St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE TIBIA DIST MD RGT 16H L253M

Facility

$1,968.56

Service Code	HCPCS C1713
Hospital Charge Code	64906503
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,066.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,082.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,181.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$984.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,131.92
Rate for Payer: EmblemHealth Commercial	$984.28
Rate for Payer: Fidelis Medicare Advantage	$2,066.99
Rate for Payer: Group Health Inc Commercial	$984.28
Rate for Payer: Group Health Inc Medicare	$689.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$984.28
Rate for Payer: Hamaspik Choice Inc Medicare	$984.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,279.56

PLATE TIBIA LFT PROX 6H/L97MM

Facility

$2,101.20

Service Code	HCPCS C1713
Hospital Charge Code	64906514
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,206.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,155.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,260.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,050.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,208.19
Rate for Payer: EmblemHealth Commercial	$1,050.60
Rate for Payer: Fidelis Medicare Advantage	$2,206.26
Rate for Payer: Group Health Inc Commercial	$1,050.60
Rate for Payer: Group Health Inc Medicare	$735.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,050.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,050.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,365.78

PLATE TIBIA LFT PROX 6H/L97MM

Facility

$2,101.20

Service Code	HCPCS C1713
Hospital Charge Code	64906514
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.60
Max. Negotiated Rate	$1,050.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,050.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,050.60

PLATE TIBIAL STEMMED

Facility

$5,528.00

Service Code	HCPCS C1713
Hospital Charge Code	40202125
Hospital Revenue Code	278
Min. Negotiated Rate	$2,764.00
Max. Negotiated Rate	$2,764.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,764.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,764.00

PLATE TIBIAL STEMMED

Facility

$5,528.00

Service Code	HCPCS C1713
Hospital Charge Code	40202125
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,804.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,040.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,316.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,764.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,178.60
Rate for Payer: EmblemHealth Commercial	$2,764.00
Rate for Payer: Fidelis Medicare Advantage	$5,804.40
Rate for Payer: Group Health Inc Commercial	$2,764.00
Rate for Payer: Group Health Inc Medicare	$1,934.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,764.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,764.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,593.20

PLATE TIBIA PROX L 5HLE L84MM

Facility

$1,854.00

Service Code	HCPCS C1713
Hospital Charge Code	64906342
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,946.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,019.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,112.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$927.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,066.05
Rate for Payer: EmblemHealth Commercial	$927.00
Rate for Payer: Fidelis Medicare Advantage	$1,946.70
Rate for Payer: Group Health Inc Commercial	$927.00
Rate for Payer: Group Health Inc Medicare	$648.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$927.00
Rate for Payer: Hamaspik Choice Inc Medicare	$927.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,205.10

PLATE TIBIA PROX L 5HLE L84MM

Facility

$1,854.00

Service Code	HCPCS C1713
Hospital Charge Code	64906342
Hospital Revenue Code	278
Min. Negotiated Rate	$927.00
Max. Negotiated Rate	$927.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$927.00
Rate for Payer: Hamaspik Choice Inc Medicare	$927.00

PLATE TIBIA PROX,LAT,LT 6-HOLE

Facility

$4,664.80

Service Code	HCPCS C1713
Hospital Charge Code	40006561
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,898.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,565.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,798.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,332.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,682.26
Rate for Payer: EmblemHealth Commercial	$2,332.40
Rate for Payer: Fidelis Medicare Advantage	$4,898.04
Rate for Payer: Group Health Inc Commercial	$2,332.40
Rate for Payer: Group Health Inc Medicare	$1,632.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,332.40
Rate for Payer: Hamaspik Choice Inc Medicare	$2,332.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,032.12

PLATE TIBIA PROX,LAT,LT 6-HOLE

Facility

$4,664.80

Service Code	HCPCS C1713
Hospital Charge Code	40006561
Hospital Revenue Code	278
Min. Negotiated Rate	$2,332.40
Max. Negotiated Rate	$2,332.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,332.40
Rate for Payer: Hamaspik Choice Inc Medicare	$2,332.40

PLATE TIBIA PROX RT 5H L84MM

Facility

$4,635.17

Service Code	HCPCS C1713
Hospital Charge Code	64906980
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,866.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,549.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,781.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,317.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,665.22
Rate for Payer: EmblemHealth Commercial	$2,317.58
Rate for Payer: Fidelis Medicare Advantage	$4,866.93
Rate for Payer: Group Health Inc Commercial	$2,317.58
Rate for Payer: Group Health Inc Medicare	$1,622.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,317.58
Rate for Payer: Hamaspik Choice Inc Medicare	$2,317.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,012.86

PLATE TIBIA PROX RT 5H L84MM

Facility

$4,635.17

Service Code	HCPCS C1713
Hospital Charge Code	64906980
Hospital Revenue Code	278
Min. Negotiated Rate	$2,317.58
Max. Negotiated Rate	$2,317.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,317.58
Rate for Payer: Hamaspik Choice Inc Medicare	$2,317.58

PLATE TIBIA PRX LAT LT 10 HL

Facility

$2,425.00

Service Code	HCPCS C1713
Hospital Charge Code	64906328
Hospital Revenue Code	278
Min. Negotiated Rate	$1,212.50
Max. Negotiated Rate	$1,212.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,212.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,212.50

