St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

PLATE SCREW BRIGADE 5.5X35.0MM

Facility

$2,210.00

Service Code	HCPCS C1713
Hospital Charge Code	64905333
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 BRIGADE 5.5X35.0MM

Facility

$2,210.00

Service Code	HCPCS C1713
Hospital Charge Code	64905333
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 SHAFT HOLE HUMERUS

Facility

$5,238.52

Service Code	HCPCS C1713
Hospital Charge Code	64907029
Hospital Revenue Code	278
Min. Negotiated Rate	$2,619.26
Max. Negotiated Rate	$2,619.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,619.26
Rate for Payer: Hamaspik Choice Inc Medicare	$2,619.26

PLATE SHAFT HOLE HUMERUS

Facility

$5,238.52

Service Code	HCPCS C1713
Hospital Charge Code	64907029
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,500.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,881.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,143.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,619.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,012.15
Rate for Payer: EmblemHealth Commercial	$2,619.26
Rate for Payer: Fidelis Medicare Advantage	$5,500.45
Rate for Payer: Group Health Inc Commercial	$2,619.26
Rate for Payer: Group Health Inc Medicare	$1,833.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,619.26
Rate for Payer: Hamaspik Choice Inc Medicare	$2,619.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,405.04

PLATE SHORT 4H COMMAND

Facility

$432.44

Service Code	HCPCS C1713
Hospital Charge Code	40200731
Hospital Revenue Code	278
Min. Negotiated Rate	$216.22
Max. Negotiated Rate	$216.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$216.22
Rate for Payer: Hamaspik Choice Inc Medicare	$216.22

PLATE SHORT 4H COMMAND

Facility

$432.44

Service Code	HCPCS C1713
Hospital Charge Code	40200731
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$454.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$237.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$259.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$216.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$248.65
Rate for Payer: EmblemHealth Commercial	$216.22
Rate for Payer: Fidelis Medicare Advantage	$454.06
Rate for Payer: Group Health Inc Commercial	$216.22
Rate for Payer: Group Health Inc Medicare	$151.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$216.22
Rate for Payer: Hamaspik Choice Inc Medicare	$216.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$281.09

PLATE SHORT BEND LCP WRIST

Facility

$5,765.00

Service Code	HCPCS C1713
Hospital Charge Code	64902202
Hospital Revenue Code	278
Min. Negotiated Rate	$2,882.50
Max. Negotiated Rate	$2,882.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,882.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,882.50

PLATE SHORT BEND LCP WRIST

Facility

$3,160.00

Service Code	HCPCS C1776
Hospital Charge Code	40209009
Hospital Revenue Code	278
Min. Negotiated Rate	$1,580.00
Max. Negotiated Rate	$1,580.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,580.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,580.00

PLATE SHORT BEND LCP WRIST

Facility

$5,765.00

Service Code	HCPCS C1713
Hospital Charge Code	64902202
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,053.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,170.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,459.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,882.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,314.88
Rate for Payer: EmblemHealth Commercial	$2,882.50
Rate for Payer: Fidelis Medicare Advantage	$6,053.25
Rate for Payer: Group Health Inc Commercial	$2,882.50
Rate for Payer: Group Health Inc Medicare	$2,017.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,882.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,882.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,747.25

PLATE SHORT BEND LCP WRIST

Facility

$3,160.00

Service Code	HCPCS C1776
Hospital Charge Code	40209009
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,318.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,738.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,896.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,580.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,817.00
Rate for Payer: EmblemHealth Commercial	$1,580.00
Rate for Payer: Fidelis Medicare Advantage	$3,318.00
Rate for Payer: Group Health Inc Commercial	$1,580.00
Rate for Payer: Group Health Inc Medicare	$1,106.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,580.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,580.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,054.00

PLATE, SHORT STANDARD RIGHT

Facility

$3,476.25

Service Code	HCPCS C1713
Hospital Charge Code	64905248
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,650.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,911.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,085.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,738.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,998.84
Rate for Payer: EmblemHealth Commercial	$1,738.12
Rate for Payer: Fidelis Medicare Advantage	$3,650.06
Rate for Payer: Group Health Inc Commercial	$1,738.12
Rate for Payer: Group Health Inc Medicare	$1,216.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,738.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,738.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,259.56

PLATE, SHORT STANDARD RIGHT

Facility

$3,476.25

Service Code	HCPCS C1713
Hospital Charge Code	64905248
Hospital Revenue Code	278
Min. Negotiated Rate	$1,738.12
Max. Negotiated Rate	$1,738.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,738.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,738.12

PLATE SHUNT MODED A

Facility

$698.03

Service Code	HCPCS C1713
Hospital Charge Code	64904538
Hospital Revenue Code	278
Min. Negotiated Rate	$349.02
Max. Negotiated Rate	$349.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$349.02
Rate for Payer: Hamaspik Choice Inc Medicare	$349.02

