St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE L 6H 8MM AC 100D ST STD

Facility

$281.13

Service Code	HCPCS C1713
Hospital Charge Code	64901572
Hospital Revenue Code	278
Min. Negotiated Rate	$140.56
Max. Negotiated Rate	$140.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.56
Rate for Payer: Hamaspik Choice Inc Medicare	$140.56

PLATE L 6H 8MM AD 100D RT STD

Facility

$422.13

Service Code	HCPCS C1713
Hospital Charge Code	64901574
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$443.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$232.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$253.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$211.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$242.72
Rate for Payer: EmblemHealth Commercial	$211.06
Rate for Payer: Fidelis Medicare Advantage	$443.24
Rate for Payer: Group Health Inc Commercial	$211.06
Rate for Payer: Group Health Inc Medicare	$147.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$211.06
Rate for Payer: Hamaspik Choice Inc Medicare	$211.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$274.38

PLATE L 6H 8MM AD 100D RT STD

Facility

$422.13

Service Code	HCPCS C1713
Hospital Charge Code	64901574
Hospital Revenue Code	278
Min. Negotiated Rate	$211.06
Max. Negotiated Rate	$211.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$211.06
Rate for Payer: Hamaspik Choice Inc Medicare	$211.06

PLATE L 6H 8MM ADV MDFC LOCK

Facility

$573.20

Service Code	HCPCS C1713
Hospital Charge Code	64901593
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$601.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$315.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$343.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$286.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$329.59
Rate for Payer: EmblemHealth Commercial	$286.60
Rate for Payer: Fidelis Medicare Advantage	$601.86
Rate for Payer: Group Health Inc Commercial	$286.60
Rate for Payer: Group Health Inc Medicare	$200.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$286.60
Rate for Payer: Hamaspik Choice Inc Medicare	$286.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$372.58

PLATE L 6H 8MM ADV MDFC LOCK

Facility

$573.20

Service Code	HCPCS C1713
Hospital Charge Code	64901593
Hospital Revenue Code	278
Min. Negotiated Rate	$286.60
Max. Negotiated Rate	$286.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$286.60
Rate for Payer: Hamaspik Choice Inc Medicare	$286.60

PLATE L 8MM BAR 100D 6 HOLE

Facility

$336.00

Service Code	HCPCS C1713
Hospital Charge Code	64906629
Hospital Revenue Code	278
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$168.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.00
Rate for Payer: Hamaspik Choice Inc Medicare	$168.00

PLATE L 8MM BAR 100D 6 HOLE

Facility

$336.00

Service Code	HCPCS C1713
Hospital Charge Code	64906629
Hospital Revenue Code	278
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$352.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$184.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$201.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$168.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$193.20
Rate for Payer: EmblemHealth Commercial	$168.00
Rate for Payer: Fidelis Medicare Advantage	$352.80
Rate for Payer: Group Health Inc Commercial	$168.00
Rate for Payer: Group Health Inc Medicare	$117.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.00
Rate for Payer: Hamaspik Choice Inc Medicare	$168.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$218.40

PLATE LAPIDUS CP

Facility

$490.00

Service Code	HCPCS C1713
Hospital Charge Code	64902936
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$514.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$269.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$294.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$245.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$281.75
Rate for Payer: EmblemHealth Commercial	$245.00
Rate for Payer: Fidelis Medicare Advantage	$514.50
Rate for Payer: Group Health Inc Commercial	$245.00
Rate for Payer: Group Health Inc Medicare	$171.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$245.00
Rate for Payer: Hamaspik Choice Inc Medicare	$245.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$318.50

PLATE LAPIDUS CP

Facility

$490.00

Service Code	HCPCS C1713
Hospital Charge Code	64902936
Hospital Revenue Code	278
Min. Negotiated Rate	$245.00
Max. Negotiated Rate	$245.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$245.00
Rate for Payer: Hamaspik Choice Inc Medicare	$245.00

PLATE LARGE UN3 BOX (53-34240)

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	64906670
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$300.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$287.50
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis Medicare Advantage	$525.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$325.00

PLATE LARGE UN3 BOX (53-34240)

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	64906670
Hospital Revenue Code	278
Min. Negotiated Rate	$250.00
Max. Negotiated Rate	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

PLATE LC-DCP 7HOLE 3.5MM

Facility

$153.00

Service Code	HCPCS C1713
Hospital Charge Code	40209432
Hospital Revenue Code	278
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$160.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$84.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$91.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$76.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$87.98
Rate for Payer: EmblemHealth Commercial	$76.50
Rate for Payer: Fidelis Medicare Advantage	$160.65
Rate for Payer: Group Health Inc Commercial	$76.50
Rate for Payer: Group Health Inc Medicare	$53.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.50
Rate for Payer: Hamaspik Choice Inc Medicare	$76.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$99.45

PLATE LC-DCP 7HOLE 3.5MM

Facility

$153.00

Service Code	HCPCS C1713
Hospital Charge Code	40209432
Hospital Revenue Code	278
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$76.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.50
Rate for Payer: Hamaspik Choice Inc Medicare	$76.50

