St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$134.20
Max. Negotiated Rate	$1,004.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$525.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$573.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$478.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$549.84
Rate for Payer: EmblemHealth Commercial	$478.12
Rate for Payer: Fidelis Medicare Advantage	$1,004.06
Rate for Payer: Group Health Inc Commercial	$478.12
Rate for Payer: Group Health Inc Medicare	$334.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$478.12
Rate for Payer: Hamaspik Choice Inc Medicare	$478.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$621.56

PLATE 1/3 TUBULAR (AR-8943T-04)

Facility

$225.00

Service Code	HCPCS C1713
Hospital Charge Code	64906354
Hospital Revenue Code	278
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$236.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$123.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$135.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$112.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$129.38
Rate for Payer: EmblemHealth Commercial	$112.50
Rate for Payer: Fidelis Medicare Advantage	$236.25
Rate for Payer: Group Health Inc Commercial	$112.50
Rate for Payer: Group Health Inc Medicare	$78.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.50
Rate for Payer: Hamaspik Choice Inc Medicare	$112.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$146.25

PLATE 1/3 TUBULAR (AR-8943T-04)

Facility

$225.00

Service Code	HCPCS C1713
Hospital Charge Code	64906354
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.50
Rate for Payer: Hamaspik Choice Inc Medicare	$112.50

PLATE 1/3 TUBULAR LCP 6H 69MM

Facility

$580.00

Service Code	HCPCS C1713
Hospital Charge Code	64901323
Hospital Revenue Code	278
Min. Negotiated Rate	$290.00
Max. Negotiated Rate	$290.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$290.00
Rate for Payer: Hamaspik Choice Inc Medicare	$290.00

PLATE 1/3 TUBULAR LCP 6H 69MM

Facility

$580.00

Service Code	HCPCS C1713
Hospital Charge Code	64901323
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$609.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$319.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$348.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$290.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$333.50
Rate for Payer: EmblemHealth Commercial	$290.00
Rate for Payer: Fidelis Medicare Advantage	$609.00
Rate for Payer: Group Health Inc Commercial	$290.00
Rate for Payer: Group Health Inc Medicare	$203.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$290.00
Rate for Payer: Hamaspik Choice Inc Medicare	$290.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$377.00

PLATE 140DEG DHS 2H

Facility

$754.00

Service Code	HCPCS C1713
Hospital Charge Code	40209888
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

PLATE 140DEG DHS 2H

Facility

$754.00

Service Code	HCPCS C1713
Hospital Charge Code	40209888
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

PLATE 145 DEG LCP D SIDE

Facility

$2,195.00

Service Code	HCPCS C1713
Hospital Charge Code	64904358
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,304.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,207.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,317.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,097.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,262.12
Rate for Payer: EmblemHealth Commercial	$1,097.50
Rate for Payer: Fidelis Medicare Advantage	$2,304.75
Rate for Payer: Group Health Inc Commercial	$1,097.50
Rate for Payer: Group Health Inc Medicare	$768.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,097.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,097.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,426.75

PLATE 145 DEG LCP D SIDE

Facility

$2,195.00

Service Code	HCPCS C1713
Hospital Charge Code	64904358
Hospital Revenue Code	278
Min. Negotiated Rate	$1,097.50
Max. Negotiated Rate	$1,097.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,097.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,097.50

PLATE 14 HOLE

Facility

$5,646.55

Service Code	HCPCS C1713
Hospital Charge Code	64907127
Hospital Revenue Code	278
Min. Negotiated Rate	$2,823.28
Max. Negotiated Rate	$2,823.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,823.28
Rate for Payer: Hamaspik Choice Inc Medicare	$2,823.28

PLATE 14 HOLE

Facility

$812.00

Service Code	HCPCS C1713
Hospital Charge Code	40200170
Hospital Revenue Code	278
Min. Negotiated Rate	$406.00
Max. Negotiated Rate	$406.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$406.00
Rate for Payer: Hamaspik Choice Inc Medicare	$406.00

PLATE 14 HOLE

Facility

$5,646.55

Service Code	HCPCS C1713
Hospital Charge Code	64907127
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,928.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,105.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,387.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,823.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,246.77
Rate for Payer: EmblemHealth Commercial	$2,823.28
Rate for Payer: Fidelis Medicare Advantage	$5,928.88
Rate for Payer: Group Health Inc Commercial	$2,823.28
Rate for Payer: Group Health Inc Medicare	$1,976.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,823.28
Rate for Payer: Hamaspik Choice Inc Medicare	$2,823.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,670.26

PLATE 14 HOLE

Facility

$812.00

Service Code	HCPCS C1713
Hospital Charge Code	40200170
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$852.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$446.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$487.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$406.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$466.90
Rate for Payer: EmblemHealth Commercial	$406.00
Rate for Payer: Fidelis Medicare Advantage	$852.60
Rate for Payer: Group Health Inc Commercial	$406.00
Rate for Payer: Group Health Inc Medicare	$284.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$406.00
Rate for Payer: Hamaspik Choice Inc Medicare	$406.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$527.80

