St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE TUBULAR 1/3 7 HOLES 85MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	64901148
Hospital Revenue Code	278
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$207.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$108.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$118.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$99.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$113.85
Rate for Payer: EmblemHealth Commercial	$99.00
Rate for Payer: Fidelis Medicare Advantage	$207.90
Rate for Payer: Group Health Inc Commercial	$99.00
Rate for Payer: Group Health Inc Medicare	$69.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.00
Rate for Payer: Hamaspik Choice Inc Medicare	$99.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$128.70

PLATE TUBULAR 1/3 9 HOLES

Facility

$122.00

Service Code	HCPCS C1713
Hospital Charge Code	40201232
Hospital Revenue Code	278
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$67.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$73.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$61.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$70.15
Rate for Payer: EmblemHealth Commercial	$61.00
Rate for Payer: Fidelis Medicare Advantage	$128.10
Rate for Payer: Group Health Inc Commercial	$61.00
Rate for Payer: Group Health Inc Medicare	$42.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.00
Rate for Payer: Hamaspik Choice Inc Medicare	$61.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$79.30

PLATE TUBULAR 1/3 9 HOLES

Facility

$122.00

Service Code	HCPCS C1713
Hospital Charge Code	40201232
Hospital Revenue Code	278
Min. Negotiated Rate	$61.00
Max. Negotiated Rate	$61.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.00
Rate for Payer: Hamaspik Choice Inc Medicare	$61.00

PLATE TUBULAR 1/3COL LCP 8H 93MM

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	40209398
Hospital Revenue Code	278
Min. Negotiated Rate	$110.25
Max. Negotiated Rate	$330.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$173.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$189.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$157.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$181.12
Rate for Payer: EmblemHealth Commercial	$157.50
Rate for Payer: Fidelis Medicare Advantage	$330.75
Rate for Payer: Group Health Inc Commercial	$157.50
Rate for Payer: Group Health Inc Medicare	$110.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.50
Rate for Payer: Hamaspik Choice Inc Medicare	$157.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$204.75

PLATE TUBULAR 1/3COL LCP 8H 93MM

Facility

$315.00

Service Code	HCPCS C1713
Hospital Charge Code	40209398
Hospital Revenue Code	278
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$157.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.50
Rate for Payer: Hamaspik Choice Inc Medicare	$157.50

PLATE TUBULAR W/COLLAR

Facility

$112.00

Service Code	HCPCS C1713
Hospital Charge Code	40201500
Hospital Revenue Code	278
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$56.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.00
Rate for Payer: Hamaspik Choice Inc Medicare	$56.00

PLATE TUBULAR W/COLLAR

Facility

$112.00

Service Code	HCPCS C1713
Hospital Charge Code	40201500
Hospital Revenue Code	278
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$67.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$64.40
Rate for Payer: EmblemHealth Commercial	$56.00
Rate for Payer: Fidelis Medicare Advantage	$117.60
Rate for Payer: Group Health Inc Commercial	$56.00
Rate for Payer: Group Health Inc Medicare	$39.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.00
Rate for Payer: Hamaspik Choice Inc Medicare	$56.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$72.80

PLATE ULNAR SMRTLCK 5H LNG LT5405

Facility

$980.08

Service Code	HCPCS C1713
Hospital Charge Code	64906535
Hospital Revenue Code	278
Min. Negotiated Rate	$490.04
Max. Negotiated Rate	$490.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$490.04
Rate for Payer: Hamaspik Choice Inc Medicare	$490.04

PLATE ULNAR SMRTLCK 5H LNG LT5405

Facility

$980.08

Service Code	HCPCS C1713
Hospital Charge Code	64906535
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,029.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$539.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$588.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$490.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$563.55
Rate for Payer: EmblemHealth Commercial	$490.04
Rate for Payer: Fidelis Medicare Advantage	$1,029.08
Rate for Payer: Group Health Inc Commercial	$490.04
Rate for Payer: Group Health Inc Medicare	$343.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$490.04
Rate for Payer: Hamaspik Choice Inc Medicare	$490.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$637.05

