St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE 7 HOLE Y ORTHO 6984

Facility

$3,048.00

Service Code	HCPCS C1713
Hospital Charge Code	64906777
Hospital Revenue Code	278
Min. Negotiated Rate	$1,524.00
Max. Negotiated Rate	$1,524.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,524.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,524.00

PLATE 7 HOLE Y ORTHO 6984

Facility

$3,048.00

Service Code	HCPCS C1713
Hospital Charge Code	64906777
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,200.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,676.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,828.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,524.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,752.60
Rate for Payer: EmblemHealth Commercial	$1,524.00
Rate for Payer: Fidelis Medicare Advantage	$3,200.40
Rate for Payer: Group Health Inc Commercial	$1,524.00
Rate for Payer: Group Health Inc Medicare	$1,066.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,524.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,524.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,981.20

PLATE 7MM

Facility

$6,575.00

Service Code	HCPCS C1713
Hospital Charge Code	64904835
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,903.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,616.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,945.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,287.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,780.62
Rate for Payer: EmblemHealth Commercial	$3,287.50
Rate for Payer: Fidelis Medicare Advantage	$6,903.75
Rate for Payer: Group Health Inc Commercial	$3,287.50
Rate for Payer: Group Health Inc Medicare	$2,301.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,287.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,287.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,273.75

PLATE 7MM

Facility

$6,575.00

Service Code	HCPCS C1713
Hospital Charge Code	64904835
Hospital Revenue Code	278
Min. Negotiated Rate	$3,287.50
Max. Negotiated Rate	$3,287.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,287.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,287.50

PLATE 8 HOLE

Facility

$1,004.00

Service Code	HCPCS C1713
Hospital Charge Code	40200720
Hospital Revenue Code	278
Min. Negotiated Rate	$502.00
Max. Negotiated Rate	$502.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$502.00
Rate for Payer: Hamaspik Choice Inc Medicare	$502.00

PLATE 8 HOLE

Facility

$1,004.00

Service Code	HCPCS C1713
Hospital Charge Code	40200720
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,054.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$552.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$602.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$502.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$577.30
Rate for Payer: EmblemHealth Commercial	$502.00
Rate for Payer: Fidelis Medicare Advantage	$1,054.20
Rate for Payer: Group Health Inc Commercial	$502.00
Rate for Payer: Group Health Inc Medicare	$351.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$502.00
Rate for Payer: Hamaspik Choice Inc Medicare	$502.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$652.60

PLATE 8 HOLE COMPRESSION

Facility

$2,550.00

Service Code	HCPCS C1713
Hospital Charge Code	64904714
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,677.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,402.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,530.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,275.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,466.25
Rate for Payer: EmblemHealth Commercial	$1,275.00
Rate for Payer: Fidelis Medicare Advantage	$2,677.50
Rate for Payer: Group Health Inc Commercial	$1,275.00
Rate for Payer: Group Health Inc Medicare	$892.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,275.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,657.50

PLATE 8 HOLE COMPRESSION

Facility

$2,550.00

Service Code	HCPCS C1713
Hospital Charge Code	64904714
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$1,275.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,275.00

PLATE 8 HOLE L 90D LFT UPPERFC

Facility

$343.88

Service Code	HCPCS C1713
Hospital Charge Code	64901538
Hospital Revenue Code	278
Min. Negotiated Rate	$120.36
Max. Negotiated Rate	$361.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$189.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$206.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$171.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$197.73
Rate for Payer: EmblemHealth Commercial	$171.94
Rate for Payer: Fidelis Medicare Advantage	$361.07
Rate for Payer: Group Health Inc Commercial	$171.94
Rate for Payer: Group Health Inc Medicare	$120.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$171.94
Rate for Payer: Hamaspik Choice Inc Medicare	$171.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$223.52

PLATE 8 HOLE L 90D LFT UPPERFC

Facility

$343.88

Service Code	HCPCS C1713
Hospital Charge Code	64901538
Hospital Revenue Code	278
Min. Negotiated Rate	$171.94
Max. Negotiated Rate	$171.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$171.94
Rate for Payer: Hamaspik Choice Inc Medicare	$171.94

PLATE 8 HOLE L95 ONE THIRD

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	64905015
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 8 HOLE L95 ONE THIRD

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	64905015
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 8-HOLE LOW PROF W/O BAR

Facility

$338.73

Service Code	HCPCS C1713
Hospital Charge Code	64901877
Hospital Revenue Code	278
Min. Negotiated Rate	$118.56
Max. Negotiated Rate	$355.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$203.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$169.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$194.77
Rate for Payer: EmblemHealth Commercial	$169.36
Rate for Payer: Fidelis Medicare Advantage	$355.67
Rate for Payer: Group Health Inc Commercial	$169.36
Rate for Payer: Group Health Inc Medicare	$118.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.36
Rate for Payer: Hamaspik Choice Inc Medicare	$169.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$220.17

