St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE INVIZIA 40MM

Facility

$5,990.00

Service Code	HCPCS C1713
Hospital Charge Code	64904012
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,289.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,294.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,594.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,995.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,444.25
Rate for Payer: EmblemHealth Commercial	$2,995.00
Rate for Payer: Fidelis Medicare Advantage	$6,289.50
Rate for Payer: Group Health Inc Commercial	$2,995.00
Rate for Payer: Group Health Inc Medicare	$2,096.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,995.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,995.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,893.50

PLATE INVIZIA 40MM

Facility

$5,990.00

Service Code	HCPCS C1713
Hospital Charge Code	64904012
Hospital Revenue Code	278
Min. Negotiated Rate	$2,995.00
Max. Negotiated Rate	$2,995.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,995.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,995.00

PLATE KLS 2.7MM 8HOLE

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	40200390
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$546.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$286.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$312.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$260.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$299.00
Rate for Payer: EmblemHealth Commercial	$260.00
Rate for Payer: Fidelis Medicare Advantage	$546.00
Rate for Payer: Group Health Inc Commercial	$260.00
Rate for Payer: Group Health Inc Medicare	$182.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$260.00
Rate for Payer: Hamaspik Choice Inc Medicare	$260.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$338.00

PLATE KLS 2.7MM 8HOLE

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	40200390
Hospital Revenue Code	278
Min. Negotiated Rate	$260.00
Max. Negotiated Rate	$260.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$260.00
Rate for Payer: Hamaspik Choice Inc Medicare	$260.00

PLATE L 12MM BAR 100D 6 HOLE

Facility

$347.02

Service Code	HCPCS C1713
Hospital Charge Code	64906630
Hospital Revenue Code	278
Min. Negotiated Rate	$121.46
Max. Negotiated Rate	$364.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$190.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$208.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$173.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$199.54
Rate for Payer: EmblemHealth Commercial	$173.51
Rate for Payer: Fidelis Medicare Advantage	$364.37
Rate for Payer: Group Health Inc Commercial	$173.51
Rate for Payer: Group Health Inc Medicare	$121.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$173.51
Rate for Payer: Hamaspik Choice Inc Medicare	$173.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$225.56

PLATE L 12MM BAR 100D 6 HOLE

Facility

$347.02

Service Code	HCPCS C1713
Hospital Charge Code	64906630
Hospital Revenue Code	278
Min. Negotiated Rate	$173.51
Max. Negotiated Rate	$173.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$173.51
Rate for Payer: Hamaspik Choice Inc Medicare	$173.51

PLATE L 2MM BAR 100D 5 HOLE

Facility

$315.44

Service Code	HCPCS C1713
Hospital Charge Code	64906627
Hospital Revenue Code	278
Min. Negotiated Rate	$110.40
Max. Negotiated Rate	$331.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$173.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$189.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$157.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$181.38
Rate for Payer: EmblemHealth Commercial	$157.72
Rate for Payer: Fidelis Medicare Advantage	$331.21
Rate for Payer: Group Health Inc Commercial	$157.72
Rate for Payer: Group Health Inc Medicare	$110.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.72
Rate for Payer: Hamaspik Choice Inc Medicare	$157.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$205.04

PLATE L 2MM BAR 100D 5 HOLE

Facility

$315.44

Service Code	HCPCS C1713
Hospital Charge Code	64906627
Hospital Revenue Code	278
Min. Negotiated Rate	$157.72
Max. Negotiated Rate	$157.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.72
Rate for Payer: Hamaspik Choice Inc Medicare	$157.72

PLATE L 2 MM MED 2X2H RT TIT

Facility

$330.00

Service Code	HCPCS C1713
Hospital Charge Code	40200729
Hospital Revenue Code	278
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$346.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$181.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$198.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$165.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$189.75
Rate for Payer: EmblemHealth Commercial	$165.00
Rate for Payer: Fidelis Medicare Advantage	$346.50
Rate for Payer: Group Health Inc Commercial	$165.00
Rate for Payer: Group Health Inc Medicare	$115.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.00
Rate for Payer: Hamaspik Choice Inc Medicare	$165.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$214.50

