St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE PROF 2.0

Facility

$1,785.00

Service Code	HCPCS C1889
Hospital Charge Code	64907530
Hospital Revenue Code	278
Min. Negotiated Rate	$892.50
Max. Negotiated Rate	$892.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$892.50
Rate for Payer: Hamaspik Choice Inc Medicare	$892.50

PLATE PROF 2.0

Facility

$1,785.00

Service Code	HCPCS C1889
Hospital Charge Code	64907530
Hospital Revenue Code	278
Min. Negotiated Rate	$624.75
Max. Negotiated Rate	$1,874.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$981.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$892.50
Rate for Payer: Aetna Government	$892.50
Rate for Payer: Brighton Health Commercial	$1,071.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$892.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,026.38
Rate for Payer: EmblemHealth Commercial	$892.50
Rate for Payer: Fidelis Medicare Advantage	$1,874.25
Rate for Payer: Group Health Inc Commercial	$892.50
Rate for Payer: Group Health Inc Medicare	$624.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$892.50
Rate for Payer: Hamaspik Choice Inc Medicare	$892.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,160.25

PLATE PROFILE

Facility

$1,578.00

Service Code	HCPCS C1713
Hospital Charge Code	64907420
Hospital Revenue Code	278
Min. Negotiated Rate	$789.00
Max. Negotiated Rate	$789.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$789.00
Rate for Payer: Hamaspik Choice Inc Medicare	$789.00

PLATE PROFILE

Facility

$1,578.00

Service Code	HCPCS C1713
Hospital Charge Code	64907420
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,656.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$867.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$946.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$789.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$907.35
Rate for Payer: EmblemHealth Commercial	$789.00
Rate for Payer: Fidelis Medicare Advantage	$1,656.90
Rate for Payer: Group Health Inc Commercial	$789.00
Rate for Payer: Group Health Inc Medicare	$552.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$789.00
Rate for Payer: Hamaspik Choice Inc Medicare	$789.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,025.70

PLATE PROFYLE/S T90 NRW 6H

Facility

$487.50

Service Code	HCPCS C1713
Hospital Charge Code	64902563
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$243.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$243.75

PLATE PROFYLE/S T90 NRW 6H

Facility

$487.50

Service Code	HCPCS C1713
Hospital Charge Code	64902563
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$511.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$268.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$292.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$243.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$280.31
Rate for Payer: EmblemHealth Commercial	$243.75
Rate for Payer: Fidelis Medicare Advantage	$511.88
Rate for Payer: Group Health Inc Commercial	$243.75
Rate for Payer: Group Health Inc Medicare	$170.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$243.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$316.88

PLATE PROFYLE/XS 3-D 2X2 HOLE

Facility

$568.75

Service Code	HCPCS C1713
Hospital Charge Code	64905913
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$597.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$312.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$341.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$284.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$327.03
Rate for Payer: EmblemHealth Commercial	$284.38
Rate for Payer: Fidelis Medicare Advantage	$597.19
Rate for Payer: Group Health Inc Commercial	$284.38
Rate for Payer: Group Health Inc Medicare	$199.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$284.38
Rate for Payer: Hamaspik Choice Inc Medicare	$284.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$369.69

PLATE PROFYLE/XS 3-D 2X2 HOLE

Facility

$568.75

Service Code	HCPCS C1713
Hospital Charge Code	64905913
Hospital Revenue Code	278
Min. Negotiated Rate	$284.38
Max. Negotiated Rate	$284.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$284.38
Rate for Payer: Hamaspik Choice Inc Medicare	$284.38

PLATE PROFYLE/XS T-BEVL NRW RT

Facility

$568.75

Service Code	HCPCS C1713
Hospital Charge Code	64905647
Hospital Revenue Code	278
Min. Negotiated Rate	$284.38
Max. Negotiated Rate	$284.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$284.38
Rate for Payer: Hamaspik Choice Inc Medicare	$284.38

PLATE PROFYLE/XS T-BEVL NRW RT

Facility

$568.75

Service Code	HCPCS C1713
Hospital Charge Code	64905647
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$597.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$312.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$341.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$284.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$327.03
Rate for Payer: EmblemHealth Commercial	$284.38
Rate for Payer: Fidelis Medicare Advantage	$597.19
Rate for Payer: Group Health Inc Commercial	$284.38
Rate for Payer: Group Health Inc Medicare	$199.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$284.38
Rate for Payer: Hamaspik Choice Inc Medicare	$284.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$369.69

PLATE PROXIMAL LAT HUM 6HOLE

Facility

$7,815.00

Service Code	HCPCS C1713
Hospital Charge Code	64905061
Hospital Revenue Code	278
Min. Negotiated Rate	$3,907.50
Max. Negotiated Rate	$3,907.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,907.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,907.50

PLATE PROXIMAL LAT HUM 6HOLE

Facility

$7,815.00

Service Code	HCPCS C1713
Hospital Charge Code	64905061
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$8,205.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,298.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,689.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,907.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,493.62
Rate for Payer: EmblemHealth Commercial	$3,907.50
Rate for Payer: Fidelis Medicare Advantage	$8,205.75
Rate for Payer: Group Health Inc Commercial	$3,907.50
Rate for Payer: Group Health Inc Medicare	$2,735.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,907.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,907.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,079.75

