St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE GRIP CABLE

Facility

$3,416.25

Service Code	HCPCS C1776
Hospital Charge Code	64907230
Hospital Revenue Code	278
Min. Negotiated Rate	$1,708.12
Max. Negotiated Rate	$1,708.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,708.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,708.12

PLATE HIP STD BAR KEY 135D, 4H

Facility

$1,131.00

Service Code	HCPCS C1713
Hospital Charge Code	64905741
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,187.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$622.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$678.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$565.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$650.32
Rate for Payer: EmblemHealth Commercial	$565.50
Rate for Payer: Fidelis Medicare Advantage	$1,187.55
Rate for Payer: Group Health Inc Commercial	$565.50
Rate for Payer: Group Health Inc Medicare	$395.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$565.50
Rate for Payer: Hamaspik Choice Inc Medicare	$565.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$735.15

PLATE HIP STD BAR KEY 135D, 4H

Facility

$1,131.00

Service Code	HCPCS C1713
Hospital Charge Code	64905741
Hospital Revenue Code	278
Min. Negotiated Rate	$565.50
Max. Negotiated Rate	$565.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$565.50
Rate for Payer: Hamaspik Choice Inc Medicare	$565.50

PLATE HLDG FORCEPS LG W/BALL TIPS

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	40209516
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: EmblemHealth Commercial	$1,500.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

PLATE HLDG FORCEPS LG W/BALL TIPS

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	40209516
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

PLATE HLDG FORCEPS SMALL

Facility

$950.00

Service Code	HCPCS C1713
Hospital Charge Code	40209530
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$997.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$522.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$570.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$475.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$546.25
Rate for Payer: EmblemHealth Commercial	$475.00
Rate for Payer: Fidelis Medicare Advantage	$997.50
Rate for Payer: Group Health Inc Commercial	$475.00
Rate for Payer: Group Health Inc Medicare	$332.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$475.00
Rate for Payer: Hamaspik Choice Inc Medicare	$475.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$617.50

PLATE HLDG FORCEPS SMALL

Facility

$950.00

Service Code	HCPCS C1713
Hospital Charge Code	40209530
Hospital Revenue Code	278
Min. Negotiated Rate	$475.00
Max. Negotiated Rate	$475.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$475.00
Rate for Payer: Hamaspik Choice Inc Medicare	$475.00

PLATE HLDG FORCEPS,SM W/BALL TIPS

Facility

$950.00

Service Code	HCPCS C1713
Hospital Charge Code	40209515
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$997.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$522.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$570.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$475.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$546.25
Rate for Payer: EmblemHealth Commercial	$475.00
Rate for Payer: Fidelis Medicare Advantage	$997.50
Rate for Payer: Group Health Inc Commercial	$475.00
Rate for Payer: Group Health Inc Medicare	$332.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$475.00
Rate for Payer: Hamaspik Choice Inc Medicare	$475.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$617.50

PLATE HLDG FORCEPS,SM W/BALL TIPS

Facility

$950.00

Service Code	HCPCS C1713
Hospital Charge Code	40209515
Hospital Revenue Code	278
Min. Negotiated Rate	$475.00
Max. Negotiated Rate	$475.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$475.00
Rate for Payer: Hamaspik Choice Inc Medicare	$475.00

PLATE HOLE M 2.5MM

Facility

$4,544.60

Service Code	HCPCS C1713
Hospital Charge Code	64903843
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,771.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,499.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,726.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,272.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,613.14
Rate for Payer: EmblemHealth Commercial	$2,272.30
Rate for Payer: Fidelis Medicare Advantage	$4,771.83
Rate for Payer: Group Health Inc Commercial	$2,272.30
Rate for Payer: Group Health Inc Medicare	$1,590.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,272.30
Rate for Payer: Hamaspik Choice Inc Medicare	$2,272.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,953.99

PLATE HOLE M 2.5MM

Facility

$4,544.60

Service Code	HCPCS C1713
Hospital Charge Code	64903843
Hospital Revenue Code	278
Min. Negotiated Rate	$2,272.30
Max. Negotiated Rate	$2,272.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,272.30
Rate for Payer: Hamaspik Choice Inc Medicare	$2,272.30

PLATE HOLE ORBITAL RIM MIDFACE

Facility

$482.58

Service Code	HCPCS C1713
Hospital Charge Code	64901560
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$506.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$265.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$289.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$241.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$277.48
Rate for Payer: EmblemHealth Commercial	$241.29
Rate for Payer: Fidelis Medicare Advantage	$506.71
Rate for Payer: Group Health Inc Commercial	$241.29
Rate for Payer: Group Health Inc Medicare	$168.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$241.29
Rate for Payer: Hamaspik Choice Inc Medicare	$241.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$313.68

PLATE HOLE ORBITAL RIM MIDFACE

Facility

$482.58

Service Code	HCPCS C1713
Hospital Charge Code	64901560
Hospital Revenue Code	278
Min. Negotiated Rate	$241.29
Max. Negotiated Rate	$241.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$241.29
Rate for Payer: Hamaspik Choice Inc Medicare	$241.29

