St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE 11 HOLE 4 RIGHT

Facility

$685.13

Service Code	HCPCS C1713
Hospital Charge Code	64904487
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$719.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$376.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$411.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$342.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$393.95
Rate for Payer: EmblemHealth Commercial	$342.56
Rate for Payer: Fidelis Medicare Advantage	$719.39
Rate for Payer: Group Health Inc Commercial	$342.56
Rate for Payer: Group Health Inc Medicare	$239.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$342.56
Rate for Payer: Hamaspik Choice Inc Medicare	$342.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$445.33

PLATE 11 HOLE 4 RIGHT

Facility

$685.13

Service Code	HCPCS C1713
Hospital Charge Code	64904487
Hospital Revenue Code	278
Min. Negotiated Rate	$342.56
Max. Negotiated Rate	$342.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$342.56
Rate for Payer: Hamaspik Choice Inc Medicare	$342.56

PLATE 11-HOLE EXTENDED Y

Facility

$395.00

Service Code	HCPCS C1713
Hospital Charge Code	64901941
Hospital Revenue Code	278
Min. Negotiated Rate	$197.50
Max. Negotiated Rate	$197.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$197.50
Rate for Payer: Hamaspik Choice Inc Medicare	$197.50

PLATE 11-HOLE EXTENDED Y

Facility

$395.00

Service Code	HCPCS C1713
Hospital Charge Code	64901941
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$414.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$217.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$237.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$197.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$227.12
Rate for Payer: EmblemHealth Commercial	$197.50
Rate for Payer: Fidelis Medicare Advantage	$414.75
Rate for Payer: Group Health Inc Commercial	$197.50
Rate for Payer: Group Health Inc Medicare	$138.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$197.50
Rate for Payer: Hamaspik Choice Inc Medicare	$197.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$256.75

PLATE 11HOLE LE FORT 3MM

Facility

$685.13

Service Code	HCPCS C1713
Hospital Charge Code	64905918
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$719.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$376.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$411.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$342.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$393.95
Rate for Payer: EmblemHealth Commercial	$342.56
Rate for Payer: Fidelis Medicare Advantage	$719.39
Rate for Payer: Group Health Inc Commercial	$342.56
Rate for Payer: Group Health Inc Medicare	$239.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$342.56
Rate for Payer: Hamaspik Choice Inc Medicare	$342.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$445.33

PLATE 11HOLE LE FORT 3MM

Facility

$685.13

Service Code	HCPCS C1713
Hospital Charge Code	64905918
Hospital Revenue Code	278
Min. Negotiated Rate	$342.56
Max. Negotiated Rate	$342.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$342.56
Rate for Payer: Hamaspik Choice Inc Medicare	$342.56

PLATE 11 HOLE RECONSTRUCTION

Facility

$4,273.60

Service Code	HCPCS C1713
Hospital Charge Code	64903096
Hospital Revenue Code	278
Min. Negotiated Rate	$2,136.80
Max. Negotiated Rate	$2,136.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,136.80
Rate for Payer: Hamaspik Choice Inc Medicare	$2,136.80

PLATE 11 HOLE RECONSTRUCTION

Facility

$4,273.60

Service Code	HCPCS C1713
Hospital Charge Code	64903096
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,487.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,350.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,564.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,136.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,457.32
Rate for Payer: EmblemHealth Commercial	$2,136.80
Rate for Payer: Fidelis Medicare Advantage	$4,487.28
Rate for Payer: Group Health Inc Commercial	$2,136.80
Rate for Payer: Group Health Inc Medicare	$1,495.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,136.80
Rate for Payer: Hamaspik Choice Inc Medicare	$2,136.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,777.84

PLATE 12 INCH 11 HOLE

Facility

$2,232.50

Service Code	HCPCS C1713
Hospital Charge Code	64903653
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,344.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,227.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,339.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,116.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,283.69
Rate for Payer: EmblemHealth Commercial	$1,116.25
Rate for Payer: Fidelis Medicare Advantage	$2,344.12
Rate for Payer: Group Health Inc Commercial	$1,116.25
Rate for Payer: Group Health Inc Medicare	$781.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,116.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,116.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,451.12

PLATE 12 INCH 11 HOLE

Facility

$2,232.50

Service Code	HCPCS C1713
Hospital Charge Code	64903653
Hospital Revenue Code	278
Min. Negotiated Rate	$1,116.25
Max. Negotiated Rate	$1,116.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,116.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,116.25

PLATE 12MM DOG BONE

Facility

$250.80

Service Code	HCPCS C1713
Hospital Charge Code	64902965
Hospital Revenue Code	278
Min. Negotiated Rate	$87.78
Max. Negotiated Rate	$263.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$150.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$125.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.21
Rate for Payer: EmblemHealth Commercial	$125.40
Rate for Payer: Fidelis Medicare Advantage	$263.34
Rate for Payer: Group Health Inc Commercial	$125.40
Rate for Payer: Group Health Inc Medicare	$87.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.40
Rate for Payer: Hamaspik Choice Inc Medicare	$125.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$163.02

PLATE 12MM DOG BONE

Facility

$250.80

Service Code	HCPCS C1713
Hospital Charge Code	64902965
Hospital Revenue Code	278
Min. Negotiated Rate	$125.40
Max. Negotiated Rate	$125.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.40
Rate for Payer: Hamaspik Choice Inc Medicare	$125.40

