St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE SLOTTED

Facility

$550.50

Service Code	HCPCS C1713
Hospital Charge Code	64907409
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$578.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$302.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$330.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$275.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$316.54
Rate for Payer: EmblemHealth Commercial	$275.25
Rate for Payer: Fidelis Medicare Advantage	$578.02
Rate for Payer: Group Health Inc Commercial	$275.25
Rate for Payer: Group Health Inc Medicare	$192.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.25
Rate for Payer: Hamaspik Choice Inc Medicare	$275.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$357.82

PLATE SLOTTED

Facility

$550.50

Service Code	HCPCS C1713
Hospital Charge Code	64907409
Hospital Revenue Code	278
Min. Negotiated Rate	$275.25
Max. Negotiated Rate	$275.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.25
Rate for Payer: Hamaspik Choice Inc Medicare	$275.25

PLATE SMALL OCCIPITAL

Facility

$16,373.13

Service Code	HCPCS C1713
Hospital Charge Code	64907123
Hospital Revenue Code	278
Min. Negotiated Rate	$8,186.56
Max. Negotiated Rate	$8,186.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,186.56
Rate for Payer: Hamaspik Choice Inc Medicare	$8,186.56

PLATE SMALL OCCIPITAL

Facility

$16,373.13

Service Code	HCPCS C1713
Hospital Charge Code	64907123
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$17,191.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9,005.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$9,823.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,186.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$9,414.55
Rate for Payer: EmblemHealth Commercial	$8,186.56
Rate for Payer: Fidelis Medicare Advantage	$17,191.79
Rate for Payer: Group Health Inc Commercial	$8,186.56
Rate for Payer: Group Health Inc Medicare	$5,730.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,186.56
Rate for Payer: Hamaspik Choice Inc Medicare	$8,186.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10,642.53

PLATE SM FRAGSET 5H TUBULAR

Facility

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40209438
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 SM FRAGSET 5H TUBULAR

Facility

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40209438
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 SM OC YUKON

Facility

$3,515.00

Service Code	HCPCS C1713
Hospital Charge Code	64907511
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,690.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,933.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,109.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,757.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,021.12
Rate for Payer: EmblemHealth Commercial	$1,757.50
Rate for Payer: Fidelis Medicare Advantage	$3,690.75
Rate for Payer: Group Health Inc Commercial	$1,757.50
Rate for Payer: Group Health Inc Medicare	$1,230.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,757.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,757.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,284.75

PLATE SM OC YUKON

Facility

$3,515.00

Service Code	HCPCS C1713
Hospital Charge Code	64907511
Hospital Revenue Code	278
Min. Negotiated Rate	$1,757.50
Max. Negotiated Rate	$1,757.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,757.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,757.50

PLATE SMRTLK ULNR CLMN SHT LT5403

Facility

$1,077.00

Service Code	HCPCS C1713
Hospital Charge Code	64906534
Hospital Revenue Code	278
Min. Negotiated Rate	$538.50
Max. Negotiated Rate	$538.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$538.50
Rate for Payer: Hamaspik Choice Inc Medicare	$538.50

PLATE SMRTLK ULNR CLMN SHT LT5403

Facility

$1,077.00

Service Code	HCPCS C1713
Hospital Charge Code	64906534
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,130.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$592.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$646.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$538.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$619.28
Rate for Payer: EmblemHealth Commercial	$538.50
Rate for Payer: Fidelis Medicare Advantage	$1,130.85
Rate for Payer: Group Health Inc Commercial	$538.50
Rate for Payer: Group Health Inc Medicare	$376.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$538.50
Rate for Payer: Hamaspik Choice Inc Medicare	$538.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$700.05

PLATE SOLID X 16HOLE

Facility

$2,558.00

Service Code	HCPCS C1713
Hospital Charge Code	64906887
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,685.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,406.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,534.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,279.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,470.85
Rate for Payer: EmblemHealth Commercial	$1,279.00
Rate for Payer: Fidelis Medicare Advantage	$2,685.90
Rate for Payer: Group Health Inc Commercial	$1,279.00
Rate for Payer: Group Health Inc Medicare	$895.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,279.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,279.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,662.70

PLATE SOLID X 16HOLE

Facility

$2,558.00

Service Code	HCPCS C1713
Hospital Charge Code	64906887
Hospital Revenue Code	278
Min. Negotiated Rate	$1,279.00
Max. Negotiated Rate	$1,279.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,279.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,279.00

PLATE SPAR X 14HOLE

Facility

$2,558.00

Service Code	HCPCS C1713
Hospital Charge Code	64906888
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,685.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,406.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,534.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,279.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,470.85
Rate for Payer: EmblemHealth Commercial	$1,279.00
Rate for Payer: Fidelis Medicare Advantage	$2,685.90
Rate for Payer: Group Health Inc Commercial	$1,279.00
Rate for Payer: Group Health Inc Medicare	$895.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,279.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,279.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,662.70

