St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE DISTAL TIB L

Facility

$5,501.50

Service Code	HCPCS C1713
Hospital Charge Code	64907462
Hospital Revenue Code	278
Min. Negotiated Rate	$2,750.75
Max. Negotiated Rate	$2,750.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,750.75
Rate for Payer: Hamaspik Choice Inc Medicare	$2,750.75

PLATE DISTAL TIB L

Facility

$5,501.50

Service Code	HCPCS C1713
Hospital Charge Code	64907462
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,776.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,025.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,300.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,750.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,163.36
Rate for Payer: EmblemHealth Commercial	$2,750.75
Rate for Payer: Fidelis Medicare Advantage	$5,776.58
Rate for Payer: Group Health Inc Commercial	$2,750.75
Rate for Payer: Group Health Inc Medicare	$1,925.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,750.75
Rate for Payer: Hamaspik Choice Inc Medicare	$2,750.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,575.98

PLATE DIST HUMERUS LAT 6 HOLE

Facility

$1,527.90

Service Code	HCPCS C1713
Hospital Charge Code	64906807
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,604.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$840.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$916.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$763.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$878.54
Rate for Payer: EmblemHealth Commercial	$763.95
Rate for Payer: Fidelis Medicare Advantage	$1,604.30
Rate for Payer: Group Health Inc Commercial	$763.95
Rate for Payer: Group Health Inc Medicare	$534.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$763.95
Rate for Payer: Hamaspik Choice Inc Medicare	$763.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$993.14

PLATE DIST HUMERUS LAT 6 HOLE

Facility

$1,527.90

Service Code	HCPCS C1713
Hospital Charge Code	64906807
Hospital Revenue Code	278
Min. Negotiated Rate	$763.95
Max. Negotiated Rate	$763.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$763.95
Rate for Payer: Hamaspik Choice Inc Medicare	$763.95

PLATE DIST HUMERUS MED 6 HOLE

Facility

$1,527.90

Service Code	HCPCS C1713
Hospital Charge Code	64906806
Hospital Revenue Code	278
Min. Negotiated Rate	$763.95
Max. Negotiated Rate	$763.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$763.95
Rate for Payer: Hamaspik Choice Inc Medicare	$763.95

PLATE DIST HUMERUS MED 6 HOLE

Facility

$1,527.90

Service Code	HCPCS C1713
Hospital Charge Code	64906806
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,604.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$840.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$916.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$763.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$878.54
Rate for Payer: EmblemHealth Commercial	$763.95
Rate for Payer: Fidelis Medicare Advantage	$1,604.30
Rate for Payer: Group Health Inc Commercial	$763.95
Rate for Payer: Group Health Inc Medicare	$534.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$763.95
Rate for Payer: Hamaspik Choice Inc Medicare	$763.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$993.14

PLATE DIST LAT 20H

Facility

$7,669.25

Service Code	HCPCS C1889
Hospital Charge Code	64907528
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 DIST LAT 20H

Facility

$7,669.25

Service Code	HCPCS C1889
Hospital Charge Code	64907528
Hospital Revenue Code	278
Min. Negotiated Rate	$2,684.24
Max. Negotiated Rate	$8,052.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,218.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,834.62
Rate for Payer: Aetna Government	$3,834.62
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 DIST RAD NRW GMN

Facility

$2,090.00

Service Code	HCPCS C1713
Hospital Charge Code	64906930
Hospital Revenue Code	278
Min. Negotiated Rate	$1,045.00
Max. Negotiated Rate	$1,045.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,045.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,045.00

PLATE DIST RAD NRW GMN

Facility

$2,090.00

Service Code	HCPCS C1713
Hospital Charge Code	64906930
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,194.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,149.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,254.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,045.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,201.75
Rate for Payer: EmblemHealth Commercial	$1,045.00
Rate for Payer: Fidelis Medicare Advantage	$2,194.50
Rate for Payer: Group Health Inc Commercial	$1,045.00
Rate for Payer: Group Health Inc Medicare	$731.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,045.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,045.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,358.50

PLATE DIST RAD STD GMN

Facility

$2,090.00

Service Code	HCPCS C1713
Hospital Charge Code	64906931
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,194.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,149.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,254.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,045.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,201.75
Rate for Payer: EmblemHealth Commercial	$1,045.00
Rate for Payer: Fidelis Medicare Advantage	$2,194.50
Rate for Payer: Group Health Inc Commercial	$1,045.00
Rate for Payer: Group Health Inc Medicare	$731.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,045.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,045.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,358.50

PLATE DIST RAD STD GMN

Facility

$2,090.00

Service Code	HCPCS C1713
Hospital Charge Code	64906931
Hospital Revenue Code	278
Min. Negotiated Rate	$1,045.00
Max. Negotiated Rate	$1,045.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,045.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,045.00

PLATE DIST RAD WIDE GMN

Facility

$2,090.00

Service Code	HCPCS C1713
Hospital Charge Code	64906932
Hospital Revenue Code	278
Min. Negotiated Rate	$1,045.00
Max. Negotiated Rate	$1,045.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,045.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,045.00