PLATE L 2 MM MED 2X2H RT TIT

Facility

$330.00

Service Code	HCPCS C1713
Hospital Charge Code	40200729
Hospital Revenue Code	278
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$165.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.00
Rate for Payer: Hamaspik Choice Inc Medicare	$165.00

PLATE L 5H 2MM AD 100D RT STD

Facility

$403.78

Service Code	HCPCS C1713
Hospital Charge Code	64901570
Hospital Revenue Code	278
Min. Negotiated Rate	$201.89
Max. Negotiated Rate	$201.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$201.89
Rate for Payer: Hamaspik Choice Inc Medicare	$201.89

PLATE L 5H 2MM AD 100D RT STD

Facility

$403.78

Service Code	HCPCS C1713
Hospital Charge Code	64901570
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$423.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$222.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$242.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$201.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$232.17
Rate for Payer: EmblemHealth Commercial	$201.89
Rate for Payer: Fidelis Medicare Advantage	$423.97
Rate for Payer: Group Health Inc Commercial	$201.89
Rate for Payer: Group Health Inc Medicare	$141.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$201.89
Rate for Payer: Hamaspik Choice Inc Medicare	$201.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$262.46

PLATE L 5H 2MM ADV MDFC LOCK

Facility

$433.78

Service Code	HCPCS C1713
Hospital Charge Code	64901590
Hospital Revenue Code	278
Min. Negotiated Rate	$216.89
Max. Negotiated Rate	$216.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$216.89
Rate for Payer: Hamaspik Choice Inc Medicare	$216.89

PLATE L 5H 2MM ADV MDFC LOCK

Facility

$433.78

Service Code	HCPCS C1713
Hospital Charge Code	64901590
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$455.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$238.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$260.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$216.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$249.42
Rate for Payer: EmblemHealth Commercial	$216.89
Rate for Payer: Fidelis Medicare Advantage	$455.47
Rate for Payer: Group Health Inc Commercial	$216.89
Rate for Payer: Group Health Inc Medicare	$151.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$216.89
Rate for Payer: Hamaspik Choice Inc Medicare	$216.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$281.96

PLATE L 5H 5MM ADV MDFC LOCK

Facility

$459.35

Service Code	HCPCS C1713
Hospital Charge Code	64901591
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$482.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$252.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$275.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$229.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$264.13
Rate for Payer: EmblemHealth Commercial	$229.68
Rate for Payer: Fidelis Medicare Advantage	$482.32
Rate for Payer: Group Health Inc Commercial	$229.68
Rate for Payer: Group Health Inc Medicare	$160.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$229.68
Rate for Payer: Hamaspik Choice Inc Medicare	$229.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$298.58

PLATE L 5H 5MM ADV MDFC LOCK

Facility

$459.35

Service Code	HCPCS C1713
Hospital Charge Code	64901591
Hospital Revenue Code	278
Min. Negotiated Rate	$229.68
Max. Negotiated Rate	$229.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$229.68
Rate for Payer: Hamaspik Choice Inc Medicare	$229.68

PLATE L 5-HOLE 2MM ADVC LT STD

Facility

$384.70

Service Code	HCPCS C1713
Hospital Charge Code	64901407
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$403.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$211.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$230.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$192.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$221.20
Rate for Payer: EmblemHealth Commercial	$192.35
Rate for Payer: Fidelis Medicare Advantage	$403.94
Rate for Payer: Group Health Inc Commercial	$192.35
Rate for Payer: Group Health Inc Medicare	$134.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$192.35
Rate for Payer: Hamaspik Choice Inc Medicare	$192.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$250.06