PLATE 8-HOLE LOW PROF W/O BAR

Facility

$338.73

Service Code	HCPCS C1713
Hospital Charge Code	64901877
Hospital Revenue Code	278
Min. Negotiated Rate	$169.36
Max. Negotiated Rate	$169.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.36
Rate for Payer: Hamaspik Choice Inc Medicare	$169.36

PLATE 8 HOLE MIDFACE

Facility

$507.60

Service Code	HCPCS C1713
Hospital Charge Code	64901558
Hospital Revenue Code	278
Min. Negotiated Rate	$253.80
Max. Negotiated Rate	$253.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$253.80
Rate for Payer: Hamaspik Choice Inc Medicare	$253.80

PLATE 8 HOLE MIDFACE

Facility

$507.60

Service Code	HCPCS C1713
Hospital Charge Code	64901558
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$532.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$279.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$304.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$253.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$291.87
Rate for Payer: EmblemHealth Commercial	$253.80
Rate for Payer: Fidelis Medicare Advantage	$532.98
Rate for Payer: Group Health Inc Commercial	$253.80
Rate for Payer: Group Health Inc Medicare	$177.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$253.80
Rate for Payer: Hamaspik Choice Inc Medicare	$253.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$329.94

PLATE 8 HOLE T

Facility

$2,950.00

Service Code	HCPCS C1713
Hospital Charge Code	64906956
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 8 HOLE T

Facility

$2,950.00

Service Code	HCPCS C1713
Hospital Charge Code	64906956
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 90DEG L 8HOLE

Facility

$343.88

Service Code	HCPCS C1713
Hospital Charge Code	64905498
Hospital Revenue Code	278
Min. Negotiated Rate	$171.94
Max. Negotiated Rate	$171.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$171.94
Rate for Payer: Hamaspik Choice Inc Medicare	$171.94

PLATE 90DEG L 8HOLE

Facility

$343.88

Service Code	HCPCS C1713
Hospital Charge Code	64905498
Hospital Revenue Code	278
Min. Negotiated Rate	$120.36
Max. Negotiated Rate	$361.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$189.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$206.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$171.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$197.73
Rate for Payer: EmblemHealth Commercial	$171.94
Rate for Payer: Fidelis Medicare Advantage	$361.07
Rate for Payer: Group Health Inc Commercial	$171.94
Rate for Payer: Group Health Inc Medicare	$120.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$171.94
Rate for Payer: Hamaspik Choice Inc Medicare	$171.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$223.52

PLATE 9HOLE ORTHO

Facility

$7,740.00

Service Code	HCPCS C1713
Hospital Charge Code	64907016
Hospital Revenue Code	278
Min. Negotiated Rate	$3,870.00
Max. Negotiated Rate	$3,870.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,870.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,870.00

PLATE 9HOLE ORTHO

Facility

$7,740.00

Service Code	HCPCS C1713
Hospital Charge Code	64907016
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$8,127.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,257.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,644.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,870.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,450.50
Rate for Payer: EmblemHealth Commercial	$3,870.00
Rate for Payer: Fidelis Medicare Advantage	$8,127.00
Rate for Payer: Group Health Inc Commercial	$3,870.00
Rate for Payer: Group Health Inc Medicare	$2,709.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,870.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,870.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,031.00

PLATE ABRASIVE BURR, 42MM

Facility

$446.00

Hospital Charge Code	40202146
Hospital Revenue Code	270
Min. Negotiated Rate	$156.10
Max. Negotiated Rate	$356.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$245.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$223.00
Rate for Payer: Aetna Government	$223.00
Rate for Payer: Brighton Health Commercial	$334.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$356.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$303.28
Rate for Payer: Group Health Inc Commercial	$223.00
Rate for Payer: Group Health Inc Medicare	$156.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$223.00
Rate for Payer: Hamaspik Choice Inc Medicare	$223.00

PLATE ANAT DIST LT

Facility

$3,125.00

Service Code	HCPCS C1713
Hospital Charge Code	64907481
Hospital Revenue Code	278
Min. Negotiated Rate	$1,562.50
Max. Negotiated Rate	$1,562.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,562.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,562.50

PLATE ANAT DIST LT

Facility

$3,125.00

Service Code	HCPCS C1713
Hospital Charge Code	64907481
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,281.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,718.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,875.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,562.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,796.88
Rate for Payer: EmblemHealth Commercial	$1,562.50
Rate for Payer: Fidelis Medicare Advantage	$3,281.25
Rate for Payer: Group Health Inc Commercial	$1,562.50
Rate for Payer: Group Health Inc Medicare	$1,093.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,562.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,562.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,031.25

Know your out-of-pocket cost for care.

All Charges