St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE MINI 6 HOLE

Facility

$228.38

Service Code	HCPCS C1713
Hospital Charge Code	64901405
Hospital Revenue Code	278
Min. Negotiated Rate	$114.19
Max. Negotiated Rate	$114.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.19
Rate for Payer: Hamaspik Choice Inc Medicare	$114.19

PLATE MINI 7 HOLE

Facility

$1,319.00

Service Code	HCPCS C1713
Hospital Charge Code	64906294
Hospital Revenue Code	278
Min. Negotiated Rate	$659.50
Max. Negotiated Rate	$659.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$659.50
Rate for Payer: Hamaspik Choice Inc Medicare	$659.50

PLATE MINI 7 HOLE

Facility

$1,319.00

Service Code	HCPCS C1713
Hospital Charge Code	64906294
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,384.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$725.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$791.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$659.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$758.42
Rate for Payer: EmblemHealth Commercial	$659.50
Rate for Payer: Fidelis Medicare Advantage	$1,384.95
Rate for Payer: Group Health Inc Commercial	$659.50
Rate for Payer: Group Health Inc Medicare	$461.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$659.50
Rate for Payer: Hamaspik Choice Inc Medicare	$659.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$857.35

PLATE MINI ORTHO

Facility

$2,150.00

Service Code	HCPCS C1713
Hospital Charge Code	64907119
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,257.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,182.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,290.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,075.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,236.25
Rate for Payer: EmblemHealth Commercial	$1,075.00
Rate for Payer: Fidelis Medicare Advantage	$2,257.50
Rate for Payer: Group Health Inc Commercial	$1,075.00
Rate for Payer: Group Health Inc Medicare	$752.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,075.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,075.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,397.50

PLATE MINI ORTHO

Facility

$2,150.00

Service Code	HCPCS C1713
Hospital Charge Code	64907119
Hospital Revenue Code	278
Min. Negotiated Rate	$1,075.00
Max. Negotiated Rate	$1,075.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,075.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,075.00

PLATE MINI RIGID BLUE 4H MEDIUM

Facility

$124.00

Service Code	HCPCS C1776
Hospital Charge Code	40209442
Hospital Revenue Code	278
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$62.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.00
Rate for Payer: Hamaspik Choice Inc Medicare	$62.00

PLATE MINI RIGID BLUE 4H MEDIUM

Facility

$124.00

Service Code	HCPCS C1776
Hospital Charge Code	40209442
Hospital Revenue Code	278
Min. Negotiated Rate	$43.40
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$68.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$74.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$62.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$71.30
Rate for Payer: EmblemHealth Commercial	$62.00
Rate for Payer: Fidelis Medicare Advantage	$130.20
Rate for Payer: Group Health Inc Commercial	$62.00
Rate for Payer: Group Health Inc Medicare	$43.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.00
Rate for Payer: Hamaspik Choice Inc Medicare	$62.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$80.60

PLATE MINI RIGID BLUE 4HOLE

Facility

$280.00

Service Code	HCPCS C1713
Hospital Charge Code	64901341
Hospital Revenue Code	278
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$294.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$154.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$168.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$140.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.00
Rate for Payer: EmblemHealth Commercial	$140.00
Rate for Payer: Fidelis Medicare Advantage	$294.00
Rate for Payer: Group Health Inc Commercial	$140.00
Rate for Payer: Group Health Inc Medicare	$98.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.00
Rate for Payer: Hamaspik Choice Inc Medicare	$140.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$182.00

PLATE MINI RIGID BLUE 4HOLE

Facility

$280.00

Service Code	HCPCS C1713
Hospital Charge Code	64901341
Hospital Revenue Code	278
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$140.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.00
Rate for Payer: Hamaspik Choice Inc Medicare	$140.00

PLATE MIS LK CALC LG EXTD 3H RT

Facility

$2,223.00

Service Code	HCPCS C1713
Hospital Charge Code	40204640
Hospital Revenue Code	278
Min. Negotiated Rate	$1,111.50
Max. Negotiated Rate	$1,111.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,111.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,111.50

PLATE MIS LK CALC LG EXTD 3H RT

Facility

$2,223.00

Service Code	HCPCS C1713
Hospital Charge Code	40007559
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,334.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,222.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,333.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,111.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,278.22
Rate for Payer: EmblemHealth Commercial	$1,111.50
Rate for Payer: Fidelis Medicare Advantage	$2,334.15
Rate for Payer: Group Health Inc Commercial	$1,111.50
Rate for Payer: Group Health Inc Medicare	$778.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,111.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,111.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,444.95

PLATE MIS LK CALC LG EXTD 3H RT

Facility

$2,223.00

Service Code	HCPCS C1713
Hospital Charge Code	40204640
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,334.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,222.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,333.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,111.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,278.22
Rate for Payer: EmblemHealth Commercial	$1,111.50
Rate for Payer: Fidelis Medicare Advantage	$2,334.15
Rate for Payer: Group Health Inc Commercial	$1,111.50
Rate for Payer: Group Health Inc Medicare	$778.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,111.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,111.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,444.95