PLATE 1.7 S PR HLOCK 3D 2X22H

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64905785
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,109.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$580.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$633.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$528.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$607.34
Rate for Payer: EmblemHealth Commercial	$528.12
Rate for Payer: Fidelis Medicare Advantage	$1,109.06
Rate for Payer: Group Health Inc Commercial	$528.12
Rate for Payer: Group Health Inc Medicare	$369.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$528.12
Rate for Payer: Hamaspik Choice Inc Medicare	$528.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$686.56

PLATE 1.7 S PR HLOCK 3D 2X22H

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64905785
Hospital Revenue Code	278
Min. Negotiated Rate	$528.12
Max. Negotiated Rate	$528.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$528.12
Rate for Payer: Hamaspik Choice Inc Medicare	$528.12

PLATE 1.7 S PROF H-LCK 2X2H

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64905640
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,109.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$580.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$633.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$528.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$607.34
Rate for Payer: EmblemHealth Commercial	$528.12
Rate for Payer: Fidelis Medicare Advantage	$1,109.06
Rate for Payer: Group Health Inc Commercial	$528.12
Rate for Payer: Group Health Inc Medicare	$369.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$528.12
Rate for Payer: Hamaspik Choice Inc Medicare	$528.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$686.56

PLATE 1.7 S PROF H-LCK 2X2H

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64905640
Hospital Revenue Code	278
Min. Negotiated Rate	$528.12
Max. Negotiated Rate	$528.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$528.12
Rate for Payer: Hamaspik Choice Inc Medicare	$528.12

PLATE 2000-2999

Facility

$3,999.12

Service Code	HCPCS C1713
Hospital Charge Code	40203020
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,199.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,199.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,399.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,999.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,299.49
Rate for Payer: EmblemHealth Commercial	$1,999.56
Rate for Payer: Fidelis Medicare Advantage	$4,199.08
Rate for Payer: Group Health Inc Commercial	$1,999.56
Rate for Payer: Group Health Inc Medicare	$1,399.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,999.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1,999.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,599.43

PLATE 2000-2999

Facility

$3,999.12

Service Code	HCPCS C1713
Hospital Charge Code	40203020
Hospital Revenue Code	278
Min. Negotiated Rate	$1,999.56
Max. Negotiated Rate	$1,999.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,999.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1,999.56

PLATE 20 HOLE

Facility

$3,950.00

Service Code	HCPCS C1713
Hospital Charge Code	64906954
Hospital Revenue Code	278
Min. Negotiated Rate	$1,975.00
Max. Negotiated Rate	$1,975.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,975.00

PLATE 20 HOLE

Facility

$3,950.00

Service Code	HCPCS C1713
Hospital Charge Code	64906954
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,147.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,172.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,370.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,975.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,271.25
Rate for Payer: EmblemHealth Commercial	$1,975.00
Rate for Payer: Fidelis Medicare Advantage	$4,147.50
Rate for Payer: Group Health Inc Commercial	$1,975.00
Rate for Payer: Group Health Inc Medicare	$1,382.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,975.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,567.50

PLATE 2.0 L-SHAPED LEFT

Facility

$460.00

Service Code	HCPCS C1713
Hospital Charge Code	64901845
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$483.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$253.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$276.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$230.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$264.50
Rate for Payer: EmblemHealth Commercial	$230.00
Rate for Payer: Fidelis Medicare Advantage	$483.00
Rate for Payer: Group Health Inc Commercial	$230.00
Rate for Payer: Group Health Inc Medicare	$161.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$230.00
Rate for Payer: Hamaspik Choice Inc Medicare	$230.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$299.00

PLATE 2.0 L-SHAPED LEFT

Facility

$460.00

Service Code	HCPCS C1713
Hospital Charge Code	64901845
Hospital Revenue Code	278
Min. Negotiated Rate	$230.00
Max. Negotiated Rate	$230.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$230.00
Rate for Payer: Hamaspik Choice Inc Medicare	$230.00

PLATE 2.0MM 4H

Facility

$175.00

Service Code	HCPCS C1713
Hospital Charge Code	40200717
Hospital Revenue Code	278
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$87.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.50
Rate for Payer: Hamaspik Choice Inc Medicare	$87.50

PLATE 2.0MM 4H

Facility

$175.00

Service Code	HCPCS C1713
Hospital Charge Code	40200717
Hospital Revenue Code	278
Min. Negotiated Rate	$61.25
Max. Negotiated Rate	$183.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$96.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$105.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$100.62
Rate for Payer: EmblemHealth Commercial	$87.50
Rate for Payer: Fidelis Medicare Advantage	$183.75
Rate for Payer: Group Health Inc Commercial	$87.50
Rate for Payer: Group Health Inc Medicare	$61.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.50
Rate for Payer: Hamaspik Choice Inc Medicare	$87.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$113.75

Know your out-of-pocket cost for care.

All Charges