PLATE TIBIA PRX LAT LT 10 HL

Facility

$2,425.00

Service Code	HCPCS C1713
Hospital Charge Code	64906328
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,546.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,333.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,455.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,212.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,394.38
Rate for Payer: EmblemHealth Commercial	$1,212.50
Rate for Payer: Fidelis Medicare Advantage	$2,546.25
Rate for Payer: Group Health Inc Commercial	$1,212.50
Rate for Payer: Group Health Inc Medicare	$848.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,212.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,212.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,576.25

PLATE TIB STEMMED SZ E/GREEN

Facility

$5,946.00

Service Code	HCPCS C1713
Hospital Charge Code	40202124
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,243.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,270.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,567.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,973.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,418.95
Rate for Payer: EmblemHealth Commercial	$2,973.00
Rate for Payer: Fidelis Medicare Advantage	$6,243.30
Rate for Payer: Group Health Inc Commercial	$2,973.00
Rate for Payer: Group Health Inc Medicare	$2,081.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,973.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,973.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,864.90

PLATE TIB STEMMED SZ E/GREEN

Facility

$5,946.00

Service Code	HCPCS C1713
Hospital Charge Code	40202124
Hospital Revenue Code	278
Min. Negotiated Rate	$2,973.00
Max. Negotiated Rate	$2,973.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,973.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,973.00

PLATE, TITANIUM 8MM

Facility

$6,575.00

Service Code	HCPCS C1713
Hospital Charge Code	64905523
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,903.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,616.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,945.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,287.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,780.62
Rate for Payer: EmblemHealth Commercial	$3,287.50
Rate for Payer: Fidelis Medicare Advantage	$6,903.75
Rate for Payer: Group Health Inc Commercial	$3,287.50
Rate for Payer: Group Health Inc Medicare	$2,301.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,287.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,287.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,273.75

PLATE, TITANIUM 8MM

Facility

$6,575.00

Service Code	HCPCS C1713
Hospital Charge Code	64905523
Hospital Revenue Code	278
Min. Negotiated Rate	$3,287.50
Max. Negotiated Rate	$3,287.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,287.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,287.50

PLATE T ORTHO

Facility

$3,450.00

Service Code	HCPCS C1713
Hospital Charge Code	64907121
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$1,725.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,725.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,725.00

PLATE T ORTHO

Facility

$3,450.00

Service Code	HCPCS C1713
Hospital Charge Code	64907121
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,622.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,897.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,070.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,725.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,983.75
Rate for Payer: EmblemHealth Commercial	$1,725.00
Rate for Payer: Fidelis Medicare Advantage	$3,622.50
Rate for Payer: Group Health Inc Commercial	$1,725.00
Rate for Payer: Group Health Inc Medicare	$1,207.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,725.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,725.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,242.50

PLATE, TRABEC 11X14MM 26MM

Facility

$10,950.00

Service Code	HCPCS C1713
Hospital Charge Code	64905551
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$11,497.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,022.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$6,570.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,475.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,296.25
Rate for Payer: EmblemHealth Commercial	$5,475.00
Rate for Payer: Fidelis Medicare Advantage	$11,497.50
Rate for Payer: Group Health Inc Commercial	$5,475.00
Rate for Payer: Group Health Inc Medicare	$3,832.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,475.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,475.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,117.50

PLATE, TRABEC 11X14MM 26MM

Facility

$10,950.00

Service Code	HCPCS C1713
Hospital Charge Code	64905551
Hospital Revenue Code	278
Min. Negotiated Rate	$5,475.00
Max. Negotiated Rate	$5,475.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,475.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,475.00

PLATE,TRABECULAR MTL 11X14MM 26MM

Facility

$8,760.00

Service Code	HCPCS L8699
Hospital Charge Code	40007524
Hospital Revenue Code	278
Min. Negotiated Rate	$3,066.00
Max. Negotiated Rate	$9,198.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,818.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,380.00
Rate for Payer: Aetna Government	$4,380.00
Rate for Payer: Brighton Health Commercial	$5,256.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,380.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,037.00
Rate for Payer: EmblemHealth Commercial	$4,380.00
Rate for Payer: Fidelis Medicare Advantage	$9,198.00
Rate for Payer: Group Health Inc Commercial	$4,380.00
Rate for Payer: Group Health Inc Medicare	$3,066.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,380.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,380.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,694.00

PLATE,TRABECULAR MTL 11X14MM 26MM

Facility

$8,760.00

Service Code	HCPCS L8699
Hospital Charge Code	40007524
Hospital Revenue Code	278
Min. Negotiated Rate	$4,380.00
Max. Negotiated Rate	$4,380.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,380.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,380.00

PLATE TRAB MTL 11X14MM 26MM VBR-S

Facility

$8,760.00

Service Code	HCPCS C1713
Hospital Charge Code	40204605
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$9,198.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,818.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$5,256.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,380.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,037.00
Rate for Payer: EmblemHealth Commercial	$4,380.00
Rate for Payer: Fidelis Medicare Advantage	$9,198.00
Rate for Payer: Group Health Inc Commercial	$4,380.00
Rate for Payer: Group Health Inc Medicare	$3,066.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,380.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,380.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,694.00

PLATE TRAB MTL 11X14MM 26MM VBR-S

Facility

$8,760.00

Service Code	HCPCS C1713
Hospital Charge Code	40204605
Hospital Revenue Code	278
Min. Negotiated Rate	$4,380.00
Max. Negotiated Rate	$4,380.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,380.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,380.00

Know your out-of-pocket cost for care.

All Charges