St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

PLATE 6 HOLE ST SAG 12MM BAR

Facility

$549.40

Service Code	HCPCS C1713
Hospital Charge Code	64903325
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 ST SAG 12MM BAR

Facility

$549.40

Service Code	HCPCS C1713
Hospital Charge Code	64903325
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 V3 VAR

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	64904548
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$562.50
Rate for Payer: Hamaspik Choice Inc Medicare	$562.50

PLATE 6 HOLE V3 VAR

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	64904548
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,181.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$618.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$675.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$562.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$646.88
Rate for Payer: EmblemHealth Commercial	$562.50
Rate for Payer: Fidelis Medicare Advantage	$1,181.25
Rate for Payer: Group Health Inc Commercial	$562.50
Rate for Payer: Group Health Inc Medicare	$393.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$562.50
Rate for Payer: Hamaspik Choice Inc Medicare	$562.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$731.25

PLATE 6H STRT W/BAR,MAND, LOCK

Facility

$459.35

Service Code	HCPCS C1713
Hospital Charge Code	64901479
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$482.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$252.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$275.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$229.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$264.13
Rate for Payer: EmblemHealth Commercial	$229.68
Rate for Payer: Fidelis Medicare Advantage	$482.32
Rate for Payer: Group Health Inc Commercial	$229.68
Rate for Payer: Group Health Inc Medicare	$160.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$229.68
Rate for Payer: Hamaspik Choice Inc Medicare	$229.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$298.58

PLATE 6H STRT W/BAR,MAND, LOCK

Facility

$459.35

Service Code	HCPCS C1713
Hospital Charge Code	64901479
Hospital Revenue Code	278
Min. Negotiated Rate	$229.68
Max. Negotiated Rate	$229.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$229.68
Rate for Payer: Hamaspik Choice Inc Medicare	$229.68

PLATE .75MM 12LOCH STEINH GEB

Facility

$614.60

Service Code	HCPCS C1713
Hospital Charge Code	64902015
Hospital Revenue Code	278
Min. Negotiated Rate	$307.30
Max. Negotiated Rate	$307.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$307.30
Rate for Payer: Hamaspik Choice Inc Medicare	$307.30

PLATE .75MM 12LOCH STEINH GEB

Facility

$614.60

Service Code	HCPCS C1713
Hospital Charge Code	64902015
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$645.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$338.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$368.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$307.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$353.40
Rate for Payer: EmblemHealth Commercial	$307.30
Rate for Payer: Fidelis Medicare Advantage	$645.33
Rate for Payer: Group Health Inc Commercial	$307.30
Rate for Payer: Group Health Inc Medicare	$215.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$307.30
Rate for Payer: Hamaspik Choice Inc Medicare	$307.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$399.49

PLATE .75MM 9LOCH STEINH LPLT

Facility

$725.08

Service Code	HCPCS C1713
Hospital Charge Code	64902014
Hospital Revenue Code	278
Min. Negotiated Rate	$362.54
Max. Negotiated Rate	$362.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$362.54
Rate for Payer: Hamaspik Choice Inc Medicare	$362.54

PLATE .75MM 9LOCH STEINH LPLT

Facility

$725.08

Service Code	HCPCS C1713
Hospital Charge Code	64902014
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$761.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$398.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$435.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$362.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$416.92
Rate for Payer: EmblemHealth Commercial	$362.54
Rate for Payer: Fidelis Medicare Advantage	$761.33
Rate for Payer: Group Health Inc Commercial	$362.54
Rate for Payer: Group Health Inc Medicare	$253.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$362.54
Rate for Payer: Hamaspik Choice Inc Medicare	$362.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$471.30

PLATE 7 HOLE COMP

Facility

$178.00

Service Code	HCPCS C1713
Hospital Charge Code	40201405
Hospital Revenue Code	278
Min. Negotiated Rate	$89.00
Max. Negotiated Rate	$89.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.00
Rate for Payer: Hamaspik Choice Inc Medicare	$89.00

PLATE 7 HOLE COMP

Facility

$178.00

Service Code	HCPCS C1713
Hospital Charge Code	40201405
Hospital Revenue Code	278
Min. Negotiated Rate	$62.30
Max. Negotiated Rate	$186.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$97.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$106.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$89.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.35
Rate for Payer: EmblemHealth Commercial	$89.00
Rate for Payer: Fidelis Medicare Advantage	$186.90
Rate for Payer: Group Health Inc Commercial	$89.00
Rate for Payer: Group Health Inc Medicare	$62.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.00
Rate for Payer: Hamaspik Choice Inc Medicare	$89.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$115.70

PLATE 7HOLE COMPRESSION (627507)

