St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE LOCKN STRAIGHT SS

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	64907377
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$562.50
Rate for Payer: Hamaspik Choice Inc Medicare	$562.50

PLATE LOCKN STRAIGHT SS

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	64907377
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,181.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$618.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$675.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$562.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$646.88
Rate for Payer: EmblemHealth Commercial	$562.50
Rate for Payer: Fidelis Medicare Advantage	$1,181.25
Rate for Payer: Group Health Inc Commercial	$562.50
Rate for Payer: Group Health Inc Medicare	$393.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$562.50
Rate for Payer: Hamaspik Choice Inc Medicare	$562.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$731.25

PLATE LOCK TIBIA 4-HOLE DISTAL

Facility

$2,182.60

Service Code	HCPCS C1776
Hospital Charge Code	40202405
Hospital Revenue Code	278
Min. Negotiated Rate	$1,091.30
Max. Negotiated Rate	$1,091.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,091.30
Rate for Payer: Hamaspik Choice Inc Medicare	$1,091.30

PLATE LOCK TIBIA 4-HOLE DISTAL

Facility

$2,182.60

Service Code	HCPCS C1776
Hospital Charge Code	40202405
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,291.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,200.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,309.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,091.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,255.00
Rate for Payer: EmblemHealth Commercial	$1,091.30
Rate for Payer: Fidelis Medicare Advantage	$2,291.73
Rate for Payer: Group Health Inc Commercial	$1,091.30
Rate for Payer: Group Health Inc Medicare	$763.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,091.30
Rate for Payer: Hamaspik Choice Inc Medicare	$1,091.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,418.69

PLATE LONG 4H STR COMMAND

Facility

$563.58

Service Code	HCPCS C1713
Hospital Charge Code	40200730
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$591.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$309.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$338.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$281.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$324.06
Rate for Payer: EmblemHealth Commercial	$281.79
Rate for Payer: Fidelis Medicare Advantage	$591.76
Rate for Payer: Group Health Inc Commercial	$281.79
Rate for Payer: Group Health Inc Medicare	$197.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.79
Rate for Payer: Hamaspik Choice Inc Medicare	$281.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$366.33

PLATE LONG 4H STR COMMAND

Facility

$563.58

Service Code	HCPCS C1713
Hospital Charge Code	40200730
Hospital Revenue Code	278
Min. Negotiated Rate	$281.79
Max. Negotiated Rate	$281.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.79
Rate for Payer: Hamaspik Choice Inc Medicare	$281.79

PLATE LONG SLR DR INTERM L

Facility

$4,450.00

Service Code	HCPCS C1713
Hospital Charge Code	64904954
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,672.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,447.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,670.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,225.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,558.75
Rate for Payer: EmblemHealth Commercial	$2,225.00
Rate for Payer: Fidelis Medicare Advantage	$4,672.50
Rate for Payer: Group Health Inc Commercial	$2,225.00
Rate for Payer: Group Health Inc Medicare	$1,557.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,225.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,892.50

PLATE LONG SLR DR INTERM L

Facility

$4,450.00

Service Code	HCPCS C1713
Hospital Charge Code	64904954
Hospital Revenue Code	278
Min. Negotiated Rate	$2,225.00
Max. Negotiated Rate	$2,225.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,225.00

PLATE LORDOTIC 34MM BRIGADE

Facility

$14,582.50

Service Code	HCPCS C1713
Hospital Charge Code	64905038
Hospital Revenue Code	278
Min. Negotiated Rate	$7,291.25
Max. Negotiated Rate	$7,291.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,291.25
Rate for Payer: Hamaspik Choice Inc Medicare	$7,291.25

PLATE LORDOTIC 34MM BRIGADE

Facility

$14,582.50

Service Code	HCPCS C1713
Hospital Charge Code	64905038
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$15,311.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8,020.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$8,749.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,291.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$8,384.94
Rate for Payer: EmblemHealth Commercial	$7,291.25
Rate for Payer: Fidelis Medicare Advantage	$15,311.62
Rate for Payer: Group Health Inc Commercial	$7,291.25
Rate for Payer: Group Health Inc Medicare	$5,103.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,291.25
Rate for Payer: Hamaspik Choice Inc Medicare	$7,291.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9,478.62

PLATE LOW PROFILE 2 HOLE

Facility

$300.43

Service Code	HCPCS C1713
Hospital Charge Code	64903216
Hospital Revenue Code	278
Min. Negotiated Rate	$150.22
Max. Negotiated Rate	$150.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.22
Rate for Payer: Hamaspik Choice Inc Medicare	$150.22

PLATE LOW PROFILE 2 HOLE

Facility

$300.43

Service Code	HCPCS C1713
Hospital Charge Code	64903216
Hospital Revenue Code	278
Min. Negotiated Rate	$105.15
Max. Negotiated Rate	$315.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$180.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$150.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$172.75
Rate for Payer: EmblemHealth Commercial	$150.22
Rate for Payer: Fidelis Medicare Advantage	$315.45
Rate for Payer: Group Health Inc Commercial	$150.22
Rate for Payer: Group Health Inc Medicare	$105.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.22
Rate for Payer: Hamaspik Choice Inc Medicare	$150.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$195.28

PLATE L RGT 5H HL 5MM ADVC 100D

Facility

$396.38

Service Code	HCPCS C1713
Hospital Charge Code	64901380
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$416.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$218.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$237.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$198.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$227.92
Rate for Payer: EmblemHealth Commercial	$198.19
Rate for Payer: Fidelis Medicare Advantage	$416.20
Rate for Payer: Group Health Inc Commercial	$198.19
Rate for Payer: Group Health Inc Medicare	$138.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$198.19
Rate for Payer: Hamaspik Choice Inc Medicare	$198.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$257.65