PLATE L 5-HOLE 2MM ADVC LT STD

Facility

$384.70

Service Code	HCPCS C1713
Hospital Charge Code	64901407
Hospital Revenue Code	278
Min. Negotiated Rate	$192.35
Max. Negotiated Rate	$192.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$192.35
Rate for Payer: Hamaspik Choice Inc Medicare	$192.35

PLATE L 5MM BAR 100D 5 HOLE

Facility

$326.74

Service Code	HCPCS C1713
Hospital Charge Code	64906628
Hospital Revenue Code	278
Min. Negotiated Rate	$114.36
Max. Negotiated Rate	$343.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$196.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$163.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$187.88
Rate for Payer: EmblemHealth Commercial	$163.37
Rate for Payer: Fidelis Medicare Advantage	$343.08
Rate for Payer: Group Health Inc Commercial	$163.37
Rate for Payer: Group Health Inc Medicare	$114.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.37
Rate for Payer: Hamaspik Choice Inc Medicare	$163.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$212.38

PLATE L 5MM BAR 100D 5 HOLE

Facility

$326.74

Service Code	HCPCS C1713
Hospital Charge Code	64906628
Hospital Revenue Code	278
Min. Negotiated Rate	$163.37
Max. Negotiated Rate	$163.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.37
Rate for Payer: Hamaspik Choice Inc Medicare	$163.37

PLATE L 6H 12MM AD 100D RT STD

Facility

$433.78

Service Code	HCPCS C1713
Hospital Charge Code	64901578
Hospital Revenue Code	278
Min. Negotiated Rate	$216.89
Max. Negotiated Rate	$216.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$216.89
Rate for Payer: Hamaspik Choice Inc Medicare	$216.89

PLATE L 6H 12MM AD 100D RT STD

Facility

$433.78

Service Code	HCPCS C1713
Hospital Charge Code	64901578
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$455.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$238.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$260.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$216.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$249.42
Rate for Payer: EmblemHealth Commercial	$216.89
Rate for Payer: Fidelis Medicare Advantage	$455.47
Rate for Payer: Group Health Inc Commercial	$216.89
Rate for Payer: Group Health Inc Medicare	$151.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$216.89
Rate for Payer: Hamaspik Choice Inc Medicare	$216.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$281.96

PLATE L 6H 12MM ADV MDFC LOC

Facility

$495.75

Service Code	HCPCS C1713
Hospital Charge Code	64901595
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$520.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$272.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$297.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$247.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$285.06
Rate for Payer: EmblemHealth Commercial	$247.88
Rate for Payer: Fidelis Medicare Advantage	$520.54
Rate for Payer: Group Health Inc Commercial	$247.88
Rate for Payer: Group Health Inc Medicare	$173.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$247.88
Rate for Payer: Hamaspik Choice Inc Medicare	$247.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$322.24

PLATE L 6H 12MM ADV MDFC LOC

Facility

$495.75

Service Code	HCPCS C1713
Hospital Charge Code	64901595
Hospital Revenue Code	278
Min. Negotiated Rate	$247.88
Max. Negotiated Rate	$247.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$247.88
Rate for Payer: Hamaspik Choice Inc Medicare	$247.88

PLATE L 6H 8MM AC 100D ST STD

Facility

$281.13

Service Code	HCPCS C1713
Hospital Charge Code	64901572
Hospital Revenue Code	278
Min. Negotiated Rate	$98.40
Max. Negotiated Rate	$295.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$154.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$168.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$140.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.65
Rate for Payer: EmblemHealth Commercial	$140.56
Rate for Payer: Fidelis Medicare Advantage	$295.19
Rate for Payer: Group Health Inc Commercial	$140.56
Rate for Payer: Group Health Inc Medicare	$98.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.56
Rate for Payer: Hamaspik Choice Inc Medicare	$140.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$182.73

Know your out-of-pocket cost for care.

All Charges