PLATE HYBRID MMF LOCKING

Facility

$731.25

Service Code	HCPCS C1713
Hospital Charge Code	64902779
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$767.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$402.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$438.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$365.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$420.47
Rate for Payer: EmblemHealth Commercial	$365.62
Rate for Payer: Fidelis Medicare Advantage	$767.81
Rate for Payer: Group Health Inc Commercial	$365.62
Rate for Payer: Group Health Inc Medicare	$255.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$365.62
Rate for Payer: Hamaspik Choice Inc Medicare	$365.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$475.31

PLATE HYBRID MMF LOCKING

Facility

$731.25

Service Code	HCPCS C1713
Hospital Charge Code	64902779
Hospital Revenue Code	278
Min. Negotiated Rate	$365.62
Max. Negotiated Rate	$365.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$365.62
Rate for Payer: Hamaspik Choice Inc Medicare	$365.62

PLATE IMPLANT 6-HOLE FX W/BAR

Facility

$989.40

Service Code	HCPCS C1713
Hospital Charge Code	64901365
Hospital Revenue Code	278
Min. Negotiated Rate	$494.70
Max. Negotiated Rate	$494.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$494.70
Rate for Payer: Hamaspik Choice Inc Medicare	$494.70

PLATE IMPLANT 6-HOLE FX W/BAR

Facility

$989.40

Service Code	HCPCS C1713
Hospital Charge Code	64901365
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,038.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$544.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$593.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$494.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$568.90
Rate for Payer: EmblemHealth Commercial	$494.70
Rate for Payer: Fidelis Medicare Advantage	$1,038.87
Rate for Payer: Group Health Inc Commercial	$494.70
Rate for Payer: Group Health Inc Medicare	$346.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$494.70
Rate for Payer: Hamaspik Choice Inc Medicare	$494.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$643.11

PLATE IMPLANT STR 4H MIDFACE

Facility

$228.38

Service Code	HCPCS C1713
Hospital Charge Code	64901388
Hospital Revenue Code	278
Min. Negotiated Rate	$79.93
Max. Negotiated Rate	$239.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$125.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$137.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$114.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$131.32
Rate for Payer: EmblemHealth Commercial	$114.19
Rate for Payer: Fidelis Medicare Advantage	$239.80
Rate for Payer: Group Health Inc Commercial	$114.19
Rate for Payer: Group Health Inc Medicare	$79.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.19
Rate for Payer: Hamaspik Choice Inc Medicare	$114.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$148.45

PLATE IMPLANT STR 4H MIDFACE

Facility

$228.38

Service Code	HCPCS C1713
Hospital Charge Code	64901388
Hospital Revenue Code	278
Min. Negotiated Rate	$114.19
Max. Negotiated Rate	$114.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.19
Rate for Payer: Hamaspik Choice Inc Medicare	$114.19

PLATE INTERMEDIATE RIGHT 10

Facility

$3,610.00

Service Code	HCPCS C1713
Hospital Charge Code	64904417
Hospital Revenue Code	278
Min. Negotiated Rate	$1,805.00
Max. Negotiated Rate	$1,805.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,805.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,805.00

PLATE INTERMEDIATE RIGHT 10

Facility

$3,610.00

Service Code	HCPCS C1713
Hospital Charge Code	64904417
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,790.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,985.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,166.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,805.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,075.75
Rate for Payer: EmblemHealth Commercial	$1,805.00
Rate for Payer: Fidelis Medicare Advantage	$3,790.50
Rate for Payer: Group Health Inc Commercial	$1,805.00
Rate for Payer: Group Health Inc Medicare	$1,263.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,805.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,805.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,346.50

PLATE INTERMEDIATE STANDARD

Facility

$3,862.50

Service Code	HCPCS C1713
Hospital Charge Code	64904419
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,055.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,124.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,317.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,931.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,220.94
Rate for Payer: EmblemHealth Commercial	$1,931.25
Rate for Payer: Fidelis Medicare Advantage	$4,055.62
Rate for Payer: Group Health Inc Commercial	$1,931.25
Rate for Payer: Group Health Inc Medicare	$1,351.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,931.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,931.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,510.62

PLATE INTERMEDIATE STANDARD

Facility

$3,862.50

Service Code	HCPCS C1713
Hospital Charge Code	64904419
Hospital Revenue Code	278
Min. Negotiated Rate	$1,931.25
Max. Negotiated Rate	$1,931.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,931.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,931.25

PLATE INVIZIA 22MM

Facility

$5,430.00

Service Code	HCPCS C1713
Hospital Charge Code	64904018
Hospital Revenue Code	278
Min. Negotiated Rate	$2,715.00
Max. Negotiated Rate	$2,715.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,715.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,715.00

PLATE INVIZIA 22MM

Facility

$5,430.00

Service Code	HCPCS C1713
Hospital Charge Code	64904018
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,701.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,986.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,258.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,715.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,122.25
Rate for Payer: EmblemHealth Commercial	$2,715.00
Rate for Payer: Fidelis Medicare Advantage	$5,701.50
Rate for Payer: Group Health Inc Commercial	$2,715.00
Rate for Payer: Group Health Inc Medicare	$1,900.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,715.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,715.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,529.50

Know your out-of-pocket cost for care.

All Charges