St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE ANATOMICAL LEFT

Facility

$1,950.00

Service Code	HCPCS C1713
Hospital Charge Code	64901780
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$975.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00

PLATE ANATOMICAL LEFT

Facility

$1,950.00

Service Code	HCPCS C1713
Hospital Charge Code	64901780
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,047.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,072.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,170.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$975.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,121.25
Rate for Payer: EmblemHealth Commercial	$975.00
Rate for Payer: Fidelis Medicare Advantage	$2,047.50
Rate for Payer: Group Health Inc Commercial	$975.00
Rate for Payer: Group Health Inc Medicare	$682.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,267.50

PLATE ANATOMICAL SHORT NARROW

Facility

$1,440.60

Service Code	HCPCS C1713
Hospital Charge Code	40201271
Hospital Revenue Code	278
Min. Negotiated Rate	$720.30
Max. Negotiated Rate	$720.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$720.30
Rate for Payer: Hamaspik Choice Inc Medicare	$720.30

PLATE ANATOMICAL SHORT NARROW

Facility

$1,512.00

Service Code	HCPCS C1713
Hospital Charge Code	40205645
Hospital Revenue Code	278
Min. Negotiated Rate	$756.00
Max. Negotiated Rate	$756.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$756.00
Rate for Payer: Hamaspik Choice Inc Medicare	$756.00

PLATE ANATOMICAL SHORT NARROW

Facility

$1,512.00

Service Code	HCPCS C1713
Hospital Charge Code	40205645
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,587.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$831.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$907.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$756.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$869.40
Rate for Payer: EmblemHealth Commercial	$756.00
Rate for Payer: Fidelis Medicare Advantage	$1,587.60
Rate for Payer: Group Health Inc Commercial	$756.00
Rate for Payer: Group Health Inc Medicare	$529.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$756.00
Rate for Payer: Hamaspik Choice Inc Medicare	$756.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$982.80

PLATE ANATOMICAL SHORT NARROW

Facility

$1,440.60

Service Code	HCPCS C1713
Hospital Charge Code	40201271
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,512.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$792.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$864.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$720.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$828.34
Rate for Payer: EmblemHealth Commercial	$720.30
Rate for Payer: Fidelis Medicare Advantage	$1,512.63
Rate for Payer: Group Health Inc Commercial	$720.30
Rate for Payer: Group Health Inc Medicare	$504.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$720.30
Rate for Payer: Hamaspik Choice Inc Medicare	$720.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$936.39

PLATE ANCHORAGE LAP LS ST 0MM

Facility

$5,357.50

Service Code	HCPCS C1713
Hospital Charge Code	64905675
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,625.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,946.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,214.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,678.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,080.56
Rate for Payer: EmblemHealth Commercial	$2,678.75
Rate for Payer: Fidelis Medicare Advantage	$5,625.38
Rate for Payer: Group Health Inc Commercial	$2,678.75
Rate for Payer: Group Health Inc Medicare	$1,875.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,678.75
Rate for Payer: Hamaspik Choice Inc Medicare	$2,678.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,482.38

PLATE ANCHORAGE LAP LS ST 0MM

Facility

$5,357.50

Service Code	HCPCS C1713
Hospital Charge Code	64905675
Hospital Revenue Code	278
Min. Negotiated Rate	$2,678.75
Max. Negotiated Rate	$2,678.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,678.75
Rate for Payer: Hamaspik Choice Inc Medicare	$2,678.75

PLATE ANG COMP 2.3MM COM 6H TIT

Facility

$1,242.00

Service Code	HCPCS C1713
Hospital Charge Code	40200721
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,304.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$683.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$745.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$621.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$714.15
Rate for Payer: EmblemHealth Commercial	$621.00
Rate for Payer: Fidelis Medicare Advantage	$1,304.10
Rate for Payer: Group Health Inc Commercial	$621.00
Rate for Payer: Group Health Inc Medicare	$434.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$621.00
Rate for Payer: Hamaspik Choice Inc Medicare	$621.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$807.30

PLATE ANG COMP 2.3MM COM 6H TIT

Facility

$1,242.00

Service Code	HCPCS C1713
Hospital Charge Code	40200721
Hospital Revenue Code	278
Min. Negotiated Rate	$621.00
Max. Negotiated Rate	$621.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$621.00
Rate for Payer: Hamaspik Choice Inc Medicare	$621.00

PLATE ANTE TIB LEFT 12 HOLE

Facility

$6,597.50

Service Code	HCPCS C1713
Hospital Charge Code	64905470
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,927.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,628.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,958.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,298.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,793.56
Rate for Payer: EmblemHealth Commercial	$3,298.75
Rate for Payer: Fidelis Medicare Advantage	$6,927.38
Rate for Payer: Group Health Inc Commercial	$3,298.75
Rate for Payer: Group Health Inc Medicare	$2,309.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,298.75
Rate for Payer: Hamaspik Choice Inc Medicare	$3,298.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,288.38

PLATE ANTE TIB LEFT 12 HOLE

Facility

$6,597.50

Service Code	HCPCS C1713
Hospital Charge Code	64905470
Hospital Revenue Code	278
Min. Negotiated Rate	$3,298.75
Max. Negotiated Rate	$3,298.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,298.75
Rate for Payer: Hamaspik Choice Inc Medicare	$3,298.75