PLATE SHUNT MODED A

Facility

$698.03

Service Code	HCPCS C1713
Hospital Charge Code	64904538
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$732.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$383.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$418.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$349.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$401.37
Rate for Payer: EmblemHealth Commercial	$349.02
Rate for Payer: Fidelis Medicare Advantage	$732.93
Rate for Payer: Group Health Inc Commercial	$349.02
Rate for Payer: Group Health Inc Medicare	$244.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$349.02
Rate for Payer: Hamaspik Choice Inc Medicare	$349.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$453.72

PLATE SHUNT MODED B

Facility

$633.28

Service Code	HCPCS C1713
Hospital Charge Code	64904540
Hospital Revenue Code	278
Min. Negotiated Rate	$316.64
Max. Negotiated Rate	$316.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$316.64
Rate for Payer: Hamaspik Choice Inc Medicare	$316.64

PLATE SHUNT MODED B

Facility

$633.28

Service Code	HCPCS C1713
Hospital Charge Code	64904540
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$664.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$348.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$379.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$316.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$364.14
Rate for Payer: EmblemHealth Commercial	$316.64
Rate for Payer: Fidelis Medicare Advantage	$664.94
Rate for Payer: Group Health Inc Commercial	$316.64
Rate for Payer: Group Health Inc Medicare	$221.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$316.64
Rate for Payer: Hamaspik Choice Inc Medicare	$316.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$411.63

PLATE SHUNT UN3 14MM W-TAB

Facility

$560.83

Service Code	HCPCS C1713
Hospital Charge Code	64905901
Hospital Revenue Code	278
Min. Negotiated Rate	$280.42
Max. Negotiated Rate	$280.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$280.42
Rate for Payer: Hamaspik Choice Inc Medicare	$280.42

PLATE SHUNT UN3 14MM W-TAB

Facility

$560.83

Service Code	HCPCS C1713
Hospital Charge Code	64905901
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$588.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$308.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$336.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$280.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$322.48
Rate for Payer: EmblemHealth Commercial	$280.42
Rate for Payer: Fidelis Medicare Advantage	$588.87
Rate for Payer: Group Health Inc Commercial	$280.42
Rate for Payer: Group Health Inc Medicare	$196.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$280.42
Rate for Payer: Hamaspik Choice Inc Medicare	$280.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$364.54

PLATE SLIM Y 2SHAFT HOLE T8

Facility

$1,524.00

Service Code	HCPCS C1713
Hospital Charge Code	64906499
Hospital Revenue Code	278
Min. Negotiated Rate	$762.00
Max. Negotiated Rate	$762.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$762.00
Rate for Payer: Hamaspik Choice Inc Medicare	$762.00

PLATE SLIM Y 2SHAFT HOLE T8

Facility

$1,524.00

Service Code	HCPCS C1713
Hospital Charge Code	64906499
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,600.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$838.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$914.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$762.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$876.30
Rate for Payer: EmblemHealth Commercial	$762.00
Rate for Payer: Fidelis Medicare Advantage	$1,600.20
Rate for Payer: Group Health Inc Commercial	$762.00
Rate for Payer: Group Health Inc Medicare	$533.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$762.00
Rate for Payer: Hamaspik Choice Inc Medicare	$762.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$990.60

PLATE SLIM Y 5SHAFT HOLES T8

Facility

$1,524.00

Service Code	HCPCS C1713
Hospital Charge Code	64906320
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,600.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$838.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$914.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$762.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$876.30
Rate for Payer: EmblemHealth Commercial	$762.00
Rate for Payer: Fidelis Medicare Advantage	$1,600.20
Rate for Payer: Group Health Inc Commercial	$762.00
Rate for Payer: Group Health Inc Medicare	$533.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$762.00
Rate for Payer: Hamaspik Choice Inc Medicare	$762.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$990.60

PLATE SLIM Y 5SHAFT HOLES T8

Facility

$1,524.00

Service Code	HCPCS C1713
Hospital Charge Code	64906320
Hospital Revenue Code	278
Min. Negotiated Rate	$762.00
Max. Negotiated Rate	$762.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$762.00
Rate for Payer: Hamaspik Choice Inc Medicare	$762.00

PLATE SLIM Y6 SHAFT HOLE T8

Facility

$1,524.00

Service Code	HCPCS C1713
Hospital Charge Code	64906310
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,600.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$838.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$914.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$762.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$876.30
Rate for Payer: EmblemHealth Commercial	$762.00
Rate for Payer: Fidelis Medicare Advantage	$1,600.20
Rate for Payer: Group Health Inc Commercial	$762.00
Rate for Payer: Group Health Inc Medicare	$533.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$762.00
Rate for Payer: Hamaspik Choice Inc Medicare	$762.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$990.60

PLATE SLIM Y6 SHAFT HOLE T8

Facility

$1,524.00

Service Code	HCPCS C1713
Hospital Charge Code	64906310
Hospital Revenue Code	278
Min. Negotiated Rate	$762.00
Max. Negotiated Rate	$762.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$762.00
Rate for Payer: Hamaspik Choice Inc Medicare	$762.00

Know your out-of-pocket cost for care.

All Charges