	$1,104.60
Rate for Payer: Fidelis Medicare Advantage	$2,319.66
Rate for Payer: Group Health Inc Commercial	$1,104.60
Rate for Payer: Group Health Inc Medicare	$773.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,104.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,104.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,435.98

90 DEGREE ANGLED POST

Facility

$186.20

Service Code	HCPCS C1713
Hospital Charge Code	40201183
Hospital Revenue Code	278
Min. Negotiated Rate	$65.17
Max. Negotiated Rate	$195.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$102.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$111.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$93.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$107.06
Rate for Payer: EmblemHealth Commercial	$93.10
Rate for Payer: Fidelis Medicare Advantage	$195.51
Rate for Payer: Group Health Inc Commercial	$93.10
Rate for Payer: Group Health Inc Medicare	$65.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$93.10
Rate for Payer: Hamaspik Choice Inc Medicare	$93.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$121.03

90 DEGREE ANGLED POST

Facility

$186.20

Service Code	HCPCS C1713
Hospital Charge Code	40201183
Hospital Revenue Code	278
Min. Negotiated Rate	$93.10
Max. Negotiated Rate	$93.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$93.10
Rate for Payer: Hamaspik Choice Inc Medicare	$93.10

90 DEGREE POST

Facility

$170.00

Service Code	HCPCS C1713
Hospital Charge Code	40200567
Hospital Revenue Code	278
Min. Negotiated Rate	$85.00
Max. Negotiated Rate	$85.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.00
Rate for Payer: Hamaspik Choice Inc Medicare	$85.00

90 DEGREE POST

Facility

$170.00

Service Code	HCPCS C1713
Hospital Charge Code	40200567
Hospital Revenue Code	278
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$178.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$102.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$85.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$97.75
Rate for Payer: EmblemHealth Commercial	$85.00
Rate for Payer: Fidelis Medicare Advantage	$178.50
Rate for Payer: Group Health Inc Commercial	$85.00
Rate for Payer: Group Health Inc Medicare	$59.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.00
Rate for Payer: Hamaspik Choice Inc Medicare	$85.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$110.50

90 DEGREE T-BONE PLATE NO BAR

Facility

$368.00

Service Code	HCPCS C1713
Hospital Charge Code	40201184
Hospital Revenue Code	278
Min. Negotiated Rate	$184.00
Max. Negotiated Rate	$184.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$184.00
Rate for Payer: Hamaspik Choice Inc Medicare	$184.00

90 DEGREE T-BONE PLATE NO BAR

Facility

$368.00

Service Code	HCPCS C1713
Hospital Charge Code	40201184
Hospital Revenue Code	278
Min. Negotiated Rate	$128.80
Max. Negotiated Rate	$386.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$202.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$220.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$184.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$211.60
Rate for Payer: EmblemHealth Commercial	$184.00
Rate for Payer: Fidelis Medicare Advantage	$386.40
Rate for Payer: Group Health Inc Commercial	$184.00
Rate for Payer: Group Health Inc Medicare	$128.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$184.00
Rate for Payer: Hamaspik Choice Inc Medicare	$184.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$239.20

950 GUIDE FOR NCB-DF PLT LEFT

Facility

$1,364.56

Hospital Charge Code	40006764
Hospital Revenue Code	272
Min. Negotiated Rate	$477.60
Max. Negotiated Rate	$1,091.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$750.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$682.28
Rate for Payer: Aetna Government	$682.28
Rate for Payer: Brighton Health Commercial	$1,023.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,091.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$927.90
Rate for Payer: Group Health Inc Commercial	$682.28
Rate for Payer: Group Health Inc Medicare	$477.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$682.28
Rate for Payer: Hamaspik Choice Inc Medicare	$682.28

950 GUIDE FOR NCB-DF PLT RIGHT

Facility

$1,364.56

Hospital Charge Code	40006763
Hospital Revenue Code	272
Min. Negotiated Rate	$477.60
Max. Negotiated Rate	$1,091.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$750.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$682.28
Rate for Payer: Aetna Government	$682.28
Rate for Payer: Brighton Health Commercial	$1,023.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,091.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$927.90
Rate for Payer: Group Health Inc Commercial	$682.28
Rate for Payer: Group Health Inc Medicare	$477.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$682.28
Rate for Payer: Hamaspik Choice Inc Medicare	$682.28

9.5FR SHEATH INTRODUCER

Facility

$100.00

Hospital Charge Code	66526906
Hospital Revenue Code	272
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$80.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.00
Rate for Payer: Aetna Government	$50.00
Rate for Payer: Brighton Health Commercial	$75.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.00
Rate for Payer: Group Health Inc Commercial	$50.00
Rate for Payer: Group Health Inc Medicare	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00

Know your out-of-pocket cost for care.

All Charges