St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE 2X2 HOLE 3D UPPERFACE

Facility

$432.55

Service Code	HCPCS C1713
Hospital Charge Code	64901542
Hospital Revenue Code	278
Min. Negotiated Rate	$216.28
Max. Negotiated Rate	$216.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$216.28
Rate for Payer: Hamaspik Choice Inc Medicare	$216.28

PLATE 2X6 HOLE 3E MDFACE LOCK

Facility

$1,206.05

Service Code	HCPCS C1713
Hospital Charge Code	64901584
Hospital Revenue Code	278
Min. Negotiated Rate	$603.02
Max. Negotiated Rate	$603.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$603.02
Rate for Payer: Hamaspik Choice Inc Medicare	$603.02

PLATE 2X6 HOLE 3E MDFACE LOCK

Facility

$1,206.05

Service Code	HCPCS C1713
Hospital Charge Code	64901584
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,266.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$663.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$723.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$603.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$693.48
Rate for Payer: EmblemHealth Commercial	$603.02
Rate for Payer: Fidelis Medicare Advantage	$1,266.35
Rate for Payer: Group Health Inc Commercial	$603.02
Rate for Payer: Group Health Inc Medicare	$422.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$603.02
Rate for Payer: Hamaspik Choice Inc Medicare	$603.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$783.93

PLATE 3.5MM 10H

Facility

$326.00

Service Code	HCPCS C1713
Hospital Charge Code	40209894
Hospital Revenue Code	278
Min. Negotiated Rate	$163.00
Max. Negotiated Rate	$163.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.00
Rate for Payer: Hamaspik Choice Inc Medicare	$163.00

PLATE 3.5MM 10H

Facility

$326.00

Service Code	HCPCS C1713
Hospital Charge Code	40209894
Hospital Revenue Code	278
Min. Negotiated Rate	$114.10
Max. Negotiated Rate	$342.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$195.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$163.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$187.45
Rate for Payer: EmblemHealth Commercial	$163.00
Rate for Payer: Fidelis Medicare Advantage	$342.30
Rate for Payer: Group Health Inc Commercial	$163.00
Rate for Payer: Group Health Inc Medicare	$114.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.00
Rate for Payer: Hamaspik Choice Inc Medicare	$163.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$211.90

PLATE 3.5MM LCP 6H 85MM

Facility

$568.00

Service Code	HCPCS C1713
Hospital Charge Code	40209895
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$596.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$312.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$340.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$284.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$326.60
Rate for Payer: EmblemHealth Commercial	$284.00
Rate for Payer: Fidelis Medicare Advantage	$596.40
Rate for Payer: Group Health Inc Commercial	$284.00
Rate for Payer: Group Health Inc Medicare	$198.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$284.00
Rate for Payer: Hamaspik Choice Inc Medicare	$284.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$369.20

PLATE 3.5MM LCP 6H 85MM

Facility

$568.00

Service Code	HCPCS C1713
Hospital Charge Code	40209895
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$284.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$284.00
Rate for Payer: Hamaspik Choice Inc Medicare	$284.00

PLATE 3.5MM RECONSTRUCT 7-H 82MM

Facility

$646.00

Service Code	HCPCS C1713
Hospital Charge Code	40209891
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$678.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$355.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$387.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$323.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$371.45
Rate for Payer: EmblemHealth Commercial	$323.00
Rate for Payer: Fidelis Medicare Advantage	$678.30
Rate for Payer: Group Health Inc Commercial	$323.00
Rate for Payer: Group Health Inc Medicare	$226.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$323.00
Rate for Payer: Hamaspik Choice Inc Medicare	$323.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$419.90

PLATE 3.5MM RECONSTRUCT 7-H 82MM

Facility

$646.00

Service Code	HCPCS C1713
Hospital Charge Code	40209891
Hospital Revenue Code	278
Min. Negotiated Rate	$323.00
Max. Negotiated Rate	$323.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$323.00
Rate for Payer: Hamaspik Choice Inc Medicare	$323.00

PLATE 3.5 RECONSTRUCT 6H/70MM

Facility

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40209437
Hospital Revenue Code	278
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$65.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00

PLATE 3.5 RECONSTRUCT 6H/70MM

Facility

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40209437
Hospital Revenue Code	278
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$136.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$78.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.75
Rate for Payer: EmblemHealth Commercial	$65.00
Rate for Payer: Fidelis Medicare Advantage	$136.50
Rate for Payer: Group Health Inc Commercial	$65.00
Rate for Payer: Group Health Inc Medicare	$45.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$84.50

PLATE 3.5 RECONSTRUCT 8H/94MM

Facility

$786.00

Service Code	HCPCS C1713
Hospital Charge Code	40209986
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$825.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$432.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$471.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$393.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$451.95
Rate for Payer: EmblemHealth Commercial	$393.00
Rate for Payer: Fidelis Medicare Advantage	$825.30
Rate for Payer: Group Health Inc Commercial	$393.00
Rate for Payer: Group Health Inc Medicare	$275.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$393.00
Rate for Payer: Hamaspik Choice Inc Medicare	$393.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$510.90

PLATE 3.5 RECONSTRUCT 8H/94MM

Facility

$786.00

Service Code	HCPCS C1713
Hospital Charge Code	40209986
Hospital Revenue Code	278
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$393.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$393.00
Rate for Payer: Hamaspik Choice Inc Medicare	$393.00

