St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE BURR HOLE COVER 14MM DIA

Facility

$337.70

Service Code	HCPCS C1713
Hospital Charge Code	64906634
Hospital Revenue Code	278
Min. Negotiated Rate	$118.20
Max. Negotiated Rate	$354.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$185.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$202.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$168.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$194.18
Rate for Payer: EmblemHealth Commercial	$168.85
Rate for Payer: Fidelis Medicare Advantage	$354.58
Rate for Payer: Group Health Inc Commercial	$168.85
Rate for Payer: Group Health Inc Medicare	$118.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.85
Rate for Payer: Hamaspik Choice Inc Medicare	$168.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$219.50

PLATE BURR HOLE COVER 7MM DIA

Facility

$379.22

Service Code	HCPCS C1713
Hospital Charge Code	64906639
Hospital Revenue Code	278
Min. Negotiated Rate	$189.61
Max. Negotiated Rate	$189.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$189.61
Rate for Payer: Hamaspik Choice Inc Medicare	$189.61

PLATE BURR HOLE COVER 7MM DIA

Facility

$379.22

Service Code	HCPCS C1713
Hospital Charge Code	64906639
Hospital Revenue Code	278
Min. Negotiated Rate	$132.73
Max. Negotiated Rate	$398.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$208.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$227.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$189.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$218.05
Rate for Payer: EmblemHealth Commercial	$189.61
Rate for Payer: Fidelis Medicare Advantage	$398.18
Rate for Payer: Group Health Inc Commercial	$189.61
Rate for Payer: Group Health Inc Medicare	$132.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$189.61
Rate for Payer: Hamaspik Choice Inc Medicare	$189.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$246.49

PLATE BUTTRESS LEFT

Facility

$622.00

Service Code	HCPCS C1713
Hospital Charge Code	40200165
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$653.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$373.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$311.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$357.65
Rate for Payer: EmblemHealth Commercial	$311.00
Rate for Payer: Fidelis Medicare Advantage	$653.10
Rate for Payer: Group Health Inc Commercial	$311.00
Rate for Payer: Group Health Inc Medicare	$217.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$311.00
Rate for Payer: Hamaspik Choice Inc Medicare	$311.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$404.30

PLATE BUTTRESS LEFT

Facility

$622.00

Service Code	HCPCS C1713
Hospital Charge Code	40200165
Hospital Revenue Code	278
Min. Negotiated Rate	$311.00
Max. Negotiated Rate	$311.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$311.00
Rate for Payer: Hamaspik Choice Inc Medicare	$311.00

PLATE BUTTRESS PLATE, RIGHT

Facility

$586.00

Service Code	HCPCS C1713
Hospital Charge Code	40200073
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$615.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$322.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$351.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$293.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$336.95
Rate for Payer: EmblemHealth Commercial	$293.00
Rate for Payer: Fidelis Medicare Advantage	$615.30
Rate for Payer: Group Health Inc Commercial	$293.00
Rate for Payer: Group Health Inc Medicare	$205.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$293.00
Rate for Payer: Hamaspik Choice Inc Medicare	$293.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$380.90

PLATE BUTTRESS PLATE, RIGHT

Facility

$586.00

Service Code	HCPCS C1713
Hospital Charge Code	40200073
Hospital Revenue Code	278
Min. Negotiated Rate	$293.00
Max. Negotiated Rate	$293.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$293.00
Rate for Payer: Hamaspik Choice Inc Medicare	$293.00

PLATE CALCANEAL

Facility

$924.00

Service Code	HCPCS C1713
Hospital Charge Code	40201272
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$970.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$508.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$554.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$462.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$531.30
Rate for Payer: EmblemHealth Commercial	$462.00
Rate for Payer: Fidelis Medicare Advantage	$970.20
Rate for Payer: Group Health Inc Commercial	$462.00
Rate for Payer: Group Health Inc Medicare	$323.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$462.00
Rate for Payer: Hamaspik Choice Inc Medicare	$462.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$600.60

PLATE CALCANEAL

Facility

$924.00

Service Code	HCPCS C1713
Hospital Charge Code	40201272
Hospital Revenue Code	278
Min. Negotiated Rate	$462.00
Max. Negotiated Rate	$462.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$462.00
Rate for Payer: Hamaspik Choice Inc Medicare	$462.00

PLATE CERVICAL OZARK

Facility

$5,355.00

Service Code	HCPCS C1713
Hospital Charge Code	64906885
Hospital Revenue Code	278
Min. Negotiated Rate	$2,677.50
Max. Negotiated Rate	$2,677.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,677.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,677.50

PLATE CERVICAL OZARK

Facility

$5,355.00

Service Code	HCPCS C1713
Hospital Charge Code	64906885
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,622.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,945.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,213.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,677.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,079.12
Rate for Payer: EmblemHealth Commercial	$2,677.50
Rate for Payer: Fidelis Medicare Advantage	$5,622.75
Rate for Payer: Group Health Inc Commercial	$2,677.50
Rate for Payer: Group Health Inc Medicare	$1,874.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,677.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,677.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,480.75

