St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

4 HOLE CURVED PLATE

Facility

$266.26

Service Code	HCPCS C1713
Hospital Charge Code	40005306
Hospital Revenue Code	278
Min. Negotiated Rate	$93.19
Max. Negotiated Rate	$279.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$146.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$159.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.10
Rate for Payer: EmblemHealth Commercial	$133.13
Rate for Payer: Fidelis Medicare Advantage	$279.57
Rate for Payer: Group Health Inc Commercial	$133.13
Rate for Payer: Group Health Inc Medicare	$93.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.13
Rate for Payer: Hamaspik Choice Inc Medicare	$133.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$173.07

4 HOLE CURVED PLATE 1/ BAR MDFC

Facility

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	40201077
Hospital Revenue Code	278
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$241.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$138.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$115.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.25
Rate for Payer: EmblemHealth Commercial	$115.00
Rate for Payer: Fidelis Medicare Advantage	$241.50
Rate for Payer: Group Health Inc Commercial	$115.00
Rate for Payer: Group Health Inc Medicare	$80.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$149.50

4 HOLE CURVED PLATE 1/ BAR MDFC

Facility

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	40201077
Hospital Revenue Code	278
Min. Negotiated Rate	$115.00
Max. Negotiated Rate	$115.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00

4 HOLE CURVED PLATE UPPERFACE

Facility

$184.00

Service Code	HCPCS C1713
Hospital Charge Code	40201076
Hospital Revenue Code	278
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$193.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$101.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$110.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$92.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.80
Rate for Payer: EmblemHealth Commercial	$92.00
Rate for Payer: Fidelis Medicare Advantage	$193.20
Rate for Payer: Group Health Inc Commercial	$92.00
Rate for Payer: Group Health Inc Medicare	$64.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.00
Rate for Payer: Hamaspik Choice Inc Medicare	$92.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$119.60

4 HOLE CURVED PLATE UPPERFACE

Facility

$184.00

Service Code	HCPCS C1713
Hospital Charge Code	40201076
Hospital Revenue Code	278
Min. Negotiated Rate	$92.00
Max. Negotiated Rate	$92.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.00
Rate for Payer: Hamaspik Choice Inc Medicare	$92.00

4 HOLE L-BP LEFT 4MM BAR

Facility

$484.00

Hospital Charge Code	40200859
Hospital Revenue Code	278
Min. Negotiated Rate	$169.40
Max. Negotiated Rate	$508.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$266.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$242.00
Rate for Payer: Aetna Government	$242.00
Rate for Payer: Brighton Health Commercial	$290.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$242.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$278.30
Rate for Payer: EmblemHealth Commercial	$242.00
Rate for Payer: Fidelis Medicare Advantage	$508.20
Rate for Payer: Group Health Inc Commercial	$242.00
Rate for Payer: Group Health Inc Medicare	$169.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$242.00
Rate for Payer: Hamaspik Choice Inc Medicare	$242.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$314.60

4 HOLE L-BP LEFT 4MM BAR

Facility

$484.00

Hospital Charge Code	40200859
Hospital Revenue Code	278
Min. Negotiated Rate	$242.00
Max. Negotiated Rate	$242.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$242.00
Rate for Payer: Hamaspik Choice Inc Medicare	$242.00

4 HOLE L-BP LEFT NO BAR

Facility

$440.00

Service Code	HCPCS C1713
Hospital Charge Code	40200861
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$462.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$242.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$264.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$220.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$253.00
Rate for Payer: EmblemHealth Commercial	$220.00
Rate for Payer: Fidelis Medicare Advantage	$462.00
Rate for Payer: Group Health Inc Commercial	$220.00
Rate for Payer: Group Health Inc Medicare	$154.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.00
Rate for Payer: Hamaspik Choice Inc Medicare	$220.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$286.00

