St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OSTEOAMP GRANULES 5.0CC (2-4MM)

Facility

$2,161.96

Service Code	HCPCS C1713
Hospital Charge Code	40005191
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,270.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,189.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,297.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,080.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,243.13
Rate for Payer: EmblemHealth Commercial	$1,080.98
Rate for Payer: Fidelis Medicare Advantage	$2,270.06
Rate for Payer: Group Health Inc Commercial	$1,080.98
Rate for Payer: Group Health Inc Medicare	$756.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,080.98
Rate for Payer: Hamaspik Choice Inc Medicare	$1,080.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,405.27

OSTEOAMP GRANULES 5.0CC (2-4MM)

Facility

$2,161.96

Service Code	HCPCS C1713
Hospital Charge Code	40005191
Hospital Revenue Code	278
Min. Negotiated Rate	$1,080.98
Max. Negotiated Rate	$1,080.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,080.98
Rate for Payer: Hamaspik Choice Inc Medicare	$1,080.98

OSTEOCONDUCTIVE SCAFFOLD M PUTTY

Facility

$1,700.00

Service Code	HCPCS C1713
Hospital Charge Code	40209722
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,785.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$935.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,020.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$850.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$977.50
Rate for Payer: EmblemHealth Commercial	$850.00
Rate for Payer: Fidelis Medicare Advantage	$1,785.00
Rate for Payer: Group Health Inc Commercial	$850.00
Rate for Payer: Group Health Inc Medicare	$595.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$850.00
Rate for Payer: Hamaspik Choice Inc Medicare	$850.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,105.00

OSTEOCONDUCTIVE SCAFFOLD M PUTTY

Facility

$1,700.00

Service Code	HCPCS C1713
Hospital Charge Code	40209722
Hospital Revenue Code	278
Min. Negotiated Rate	$850.00
Max. Negotiated Rate	$850.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$850.00
Rate for Payer: Hamaspik Choice Inc Medicare	$850.00

OSTEOGENICS CYTOPLAST 15X20

Facility

$350.00

Service Code	HCPCS C1762
Hospital Charge Code	40206276
Hospital Revenue Code	278
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$1,879.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,879.82
Rate for Payer: Aetna Government	$1,879.82
Rate for Payer: Brighton Health Commercial	$210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$175.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.25
Rate for Payer: EmblemHealth Commercial	$175.00
Rate for Payer: Fidelis Medicare Advantage	$367.50
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$227.50

OSTEOGENICS CYTOPLAST 15X20

Facility

$350.00

Service Code	HCPCS C1762
Hospital Charge Code	40206276
Hospital Revenue Code	278
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

OSTEOMED 10 H STRAIGHT PLATE

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	40209399
Hospital Revenue Code	278
Min. Negotiated Rate	$155.00
Max. Negotiated Rate	$155.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$155.00
Rate for Payer: Hamaspik Choice Inc Medicare	$155.00

OSTEOMED 10 H STRAIGHT PLATE

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	40209399
Hospital Revenue Code	278
Min. Negotiated Rate	$108.50
Max. Negotiated Rate	$325.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$170.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$186.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$178.25
Rate for Payer: EmblemHealth Commercial	$155.00
Rate for Payer: Fidelis Medicare Advantage	$325.50
Rate for Payer: Group Health Inc Commercial	$155.00
Rate for Payer: Group Health Inc Medicare	$108.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$155.00
Rate for Payer: Hamaspik Choice Inc Medicare	$155.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$201.50

OSTEOMED 11 H EXTENDED Y PLATE

Facility

$395.00

Service Code	HCPCS C1713
Hospital Charge Code	40209397
Hospital Revenue Code	278
Min. Negotiated Rate	$197.50
Max. Negotiated Rate	$197.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$197.50
Rate for Payer: Hamaspik Choice Inc Medicare	$197.50

OSTEOMED 11 H EXTENDED Y PLATE

Facility

$395.00

Service Code	HCPCS C1713
Hospital Charge Code	40209397
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$414.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$217.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$237.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$197.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$227.12
Rate for Payer: EmblemHealth Commercial	$197.50
Rate for Payer: Fidelis Medicare Advantage	$414.75
Rate for Payer: Group Health Inc Commercial	$197.50
Rate for Payer: Group Health Inc Medicare	$138.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$197.50
Rate for Payer: Hamaspik Choice Inc Medicare	$197.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$256.75

OSTEOMED 15 HOLE PLATE

Facility

$1,602.00

Service Code	HCPCS C1713
Hospital Charge Code	40203655
Hospital Revenue Code	278
Min. Negotiated Rate	$801.00
Max. Negotiated Rate	$801.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$801.00
Rate for Payer: Hamaspik Choice Inc Medicare	$801.00

OSTEOMED 15 HOLE PLATE

Facility

$1,602.00

Service Code	HCPCS C1713
Hospital Charge Code	40203655
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,682.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$881.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$961.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$801.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$921.15
Rate for Payer: EmblemHealth Commercial	$801.00
Rate for Payer: Fidelis Medicare Advantage	$1,682.10
Rate for Payer: Group Health Inc Commercial	$801.00
Rate for Payer: Group Health Inc Medicare	$560.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$801.00
Rate for Payer: Hamaspik Choice Inc Medicare	$801.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,041.30

OSTEOMED 34 HOLE STRIP PLATE

Facility

$447.50

Service Code	HCPCS C1713
Hospital Charge Code	40205055
Hospital Revenue Code	278
Min. Negotiated Rate	$223.75
Max. Negotiated Rate	$223.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$223.75
Rate for Payer: Hamaspik Choice Inc Medicare	$223.75