PLATE L RGT 5H HL 5MM ADVC 100D

Facility

$396.38

Service Code	HCPCS C1713
Hospital Charge Code	64901380
Hospital Revenue Code	278
Min. Negotiated Rate	$198.19
Max. Negotiated Rate	$198.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$198.19
Rate for Payer: Hamaspik Choice Inc Medicare	$198.19

PLATE L TI-OBL 4X6H RT.5MM TH

Facility

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	64902596
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$887.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$464.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$507.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$422.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$485.88
Rate for Payer: EmblemHealth Commercial	$422.50
Rate for Payer: Fidelis Medicare Advantage	$887.25
Rate for Payer: Group Health Inc Commercial	$422.50
Rate for Payer: Group Health Inc Medicare	$295.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$422.50
Rate for Payer: Hamaspik Choice Inc Medicare	$422.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$549.25

PLATE L TI-OBL 4X6H RT.5MM TH

Facility

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	64902596
Hospital Revenue Code	278
Min. Negotiated Rate	$422.50
Max. Negotiated Rate	$422.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$422.50
Rate for Payer: Hamaspik Choice Inc Medicare	$422.50

PLATE L TI-OBL 4X6H RT.7MM TH

Facility

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	64902597
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$887.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$464.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$507.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$422.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$485.88
Rate for Payer: EmblemHealth Commercial	$422.50
Rate for Payer: Fidelis Medicare Advantage	$887.25
Rate for Payer: Group Health Inc Commercial	$422.50
Rate for Payer: Group Health Inc Medicare	$295.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$422.50
Rate for Payer: Hamaspik Choice Inc Medicare	$422.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$549.25

PLATE L TI-OBL 4X6H RT.7MM TH

Facility

$845.00

Service Code	HCPCS C1713
Hospital Charge Code	64902597
Hospital Revenue Code	278
Min. Negotiated Rate	$422.50
Max. Negotiated Rate	$422.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$422.50
Rate for Payer: Hamaspik Choice Inc Medicare	$422.50

PLATE L-TYPE REGULAR LEFT

Facility

$438.33

Service Code	HCPCS C1713
Hospital Charge Code	64901882
Hospital Revenue Code	278
Min. Negotiated Rate	$219.16
Max. Negotiated Rate	$219.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$219.16
Rate for Payer: Hamaspik Choice Inc Medicare	$219.16

PLATE L-TYPE REGULAR LEFT

Facility

$438.33

Service Code	HCPCS C1713
Hospital Charge Code	64901882
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$460.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$241.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$263.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$219.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$252.04
Rate for Payer: EmblemHealth Commercial	$219.16
Rate for Payer: Fidelis Medicare Advantage	$460.25
Rate for Payer: Group Health Inc Commercial	$219.16
Rate for Payer: Group Health Inc Medicare	$153.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$219.16
Rate for Payer: Hamaspik Choice Inc Medicare	$219.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$284.91

PLATE LW PROF 4-HOLE 6MM BAR

Facility

$250.25

Service Code	HCPCS C1713
Hospital Charge Code	64901871
Hospital Revenue Code	278
Min. Negotiated Rate	$125.12
Max. Negotiated Rate	$125.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.12
Rate for Payer: Hamaspik Choice Inc Medicare	$125.12

PLATE LW PROF 4-HOLE 6MM BAR

Facility

$250.25

Service Code	HCPCS C1713
Hospital Charge Code	64901871
Hospital Revenue Code	278
Min. Negotiated Rate	$87.59
Max. Negotiated Rate	$262.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$150.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$125.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$143.89
Rate for Payer: EmblemHealth Commercial	$125.12
Rate for Payer: Fidelis Medicare Advantage	$262.76
Rate for Payer: Group Health Inc Commercial	$125.12
Rate for Payer: Group Health Inc Medicare	$87.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.12
Rate for Payer: Hamaspik Choice Inc Medicare	$125.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$162.66

PLATE MAND ANG 7X23H REC LFT

Facility

$3,608.00

Service Code	HCPCS C1713
Hospital Charge Code	40205073
Hospital Revenue Code	278
Min. Negotiated Rate	$1,804.00
Max. Negotiated Rate	$1,804.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,804.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,804.00

PLATE MAND ANG 7X23H REC LFT

Facility

$3,608.00

Service Code	HCPCS C1713
Hospital Charge Code	40205073
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,788.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,984.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,164.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,804.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,074.60
Rate for Payer: EmblemHealth Commercial	$1,804.00
Rate for Payer: Fidelis Medicare Advantage	$3,788.40
Rate for Payer: Group Health Inc Commercial	$1,804.00
Rate for Payer: Group Health Inc Medicare	$1,262.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,804.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,804.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,345.20

PLATE MEDGRIP

Facility

$4,509.00

Service Code	HCPCS C1713
Hospital Charge Code	64902200
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,734.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,479.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,705.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,254.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,592.68
Rate for Payer: EmblemHealth Commercial	$2,254.50
Rate for Payer: Fidelis Medicare Advantage	$4,734.45
Rate for Payer: Group Health Inc Commercial	$2,254.50
Rate for Payer: Group Health Inc Medicare	$1,578.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,254.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,254.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,930.85

Know your out-of-pocket cost for care.

All Charges