St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE DST

Facility

$1,937.50

Service Code	HCPCS C1713
Hospital Charge Code	64907157
Hospital Revenue Code	278
Min. Negotiated Rate	$968.75
Max. Negotiated Rate	$968.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$968.75
Rate for Payer: Hamaspik Choice Inc Medicare	$968.75

PLATE DST ANTLAT TIB LT6HL/L127MM

Facility

$4,588.30

Service Code	HCPCS C1713
Hospital Charge Code	40005928
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,817.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,523.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,752.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,294.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,638.27
Rate for Payer: EmblemHealth Commercial	$2,294.15
Rate for Payer: Fidelis Medicare Advantage	$4,817.72
Rate for Payer: Group Health Inc Commercial	$2,294.15
Rate for Payer: Group Health Inc Medicare	$1,605.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,294.15
Rate for Payer: Hamaspik Choice Inc Medicare	$2,294.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,982.40

PLATE DST ANTLAT TIB LT6HL/L127MM

Facility

$4,588.30

Service Code	HCPCS C1713
Hospital Charge Code	40005928
Hospital Revenue Code	278
Min. Negotiated Rate	$2,294.15
Max. Negotiated Rate	$2,294.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,294.15
Rate for Payer: Hamaspik Choice Inc Medicare	$2,294.15

PLATE DST LAT FMR LT 16HL,L343MM

Facility

$2,837.00

Service Code	HCPCS C1713
Hospital Charge Code	64906321
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,978.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,560.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,702.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,418.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,631.28
Rate for Payer: EmblemHealth Commercial	$1,418.50
Rate for Payer: Fidelis Medicare Advantage	$2,978.85
Rate for Payer: Group Health Inc Commercial	$1,418.50
Rate for Payer: Group Health Inc Medicare	$992.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,418.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,418.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,844.05

PLATE DST LAT FMR LT 16HL,L343MM

Facility

$2,837.00

Service Code	HCPCS C1713
Hospital Charge Code	64906321
Hospital Revenue Code	278
Min. Negotiated Rate	$1,418.50
Max. Negotiated Rate	$1,418.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,418.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,418.50

PLATE DST LCK FBLA 6HLE 894306

Facility

$1,450.00

Service Code	HCPCS C1713
Hospital Charge Code	64906654
Hospital Revenue Code	278
Min. Negotiated Rate	$725.00
Max. Negotiated Rate	$725.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$725.00
Rate for Payer: Hamaspik Choice Inc Medicare	$725.00

PLATE DST LCK FBLA 6HLE 894306

Facility

$1,450.00

Service Code	HCPCS C1713
Hospital Charge Code	64906654
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,522.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$797.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$870.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$725.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$833.75
Rate for Payer: EmblemHealth Commercial	$725.00
Rate for Payer: Fidelis Medicare Advantage	$1,522.50
Rate for Payer: Group Health Inc Commercial	$725.00
Rate for Payer: Group Health Inc Medicare	$507.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$725.00
Rate for Payer: Hamaspik Choice Inc Medicare	$725.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$942.50

PLATE DST MED HUMERUS EXT L/R 3HL

Facility

$2,741.40

Service Code	HCPCS C1713
Hospital Charge Code	40005932
Hospital Revenue Code	278
Min. Negotiated Rate	$1,370.70
Max. Negotiated Rate	$1,370.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,370.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1,370.70

PLATE DST MED HUMERUS EXT L/R 3HL

Facility

$2,741.40

Service Code	HCPCS C1713
Hospital Charge Code	40005932
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,878.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,507.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,644.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,370.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,576.30
Rate for Payer: EmblemHealth Commercial	$1,370.70
Rate for Payer: Fidelis Medicare Advantage	$2,878.47
Rate for Payer: Group Health Inc Commercial	$1,370.70
Rate for Payer: Group Health Inc Medicare	$959.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,370.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1,370.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,781.91

PLATE DU BASE L SH L43MM

Facility

$4,820.00

Service Code	HCPCS C1889
Hospital Charge Code	64907536
Hospital Revenue Code	278
Min. Negotiated Rate	$2,410.00
Max. Negotiated Rate	$2,410.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,410.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,410.00

PLATE DU BASE L SH L43MM

Facility

$4,820.00

Service Code	HCPCS C1889
Hospital Charge Code	64907536
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.00
Max. Negotiated Rate	$5,061.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,651.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,410.00
Rate for Payer: Aetna Government	$2,410.00
Rate for Payer: Brighton Health Commercial	$2,892.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,410.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,771.50
Rate for Payer: EmblemHealth Commercial	$2,410.00
Rate for Payer: Fidelis Medicare Advantage	$5,061.00
Rate for Payer: Group Health Inc Commercial	$2,410.00
Rate for Payer: Group Health Inc Medicare	$1,687.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,410.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,410.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,133.00

PLATE FACIALI D OTHOG 1-7892001

Facility

$7,177.00

Service Code	HCPCS C1713
Hospital Charge Code	64906479
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$7,535.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,947.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,306.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,588.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,126.78
Rate for Payer: EmblemHealth Commercial	$3,588.50
Rate for Payer: Fidelis Medicare Advantage	$7,535.85
Rate for Payer: Group Health Inc Commercial	$3,588.50
Rate for Payer: Group Health Inc Medicare	$2,511.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,588.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,588.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,665.05