PLATE SPAR X 14HOLE

Facility

$2,558.00

Service Code	HCPCS C1713
Hospital Charge Code	64906888
Hospital Revenue Code	278
Min. Negotiated Rate	$1,279.00
Max. Negotiated Rate	$1,279.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,279.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,279.00

PLATE SPINAL

Facility

$6,875.00

Service Code	HCPCS C1713
Hospital Charge Code	64907341
Hospital Revenue Code	278
Min. Negotiated Rate	$3,437.50
Max. Negotiated Rate	$3,437.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,437.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,437.50

PLATE SPINAL

Facility

$6,875.00

Service Code	HCPCS C1713
Hospital Charge Code	64907341
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$7,218.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,781.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,125.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,437.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,953.12
Rate for Payer: EmblemHealth Commercial	$3,437.50
Rate for Payer: Fidelis Medicare Advantage	$7,218.75
Rate for Payer: Group Health Inc Commercial	$3,437.50
Rate for Payer: Group Health Inc Medicare	$2,406.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,437.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,437.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,468.75

PLATE SPINAL COVER 12MMH TT

Facility

$2,292.50

Service Code	HCPCS C1713
Hospital Charge Code	64904677
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,407.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,260.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,375.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,146.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,318.19
Rate for Payer: EmblemHealth Commercial	$1,146.25
Rate for Payer: Fidelis Medicare Advantage	$2,407.12
Rate for Payer: Group Health Inc Commercial	$1,146.25
Rate for Payer: Group Health Inc Medicare	$802.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,146.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,146.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,490.12

PLATE SPINAL COVER 12MMH TT

Facility

$2,292.50

Service Code	HCPCS C1713
Hospital Charge Code	64904677
Hospital Revenue Code	278
Min. Negotiated Rate	$1,146.25
Max. Negotiated Rate	$1,146.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,146.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,146.25

PLATE SPUR LAT 5HOLE

Facility

$1,208.00

Service Code	HCPCS C1713
Hospital Charge Code	64906263
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,268.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$664.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$724.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$604.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$694.60
Rate for Payer: EmblemHealth Commercial	$604.00
Rate for Payer: Fidelis Medicare Advantage	$1,268.40
Rate for Payer: Group Health Inc Commercial	$604.00
Rate for Payer: Group Health Inc Medicare	$422.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$604.00
Rate for Payer: Hamaspik Choice Inc Medicare	$604.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$785.20

PLATE SPUR LAT 5HOLE

Facility

$1,208.00

Service Code	HCPCS C1713
Hospital Charge Code	64906263
Hospital Revenue Code	278
Min. Negotiated Rate	$604.00
Max. Negotiated Rate	$604.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$604.00
Rate for Payer: Hamaspik Choice Inc Medicare	$604.00

PLATE ST 1.2MM MICRO PLUS 8H TI

Facility

$332.00

Service Code	HCPCS C1713
Hospital Charge Code	40200732
Hospital Revenue Code	278
Min. Negotiated Rate	$116.20
Max. Negotiated Rate	$348.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$182.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$199.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$166.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$190.90
Rate for Payer: EmblemHealth Commercial	$166.00
Rate for Payer: Fidelis Medicare Advantage	$348.60
Rate for Payer: Group Health Inc Commercial	$166.00
Rate for Payer: Group Health Inc Medicare	$116.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$166.00
Rate for Payer: Hamaspik Choice Inc Medicare	$166.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$215.80

PLATE ST 1.2MM MICRO PLUS 8H TI

Facility

$332.00

Service Code	HCPCS C1713
Hospital Charge Code	40200732
Hospital Revenue Code	278
Min. Negotiated Rate	$166.00
Max. Negotiated Rate	$166.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$166.00
Rate for Payer: Hamaspik Choice Inc Medicare	$166.00

PLATE STANDARD ORBITAL FLOOR

Facility

$2,326.68

Service Code	HCPCS C1713
Hospital Charge Code	64906620
Hospital Revenue Code	278
Min. Negotiated Rate	$1,163.34
Max. Negotiated Rate	$1,163.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,163.34
Rate for Payer: Hamaspik Choice Inc Medicare	$1,163.34

PLATE STANDARD ORBITAL FLOOR

Facility

$2,326.68

Service Code	HCPCS C1713
Hospital Charge Code	64906620
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,443.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,279.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,396.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,163.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,337.84
Rate for Payer: EmblemHealth Commercial	$1,163.34
Rate for Payer: Fidelis Medicare Advantage	$2,443.01
Rate for Payer: Group Health Inc Commercial	$1,163.34
Rate for Payer: Group Health Inc Medicare	$814.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,163.34
Rate for Payer: Hamaspik Choice Inc Medicare	$1,163.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,512.34

PLATE STD ORB FL,BASIC,MD,.3MM

Facility

$1,198.26

Service Code	HCPCS C1713
Hospital Charge Code	64906618
Hospital Revenue Code	278
Min. Negotiated Rate	$599.13
Max. Negotiated Rate	$599.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$599.13
Rate for Payer: Hamaspik Choice Inc Medicare	$599.13

Know your out-of-pocket cost for care.

All Charges