Facility

$2,045.00

Service Code	HCPCS C1713
Hospital Charge Code	64906390
Hospital Revenue Code	278
Min. Negotiated Rate	$1,022.50
Max. Negotiated Rate	$1,022.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,022.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,022.50

PLATE 7HOLE COMPRESSION (627507)

Facility

$2,045.00

Service Code	HCPCS C1713
Hospital Charge Code	64906390
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,147.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,124.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,227.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,022.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,175.88
Rate for Payer: EmblemHealth Commercial	$1,022.50
Rate for Payer: Fidelis Medicare Advantage	$2,147.25
Rate for Payer: Group Health Inc Commercial	$1,022.50
Rate for Payer: Group Health Inc Medicare	$715.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,022.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,022.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,329.25

PLATE 7 HOLE DBL Y UPFC MLBL

Facility

$394.30

Service Code	HCPCS C1713
Hospital Charge Code	64901532
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$414.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$216.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$236.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$197.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$226.72
Rate for Payer: EmblemHealth Commercial	$197.15
Rate for Payer: Fidelis Medicare Advantage	$414.02
Rate for Payer: Group Health Inc Commercial	$197.15
Rate for Payer: Group Health Inc Medicare	$138.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$197.15
Rate for Payer: Hamaspik Choice Inc Medicare	$197.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$256.30

PLATE 7 HOLE DBL Y UPFC MLBL

Facility

$394.30

Service Code	HCPCS C1713
Hospital Charge Code	64901532
Hospital Revenue Code	278
Min. Negotiated Rate	$197.15
Max. Negotiated Rate	$197.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$197.15
Rate for Payer: Hamaspik Choice Inc Medicare	$197.15

PLATE 7 HOLE DBL Y UPPERFACE

Facility

$357.73

Service Code	HCPCS C1713
Hospital Charge Code	64901540
Hospital Revenue Code	278
Min. Negotiated Rate	$178.86
Max. Negotiated Rate	$178.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$178.86
Rate for Payer: Hamaspik Choice Inc Medicare	$178.86

PLATE 7 HOLE DBL Y UPPERFACE

Facility

$357.73

Service Code	HCPCS C1713
Hospital Charge Code	64901540
Hospital Revenue Code	278
Min. Negotiated Rate	$125.21
Max. Negotiated Rate	$375.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$196.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$214.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$178.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$205.69
Rate for Payer: EmblemHealth Commercial	$178.86
Rate for Payer: Fidelis Medicare Advantage	$375.62
Rate for Payer: Group Health Inc Commercial	$178.86
Rate for Payer: Group Health Inc Medicare	$125.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$178.86
Rate for Payer: Hamaspik Choice Inc Medicare	$178.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$232.52

PLATE 7 HOLE NARROW

Facility

$1,655.00

Service Code	HCPCS C1713
Hospital Charge Code	64904071
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,737.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$910.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$993.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$827.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$951.62
Rate for Payer: EmblemHealth Commercial	$827.50
Rate for Payer: Fidelis Medicare Advantage	$1,737.75
Rate for Payer: Group Health Inc Commercial	$827.50
Rate for Payer: Group Health Inc Medicare	$579.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$827.50
Rate for Payer: Hamaspik Choice Inc Medicare	$827.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,075.75

PLATE 7 HOLE NARROW

Facility

$1,655.00

Service Code	HCPCS C1713
Hospital Charge Code	64904071
Hospital Revenue Code	278
Min. Negotiated Rate	$827.50
Max. Negotiated Rate	$827.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$827.50
Rate for Payer: Hamaspik Choice Inc Medicare	$827.50

PLATE 7HOLE ORTHO

Facility

$2,950.00

Service Code	HCPCS C1713
Hospital Charge Code	64907042
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,097.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,622.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,770.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,475.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,696.25
Rate for Payer: EmblemHealth Commercial	$1,475.00
Rate for Payer: Fidelis Medicare Advantage	$3,097.50
Rate for Payer: Group Health Inc Commercial	$1,475.00
Rate for Payer: Group Health Inc Medicare	$1,032.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,475.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,475.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,917.50

PLATE 7HOLE ORTHO

Facility

$2,950.00

Service Code	HCPCS C1713
Hospital Charge Code	64907042
Hospital Revenue Code	278
Min. Negotiated Rate	$1,475.00
Max. Negotiated Rate	$1,475.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,475.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,475.00

PLATE 7 HOLE TAB

Facility

$956.25

Service Code	HCPCS C1713
Hospital Charge Code	64904876
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 7 HOLE TAB

Facility

$956.25

Service Code	HCPCS C1713
Hospital Charge Code	64904876
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