PLATE PROX LAT LEFT

Facility

$6,425.85

Service Code	HCPCS C1713
Hospital Charge Code	64907496
Hospital Revenue Code	278
Min. Negotiated Rate	$3,212.92
Max. Negotiated Rate	$3,212.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,212.92
Rate for Payer: Hamaspik Choice Inc Medicare	$3,212.92

PLATE PROX LAT LEFT

Facility

$6,425.85

Service Code	HCPCS C1713
Hospital Charge Code	64907496
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,747.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,534.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,855.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,212.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,694.86
Rate for Payer: EmblemHealth Commercial	$3,212.92
Rate for Payer: Fidelis Medicare Advantage	$6,747.14
Rate for Payer: Group Health Inc Commercial	$3,212.92
Rate for Payer: Group Health Inc Medicare	$2,249.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,212.92
Rate for Payer: Hamaspik Choice Inc Medicare	$3,212.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,176.80

PLATE PROX LAT TIB 14 HOLE

Facility

$4,711.90

Service Code	HCPCS C1776
Hospital Charge Code	64907023
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,947.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,591.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,827.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,355.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,709.34
Rate for Payer: EmblemHealth Commercial	$2,355.95
Rate for Payer: Fidelis Medicare Advantage	$4,947.50
Rate for Payer: Group Health Inc Commercial	$2,355.95
Rate for Payer: Group Health Inc Medicare	$1,649.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,355.95
Rate for Payer: Hamaspik Choice Inc Medicare	$2,355.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,062.74

PLATE PROX LAT TIB 14 HOLE

Facility

$4,711.90

Service Code	HCPCS C1776
Hospital Charge Code	64907023
Hospital Revenue Code	278
Min. Negotiated Rate	$2,355.95
Max. Negotiated Rate	$2,355.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,355.95
Rate for Payer: Hamaspik Choice Inc Medicare	$2,355.95

PLATE PRX LAT HUM

Facility

$6,311.75

Service Code	HCPCS C1713
Hospital Charge Code	64907421
Hospital Revenue Code	278
Min. Negotiated Rate	$3,155.88
Max. Negotiated Rate	$3,155.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,155.88
Rate for Payer: Hamaspik Choice Inc Medicare	$3,155.88

PLATE PRX LAT HUM

Facility

$6,311.75

Service Code	HCPCS C1713
Hospital Charge Code	64907421
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,627.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,471.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,787.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,155.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,629.26
Rate for Payer: EmblemHealth Commercial	$3,155.88
Rate for Payer: Fidelis Medicare Advantage	$6,627.34
Rate for Payer: Group Health Inc Commercial	$3,155.88
Rate for Payer: Group Health Inc Medicare	$2,209.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,155.88
Rate for Payer: Hamaspik Choice Inc Medicare	$3,155.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,102.64

PLATE RECON 2.7M ANG 12H TIT

Facility

$2,372.50

Service Code	HCPCS C1713
Hospital Charge Code	64901462
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,491.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,304.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,423.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,186.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,364.19
Rate for Payer: EmblemHealth Commercial	$1,186.25
Rate for Payer: Fidelis Medicare Advantage	$2,491.12
Rate for Payer: Group Health Inc Commercial	$1,186.25
Rate for Payer: Group Health Inc Medicare	$830.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,186.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,186.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,542.12

PLATE RECON 2.7M ANG 12H TIT

Facility

$2,372.50

Service Code	HCPCS C1713
Hospital Charge Code	64901462
Hospital Revenue Code	278
Min. Negotiated Rate	$1,186.25
Max. Negotiated Rate	$1,186.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,186.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,186.25

PLATE RIGHT 1MM25-301-34

Facility

$1,106.58

Service Code	HCPCS C1713
Hospital Charge Code	64907373
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 RIGHT 1MM25-301-34

Facility

$1,106.58

Service Code	HCPCS C1713
Hospital Charge Code	64907373
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 SCREW 5.5X25MM

Facility

$2,210.00

Service Code	HCPCS C1713
Hospital Charge Code	64905040
Hospital Revenue Code	278
Min. Negotiated Rate	$1,105.00
Max. Negotiated Rate	$1,105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,105.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,105.00

PLATE SCREW 5.5X25MM

Facility

$2,210.00

Service Code	HCPCS C1713
Hospital Charge Code	64905040
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,320.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,215.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,326.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,105.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,270.75
Rate for Payer: EmblemHealth Commercial	$1,105.00
Rate for Payer: Fidelis Medicare Advantage	$2,320.50
Rate for Payer: Group Health Inc Commercial	$1,105.00
Rate for Payer: Group Health Inc Medicare	$773.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,105.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,105.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,436.50

PLATE SCREW 5.5X30MM

Facility

$2,210.00

Service Code	HCPCS C1713
Hospital Charge Code	64905041
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,320.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,215.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,326.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,105.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,270.75
Rate for Payer: EmblemHealth Commercial	$1,105.00
Rate for Payer: Fidelis Medicare Advantage	$2,320.50
Rate for Payer: Group Health Inc Commercial	$1,105.00
Rate for Payer: Group Health Inc Medicare	$773.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,105.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,105.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,436.50

Know your out-of-pocket cost for care.

All Charges