PLATE ULNAR SMRTLCK LNG RHT 25404

Facility

$980.06

Service Code	HCPCS C1713
Hospital Charge Code	64906579
Hospital Revenue Code	278
Min. Negotiated Rate	$490.03
Max. Negotiated Rate	$490.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$490.03
Rate for Payer: Hamaspik Choice Inc Medicare	$490.03

PLATE ULNAR SMRTLCK LNG RHT 25404

Facility

$980.06

Service Code	HCPCS C1713
Hospital Charge Code	64906579
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,029.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$539.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$588.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$490.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$563.53
Rate for Payer: EmblemHealth Commercial	$490.03
Rate for Payer: Fidelis Medicare Advantage	$1,029.06
Rate for Payer: Group Health Inc Commercial	$490.03
Rate for Payer: Group Health Inc Medicare	$343.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$490.03
Rate for Payer: Hamaspik Choice Inc Medicare	$490.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$637.04

PLATE UN3 BOX SMALL 53-34228

Facility

$199.79

Service Code	HCPCS C1713
Hospital Charge Code	64906508
Hospital Revenue Code	278
Min. Negotiated Rate	$99.90
Max. Negotiated Rate	$99.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.90
Rate for Payer: Hamaspik Choice Inc Medicare	$99.90

PLATE UN3 BOX SMALL 53-34228

Facility

$199.79

Service Code	HCPCS C1713
Hospital Charge Code	64906508
Hospital Revenue Code	278
Min. Negotiated Rate	$69.93
Max. Negotiated Rate	$209.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$109.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$119.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$99.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$114.88
Rate for Payer: EmblemHealth Commercial	$99.90
Rate for Payer: Fidelis Medicare Advantage	$209.78
Rate for Payer: Group Health Inc Commercial	$99.90
Rate for Payer: Group Health Inc Medicare	$69.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.90
Rate for Payer: Hamaspik Choice Inc Medicare	$99.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$129.86

PLATE UN3 GAP 6HOLE SMALL

Facility

$278.10

Service Code	HCPCS C1713
Hospital Charge Code	64906275
Hospital Revenue Code	278
Min. Negotiated Rate	$139.05
Max. Negotiated Rate	$139.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.05
Rate for Payer: Hamaspik Choice Inc Medicare	$139.05

PLATE UN3 GAP 6HOLE SMALL

Facility

$278.10

Service Code	HCPCS C1713
Hospital Charge Code	64906275
Hospital Revenue Code	278
Min. Negotiated Rate	$97.34
Max. Negotiated Rate	$292.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$152.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$166.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$139.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$159.91
Rate for Payer: EmblemHealth Commercial	$139.05
Rate for Payer: Fidelis Medicare Advantage	$292.00
Rate for Payer: Group Health Inc Commercial	$139.05
Rate for Payer: Group Health Inc Medicare	$97.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.05
Rate for Payer: Hamaspik Choice Inc Medicare	$139.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$180.76

PLATE UN3 RECTANGLE

Facility

$246.58

Service Code	HCPCS C1713
Hospital Charge Code	64906265
Hospital Revenue Code	278
Min. Negotiated Rate	$123.29
Max. Negotiated Rate	$123.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$123.29
Rate for Payer: Hamaspik Choice Inc Medicare	$123.29

PLATE UN3 RECTANGLE

Facility

$246.58

Service Code	HCPCS C1713
Hospital Charge Code	64906265
Hospital Revenue Code	278
Min. Negotiated Rate	$86.30
Max. Negotiated Rate	$258.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$135.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$147.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$123.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$141.78
Rate for Payer: EmblemHealth Commercial	$123.29
Rate for Payer: Fidelis Medicare Advantage	$258.91
Rate for Payer: Group Health Inc Commercial	$123.29
Rate for Payer: Group Health Inc Medicare	$86.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$123.29
Rate for Payer: Hamaspik Choice Inc Medicare	$123.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$160.28