PLATE CHAMPY LEFT

Facility

$733.65

Service Code	HCPCS C1713
Hospital Charge Code	64905059
Hospital Revenue Code	278
Min. Negotiated Rate	$366.82
Max. Negotiated Rate	$366.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.82
Rate for Payer: Hamaspik Choice Inc Medicare	$366.82

PLATE CHAMPY LEFT

Facility

$733.65

Service Code	HCPCS C1713
Hospital Charge Code	64905059
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$770.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$403.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$440.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$366.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$421.85
Rate for Payer: EmblemHealth Commercial	$366.82
Rate for Payer: Fidelis Medicare Advantage	$770.33
Rate for Payer: Group Health Inc Commercial	$366.82
Rate for Payer: Group Health Inc Medicare	$256.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.82
Rate for Payer: Hamaspik Choice Inc Medicare	$366.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$476.87

PLATE CLAW 3 HOLE

Facility

$4,402.50

Service Code	HCPCS C1713
Hospital Charge Code	64904705
Hospital Revenue Code	278
Min. Negotiated Rate	$2,201.25
Max. Negotiated Rate	$2,201.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,201.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,201.25

PLATE CLAW 3 HOLE

Facility

$4,402.50

Service Code	HCPCS C1713
Hospital Charge Code	64904705
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,622.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,421.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,641.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,201.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,531.44
Rate for Payer: EmblemHealth Commercial	$2,201.25
Rate for Payer: Fidelis Medicare Advantage	$4,622.62
Rate for Payer: Group Health Inc Commercial	$2,201.25
Rate for Payer: Group Health Inc Medicare	$1,540.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,201.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,201.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,861.62

PLATE COMMAND/STR 4H MED

Facility

$477.26

Service Code	HCPCS C1713
Hospital Charge Code	40200727
Hospital Revenue Code	278
Min. Negotiated Rate	$238.63
Max. Negotiated Rate	$238.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$238.63
Rate for Payer: Hamaspik Choice Inc Medicare	$238.63

PLATE COMMAND/STR 4H MED

Facility

$477.26

Service Code	HCPCS C1713
Hospital Charge Code	40200727
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$501.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$262.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$286.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$238.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$274.42
Rate for Payer: EmblemHealth Commercial	$238.63
Rate for Payer: Fidelis Medicare Advantage	$501.12
Rate for Payer: Group Health Inc Commercial	$238.63
Rate for Payer: Group Health Inc Medicare	$167.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$238.63
Rate for Payer: Hamaspik Choice Inc Medicare	$238.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$310.22

PLATE COMP LOCK

Facility

$2.50

Service Code	HCPCS C1713
Hospital Charge Code	64907346
Hospital Revenue Code	278
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.44
Rate for Payer: EmblemHealth Commercial	$1.25
Rate for Payer: Fidelis Medicare Advantage	$2.62
Rate for Payer: Group Health Inc Commercial	$1.25
Rate for Payer: Group Health Inc Medicare	$0.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.62

PLATE COMP LOCK

Facility

$2.50

Service Code	HCPCS C1713
Hospital Charge Code	64907346
Hospital Revenue Code	278
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1.25

PLATE COMP PERF TRANSPEC

Facility

$585.03

Service Code	HCPCS C1713
Hospital Charge Code	64907353
Hospital Revenue Code	278
Min. Negotiated Rate	$292.52
Max. Negotiated Rate	$292.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$292.52
Rate for Payer: Hamaspik Choice Inc Medicare	$292.52

PLATE COMP PERF TRANSPEC

Facility

$585.03

Service Code	HCPCS C1713
Hospital Charge Code	64907353
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$614.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$321.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$351.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$292.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$336.39
Rate for Payer: EmblemHealth Commercial	$292.52
Rate for Payer: Fidelis Medicare Advantage	$614.28
Rate for Payer: Group Health Inc Commercial	$292.52
Rate for Payer: Group Health Inc Medicare	$204.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$292.52
Rate for Payer: Hamaspik Choice Inc Medicare	$292.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$380.27

PLATE COMPRESSION 7 HOLE

Facility

$1,737.50

Service Code	HCPCS C1713
Hospital Charge Code	64905133
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

PLATE COMPRESSION 7 HOLE

Facility

$1,737.50

Service Code	HCPCS C1713
Hospital Charge Code	64905133
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 COMRESSION WAISTED 8 HOLE

Facility

$220.00

Service Code	HCPCS C1713
Hospital Charge Code	40201406
Hospital Revenue Code	278
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$110.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00

PLATE COMRESSION WAISTED 8 HOLE

Facility

$220.00

Service Code	HCPCS C1713
Hospital Charge Code	40201406
Hospital Revenue Code	278
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$231.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$121.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$132.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$110.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$126.50
Rate for Payer: EmblemHealth Commercial	$110.00
Rate for Payer: Fidelis Medicare Advantage	$231.00
Rate for Payer: Group Health Inc Commercial	$110.00
Rate for Payer: Group Health Inc Medicare	$77.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$143.00

Know your out-of-pocket cost for care.

All Charges