St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE CRANIAL 12MML HOLEX2 RIG

Facility

$231.90

Service Code	HCPCS C1713
Hospital Charge Code	64902870
Hospital Revenue Code	278
Min. Negotiated Rate	$115.95
Max. Negotiated Rate	$115.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.95
Rate for Payer: Hamaspik Choice Inc Medicare	$115.95

PLATE CRANIAL 12MML HOLEX2 RIG

Facility

$231.90

Service Code	HCPCS C1713
Hospital Charge Code	64902870
Hospital Revenue Code	278
Min. Negotiated Rate	$81.16
Max. Negotiated Rate	$243.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$127.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$139.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$115.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$133.34
Rate for Payer: EmblemHealth Commercial	$115.95
Rate for Payer: Fidelis Medicare Advantage	$243.50
Rate for Payer: Group Health Inc Commercial	$115.95
Rate for Payer: Group Health Inc Medicare	$81.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.95
Rate for Payer: Hamaspik Choice Inc Medicare	$115.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$150.74

PLATE CRANIAL STR 2-HOLE 1.55

Facility

$97.50

Service Code	HCPCS C1713
Hospital Charge Code	64901212
Hospital Revenue Code	278
Min. Negotiated Rate	$34.12
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$58.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$56.06
Rate for Payer: EmblemHealth Commercial	$48.75
Rate for Payer: Fidelis Medicare Advantage	$102.38
Rate for Payer: Group Health Inc Commercial	$48.75
Rate for Payer: Group Health Inc Medicare	$34.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.75
Rate for Payer: Hamaspik Choice Inc Medicare	$48.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$63.38

PLATE CRANIAL STR 2-HOLE 1.55

Facility

$97.50

Service Code	HCPCS C1713
Hospital Charge Code	64901212
Hospital Revenue Code	278
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$48.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.75
Rate for Payer: Hamaspik Choice Inc Medicare	$48.75

PLATE CRVCL HYBRD 1-LEV ANT 18MM

Facility

$3,868.36

Service Code	HCPCS C1713
Hospital Charge Code	64906590
Hospital Revenue Code	278
Min. Negotiated Rate	$1,934.18
Max. Negotiated Rate	$1,934.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,934.18
Rate for Payer: Hamaspik Choice Inc Medicare	$1,934.18

PLATE CRVCL HYBRD 1-LEV ANT 18MM

Facility

$3,868.36

Service Code	HCPCS C1713
Hospital Charge Code	64906590
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,061.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,127.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,321.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,934.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,224.31
Rate for Payer: EmblemHealth Commercial	$1,934.18
Rate for Payer: Fidelis Medicare Advantage	$4,061.78
Rate for Payer: Group Health Inc Commercial	$1,934.18
Rate for Payer: Group Health Inc Medicare	$1,353.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,934.18
Rate for Payer: Hamaspik Choice Inc Medicare	$1,934.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,514.43

PLATE CRV PELV R 108/L90.5MM/6H

Facility

$927.88

Service Code	HCPCS C1713
Hospital Charge Code	64902484
Hospital Revenue Code	278
Min. Negotiated Rate	$463.94
Max. Negotiated Rate	$463.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$463.94
Rate for Payer: Hamaspik Choice Inc Medicare	$463.94

PLATE CRV PELV R 108/L90.5MM/6H

Facility

$927.88

Service Code	HCPCS C1713
Hospital Charge Code	64902484
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$974.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$510.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$556.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$463.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$533.53
Rate for Payer: EmblemHealth Commercial	$463.94
Rate for Payer: Fidelis Medicare Advantage	$974.27
Rate for Payer: Group Health Inc Commercial	$463.94
Rate for Payer: Group Health Inc Medicare	$324.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$463.94
Rate for Payer: Hamaspik Choice Inc Medicare	$463.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$603.12

PLATE CUBOID 2.4MM LC-DCP

Facility

$717.50

Service Code	HCPCS C1713
Hospital Charge Code	64901327
Hospital Revenue Code	278
Min. Negotiated Rate	$358.75
Max. Negotiated Rate	$358.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$358.75
Rate for Payer: Hamaspik Choice Inc Medicare	$358.75

PLATE CUBOID 2.4MM LC-DCP

Facility

$717.50

Service Code	HCPCS C1713
Hospital Charge Code	64901327
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$753.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$394.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$430.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$358.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$412.56
Rate for Payer: EmblemHealth Commercial	$358.75
Rate for Payer: Fidelis Medicare Advantage	$753.38
Rate for Payer: Group Health Inc Commercial	$358.75
Rate for Payer: Group Health Inc Medicare	$251.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$358.75
Rate for Payer: Hamaspik Choice Inc Medicare	$358.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$466.38

PLATE CURV 8-OLE MDFACE LOCK

Facility

$368.60

Service Code	HCPCS C1713
Hospital Charge Code	64901581
Hospital Revenue Code	278
Min. Negotiated Rate	$129.01
Max. Negotiated Rate	$387.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$202.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$221.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$184.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$211.94
Rate for Payer: EmblemHealth Commercial	$184.30
Rate for Payer: Fidelis Medicare Advantage	$387.03
Rate for Payer: Group Health Inc Commercial	$184.30
Rate for Payer: Group Health Inc Medicare	$129.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$184.30
Rate for Payer: Hamaspik Choice Inc Medicare	$184.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$239.59

PLATE CURV 8-OLE MDFACE LOCK

Facility

$368.60

Service Code	HCPCS C1713
Hospital Charge Code	64901581
Hospital Revenue Code	278
Min. Negotiated Rate	$184.30
Max. Negotiated Rate	$184.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$184.30
Rate for Payer: Hamaspik Choice Inc Medicare	$184.30