PLATE 12MM L

Facility

$437.90

Service Code	HCPCS C1713
Hospital Charge Code	64904868
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$459.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$240.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$262.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$218.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$251.79
Rate for Payer: EmblemHealth Commercial	$218.95
Rate for Payer: Fidelis Medicare Advantage	$459.80
Rate for Payer: Group Health Inc Commercial	$218.95
Rate for Payer: Group Health Inc Medicare	$153.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$218.95
Rate for Payer: Hamaspik Choice Inc Medicare	$218.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$284.64

PLATE 12MM L

Facility

$437.90

Service Code	HCPCS C1713
Hospital Charge Code	64904868
Hospital Revenue Code	278
Min. Negotiated Rate	$218.95
Max. Negotiated Rate	$218.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$218.95
Rate for Payer: Hamaspik Choice Inc Medicare	$218.95

PLATE 1.2MM MAL BLUE STR 18 HL

Facility

$804.08

Service Code	HCPCS C1713
Hospital Charge Code	64906623
Hospital Revenue Code	278
Min. Negotiated Rate	$402.04
Max. Negotiated Rate	$402.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$402.04
Rate for Payer: Hamaspik Choice Inc Medicare	$402.04

PLATE 1.2MM MAL BLUE STR 18 HL

Facility

$804.08

Service Code	HCPCS C1713
Hospital Charge Code	64906623
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$844.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$442.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$482.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$402.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$462.35
Rate for Payer: EmblemHealth Commercial	$402.04
Rate for Payer: Fidelis Medicare Advantage	$844.28
Rate for Payer: Group Health Inc Commercial	$402.04
Rate for Payer: Group Health Inc Medicare	$281.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$402.04
Rate for Payer: Hamaspik Choice Inc Medicare	$402.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$522.65

PLATE 1.2MM STD TMPLT ORB FL

Facility

$1,279.96

Service Code	HCPCS C1713
Hospital Charge Code	64906619
Hospital Revenue Code	278
Min. Negotiated Rate	$639.98
Max. Negotiated Rate	$639.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$639.98
Rate for Payer: Hamaspik Choice Inc Medicare	$639.98

PLATE 1.2MM STD TMPLT ORB FL

Facility

$1,279.96

Service Code	HCPCS C1713
Hospital Charge Code	64906619
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,343.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$703.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$767.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$639.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$735.98
Rate for Payer: EmblemHealth Commercial	$639.98
Rate for Payer: Fidelis Medicare Advantage	$1,343.96
Rate for Payer: Group Health Inc Commercial	$639.98
Rate for Payer: Group Health Inc Medicare	$447.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$639.98
Rate for Payer: Hamaspik Choice Inc Medicare	$639.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$831.97

PLATE 1.2MM STR GOLD 8 HOLE

Facility

$391.32

Service Code	HCPCS C1713
Hospital Charge Code	64906624
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$410.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$215.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$234.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$195.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$225.01
Rate for Payer: EmblemHealth Commercial	$195.66
Rate for Payer: Fidelis Medicare Advantage	$410.89
Rate for Payer: Group Health Inc Commercial	$195.66
Rate for Payer: Group Health Inc Medicare	$136.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$195.66
Rate for Payer: Hamaspik Choice Inc Medicare	$195.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$254.36

PLATE 1.2MM STR GOLD 8 HOLE

Facility

$391.32

Service Code	HCPCS C1713
Hospital Charge Code	64906624
Hospital Revenue Code	278
Min. Negotiated Rate	$195.66
Max. Negotiated Rate	$195.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$195.66
Rate for Payer: Hamaspik Choice Inc Medicare	$195.66

PLATE 12 MM ZERO

Facility

$7,035.00

Service Code	HCPCS C1713
Hospital Charge Code	64904676
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$7,386.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,869.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,221.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,517.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,045.12
Rate for Payer: EmblemHealth Commercial	$3,517.50
Rate for Payer: Fidelis Medicare Advantage	$7,386.75
Rate for Payer: Group Health Inc Commercial	$3,517.50
Rate for Payer: Group Health Inc Medicare	$2,462.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,517.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,517.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,572.75

PLATE 12 MM ZERO

Facility

$7,035.00

Service Code	HCPCS C1713
Hospital Charge Code	64904676
Hospital Revenue Code	278
Min. Negotiated Rate	$3,517.50
Max. Negotiated Rate	$3,517.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,517.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,517.50

PLATE 12 ORTHO

Facility

$2,436.53

Service Code	HCPCS C1713
Hospital Charge Code	64907173
Hospital Revenue Code	278
Min. Negotiated Rate	$1,218.26
Max. Negotiated Rate	$1,218.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,218.26
Rate for Payer: Hamaspik Choice Inc Medicare	$1,218.26

PLATE 12 ORTHO

Facility

$2,436.53

Service Code	HCPCS C1713
Hospital Charge Code	64907173
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,558.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,340.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,461.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,218.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,401.00
Rate for Payer: EmblemHealth Commercial	$1,218.26
Rate for Payer: Fidelis Medicare Advantage	$2,558.36
Rate for Payer: Group Health Inc Commercial	$1,218.26
Rate for Payer: Group Health Inc Medicare	$852.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,218.26
Rate for Payer: Hamaspik Choice Inc Medicare	$1,218.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,583.74

PLATE 1/3 TUBULAR 5 HOLE / L59MM

Facility

$956.25

Service Code	HCPCS C1713
Hospital Charge Code	64905645
Hospital Revenue Code	278
Min. Negotiated Rate	$478.12
Max. Negotiated Rate	$478.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$478.12
Rate for Payer: Hamaspik Choice Inc Medicare	$478.12

Know your out-of-pocket cost for care.

All Charges