PLATE MIS LK CALC LG EXTD 3H RT

Facility

$2,223.00

Service Code	HCPCS C1713
Hospital Charge Code	40007559
Hospital Revenue Code	278
Min. Negotiated Rate	$1,111.50
Max. Negotiated Rate	$1,111.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,111.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,111.50

PLATE MIS LK CALC SM EXTD 2H RT

Facility

$2,080.00

Service Code	HCPCS C1713
Hospital Charge Code	40204639
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,184.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,144.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,248.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,040.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,196.00
Rate for Payer: EmblemHealth Commercial	$1,040.00
Rate for Payer: Fidelis Medicare Advantage	$2,184.00
Rate for Payer: Group Health Inc Commercial	$1,040.00
Rate for Payer: Group Health Inc Medicare	$728.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,040.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,040.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,352.00

PLATE MIS LK CALC SM EXTD 2H RT

Facility

$2,080.00

Service Code	HCPCS C1713
Hospital Charge Code	40007558
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,184.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,144.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,248.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,040.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,196.00
Rate for Payer: EmblemHealth Commercial	$1,040.00
Rate for Payer: Fidelis Medicare Advantage	$2,184.00
Rate for Payer: Group Health Inc Commercial	$1,040.00
Rate for Payer: Group Health Inc Medicare	$728.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,040.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,040.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,352.00

PLATE MIS LK CALC SM EXTD 2H RT

Facility

$2,080.00

Service Code	HCPCS C1713
Hospital Charge Code	40204639
Hospital Revenue Code	278
Min. Negotiated Rate	$1,040.00
Max. Negotiated Rate	$1,040.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,040.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,040.00

PLATE MIS LK CALC SM EXTD 2H RT

Facility

$2,080.00

Service Code	HCPCS C1713
Hospital Charge Code	40007558
Hospital Revenue Code	278
Min. Negotiated Rate	$1,040.00
Max. Negotiated Rate	$1,040.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,040.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,040.00

PLATE MIS LK CC LG EXTD 3H RT

Facility

$2,778.75

Service Code	HCPCS C1713
Hospital Charge Code	64905638
Hospital Revenue Code	278
Min. Negotiated Rate	$1,389.38
Max. Negotiated Rate	$1,389.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,389.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1,389.38

PLATE MIS LK CC LG EXTD 3H RT

Facility

$2,778.75

Service Code	HCPCS C1713
Hospital Charge Code	64905638
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,917.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,528.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,667.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,389.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,597.78
Rate for Payer: EmblemHealth Commercial	$1,389.38
Rate for Payer: Fidelis Medicare Advantage	$2,917.69
Rate for Payer: Group Health Inc Commercial	$1,389.38
Rate for Payer: Group Health Inc Medicare	$972.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,389.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1,389.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,806.19

PLATE MIS LK CC SM EXTD 2H RT

Facility

$2,600.00

Service Code	HCPCS C1713
Hospital Charge Code	64905636
Hospital Revenue Code	278
Min. Negotiated Rate	$1,300.00
Max. Negotiated Rate	$1,300.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,300.00

PLATE MIS LK CC SM EXTD 2H RT

Facility

$2,600.00

Service Code	HCPCS C1713
Hospital Charge Code	64905636
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,730.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,430.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,560.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,495.00
Rate for Payer: EmblemHealth Commercial	$1,300.00
Rate for Payer: Fidelis Medicare Advantage	$2,730.00
Rate for Payer: Group Health Inc Commercial	$1,300.00
Rate for Payer: Group Health Inc Medicare	$910.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,300.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,690.00

PLATE MRW HOLE GEM GMN

Facility

$2,612.50

Service Code	HCPCS C1713
Hospital Charge Code	64906964
Hospital Revenue Code	278
Min. Negotiated Rate	$1,306.25
Max. Negotiated Rate	$1,306.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,306.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,306.25

PLATE MRW HOLE GEM GMN

Facility

$2,612.50

Service Code	HCPCS C1713
Hospital Charge Code	64906964
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,743.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,436.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,567.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,306.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,502.19
Rate for Payer: EmblemHealth Commercial	$1,306.25
Rate for Payer: Fidelis Medicare Advantage	$2,743.12
Rate for Payer: Group Health Inc Commercial	$1,306.25
Rate for Payer: Group Health Inc Medicare	$914.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,306.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,306.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,698.12

PLATE MTB-LFT ORB FLOOR 41X42X1MM

Facility

$3,262.50

Service Code	HCPCS C1713
Hospital Charge Code	64902571
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,425.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,794.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,957.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,631.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,875.94
Rate for Payer: EmblemHealth Commercial	$1,631.25
Rate for Payer: Fidelis Medicare Advantage	$3,425.62
Rate for Payer: Group Health Inc Commercial	$1,631.25
Rate for Payer: Group Health Inc Medicare	$1,141.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,631.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,631.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,120.62

PLATE MTB-LFT ORB FLOOR 41X42X1MM

Facility

$3,262.50

Service Code	HCPCS C1713
Hospital Charge Code	64902571
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.25
Max. Negotiated Rate	$1,631.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,631.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,631.25

Know your out-of-pocket cost for care.

All Charges