4 HOLE L-BP LEFT NO BAR

Facility

$440.00

Service Code	HCPCS C1713
Hospital Charge Code	40200861
Hospital Revenue Code	278
Min. Negotiated Rate	$220.00
Max. Negotiated Rate	$220.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.00
Rate for Payer: Hamaspik Choice Inc Medicare	$220.00

4 HOLE L-BP LEFT W/8MM BAR

Facility

$370.00

Service Code	HCPCS C1713
Hospital Charge Code	40200862
Hospital Revenue Code	278
Min. Negotiated Rate	$185.00
Max. Negotiated Rate	$185.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.00
Rate for Payer: Hamaspik Choice Inc Medicare	$185.00

4 HOLE L-BP LEFT W/8MM BAR

Facility

$370.00

Service Code	HCPCS C1713
Hospital Charge Code	40200862
Hospital Revenue Code	278
Min. Negotiated Rate	$129.50
Max. Negotiated Rate	$388.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$203.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$222.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$185.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$212.75
Rate for Payer: EmblemHealth Commercial	$185.00
Rate for Payer: Fidelis Medicare Advantage	$388.50
Rate for Payer: Group Health Inc Commercial	$185.00
Rate for Payer: Group Health Inc Medicare	$129.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.00
Rate for Payer: Hamaspik Choice Inc Medicare	$185.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$240.50

4 HOLE L-BP RGHTNO BAR

Facility

$440.00

Service Code	HCPCS C1713
Hospital Charge Code	40200863
Hospital Revenue Code	278
Min. Negotiated Rate	$220.00
Max. Negotiated Rate	$220.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.00
Rate for Payer: Hamaspik Choice Inc Medicare	$220.00

4 HOLE L-BP RGHTNO BAR

Facility

$440.00

Service Code	HCPCS C1713
Hospital Charge Code	40200863
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$462.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$242.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$264.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$220.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$253.00
Rate for Payer: EmblemHealth Commercial	$220.00
Rate for Payer: Fidelis Medicare Advantage	$462.00
Rate for Payer: Group Health Inc Commercial	$220.00
Rate for Payer: Group Health Inc Medicare	$154.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.00
Rate for Payer: Hamaspik Choice Inc Medicare	$220.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$286.00

4 HOLE L-BP RGHT W/4MM BAR

Facility

$484.00

Service Code	HCPCS C1713
Hospital Charge Code	40200864
Hospital Revenue Code	278
Min. Negotiated Rate	$242.00
Max. Negotiated Rate	$242.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$242.00
Rate for Payer: Hamaspik Choice Inc Medicare	$242.00

4 HOLE L-BP RGHT W/4MM BAR

Facility

$484.00

Service Code	HCPCS C1713
Hospital Charge Code	40200864
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$508.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$266.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$290.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$242.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$278.30
Rate for Payer: EmblemHealth Commercial	$242.00
Rate for Payer: Fidelis Medicare Advantage	$508.20
Rate for Payer: Group Health Inc Commercial	$242.00
Rate for Payer: Group Health Inc Medicare	$169.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$242.00
Rate for Payer: Hamaspik Choice Inc Medicare	$242.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$314.60

4 HOLE L-BP RGHT W/8MM BAR

Facility

$370.00

Service Code	HCPCS C1713
Hospital Charge Code	40202329
Hospital Revenue Code	278
Min. Negotiated Rate	$185.00
Max. Negotiated Rate	$185.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.00
Rate for Payer: Hamaspik Choice Inc Medicare	$185.00

4 HOLE L-BP RGHT W/8MM BAR

Facility

$370.00

Service Code	HCPCS C1713
Hospital Charge Code	40202329
Hospital Revenue Code	278
Min. Negotiated Rate	$129.50
Max. Negotiated Rate	$388.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$203.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$222.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$185.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$212.75
Rate for Payer: EmblemHealth Commercial	$185.00
Rate for Payer: Fidelis Medicare Advantage	$388.50
Rate for Payer: Group Health Inc Commercial	$185.00
Rate for Payer: Group Health Inc Medicare	$129.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.00
Rate for Payer: Hamaspik Choice Inc Medicare	$185.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$240.50