OSTEOMED 34 HOLE STRIP PLATE

Facility

$447.50

Service Code	HCPCS C1713
Hospital Charge Code	40205055
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$469.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$246.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$268.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$223.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$257.31
Rate for Payer: EmblemHealth Commercial	$223.75
Rate for Payer: Fidelis Medicare Advantage	$469.88
Rate for Payer: Group Health Inc Commercial	$223.75
Rate for Payer: Group Health Inc Medicare	$156.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$223.75
Rate for Payer: Hamaspik Choice Inc Medicare	$223.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$290.88

OSTEOMED 4HOLE PLATE 24MM

Facility

$478.00

Service Code	HCPCS C1713
Hospital Charge Code	40209356
Hospital Revenue Code	278
Min. Negotiated Rate	$239.00
Max. Negotiated Rate	$239.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$239.00
Rate for Payer: Hamaspik Choice Inc Medicare	$239.00

OSTEOMED 4HOLE PLATE 24MM

Facility

$478.00

Service Code	HCPCS C1713
Hospital Charge Code	40209356
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$501.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$262.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$286.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$239.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$274.85
Rate for Payer: EmblemHealth Commercial	$239.00
Rate for Payer: Fidelis Medicare Advantage	$501.90
Rate for Payer: Group Health Inc Commercial	$239.00
Rate for Payer: Group Health Inc Medicare	$167.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$239.00
Rate for Payer: Hamaspik Choice Inc Medicare	$239.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$310.70

OSTEOMED 68HOLE 24MM PLATE

Facility

$424.00

Service Code	HCPCS C1713
Hospital Charge Code	40209363
Hospital Revenue Code	278
Min. Negotiated Rate	$212.00
Max. Negotiated Rate	$212.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$212.00
Rate for Payer: Hamaspik Choice Inc Medicare	$212.00

OSTEOMED 68HOLE 24MM PLATE

Facility

$424.00

Service Code	HCPCS C1713
Hospital Charge Code	40209363
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$445.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$233.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$254.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$212.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$243.80
Rate for Payer: EmblemHealth Commercial	$212.00
Rate for Payer: Fidelis Medicare Advantage	$445.20
Rate for Payer: Group Health Inc Commercial	$212.00
Rate for Payer: Group Health Inc Medicare	$148.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$212.00
Rate for Payer: Hamaspik Choice Inc Medicare	$212.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$275.60

OSTEOMED 68HOLE STRIP PLATE

Facility

$424.00

Service Code	HCPCS C1713
Hospital Charge Code	40209361
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$445.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$233.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$254.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$212.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$243.80
Rate for Payer: EmblemHealth Commercial	$212.00
Rate for Payer: Fidelis Medicare Advantage	$445.20
Rate for Payer: Group Health Inc Commercial	$212.00
Rate for Payer: Group Health Inc Medicare	$148.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$212.00
Rate for Payer: Hamaspik Choice Inc Medicare	$212.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$275.60

OSTEOMED 68HOLE STRIP PLATE

Facility

$424.00

Service Code	HCPCS C1713
Hospital Charge Code	40209361
Hospital Revenue Code	278
Min. Negotiated Rate	$212.00
Max. Negotiated Rate	$212.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$212.00
Rate for Payer: Hamaspik Choice Inc Medicare	$212.00

OSTEOMED 68HOLE STRIP PLATE

Facility

$424.00

Service Code	HCPCS C1713
Hospital Charge Code	40209362
Hospital Revenue Code	278
Min. Negotiated Rate	$212.00
Max. Negotiated Rate	$212.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$212.00
Rate for Payer: Hamaspik Choice Inc Medicare	$212.00

OSTEOMED 68HOLE STRIP PLATE

Facility

$424.00

Service Code	HCPCS C1713
Hospital Charge Code	40209362
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$445.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$233.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$254.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$212.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$243.80
Rate for Payer: EmblemHealth Commercial	$212.00
Rate for Payer: Fidelis Medicare Advantage	$445.20
Rate for Payer: Group Health Inc Commercial	$212.00
Rate for Payer: Group Health Inc Medicare	$148.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$212.00
Rate for Payer: Hamaspik Choice Inc Medicare	$212.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$275.60

OSTEOMED AUTO DRI SCRW 6MMX1.6MM

Facility

$104.00

Service Code	HCPCS C1776
Hospital Charge Code	40208145
Hospital Revenue Code	278
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$62.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.80
Rate for Payer: EmblemHealth Commercial	$52.00
Rate for Payer: Fidelis Medicare Advantage	$109.20
Rate for Payer: Group Health Inc Commercial	$52.00
Rate for Payer: Group Health Inc Medicare	$36.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.00
Rate for Payer: Hamaspik Choice Inc Medicare	$52.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$67.60

OSTEOMED AUTO DRI SCRW 6MMX1.6MM

Facility

$104.00

Service Code	HCPCS C1776
Hospital Charge Code	40208145
Hospital Revenue Code	278
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$52.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.00
Rate for Payer: Hamaspik Choice Inc Medicare	$52.00

OSTEOMED AUTO DRVE SCRW 5MMX2.0MM

Facility

$104.00

Service Code	HCPCS C1776
Hospital Charge Code	40205058
Hospital Revenue Code	278
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$62.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.80
Rate for Payer: EmblemHealth Commercial	$52.00
Rate for Payer: Fidelis Medicare Advantage	$109.20
Rate for Payer: Group Health Inc Commercial	$52.00
Rate for Payer: Group Health Inc Medicare	$36.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.00
Rate for Payer: Hamaspik Choice Inc Medicare	$52.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$67.60

Know your out-of-pocket cost for care.

All Charges