PLATE 3-D 10X10 HOLE (55-04237

Facility

$2,082.90

Service Code	HCPCS C1713
Hospital Charge Code	64906626
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,187.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,145.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,249.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,041.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,197.67
Rate for Payer: EmblemHealth Commercial	$1,041.45
Rate for Payer: Fidelis Medicare Advantage	$2,187.04
Rate for Payer: Group Health Inc Commercial	$1,041.45
Rate for Payer: Group Health Inc Medicare	$729.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,041.45
Rate for Payer: Hamaspik Choice Inc Medicare	$1,041.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,353.88

PLATE 3-D 10X10 HOLE (55-04237

Facility

$2,082.90

Service Code	HCPCS C1713
Hospital Charge Code	64906626
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.45
Max. Negotiated Rate	$1,041.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,041.45
Rate for Payer: Hamaspik Choice Inc Medicare	$1,041.45

PLATE 3-D 1.2MM STD 10X10 HOLE

Facility

$1,989.04

Service Code	HCPCS C1713
Hospital Charge Code	64906633
Hospital Revenue Code	278
Min. Negotiated Rate	$994.52
Max. Negotiated Rate	$994.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$994.52
Rate for Payer: Hamaspik Choice Inc Medicare	$994.52

PLATE 3-D 1.2MM STD 10X10 HOLE

Facility

$1,989.04

Service Code	HCPCS C1713
Hospital Charge Code	64906633
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,088.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,093.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,193.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$994.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,143.70
Rate for Payer: EmblemHealth Commercial	$994.52
Rate for Payer: Fidelis Medicare Advantage	$2,088.49
Rate for Payer: Group Health Inc Commercial	$994.52
Rate for Payer: Group Health Inc Medicare	$696.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$994.52
Rate for Payer: Hamaspik Choice Inc Medicare	$994.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,292.88

PLATE 3-D 1.2MM STD 6X2 HOLE

Facility

$622.16

Service Code	HCPCS C1713
Hospital Charge Code	64906631
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$653.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$373.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$311.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$357.74
Rate for Payer: EmblemHealth Commercial	$311.08
Rate for Payer: Fidelis Medicare Advantage	$653.27
Rate for Payer: Group Health Inc Commercial	$311.08
Rate for Payer: Group Health Inc Medicare	$217.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$311.08
Rate for Payer: Hamaspik Choice Inc Medicare	$311.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$404.40

PLATE 3-D 1.2MM STD 6X2 HOLE

Facility

$622.16

Service Code	HCPCS C1713
Hospital Charge Code	64906631
Hospital Revenue Code	278
Min. Negotiated Rate	$311.08
Max. Negotiated Rate	$311.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$311.08
Rate for Payer: Hamaspik Choice Inc Medicare	$311.08

PLATE 3-D 1.2MM STD 6X6 HOLE

Facility

$1,472.34

Service Code	HCPCS C1713
Hospital Charge Code	64906632
Hospital Revenue Code	278
Min. Negotiated Rate	$736.17
Max. Negotiated Rate	$736.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$736.17
Rate for Payer: Hamaspik Choice Inc Medicare	$736.17

PLATE 3-D 1.2MM STD 6X6 HOLE

Facility

$1,472.34

Service Code	HCPCS C1713
Hospital Charge Code	64906632
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,545.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$809.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$883.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$736.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$846.60
Rate for Payer: EmblemHealth Commercial	$736.17
Rate for Payer: Fidelis Medicare Advantage	$1,545.96
Rate for Payer: Group Health Inc Commercial	$736.17
Rate for Payer: Group Health Inc Medicare	$515.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$736.17
Rate for Payer: Hamaspik Choice Inc Medicare	$736.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$957.02

PLATE 3-D 2X2 HOLE (55-03731)

Facility

$289.38

Service Code	HCPCS C1713
Hospital Charge Code	64906621
Hospital Revenue Code	278
Min. Negotiated Rate	$144.69
Max. Negotiated Rate	$144.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$144.69
Rate for Payer: Hamaspik Choice Inc Medicare	$144.69

PLATE 3-D 2X2 HOLE (55-03731)

Facility

$289.38

Service Code	HCPCS C1713
Hospital Charge Code	64906621
Hospital Revenue Code	278
Min. Negotiated Rate	$101.28
Max. Negotiated Rate	$303.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$159.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$173.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$144.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$166.39
Rate for Payer: EmblemHealth Commercial	$144.69
Rate for Payer: Fidelis Medicare Advantage	$303.85
Rate for Payer: Group Health Inc Commercial	$144.69
Rate for Payer: Group Health Inc Medicare	$101.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$144.69
Rate for Payer: Hamaspik Choice Inc Medicare	$144.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$188.10

PLATE 3D 3 X 2HOLE RECTANGLE

Facility

$668.08

Service Code	HCPCS C1713
Hospital Charge Code	64901384
Hospital Revenue Code	278
Min. Negotiated Rate	$334.04
Max. Negotiated Rate	$334.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.04
Rate for Payer: Hamaspik Choice Inc Medicare	$334.04

PLATE 3D 3 X 2HOLE RECTANGLE

Facility

$668.08

Service Code	HCPCS C1713
Hospital Charge Code	64901384
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$701.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$367.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$400.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$334.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$384.15
Rate for Payer: EmblemHealth Commercial	$334.04
Rate for Payer: Fidelis Medicare Advantage	$701.48
Rate for Payer: Group Health Inc Commercial	$334.04
Rate for Payer: Group Health Inc Medicare	$233.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.04
Rate for Payer: Hamaspik Choice Inc Medicare	$334.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$434.25

Know your out-of-pocket cost for care.

All Charges