PLATE FACIALI D OTHOG 1-7892001

Facility

$7,177.00

Service Code	HCPCS C1713
Hospital Charge Code	64906479
Hospital Revenue Code	278
Min. Negotiated Rate	$3,588.50
Max. Negotiated Rate	$3,588.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,588.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,588.50

PLATE FIBULA 6-HOLE

Facility

$1,428.38

Service Code	HCPCS C1713
Hospital Charge Code	64902240
Hospital Revenue Code	278
Min. Negotiated Rate	$714.19
Max. Negotiated Rate	$714.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$714.19
Rate for Payer: Hamaspik Choice Inc Medicare	$714.19

PLATE FIBULA 6-HOLE

Facility

$1,428.38

Service Code	HCPCS C1713
Hospital Charge Code	64902240
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,499.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$785.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$857.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$714.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$821.32
Rate for Payer: EmblemHealth Commercial	$714.19
Rate for Payer: Fidelis Medicare Advantage	$1,499.80
Rate for Payer: Group Health Inc Commercial	$714.19
Rate for Payer: Group Health Inc Medicare	$499.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$714.19
Rate for Payer: Hamaspik Choice Inc Medicare	$714.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$928.45

PLATE FIXED CRUCIATE TIBIAL

Facility

$3,178.00

Service Code	HCPCS C1713
Hospital Charge Code	40209915
Hospital Revenue Code	278
Min. Negotiated Rate	$1,589.00
Max. Negotiated Rate	$1,589.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,589.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,589.00

PLATE FIXED CRUCIATE TIBIAL

Facility

$3,304.00

Service Code	HCPCS C1776
Hospital Charge Code	40204051
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,469.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,817.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,982.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,652.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,899.80
Rate for Payer: EmblemHealth Commercial	$1,652.00
Rate for Payer: Fidelis Medicare Advantage	$3,469.20
Rate for Payer: Group Health Inc Commercial	$1,652.00
Rate for Payer: Group Health Inc Medicare	$1,156.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,652.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,652.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,147.60

PLATE FIXED CRUCIATE TIBIAL

Facility

$3,178.00

Service Code	HCPCS C1713
Hospital Charge Code	40209915
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,336.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,747.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,906.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,589.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,827.35
Rate for Payer: EmblemHealth Commercial	$1,589.00
Rate for Payer: Fidelis Medicare Advantage	$3,336.90
Rate for Payer: Group Health Inc Commercial	$1,589.00
Rate for Payer: Group Health Inc Medicare	$1,112.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,589.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,589.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,065.70

PLATE FIXED CRUCIATE TIBIAL

Facility

$3,304.00

Service Code	HCPCS C1776
Hospital Charge Code	40204051
Hospital Revenue Code	278
Min. Negotiated Rate	$1,652.00
Max. Negotiated Rate	$1,652.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,652.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,652.00

PLATEFIXEDCRUCIATETIBIAL141233

Facility

$1,456.00

Service Code	HCPCS C1713
Hospital Charge Code	40209598
Hospital Revenue Code	278
Min. Negotiated Rate	$728.00
Max. Negotiated Rate	$728.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$728.00
Rate for Payer: Hamaspik Choice Inc Medicare	$728.00

PLATEFIXEDCRUCIATETIBIAL141233

Facility

$1,456.00

Service Code	HCPCS C1713
Hospital Charge Code	40209598
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,528.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$800.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$873.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$728.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$837.20
Rate for Payer: EmblemHealth Commercial	$728.00
Rate for Payer: Fidelis Medicare Advantage	$1,528.80
Rate for Payer: Group Health Inc Commercial	$728.00
Rate for Payer: Group Health Inc Medicare	$509.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$728.00
Rate for Payer: Hamaspik Choice Inc Medicare	$728.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$946.40

PLATE FORCEPS

Facility

$376.00

Hospital Charge Code	40202147
Hospital Revenue Code	270
Min. Negotiated Rate	$131.60
Max. Negotiated Rate	$300.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$206.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$188.00
Rate for Payer: Aetna Government	$188.00
Rate for Payer: Brighton Health Commercial	$282.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$300.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$255.68
Rate for Payer: Group Health Inc Commercial	$188.00
Rate for Payer: Group Health Inc Medicare	$131.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$188.00
Rate for Payer: Hamaspik Choice Inc Medicare	$188.00

PLATE FORMULA BARREL BIZ 12

Facility

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	64903819
Hospital Revenue Code	278
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$50.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00

PLATE FORMULA BARREL BIZ 12

Facility

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	64903819
Hospital Revenue Code	278
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$60.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.50
Rate for Payer: EmblemHealth Commercial	$50.00
Rate for Payer: Fidelis Medicare Advantage	$105.00
Rate for Payer: Group Health Inc Commercial	$50.00
Rate for Payer: Group Health Inc Medicare	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.00

PLATE FOR RIGHT PROXI HUME

Facility

$6,450.00

Service Code	HCPCS C1713
Hospital Charge Code	64905469
Hospital Revenue Code	278
Min. Negotiated Rate	$3,225.00
Max. Negotiated Rate	$3,225.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,225.00

Know your out-of-pocket cost for care.

All Charges