St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE STD ORB FL,BASIC,MD,.3MM

Facility

$1,198.26

Service Code	HCPCS C1713
Hospital Charge Code	64906618
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,258.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$659.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$718.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$599.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$689.00
Rate for Payer: EmblemHealth Commercial	$599.13
Rate for Payer: Fidelis Medicare Advantage	$1,258.17
Rate for Payer: Group Health Inc Commercial	$599.13
Rate for Payer: Group Health Inc Medicare	$419.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$599.13
Rate for Payer: Hamaspik Choice Inc Medicare	$599.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$778.87

PLATE STD TMPLT ORB FL CMB S/M

Facility

$70.10

Service Code	HCPCS C1713
Hospital Charge Code	64906616
Hospital Revenue Code	278
Min. Negotiated Rate	$24.54
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$42.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.31
Rate for Payer: EmblemHealth Commercial	$35.05
Rate for Payer: Fidelis Medicare Advantage	$73.60
Rate for Payer: Group Health Inc Commercial	$35.05
Rate for Payer: Group Health Inc Medicare	$24.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.05
Rate for Payer: Hamaspik Choice Inc Medicare	$35.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$45.56

PLATE STD TMPLT ORB FL CMB S/M

Facility

$70.10

Service Code	HCPCS C1713
Hospital Charge Code	64906616
Hospital Revenue Code	278
Min. Negotiated Rate	$35.05
Max. Negotiated Rate	$35.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.05
Rate for Payer: Hamaspik Choice Inc Medicare	$35.05

PLATE STD TMPLT ORB FL L,0.3MM

Facility

$1,279.96

Service Code	HCPCS C1713
Hospital Charge Code	64906617
Hospital Revenue Code	278
Min. Negotiated Rate	$639.98
Max. Negotiated Rate	$639.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$639.98
Rate for Payer: Hamaspik Choice Inc Medicare	$639.98

PLATE STD TMPLT ORB FL L,0.3MM

Facility

$1,279.96

Service Code	HCPCS C1713
Hospital Charge Code	64906617
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,343.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$703.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$767.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$639.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$735.98
Rate for Payer: EmblemHealth Commercial	$639.98
Rate for Payer: Fidelis Medicare Advantage	$1,343.96
Rate for Payer: Group Health Inc Commercial	$639.98
Rate for Payer: Group Health Inc Medicare	$447.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$639.98
Rate for Payer: Hamaspik Choice Inc Medicare	$639.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$831.97

PLATE STR 2MM WURZ REG 16H TIT

Facility

$276.00

Service Code	HCPCS C1713
Hospital Charge Code	40200733
Hospital Revenue Code	278
Min. Negotiated Rate	$138.00
Max. Negotiated Rate	$138.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.00
Rate for Payer: Hamaspik Choice Inc Medicare	$138.00

PLATE STR 2MM WURZ REG 16H TIT

Facility

$276.00

Service Code	HCPCS C1713
Hospital Charge Code	40200733
Hospital Revenue Code	278
Min. Negotiated Rate	$96.60
Max. Negotiated Rate	$289.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$151.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$165.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$138.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$158.70
Rate for Payer: EmblemHealth Commercial	$138.00
Rate for Payer: Fidelis Medicare Advantage	$289.80
Rate for Payer: Group Health Inc Commercial	$138.00
Rate for Payer: Group Health Inc Medicare	$96.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.00
Rate for Payer: Hamaspik Choice Inc Medicare	$138.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$179.40

PLATE STR 6H FRAC

Facility

$883.00

Service Code	HCPCS C1713
Hospital Charge Code	40200734
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$927.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$485.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$529.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$441.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$507.72
Rate for Payer: EmblemHealth Commercial	$441.50
Rate for Payer: Fidelis Medicare Advantage	$927.15
Rate for Payer: Group Health Inc Commercial	$441.50
Rate for Payer: Group Health Inc Medicare	$309.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$441.50
Rate for Payer: Hamaspik Choice Inc Medicare	$441.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$573.95

PLATE STR 6H FRAC

Facility

$883.00

Service Code	HCPCS C1713
Hospital Charge Code	40200734
Hospital Revenue Code	278
Min. Negotiated Rate	$441.50
Max. Negotiated Rate	$441.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$441.50
Rate for Payer: Hamaspik Choice Inc Medicare	$441.50

PLATE STR 6H LONG COMMAND

Facility

$1,065.00

Service Code	HCPCS C1713
Hospital Charge Code	40200735
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,118.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$585.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$639.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$532.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$612.38
Rate for Payer: EmblemHealth Commercial	$532.50
Rate for Payer: Fidelis Medicare Advantage	$1,118.25
Rate for Payer: Group Health Inc Commercial	$532.50
Rate for Payer: Group Health Inc Medicare	$372.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$532.50
Rate for Payer: Hamaspik Choice Inc Medicare	$532.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$692.25

PLATE STR 6H LONG COMMAND

Facility

$1,065.00

Service Code	HCPCS C1713
Hospital Charge Code	40200735
Hospital Revenue Code	278
Min. Negotiated Rate	$532.50
Max. Negotiated Rate	$532.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$532.50
Rate for Payer: Hamaspik Choice Inc Medicare	$532.50

PLATE STRAIGHT 24 HOLE 06724

Facility

$778.68

Service Code	HCPCS C1713
Hospital Charge Code	64906595
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$817.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$428.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$467.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$389.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$447.74
Rate for Payer: EmblemHealth Commercial	$389.34
Rate for Payer: Fidelis Medicare Advantage	$817.61
Rate for Payer: Group Health Inc Commercial	$389.34
Rate for Payer: Group Health Inc Medicare	$272.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$389.34
Rate for Payer: Hamaspik Choice Inc Medicare	$389.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$506.14

