St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE 5 HOLE

Facility

$372.00

Service Code	HCPCS C1713
Hospital Charge Code	40201403
Hospital Revenue Code	278
Min. Negotiated Rate	$186.00
Max. Negotiated Rate	$186.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$186.00
Rate for Payer: Hamaspik Choice Inc Medicare	$186.00

PLATE 5 HOLE

Facility

$372.00

Service Code	HCPCS C1713
Hospital Charge Code	40201403
Hospital Revenue Code	278
Min. Negotiated Rate	$130.20
Max. Negotiated Rate	$390.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$204.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$223.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$186.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$213.90
Rate for Payer: EmblemHealth Commercial	$186.00
Rate for Payer: Fidelis Medicare Advantage	$390.60
Rate for Payer: Group Health Inc Commercial	$186.00
Rate for Payer: Group Health Inc Medicare	$130.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$186.00
Rate for Payer: Hamaspik Choice Inc Medicare	$186.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$241.80

PLATE 5 HOLE -627505

Facility

$4,614.00

Service Code	HCPCS C1713
Hospital Charge Code	64906793
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,844.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,537.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,768.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,307.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,653.05
Rate for Payer: EmblemHealth Commercial	$2,307.00
Rate for Payer: Fidelis Medicare Advantage	$4,844.70
Rate for Payer: Group Health Inc Commercial	$2,307.00
Rate for Payer: Group Health Inc Medicare	$1,614.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,307.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,307.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,999.10

PLATE 5 HOLE -627505

Facility

$4,614.00

Service Code	HCPCS C1713
Hospital Charge Code	64906793
Hospital Revenue Code	278
Min. Negotiated Rate	$2,307.00
Max. Negotiated Rate	$2,307.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,307.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,307.00

PLATE 5 HOLE LEFT

Facility

$1,440.00

Service Code	HCPCS C1713
Hospital Charge Code	40201268
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,512.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$792.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$864.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$720.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$828.00
Rate for Payer: EmblemHealth Commercial	$720.00
Rate for Payer: Fidelis Medicare Advantage	$1,512.00
Rate for Payer: Group Health Inc Commercial	$720.00
Rate for Payer: Group Health Inc Medicare	$504.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$720.00
Rate for Payer: Hamaspik Choice Inc Medicare	$720.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$936.00

PLATE 5 HOLE LEFT

Facility

$1,440.00

Service Code	HCPCS C1713
Hospital Charge Code	40201268
Hospital Revenue Code	278
Min. Negotiated Rate	$720.00
Max. Negotiated Rate	$720.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$720.00
Rate for Payer: Hamaspik Choice Inc Medicare	$720.00

PLATE 5HOLE LOCKING TI

Facility

$550.55

Service Code	HCPCS C1713
Hospital Charge Code	64906317
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$578.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$302.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$330.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$275.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$316.57
Rate for Payer: EmblemHealth Commercial	$275.28
Rate for Payer: Fidelis Medicare Advantage	$578.08
Rate for Payer: Group Health Inc Commercial	$275.28
Rate for Payer: Group Health Inc Medicare	$192.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.28
Rate for Payer: Hamaspik Choice Inc Medicare	$275.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$357.86

PLATE 5HOLE LOCKING TI

Facility

$550.55

Service Code	HCPCS C1713
Hospital Charge Code	64906317
Hospital Revenue Code	278
Min. Negotiated Rate	$275.28
Max. Negotiated Rate	$275.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.28
Rate for Payer: Hamaspik Choice Inc Medicare	$275.28

PLATE 5HOLE Y W/8MM MDFC

Facility

$363.78

Service Code	HCPCS C1713
Hospital Charge Code	64905920
Hospital Revenue Code	278
Min. Negotiated Rate	$181.89
Max. Negotiated Rate	$181.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$181.89
Rate for Payer: Hamaspik Choice Inc Medicare	$181.89

PLATE 5HOLE Y W/8MM MDFC

Facility

$363.78

Service Code	HCPCS C1713
Hospital Charge Code	64905920
Hospital Revenue Code	278
Min. Negotiated Rate	$127.32
Max. Negotiated Rate	$381.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$200.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$218.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$181.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$209.17
Rate for Payer: EmblemHealth Commercial	$181.89
Rate for Payer: Fidelis Medicare Advantage	$381.97
Rate for Payer: Group Health Inc Commercial	$181.89
Rate for Payer: Group Health Inc Medicare	$127.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$181.89
Rate for Payer: Hamaspik Choice Inc Medicare	$181.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$236.46

PLATE 6 HOLE

Facility

$1,963.50

Service Code	HCPCS C1713
Hospital Charge Code	40201404
Hospital Revenue Code	278
Min. Negotiated Rate	$981.75
Max. Negotiated Rate	$981.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$981.75
Rate for Payer: Hamaspik Choice Inc Medicare	$981.75

PLATE 6 HOLE

Facility

$1,963.50

Service Code	HCPCS C1713
Hospital Charge Code	40201404
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,061.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,079.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,178.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$981.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,129.01
Rate for Payer: EmblemHealth Commercial	$981.75
Rate for Payer: Fidelis Medicare Advantage	$2,061.68
Rate for Payer: Group Health Inc Commercial	$981.75
Rate for Payer: Group Health Inc Medicare	$687.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$981.75
Rate for Payer: Hamaspik Choice Inc Medicare	$981.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,276.28

