St. Barnabas Hospital

All Charges

Charge

Type

Price

4 HOLE L-BP LEFT NO BAR

Facility IP

$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 IP

$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 OP

$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: Cigna HMO/Network Benefit Plan/Open Access	$185.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$212.75
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 IP

$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 OP

$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: Cigna HMO/Network Benefit Plan/Open Access	$220.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$253.00
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 IP

$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 OP

$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: Cigna HMO/Network Benefit Plan/Open Access	$242.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$278.30
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 IP

$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 OP

$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: Cigna HMO/Network Benefit Plan/Open Access	$185.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$212.75
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 IP

$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 OP

$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: Cigna HMO/Network Benefit Plan/Open Access	$232.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$266.80
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 OP

$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: Cigna HMO/Network Benefit Plan/Open Access	$220.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$253.00
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 IP

$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 IP

$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 4MM BAR

Facility OP

$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: Cigna HMO/Network Benefit Plan/Open Access	$242.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$278.30
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 8MM BAR

Facility IP

$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 OP

$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: Cigna HMO/Network Benefit Plan/Open Access	$185.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$212.75
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 ORBITAL PLT UPPERFACE

Facility IP

$184.00

Service Code	HCPCS C1713
Hospital Charge Code	40201087
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 ORBITAL PLT UPPERFACE

Facility OP

$184.00

Service Code	HCPCS C1713
Hospital Charge Code	40201087
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: Cigna HMO/Network Benefit Plan/Open Access	$92.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.80
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 PLATE

Facility IP

$338.38

Service Code	HCPCS C1713
Hospital Charge Code	40005303
Hospital Revenue Code	278
Min. Negotiated Rate	$169.19
Max. Negotiated Rate	$169.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.19
Rate for Payer: Hamaspik Choice Inc Medicare	$169.19

4 HOLE PLATE

Facility OP

$338.38

Service Code	HCPCS C1713
Hospital Charge Code	40005303
Hospital Revenue Code	278
Min. Negotiated Rate	$118.43
Max. Negotiated Rate	$355.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$169.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$194.57
Rate for Payer: Fidelis Medicare Advantage	$355.30
Rate for Payer: Group Health Inc Commercial	$169.19
Rate for Payer: Group Health Inc Medicare	$118.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.19
Rate for Payer: Hamaspik Choice Inc Medicare	$169.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$219.95

4 HOLE ST PLATE LONG,MAND,LOCK

Facility IP

$226.00

Service Code	HCPCS C1713
Hospital Charge Code	40201085
Hospital Revenue Code	278
Min. Negotiated Rate	$113.00
Max. Negotiated Rate	$113.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.00
Rate for Payer: Hamaspik Choice Inc Medicare	$113.00

4 HOLE ST PLATE LONG,MAND,LOCK

Facility OP

$226.00

Service Code	HCPCS C1713
Hospital Charge Code	40201085
Hospital Revenue Code	278
Min. Negotiated Rate	$79.10
Max. Negotiated Rate	$237.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$124.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$113.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$129.95
Rate for Payer: Fidelis Medicare Advantage	$237.30
Rate for Payer: Group Health Inc Commercial	$113.00
Rate for Payer: Group Health Inc Medicare	$79.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.00
Rate for Payer: Hamaspik Choice Inc Medicare	$113.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$146.90

4 HOLE STRIAGHT PLATE W/ BAR MDFC

Facility IP

$188.00

Service Code	HCPCS C1713
Hospital Charge Code	40201086
Hospital Revenue Code	278
Min. Negotiated Rate	$94.00
Max. Negotiated Rate	$94.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.00
Rate for Payer: Hamaspik Choice Inc Medicare	$94.00

4 HOLE STRIAGHT PLATE W/ BAR MDFC

Facility OP

$188.00

Service Code	HCPCS C1713
Hospital Charge Code	40201086
Hospital Revenue Code	278
Min. Negotiated Rate	$65.80
Max. Negotiated Rate	$197.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$103.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$94.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$108.10
Rate for Payer: Fidelis Medicare Advantage	$197.40
Rate for Payer: Group Health Inc Commercial	$94.00
Rate for Payer: Group Health Inc Medicare	$65.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.00
Rate for Payer: Hamaspik Choice Inc Medicare	$94.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$122.20

Price Transparency.

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