PLATE STRAIGHT 24 HOLE 06724

Facility

$778.68

Service Code	HCPCS C1713
Hospital Charge Code	64906595
Hospital Revenue Code	278
Min. Negotiated Rate	$389.34
Max. Negotiated Rate	$389.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$389.34
Rate for Payer: Hamaspik Choice Inc Medicare	$389.34

PLATE STRAIGHT 4H 2.0MM

Facility

$107.00

Service Code	HCPCS C1713
Hospital Charge Code	40200737
Hospital Revenue Code	278
Min. Negotiated Rate	$37.45
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$64.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$53.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$61.52
Rate for Payer: EmblemHealth Commercial	$53.50
Rate for Payer: Fidelis Medicare Advantage	$112.35
Rate for Payer: Group Health Inc Commercial	$53.50
Rate for Payer: Group Health Inc Medicare	$37.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.50
Rate for Payer: Hamaspik Choice Inc Medicare	$53.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$69.55

PLATE STRAIGHT 4H 2.0MM

Facility

$107.00

Service Code	HCPCS C1713
Hospital Charge Code	40200737
Hospital Revenue Code	278
Min. Negotiated Rate	$53.50
Max. Negotiated Rate	$53.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.50
Rate for Payer: Hamaspik Choice Inc Medicare	$53.50

PLATE STRAIGHT 4-H TIT LO-PROF

Facility

$170.00

Service Code	HCPCS C1713
Hospital Charge Code	64901802
Hospital Revenue Code	278
Min. Negotiated Rate	$85.00
Max. Negotiated Rate	$85.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.00
Rate for Payer: Hamaspik Choice Inc Medicare	$85.00

PLATE STRAIGHT 4-H TIT LO-PROF

Facility

$170.00

Service Code	HCPCS C1713
Hospital Charge Code	64901802
Hospital Revenue Code	278
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$178.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$102.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$85.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$97.75
Rate for Payer: EmblemHealth Commercial	$85.00
Rate for Payer: Fidelis Medicare Advantage	$178.50
Rate for Payer: Group Health Inc Commercial	$85.00
Rate for Payer: Group Health Inc Medicare	$59.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.00
Rate for Payer: Hamaspik Choice Inc Medicare	$85.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$110.50

PLATE STRAIGHT 6HOLE BROAD T10

Facility

$1,656.00

Service Code	HCPCS C1713
Hospital Charge Code	64906502
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,738.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$910.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$993.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$828.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$952.20
Rate for Payer: EmblemHealth Commercial	$828.00
Rate for Payer: Fidelis Medicare Advantage	$1,738.80
Rate for Payer: Group Health Inc Commercial	$828.00
Rate for Payer: Group Health Inc Medicare	$579.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$828.00
Rate for Payer: Hamaspik Choice Inc Medicare	$828.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,076.40

PLATE STRAIGHT 6HOLE BROAD T10

Facility

$1,656.00

Service Code	HCPCS C1713
Hospital Charge Code	64906502
Hospital Revenue Code	278
Min. Negotiated Rate	$828.00
Max. Negotiated Rate	$828.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$828.00
Rate for Payer: Hamaspik Choice Inc Medicare	$828.00

PLATE STRAIGHT VARIAX 10 HOLE

Facility

$975.00

Service Code	HCPCS C1713
Hospital Charge Code	64902726
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,023.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$536.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$585.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$487.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$560.62
Rate for Payer: EmblemHealth Commercial	$487.50
Rate for Payer: Fidelis Medicare Advantage	$1,023.75
Rate for Payer: Group Health Inc Commercial	$487.50
Rate for Payer: Group Health Inc Medicare	$341.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$487.50
Rate for Payer: Hamaspik Choice Inc Medicare	$487.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$633.75

PLATE STRAIGHT VARIAX 10 HOLE

Facility

$975.00

Service Code	HCPCS C1713
Hospital Charge Code	64902726
Hospital Revenue Code	278
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$487.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$487.50
Rate for Payer: Hamaspik Choice Inc Medicare	$487.50

PLATE STRGHT SLIM 5HOLE T8-626965

Facility

$1,391.00

Service Code	HCPCS C1713
Hospital Charge Code	64906431
Hospital Revenue Code	278
Min. Negotiated Rate	$695.50
Max. Negotiated Rate	$695.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$695.50
Rate for Payer: Hamaspik Choice Inc Medicare	$695.50

PLATE STRGHT SLIM 5HOLE T8-626965

Facility

$1,391.00

Service Code	HCPCS C1713
Hospital Charge Code	64906431
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,460.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$765.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$834.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$695.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$799.82
Rate for Payer: EmblemHealth Commercial	$695.50
Rate for Payer: Fidelis Medicare Advantage	$1,460.55
Rate for Payer: Group Health Inc Commercial	$695.50
Rate for Payer: Group Health Inc Medicare	$486.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$695.50
Rate for Payer: Hamaspik Choice Inc Medicare	$695.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$904.15

PLATE STRGT 8 HOLE

Facility

$3,200.00

Service Code	HCPCS C1713
Hospital Charge Code	64907036
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,760.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,920.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,840.00
Rate for Payer: EmblemHealth Commercial	$1,600.00
Rate for Payer: Fidelis Medicare Advantage	$3,360.00
Rate for Payer: Group Health Inc Commercial	$1,600.00
Rate for Payer: Group Health Inc Medicare	$1,120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,080.00

PLATE STRGT 8 HOLE

Facility

$3,200.00

Service Code	HCPCS C1713
Hospital Charge Code	64907036
Hospital Revenue Code	278
Min. Negotiated Rate	$1,600.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.00

Know your out-of-pocket cost for care.

All Charges