PLATE ARCHON , 18MM I-LEVEL

Facility

$3,125.00

Service Code	HCPCS C1713
Hospital Charge Code	64905421
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 ARCHON , 18MM I-LEVEL

Facility

$3,125.00

Service Code	HCPCS C1713
Hospital Charge Code	64905421
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

PLATE ARCHON , 60MM 3LEV

Facility

$3,872.50

Service Code	HCPCS C1713
Hospital Charge Code	64905278
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,066.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,129.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,323.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,936.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,226.69
Rate for Payer: EmblemHealth Commercial	$1,936.25
Rate for Payer: Fidelis Medicare Advantage	$4,066.12
Rate for Payer: Group Health Inc Commercial	$1,936.25
Rate for Payer: Group Health Inc Medicare	$1,355.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,936.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,936.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,517.12

PLATE ARCHON , 60MM 3LEV

Facility

$3,872.50

Service Code	HCPCS C1713
Hospital Charge Code	64905278
Hospital Revenue Code	278
Min. Negotiated Rate	$1,936.25
Max. Negotiated Rate	$1,936.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,936.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,936.25

PLATE, ARNETTE MED 0.8 C

Facility

$480.90

Service Code	HCPCS C1713
Hospital Charge Code	64905709
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$504.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$264.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$288.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$240.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$276.52
Rate for Payer: EmblemHealth Commercial	$240.45
Rate for Payer: Fidelis Medicare Advantage	$504.94
Rate for Payer: Group Health Inc Commercial	$240.45
Rate for Payer: Group Health Inc Medicare	$168.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$240.45
Rate for Payer: Hamaspik Choice Inc Medicare	$240.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$312.58

PLATE, ARNETTE MED 0.8 C

Facility

$480.90

Service Code	HCPCS C1713
Hospital Charge Code	64905709
Hospital Revenue Code	278
Min. Negotiated Rate	$240.45
Max. Negotiated Rate	$240.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$240.45
Rate for Payer: Hamaspik Choice Inc Medicare	$240.45

PLATE, ARNETTE MED 0.8 L

Facility

$480.90

Service Code	HCPCS C1713
Hospital Charge Code	64905712
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$504.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$264.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$288.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$240.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$276.52
Rate for Payer: EmblemHealth Commercial	$240.45
Rate for Payer: Fidelis Medicare Advantage	$504.94
Rate for Payer: Group Health Inc Commercial	$240.45
Rate for Payer: Group Health Inc Medicare	$168.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$240.45
Rate for Payer: Hamaspik Choice Inc Medicare	$240.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$312.58

PLATE, ARNETTE MED 0.8 L

Facility

$480.90

Service Code	HCPCS C1713
Hospital Charge Code	64905712
Hospital Revenue Code	278
Min. Negotiated Rate	$240.45
Max. Negotiated Rate	$240.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$240.45
Rate for Payer: Hamaspik Choice Inc Medicare	$240.45

PLATE, ARNETTE SM 0.8 L

Facility

$480.90

Service Code	HCPCS C1713
Hospital Charge Code	64905711
Hospital Revenue Code	278
Min. Negotiated Rate	$240.45
Max. Negotiated Rate	$240.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$240.45
Rate for Payer: Hamaspik Choice Inc Medicare	$240.45

PLATE, ARNETTE SM 0.8 L

Facility

$480.90

Service Code	HCPCS C1713
Hospital Charge Code	64905711
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$504.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$264.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$288.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$240.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$276.52
Rate for Payer: EmblemHealth Commercial	$240.45
Rate for Payer: Fidelis Medicare Advantage	$504.94
Rate for Payer: Group Health Inc Commercial	$240.45
Rate for Payer: Group Health Inc Medicare	$168.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$240.45
Rate for Payer: Hamaspik Choice Inc Medicare	$240.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$312.58

PLATE AVIATOR

Facility

$4,389.38

Service Code	HCPCS C1713
Hospital Charge Code	64907492
Hospital Revenue Code	278
Min. Negotiated Rate	$2,194.69
Max. Negotiated Rate	$2,194.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,194.69
Rate for Payer: Hamaspik Choice Inc Medicare	$2,194.69

PLATE AVIATOR

Facility

$4,389.38

Service Code	HCPCS C1713
Hospital Charge Code	64907492
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,608.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,414.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,633.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,194.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,523.89
Rate for Payer: EmblemHealth Commercial	$2,194.69
Rate for Payer: Fidelis Medicare Advantage	$4,608.85
Rate for Payer: Group Health Inc Commercial	$2,194.69
Rate for Payer: Group Health Inc Medicare	$1,536.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,194.69
Rate for Payer: Hamaspik Choice Inc Medicare	$2,194.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,853.10

PLATE AVIATOR 12MM

Facility

$2,291.25

Service Code	HCPCS C1713
Hospital Charge Code	64906230
Hospital Revenue Code	278
Min. Negotiated Rate	$1,145.62
Max. Negotiated Rate	$1,145.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,145.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,145.62

Know your out-of-pocket cost for care.

All Charges