4 HOLE L-PLATE, LEFT WITH 4MM BAR

Facility

$464.00

Service Code	HCPCS C1713
Hospital Charge Code	40201078
Hospital Revenue Code	278
Min. Negotiated Rate	$232.00
Max. Negotiated Rate	$232.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$232.00
Rate for Payer: Hamaspik Choice Inc Medicare	$232.00

4 HOLE L-PLATE, LEFT WITH 4MM BAR

Facility

$464.00

Service Code	HCPCS C1713
Hospital Charge Code	40201078
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$487.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$255.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$278.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$232.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$266.80
Rate for Payer: EmblemHealth Commercial	$232.00
Rate for Payer: Fidelis Medicare Advantage	$487.20
Rate for Payer: Group Health Inc Commercial	$232.00
Rate for Payer: Group Health Inc Medicare	$162.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$232.00
Rate for Payer: Hamaspik Choice Inc Medicare	$232.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$301.60

4 HOLE L-PLATE,LEFT WITH NO BAR

Facility

$440.00

Service Code	HCPCS C1713
Hospital Charge Code	40201081
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$462.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$242.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$264.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$220.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$253.00
Rate for Payer: EmblemHealth Commercial	$220.00
Rate for Payer: Fidelis Medicare Advantage	$462.00
Rate for Payer: Group Health Inc Commercial	$220.00
Rate for Payer: Group Health Inc Medicare	$154.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.00
Rate for Payer: Hamaspik Choice Inc Medicare	$220.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$286.00

4 HOLE L-PLATE,LEFT WITH NO BAR

Facility

$440.00

Service Code	HCPCS C1713
Hospital Charge Code	40201081
Hospital Revenue Code	278
Min. Negotiated Rate	$220.00
Max. Negotiated Rate	$220.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.00
Rate for Payer: Hamaspik Choice Inc Medicare	$220.00

4 HOLE L-PLATE,RIGHT WITH 4MM BAR

Facility

$484.00

Service Code	HCPCS C1713
Hospital Charge Code	40201082
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$508.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$266.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$290.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$242.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$278.30
Rate for Payer: EmblemHealth Commercial	$242.00
Rate for Payer: Fidelis Medicare Advantage	$508.20
Rate for Payer: Group Health Inc Commercial	$242.00
Rate for Payer: Group Health Inc Medicare	$169.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$242.00
Rate for Payer: Hamaspik Choice Inc Medicare	$242.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$314.60

4 HOLE L-PLATE,RIGHT WITH 4MM BAR

Facility

$484.00

Service Code	HCPCS C1713
Hospital Charge Code	40201082
Hospital Revenue Code	278
Min. Negotiated Rate	$242.00
Max. Negotiated Rate	$242.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$242.00
Rate for Payer: Hamaspik Choice Inc Medicare	$242.00

4 HOLE L-PLATE,RIGHT WITH 8MM BAR

Facility

$370.00

Service Code	HCPCS C1713
Hospital Charge Code	40201083
Hospital Revenue Code	278
Min. Negotiated Rate	$185.00
Max. Negotiated Rate	$185.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.00
Rate for Payer: Hamaspik Choice Inc Medicare	$185.00

4 HOLE L-PLATE,RIGHT WITH 8MM BAR

Facility

$370.00

Service Code	HCPCS C1713
Hospital Charge Code	40201083
Hospital Revenue Code	278
Min. Negotiated Rate	$129.50
Max. Negotiated Rate	$388.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$203.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$222.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$185.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$212.75
Rate for Payer: EmblemHealth Commercial	$185.00
Rate for Payer: Fidelis Medicare Advantage	$388.50
Rate for Payer: Group Health Inc Commercial	$185.00
Rate for Payer: Group Health Inc Medicare	$129.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.00
Rate for Payer: Hamaspik Choice Inc Medicare	$185.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$240.50

Know your out-of-pocket cost for care.

All Charges