PLATE UN3 STRAIGHT 8 H

Facility

$365.58

Service Code	HCPCS C1713
Hospital Charge Code	64904895
Hospital Revenue Code	278
Min. Negotiated Rate	$182.79
Max. Negotiated Rate	$182.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.79
Rate for Payer: Hamaspik Choice Inc Medicare	$182.79

PLATE UN3 STRAIGHT 8 H

Facility

$365.58

Service Code	HCPCS C1713
Hospital Charge Code	64904895
Hospital Revenue Code	278
Min. Negotiated Rate	$127.95
Max. Negotiated Rate	$383.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$201.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$219.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$182.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$210.21
Rate for Payer: EmblemHealth Commercial	$182.79
Rate for Payer: Fidelis Medicare Advantage	$383.86
Rate for Payer: Group Health Inc Commercial	$182.79
Rate for Payer: Group Health Inc Medicare	$127.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.79
Rate for Payer: Hamaspik Choice Inc Medicare	$182.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$237.63

PLATE UTIL ANCHOR STRAIGHT 4H

Facility

$4,465.00

Service Code	HCPCS C1713
Hospital Charge Code	64905567
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,688.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,455.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,679.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,232.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,567.38
Rate for Payer: EmblemHealth Commercial	$2,232.50
Rate for Payer: Fidelis Medicare Advantage	$4,688.25
Rate for Payer: Group Health Inc Commercial	$2,232.50
Rate for Payer: Group Health Inc Medicare	$1,562.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,232.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,232.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,902.25

PLATE UTIL ANCHOR STRAIGHT 4H

Facility

$4,465.00

Service Code	HCPCS C1713
Hospital Charge Code	64905567
Hospital Revenue Code	278
Min. Negotiated Rate	$2,232.50
Max. Negotiated Rate	$2,232.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,232.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,232.50

PLATE VAR COMP 11H

Facility

$2,759.58

Service Code	HCPCS C1889
Hospital Charge Code	64907529
Hospital Revenue Code	278
Min. Negotiated Rate	$965.85
Max. Negotiated Rate	$2,897.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,517.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,379.79
Rate for Payer: Aetna Government	$1,379.79
Rate for Payer: Brighton Health Commercial	$1,655.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,379.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,586.76
Rate for Payer: EmblemHealth Commercial	$1,379.79
Rate for Payer: Fidelis Medicare Advantage	$2,897.56
Rate for Payer: Group Health Inc Commercial	$1,379.79
Rate for Payer: Group Health Inc Medicare	$965.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,379.79
Rate for Payer: Hamaspik Choice Inc Medicare	$1,379.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,793.73

PLATE VAR COMP 11H

Facility

$2,759.58

Service Code	HCPCS C1889
Hospital Charge Code	64907529
Hospital Revenue Code	278
Min. Negotiated Rate	$1,379.79
Max. Negotiated Rate	$1,379.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,379.79
Rate for Payer: Hamaspik Choice Inc Medicare	$1,379.79

PLATE VARIAX COMP 7 H/L90 W/2

Facility

$1,737.50

Service Code	HCPCS C1713
Hospital Charge Code	64905479
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,824.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$955.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,042.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$868.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$999.06
Rate for Payer: EmblemHealth Commercial	$868.75
Rate for Payer: Fidelis Medicare Advantage	$1,824.38
Rate for Payer: Group Health Inc Commercial	$868.75
Rate for Payer: Group Health Inc Medicare	$608.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$868.75
Rate for Payer: Hamaspik Choice Inc Medicare	$868.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,129.38

PLATE VARIAX COMP 7 H/L90 W/2

Facility

$1,737.50

Service Code	HCPCS C1713
Hospital Charge Code	64905479
Hospital Revenue Code	278
Min. Negotiated Rate	$868.75
Max. Negotiated Rate	$868.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$868.75
Rate for Payer: Hamaspik Choice Inc Medicare	$868.75

Know your out-of-pocket cost for care.

All Charges