St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE DBL Y 1.2MM 6H MCPLUSS

Facility

$292.50

Service Code	HCPCS C1713
Hospital Charge Code	64901215
Hospital Revenue Code	278
Min. Negotiated Rate	$102.38
Max. Negotiated Rate	$307.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$160.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$175.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$146.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$168.19
Rate for Payer: EmblemHealth Commercial	$146.25
Rate for Payer: Fidelis Medicare Advantage	$307.12
Rate for Payer: Group Health Inc Commercial	$146.25
Rate for Payer: Group Health Inc Medicare	$102.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.25
Rate for Payer: Hamaspik Choice Inc Medicare	$146.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$190.12

PLATE DBL-Y 6-HOLE 8MM LW PROF

Facility

$522.43

Service Code	HCPCS C1713
Hospital Charge Code	64901873
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$548.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$287.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$313.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$261.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$300.40
Rate for Payer: EmblemHealth Commercial	$261.22
Rate for Payer: Fidelis Medicare Advantage	$548.55
Rate for Payer: Group Health Inc Commercial	$261.22
Rate for Payer: Group Health Inc Medicare	$182.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$261.22
Rate for Payer: Hamaspik Choice Inc Medicare	$261.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$339.58

PLATE DBL-Y 6-HOLE 8MM LW PROF

Facility

$522.43

Service Code	HCPCS C1713
Hospital Charge Code	64901873
Hospital Revenue Code	278
Min. Negotiated Rate	$261.22
Max. Negotiated Rate	$261.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$261.22
Rate for Payer: Hamaspik Choice Inc Medicare	$261.22

PLATE DIS LAT RT FEMUR 8 HOLE

Facility

$6,022.40

Service Code	HCPCS C1713
Hospital Charge Code	64906788
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,323.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,312.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,613.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,011.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,462.88
Rate for Payer: EmblemHealth Commercial	$3,011.20
Rate for Payer: Fidelis Medicare Advantage	$6,323.52
Rate for Payer: Group Health Inc Commercial	$3,011.20
Rate for Payer: Group Health Inc Medicare	$2,107.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,011.20
Rate for Payer: Hamaspik Choice Inc Medicare	$3,011.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,914.56

PLATE DIS LAT RT FEMUR 8 HOLE

Facility

$6,022.40

Service Code	HCPCS C1713
Hospital Charge Code	64906788
Hospital Revenue Code	278
Min. Negotiated Rate	$3,011.20
Max. Negotiated Rate	$3,011.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,011.20
Rate for Payer: Hamaspik Choice Inc Medicare	$3,011.20

PLATE DISTAL ANT 6 HOLE / L127MM

Facility

$5,735.38

Service Code	HCPCS C1713
Hospital Charge Code	64905613
Hospital Revenue Code	278
Min. Negotiated Rate	$2,867.69
Max. Negotiated Rate	$2,867.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,867.69
Rate for Payer: Hamaspik Choice Inc Medicare	$2,867.69

PLATE DISTAL ANT 6 HOLE / L127MM

Facility

$5,735.38

Service Code	HCPCS C1713
Hospital Charge Code	64905613
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,022.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,154.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,441.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,867.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,297.84
Rate for Payer: EmblemHealth Commercial	$2,867.69
Rate for Payer: Fidelis Medicare Advantage	$6,022.15
Rate for Payer: Group Health Inc Commercial	$2,867.69
Rate for Payer: Group Health Inc Medicare	$2,007.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,867.69
Rate for Payer: Hamaspik Choice Inc Medicare	$2,867.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,728.00

PLATE DISTAL EXT L /R 3H/L69MM

Facility

$3,426.75

Service Code	HCPCS C1713
Hospital Charge Code	64905617
Hospital Revenue Code	278
Min. Negotiated Rate	$1,713.38
Max. Negotiated Rate	$1,713.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,713.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1,713.38

PLATE DISTAL EXT L /R 3H/L69MM

Facility

$3,426.75

Service Code	HCPCS C1713
Hospital Charge Code	64905617
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,598.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,884.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,056.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,713.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,970.38
Rate for Payer: EmblemHealth Commercial	$1,713.38
Rate for Payer: Fidelis Medicare Advantage	$3,598.09
Rate for Payer: Group Health Inc Commercial	$1,713.38
Rate for Payer: Group Health Inc Medicare	$1,199.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,713.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1,713.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,227.39

PLATE DISTAL FEM L

Facility

$7,669.25

Service Code	HCPCS C1713
Hospital Charge Code	64907464
Hospital Revenue Code	278
Min. Negotiated Rate	$3,834.62
Max. Negotiated Rate	$3,834.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,834.62
Rate for Payer: Hamaspik Choice Inc Medicare	$3,834.62

PLATE DISTAL FEM L

Facility

$7,669.25

Service Code	HCPCS C1713
Hospital Charge Code	64907464
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$8,052.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,218.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,601.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,834.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,409.82
Rate for Payer: EmblemHealth Commercial	$3,834.62
Rate for Payer: Fidelis Medicare Advantage	$8,052.71
Rate for Payer: Group Health Inc Commercial	$3,834.62
Rate for Payer: Group Health Inc Medicare	$2,684.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,834.62
Rate for Payer: Hamaspik Choice Inc Medicare	$3,834.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,985.01