PLATE DIST RAD WIDE GMN

Facility

$2,090.00

Service Code	HCPCS C1713
Hospital Charge Code	64906932
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,194.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,149.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,254.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,045.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,201.75
Rate for Payer: EmblemHealth Commercial	$1,045.00
Rate for Payer: Fidelis Medicare Advantage	$2,194.50
Rate for Payer: Group Health Inc Commercial	$1,045.00
Rate for Payer: Group Health Inc Medicare	$731.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,045.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,045.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,358.50

PLATE DIST TIB LFT 10HOLE L175MM

Facility

$4,285.20

Service Code	HCPCS C1713
Hospital Charge Code	64906785
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,499.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,356.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,571.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,142.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,463.99
Rate for Payer: EmblemHealth Commercial	$2,142.60
Rate for Payer: Fidelis Medicare Advantage	$4,499.46
Rate for Payer: Group Health Inc Commercial	$2,142.60
Rate for Payer: Group Health Inc Medicare	$1,499.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,142.60
Rate for Payer: Hamaspik Choice Inc Medicare	$2,142.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,785.38

PLATE DIST TIB LFT 10HOLE L175MM

Facility

$4,285.20

Service Code	HCPCS C1713
Hospital Charge Code	64906785
Hospital Revenue Code	278
Min. Negotiated Rate	$2,142.60
Max. Negotiated Rate	$2,142.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,142.60
Rate for Payer: Hamaspik Choice Inc Medicare	$2,142.60

PLATE DORSH

Facility

$1,676.68

Service Code	HCPCS C1713
Hospital Charge Code	64907181
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,760.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$922.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,006.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$838.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$964.09
Rate for Payer: EmblemHealth Commercial	$838.34
Rate for Payer: Fidelis Medicare Advantage	$1,760.51
Rate for Payer: Group Health Inc Commercial	$838.34
Rate for Payer: Group Health Inc Medicare	$586.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$838.34
Rate for Payer: Hamaspik Choice Inc Medicare	$838.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,089.84

PLATE DORSH

Facility

$1,676.68

Service Code	HCPCS C1713
Hospital Charge Code	64907181
Hospital Revenue Code	278
Min. Negotiated Rate	$838.34
Max. Negotiated Rate	$838.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$838.34
Rate for Payer: Hamaspik Choice Inc Medicare	$838.34

PLATE, DOUBLE Y, 7 HOLE CMF

Facility

$357.73

Service Code	HCPCS C1713
Hospital Charge Code	64905589
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, DOUBLE Y, 7 HOLE CMF

Facility

$357.73

Service Code	HCPCS C1713
Hospital Charge Code	64905589
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, DOUBLE Y, 7 HOLE CMF

Facility

$286.18

Service Code	HCPCS C1713
Hospital Charge Code	40005919
Hospital Revenue Code	278
Min. Negotiated Rate	$143.09
Max. Negotiated Rate	$143.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.09
Rate for Payer: Hamaspik Choice Inc Medicare	$143.09

PLATE, DOUBLE Y, 7 HOLE CMF

Facility

$286.18

Service Code	HCPCS C1713
Hospital Charge Code	40005919
Hospital Revenue Code	278
Min. Negotiated Rate	$100.16
Max. Negotiated Rate	$300.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$171.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$143.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$164.55
Rate for Payer: EmblemHealth Commercial	$143.09
Rate for Payer: Fidelis Medicare Advantage	$300.49
Rate for Payer: Group Health Inc Commercial	$143.09
Rate for Payer: Group Health Inc Medicare	$100.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.09
Rate for Payer: Hamaspik Choice Inc Medicare	$143.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$186.02

PLATE DOUBLE-Y 7-HOLE MDFC

Facility

$408.43

Service Code	HCPCS C1713
Hospital Charge Code	64901568
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$428.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$224.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$245.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.85
Rate for Payer: EmblemHealth Commercial	$204.22
Rate for Payer: Fidelis Medicare Advantage	$428.85
Rate for Payer: Group Health Inc Commercial	$204.22
Rate for Payer: Group Health Inc Medicare	$142.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$204.22
Rate for Payer: Hamaspik Choice Inc Medicare	$204.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$265.48

PLATE DOUBLE-Y 7-HOLE MDFC

Facility

$408.43

Service Code	HCPCS C1713
Hospital Charge Code	64901568
Hospital Revenue Code	278
Min. Negotiated Rate	$204.22
Max. Negotiated Rate	$204.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$204.22
Rate for Payer: Hamaspik Choice Inc Medicare	$204.22

PLATE DST

Facility

$1,937.50

Service Code	HCPCS C1713
Hospital Charge Code	64907157
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,034.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,065.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,162.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$968.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,114.06
Rate for Payer: EmblemHealth Commercial	$968.75
Rate for Payer: Fidelis Medicare Advantage	$2,034.38
Rate for Payer: Group Health Inc Commercial	$968.75
Rate for Payer: Group Health Inc Medicare	$678.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$968.75
Rate for Payer: Hamaspik Choice Inc Medicare	$968.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,259.38

Know your out-of-pocket cost for care.

All Charges