PLATE 6 HOLE 12MM BAR

Facility

$549.40

Service Code	HCPCS C1713
Hospital Charge Code	64903589
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$576.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$302.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$329.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$274.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$315.90
Rate for Payer: EmblemHealth Commercial	$274.70
Rate for Payer: Fidelis Medicare Advantage	$576.87
Rate for Payer: Group Health Inc Commercial	$274.70
Rate for Payer: Group Health Inc Medicare	$192.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$274.70
Rate for Payer: Hamaspik Choice Inc Medicare	$274.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$357.11

PLATE 6 HOLE 12MM BAR

Facility

$549.40

Service Code	HCPCS C1713
Hospital Charge Code	64903589
Hospital Revenue Code	278
Min. Negotiated Rate	$274.70
Max. Negotiated Rate	$274.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$274.70
Rate for Payer: Hamaspik Choice Inc Medicare	$274.70

PLATE 6 HOLE B530

Facility

$535.20

Service Code	HCPCS C1713
Hospital Charge Code	64903278
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$561.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$294.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$321.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$267.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$307.74
Rate for Payer: EmblemHealth Commercial	$267.60
Rate for Payer: Fidelis Medicare Advantage	$561.96
Rate for Payer: Group Health Inc Commercial	$267.60
Rate for Payer: Group Health Inc Medicare	$187.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$267.60
Rate for Payer: Hamaspik Choice Inc Medicare	$267.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$347.88

PLATE 6 HOLE B530

Facility

$535.20

Service Code	HCPCS C1713
Hospital Charge Code	64903278
Hospital Revenue Code	278
Min. Negotiated Rate	$267.60
Max. Negotiated Rate	$267.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$267.60
Rate for Payer: Hamaspik Choice Inc Medicare	$267.60

PLATE 6 HOLE CHIN 4MM

Facility

$439.70

Service Code	HCPCS C1713
Hospital Charge Code	64903591
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$461.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$241.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$263.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$219.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$252.83
Rate for Payer: EmblemHealth Commercial	$219.85
Rate for Payer: Fidelis Medicare Advantage	$461.68
Rate for Payer: Group Health Inc Commercial	$219.85
Rate for Payer: Group Health Inc Medicare	$153.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$219.85
Rate for Payer: Hamaspik Choice Inc Medicare	$219.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$285.80

PLATE 6 HOLE CHIN 4MM

Facility

$439.70

Service Code	HCPCS C1713
Hospital Charge Code	64903591
Hospital Revenue Code	278
Min. Negotiated Rate	$219.85
Max. Negotiated Rate	$219.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$219.85
Rate for Payer: Hamaspik Choice Inc Medicare	$219.85

PLATE 6 HOLE CHIN 6MM

Facility

$439.70

Service Code	HCPCS C1713
Hospital Charge Code	64904725
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$461.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$241.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$263.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$219.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$252.83
Rate for Payer: EmblemHealth Commercial	$219.85
Rate for Payer: Fidelis Medicare Advantage	$461.68
Rate for Payer: Group Health Inc Commercial	$219.85
Rate for Payer: Group Health Inc Medicare	$153.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$219.85
Rate for Payer: Hamaspik Choice Inc Medicare	$219.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$285.80

PLATE 6 HOLE CHIN 6MM

Facility

$439.70

Service Code	HCPCS C1713
Hospital Charge Code	64904725
Hospital Revenue Code	278
Min. Negotiated Rate	$219.85
Max. Negotiated Rate	$219.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$219.85
Rate for Payer: Hamaspik Choice Inc Medicare	$219.85

PLATE 6-HOLE CURVED

Facility

$1,618.50

Service Code	HCPCS C1713
Hospital Charge Code	64901892
Hospital Revenue Code	278
Min. Negotiated Rate	$809.25
Max. Negotiated Rate	$809.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$809.25
Rate for Payer: Hamaspik Choice Inc Medicare	$809.25

PLATE 6-HOLE CURVED

Facility

$1,618.50

Service Code	HCPCS C1713
Hospital Charge Code	64901892
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,699.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$890.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$971.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$809.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$930.64
Rate for Payer: EmblemHealth Commercial	$809.25
Rate for Payer: Fidelis Medicare Advantage	$1,699.42
Rate for Payer: Group Health Inc Commercial	$809.25
Rate for Payer: Group Health Inc Medicare	$566.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$809.25
Rate for Payer: Hamaspik Choice Inc Medicare	$809.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,052.02

PLATE 6 HOLE LEFT

Facility

$2,100.00

Service Code	HCPCS C1713
Hospital Charge Code	40201270
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,205.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,155.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,260.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,050.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,207.50
Rate for Payer: EmblemHealth Commercial	$1,050.00
Rate for Payer: Fidelis Medicare Advantage	$2,205.00
Rate for Payer: Group Health Inc Commercial	$1,050.00
Rate for Payer: Group Health Inc Medicare	$735.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,050.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,365.00

PLATE 6 HOLE LEFT

Facility

$2,100.00

Service Code	HCPCS C1713
Hospital Charge Code	40201270
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,050.00

PLATE 6 HOLE ORTHO

Facility

$2,700.00

Service Code	HCPCS C1713
Hospital Charge Code	64907028
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,835.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,620.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,552.50
Rate for Payer: EmblemHealth Commercial	$1,350.00
Rate for Payer: Fidelis Medicare Advantage	$2,835.00
Rate for Payer: Group Health Inc Commercial	$1,350.00
Rate for Payer: Group Health Inc Medicare	$945.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,350.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,755.00

Know your out-of-pocket cost for care.

All Charges