PLATE DISTAL LATERAL FEMUR FOR2

Facility

$8,045.00

Service Code	HCPCS C1713
Hospital Charge Code	64903827
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$8,447.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,424.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,827.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,022.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,625.88
Rate for Payer: EmblemHealth Commercial	$4,022.50
Rate for Payer: Fidelis Medicare Advantage	$8,447.25
Rate for Payer: Group Health Inc Commercial	$4,022.50
Rate for Payer: Group Health Inc Medicare	$2,815.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,022.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,022.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,229.25

PLATE DISTAL LATERAL FEMUR FOR2

Facility

$8,045.00

Service Code	HCPCS C1713
Hospital Charge Code	64903827
Hospital Revenue Code	278
Min. Negotiated Rate	$4,022.50
Max. Negotiated Rate	$4,022.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,022.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,022.50

PLATE DISTAL LATERAL FEMUR FOR3

Facility

$10,295.00

Service Code	HCPCS C1713
Hospital Charge Code	64904087
Hospital Revenue Code	278
Min. Negotiated Rate	$5,147.50
Max. Negotiated Rate	$5,147.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,147.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5,147.50

PLATE DISTAL LATERAL FEMUR FOR3

Facility

$10,295.00

Service Code	HCPCS C1713
Hospital Charge Code	64904087
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$10,809.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,662.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$6,177.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,147.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,919.62
Rate for Payer: EmblemHealth Commercial	$5,147.50
Rate for Payer: Fidelis Medicare Advantage	$10,809.75
Rate for Payer: Group Health Inc Commercial	$5,147.50
Rate for Payer: Group Health Inc Medicare	$3,603.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,147.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5,147.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,691.75

PLATE DISTAL LATERAL FEMUR FOR4

Facility

$8,232.50

Service Code	HCPCS C1713
Hospital Charge Code	64904979
Hospital Revenue Code	278
Min. Negotiated Rate	$4,116.25
Max. Negotiated Rate	$4,116.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,116.25
Rate for Payer: Hamaspik Choice Inc Medicare	$4,116.25

PLATE DISTAL LATERAL FEMUR FOR4

Facility

$8,232.50

Service Code	HCPCS C1713
Hospital Charge Code	64904979
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$8,644.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,527.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,939.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,116.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,733.69
Rate for Payer: EmblemHealth Commercial	$4,116.25
Rate for Payer: Fidelis Medicare Advantage	$8,644.12
Rate for Payer: Group Health Inc Commercial	$4,116.25
Rate for Payer: Group Health Inc Medicare	$2,881.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,116.25
Rate for Payer: Hamaspik Choice Inc Medicare	$4,116.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,351.12

PLATE DISTAL MEDIAL HUMERUS LEF

Facility

$3,807.50

Service Code	HCPCS C1713
Hospital Charge Code	64904734
Hospital Revenue Code	278
Min. Negotiated Rate	$1,903.75
Max. Negotiated Rate	$1,903.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,903.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,903.75

PLATE DISTAL MEDIAL HUMERUS LEF

Facility

$3,807.50

Service Code	HCPCS C1713
Hospital Charge Code	64904734
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,997.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,094.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,284.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,903.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,189.31
Rate for Payer: EmblemHealth Commercial	$1,903.75
Rate for Payer: Fidelis Medicare Advantage	$3,997.88
Rate for Payer: Group Health Inc Commercial	$1,903.75
Rate for Payer: Group Health Inc Medicare	$1,332.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,903.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,903.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,474.88

PLATE DISTAL MEDIAL TIBIA FOR R

Facility

$7,112.50

Service Code	HCPCS C1713
Hospital Charge Code	64904202
Hospital Revenue Code	278
Min. Negotiated Rate	$3,556.25
Max. Negotiated Rate	$3,556.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,556.25
Rate for Payer: Hamaspik Choice Inc Medicare	$3,556.25

PLATE DISTAL MEDIAL TIBIA FOR R

Facility

$7,112.50

Service Code	HCPCS C1713
Hospital Charge Code	64904202
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$7,468.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,911.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,267.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,556.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,089.69
Rate for Payer: EmblemHealth Commercial	$3,556.25
Rate for Payer: Fidelis Medicare Advantage	$7,468.12
Rate for Payer: Group Health Inc Commercial	$3,556.25
Rate for Payer: Group Health Inc Medicare	$2,489.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,556.25
Rate for Payer: Hamaspik Choice Inc Medicare	$3,556.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,623.12

PLATE DISTAL RGT TIBIA 12H L203

Facility

$6,117.88

Service Code	HCPCS C1713
Hospital Charge Code	64905911
Hospital Revenue Code	278
Min. Negotiated Rate	$3,058.94
Max. Negotiated Rate	$3,058.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,058.94
Rate for Payer: Hamaspik Choice Inc Medicare	$3,058.94

PLATE DISTAL RGT TIBIA 12H L203

Facility

$6,117.88

Service Code	HCPCS C1713
Hospital Charge Code	64905911
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,423.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,364.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,670.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,058.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,517.78
Rate for Payer: EmblemHealth Commercial	$3,058.94
Rate for Payer: Fidelis Medicare Advantage	$6,423.77
Rate for Payer: Group Health Inc Commercial	$3,058.94
Rate for Payer: Group Health Inc Medicare	$2,141.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,058.94
Rate for Payer: Hamaspik Choice Inc Medicare	$3,058.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,976.62

PLATE DISTAL RIGHT TIB 10 HOLE

Facility

$6,597.50

Service Code	HCPCS C1713
Hospital Charge Code	64905467
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 DISTAL RIGHT TIB 10 HOLE

Facility

$6,597.50

Service Code	HCPCS C1713
Hospital Charge Code	64905467
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

Know your out-of-pocket cost for care.

All Charges