PLATE LCK LAT HOOK 3HL SS

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	64906367
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$735.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$385.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$420.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$402.50
Rate for Payer: EmblemHealth Commercial	$350.00
Rate for Payer: Fidelis Medicare Advantage	$735.00
Rate for Payer: Group Health Inc Commercial	$350.00
Rate for Payer: Group Health Inc Medicare	$245.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$455.00

PLATE LCK LAT HOOK 3HL SS

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	64906367
Hospital Revenue Code	278
Min. Negotiated Rate	$350.00
Max. Negotiated Rate	$350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00

PLATE LCP FIB 3H 73MM RIGHT

Facility

$1,836.00

Service Code	HCPCS C1713
Hospital Charge Code	64902555
Hospital Revenue Code	278
Min. Negotiated Rate	$918.00
Max. Negotiated Rate	$918.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$918.00
Rate for Payer: Hamaspik Choice Inc Medicare	$918.00

PLATE LCP FIB 3H 73MM RIGHT

Facility

$1,836.00

Service Code	HCPCS C1713
Hospital Charge Code	64902555
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,927.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,009.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,101.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$918.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,055.70
Rate for Payer: EmblemHealth Commercial	$918.00
Rate for Payer: Fidelis Medicare Advantage	$1,927.80
Rate for Payer: Group Health Inc Commercial	$918.00
Rate for Payer: Group Health Inc Medicare	$642.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$918.00
Rate for Payer: Hamaspik Choice Inc Medicare	$918.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,193.40

PLATE LCP PROX HUM 3H 3.5X90MM

Facility

$4,574.25

Service Code	HCPCS C1713
Hospital Charge Code	64901409
Hospital Revenue Code	278
Min. Negotiated Rate	$2,287.12
Max. Negotiated Rate	$2,287.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,287.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2,287.12

PLATE LCP PROX HUM 3H 3.5X90MM

Facility

$4,574.25

Service Code	HCPCS C1713
Hospital Charge Code	64901409
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,802.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,515.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,744.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,287.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,630.19
Rate for Payer: EmblemHealth Commercial	$2,287.12
Rate for Payer: Fidelis Medicare Advantage	$4,802.96
Rate for Payer: Group Health Inc Commercial	$2,287.12
Rate for Payer: Group Health Inc Medicare	$1,600.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,287.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2,287.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,973.26

PLATE LCP RECON 3.5X84MM 6H

Facility

$902.50

Service Code	HCPCS C1713
Hospital Charge Code	64901297
Hospital Revenue Code	278
Min. Negotiated Rate	$451.25
Max. Negotiated Rate	$451.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$451.25
Rate for Payer: Hamaspik Choice Inc Medicare	$451.25

PLATE LCP RECON 3.5X84MM 6H

Facility

$902.50

Service Code	HCPCS C1713
Hospital Charge Code	64901297
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$947.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$496.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$541.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$451.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$518.94
Rate for Payer: EmblemHealth Commercial	$451.25
Rate for Payer: Fidelis Medicare Advantage	$947.62
Rate for Payer: Group Health Inc Commercial	$451.25
Rate for Payer: Group Health Inc Medicare	$315.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$451.25
Rate for Payer: Hamaspik Choice Inc Medicare	$451.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$586.62

PLATE LEFT 1MM25-301-33

Facility

$1,106.58

Service Code	HCPCS C1713
Hospital Charge Code	64907372
Hospital Revenue Code	278
Min. Negotiated Rate	$553.29
Max. Negotiated Rate	$553.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$553.29
Rate for Payer: Hamaspik Choice Inc Medicare	$553.29

PLATE LEFT 1MM25-301-33

Facility

$1,106.58

Service Code	HCPCS C1713
Hospital Charge Code	64907372
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,161.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$608.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$663.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$553.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$636.28
Rate for Payer: EmblemHealth Commercial	$553.29
Rate for Payer: Fidelis Medicare Advantage	$1,161.91
Rate for Payer: Group Health Inc Commercial	$553.29
Rate for Payer: Group Health Inc Medicare	$387.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$553.29
Rate for Payer: Hamaspik Choice Inc Medicare	$553.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$719.28

PLATE LEFT INTER

Facility

$3,862.50

Service Code	HCPCS C1713
Hospital Charge Code	64904398
Hospital Revenue Code	278
Min. Negotiated Rate	$1,931.25
Max. Negotiated Rate	$1,931.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,931.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,931.25

PLATE LEFT INTER

Facility

$3,862.50

Service Code	HCPCS C1713
Hospital Charge Code	64904398
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,055.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,124.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,317.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,931.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,220.94
Rate for Payer: EmblemHealth Commercial	$1,931.25
Rate for Payer: Fidelis Medicare Advantage	$4,055.62
Rate for Payer: Group Health Inc Commercial	$1,931.25
Rate for Payer: Group Health Inc Medicare	$1,351.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,931.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,931.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,510.62

Know your out-of-pocket cost for care.

All Charges