PLATE CURVED 10H UP MALL CNDSD

Facility

$459.90

Service Code	HCPCS C1713
Hospital Charge Code	64901403
Hospital Revenue Code	278
Min. Negotiated Rate	$229.95
Max. Negotiated Rate	$229.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$229.95
Rate for Payer: Hamaspik Choice Inc Medicare	$229.95

PLATE CURVED 10H UP MALL CNDSD

Facility

$459.90

Service Code	HCPCS C1713
Hospital Charge Code	64901403
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$482.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$252.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$275.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$229.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$264.44
Rate for Payer: EmblemHealth Commercial	$229.95
Rate for Payer: Fidelis Medicare Advantage	$482.90
Rate for Payer: Group Health Inc Commercial	$229.95
Rate for Payer: Group Health Inc Medicare	$160.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$229.95
Rate for Payer: Hamaspik Choice Inc Medicare	$229.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$298.94

PLATE CURV PELV 5 88MM/L90.5/6H

Facility

$742.30

Service Code	HCPCS C1713
Hospital Charge Code	40006564
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$779.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$408.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$445.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$371.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$426.82
Rate for Payer: EmblemHealth Commercial	$371.15
Rate for Payer: Fidelis Medicare Advantage	$779.42
Rate for Payer: Group Health Inc Commercial	$371.15
Rate for Payer: Group Health Inc Medicare	$259.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$371.15
Rate for Payer: Hamaspik Choice Inc Medicare	$371.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$482.50

PLATE CURV PELV 5 88MM/L90.5/6H

Facility

$742.30

Service Code	HCPCS C1713
Hospital Charge Code	40006564
Hospital Revenue Code	278
Min. Negotiated Rate	$371.15
Max. Negotiated Rate	$371.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$371.15
Rate for Payer: Hamaspik Choice Inc Medicare	$371.15

PLATE CURV R 88MM/L186.5MM/12H

Facility

$1,119.63

Service Code	HCPCS C1713
Hospital Charge Code	64905789
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,175.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$615.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$671.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$559.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$643.79
Rate for Payer: EmblemHealth Commercial	$559.82
Rate for Payer: Fidelis Medicare Advantage	$1,175.61
Rate for Payer: Group Health Inc Commercial	$559.82
Rate for Payer: Group Health Inc Medicare	$391.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$559.82
Rate for Payer: Hamaspik Choice Inc Medicare	$559.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$727.76

PLATE CURV R 88MM/L186.5MM/12H

Facility

$1,119.63

Service Code	HCPCS C1713
Hospital Charge Code	64905789
Hospital Revenue Code	278
Min. Negotiated Rate	$559.82
Max. Negotiated Rate	$559.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$559.82
Rate for Payer: Hamaspik Choice Inc Medicare	$559.82

PLATE CVD 10H MIDFACE FIXATION

Facility

$535.20

Service Code	HCPCS C1713
Hospital Charge Code	64901377
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$561.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$294.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$321.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$267.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$307.74
Rate for Payer: EmblemHealth Commercial	$267.60
Rate for Payer: Fidelis Medicare Advantage	$561.96
Rate for Payer: Group Health Inc Commercial	$267.60
Rate for Payer: Group Health Inc Medicare	$187.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$267.60
Rate for Payer: Hamaspik Choice Inc Medicare	$267.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$347.88

PLATE CVD 10H MIDFACE FIXATION

Facility

$535.20

Service Code	HCPCS C1713
Hospital Charge Code	64901377
Hospital Revenue Code	278
Min. Negotiated Rate	$267.60
Max. Negotiated Rate	$267.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$267.60
Rate for Payer: Hamaspik Choice Inc Medicare	$267.60

PLATE CVD ANG FX 6-HOLE 115

Facility

$1,337.40

Service Code	HCPCS C1713
Hospital Charge Code	64901367
Hospital Revenue Code	278
Min. Negotiated Rate	$668.70
Max. Negotiated Rate	$668.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$668.70
Rate for Payer: Hamaspik Choice Inc Medicare	$668.70

PLATE CVD ANG FX 6-HOLE 115

Facility

$1,337.40

Service Code	HCPCS C1713
Hospital Charge Code	64901367
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,404.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$735.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$802.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$668.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$769.00
Rate for Payer: EmblemHealth Commercial	$668.70
Rate for Payer: Fidelis Medicare Advantage	$1,404.27
Rate for Payer: Group Health Inc Commercial	$668.70
Rate for Payer: Group Health Inc Medicare	$468.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$668.70
Rate for Payer: Hamaspik Choice Inc Medicare	$668.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$869.31

PLATE DBL Y 1.2MM 6H MC PLUSS

Facility

$234.00

Service Code	HCPCS C1713
Hospital Charge Code	40200728
Hospital Revenue Code	278
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$245.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$128.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$140.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$117.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$134.55
Rate for Payer: EmblemHealth Commercial	$117.00
Rate for Payer: Fidelis Medicare Advantage	$245.70
Rate for Payer: Group Health Inc Commercial	$117.00
Rate for Payer: Group Health Inc Medicare	$81.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$117.00
Rate for Payer: Hamaspik Choice Inc Medicare	$117.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$152.10

PLATE DBL Y 1.2MM 6H MC PLUSS

Facility

$234.00

Service Code	HCPCS C1713
Hospital Charge Code	40200728
Hospital Revenue Code	278
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$117.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$117.00
Rate for Payer: Hamaspik Choice Inc Medicare	$117.00

PLATE DBL Y 1.2MM 6H MCPLUSS

Facility

$292.50

Service Code	HCPCS C1713
Hospital Charge Code	64901215
Hospital Revenue Code	278
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$146.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.25
Rate for Payer: Hamaspik Choice Inc Medicare	$146.25

Know your out-of-pocket cost for care.

All Charges