St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE BONE 120MML HOLEX8

Facility

$4,125.00

Service Code	HCPCS C1713
Hospital Charge Code	64905463
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,331.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,268.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,475.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,062.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,371.88
Rate for Payer: EmblemHealth Commercial	$2,062.50
Rate for Payer: Fidelis Medicare Advantage	$4,331.25
Rate for Payer: Group Health Inc Commercial	$2,062.50
Rate for Payer: Group Health Inc Medicare	$1,443.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,062.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,062.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,681.25

PLATE BONE 120MML HOLEX8

Facility

$4,125.00

Service Code	HCPCS C1713
Hospital Charge Code	64905463
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$2,062.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,062.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,062.50

PLATE BONE 121ML HOLEX4 LEFT

Facility

$5,714.13

Service Code	HCPCS C1713
Hospital Charge Code	64905145
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,999.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,142.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,428.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,857.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,285.62
Rate for Payer: EmblemHealth Commercial	$2,857.06
Rate for Payer: Fidelis Medicare Advantage	$5,999.84
Rate for Payer: Group Health Inc Commercial	$2,857.06
Rate for Payer: Group Health Inc Medicare	$1,999.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,857.06
Rate for Payer: Hamaspik Choice Inc Medicare	$2,857.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,714.18

PLATE BONE 121ML HOLEX4 LEFT

Facility

$5,714.13

Service Code	HCPCS C1713
Hospital Charge Code	64905145
Hospital Revenue Code	278
Min. Negotiated Rate	$2,857.06
Max. Negotiated Rate	$2,857.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,857.06
Rate for Payer: Hamaspik Choice Inc Medicare	$2,857.06

PLATE BONE 125MML HOLEX7 2MM T

Facility

$1,493.75

Service Code	HCPCS C1713
Hospital Charge Code	64902259
Hospital Revenue Code	278
Min. Negotiated Rate	$746.88
Max. Negotiated Rate	$746.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$746.88
Rate for Payer: Hamaspik Choice Inc Medicare	$746.88

PLATE BONE 125MML HOLEX7 2MM T

Facility

$1,493.75

Service Code	HCPCS C1713
Hospital Charge Code	64902259
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,568.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$821.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$896.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$746.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$858.91
Rate for Payer: EmblemHealth Commercial	$746.88
Rate for Payer: Fidelis Medicare Advantage	$1,568.44
Rate for Payer: Group Health Inc Commercial	$746.88
Rate for Payer: Group Health Inc Medicare	$522.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$746.88
Rate for Payer: Hamaspik Choice Inc Medicare	$746.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$970.94

PLATE BONE 149MML HOLEX9 2MM T

Facility

$1,551.88

Service Code	HCPCS C1713
Hospital Charge Code	64902532
Hospital Revenue Code	278
Min. Negotiated Rate	$775.94
Max. Negotiated Rate	$775.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$775.94
Rate for Payer: Hamaspik Choice Inc Medicare	$775.94

PLATE BONE 149MML HOLEX9 2MM T

Facility

$1,551.88

Service Code	HCPCS C1713
Hospital Charge Code	64902532
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,629.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$853.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$931.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$775.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$892.33
Rate for Payer: EmblemHealth Commercial	$775.94
Rate for Payer: Fidelis Medicare Advantage	$1,629.47
Rate for Payer: Group Health Inc Commercial	$775.94
Rate for Payer: Group Health Inc Medicare	$543.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$775.94
Rate for Payer: Hamaspik Choice Inc Medicare	$775.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,008.72

PLATE BONE 156MML HOLEX12 2MM

Facility

$1,373.13

Service Code	HCPCS C1713
Hospital Charge Code	64903685
Hospital Revenue Code	278
Min. Negotiated Rate	$686.56
Max. Negotiated Rate	$686.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$686.56
Rate for Payer: Hamaspik Choice Inc Medicare	$686.56

PLATE BONE 156MML HOLEX12 2MM

Facility

$1,373.13

Service Code	HCPCS C1713
Hospital Charge Code	64903685
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,441.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$755.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$823.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$686.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$789.55
Rate for Payer: EmblemHealth Commercial	$686.56
Rate for Payer: Fidelis Medicare Advantage	$1,441.79
Rate for Payer: Group Health Inc Commercial	$686.56
Rate for Payer: Group Health Inc Medicare	$480.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$686.56
Rate for Payer: Hamaspik Choice Inc Medicare	$686.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$892.53

PLATE BONE 1.5MM THK TITANIUM

Facility

$5,660.00

Service Code	HCPCS C1713
Hospital Charge Code	64904655
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,943.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,113.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,396.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,830.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,254.50
Rate for Payer: EmblemHealth Commercial	$2,830.00
Rate for Payer: Fidelis Medicare Advantage	$5,943.00
Rate for Payer: Group Health Inc Commercial	$2,830.00
Rate for Payer: Group Health Inc Medicare	$1,981.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,830.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,830.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,679.00

PLATE BONE 1.5MM THK TITANIUM

Facility

$5,660.00

Service Code	HCPCS C1713
Hospital Charge Code	64904655
Hospital Revenue Code	278
Min. Negotiated Rate	$2,830.00
Max. Negotiated Rate	$2,830.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,830.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,830.00

PLATE BONE 166MML HOLEX6 DISTA

Facility

$8,045.00

Service Code	HCPCS C1713
Hospital Charge Code	64904028
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$8,447.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,424.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,827.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,022.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,625.88
Rate for Payer: EmblemHealth Commercial	$4,022.50
Rate for Payer: Fidelis Medicare Advantage	$8,447.25
Rate for Payer: Group Health Inc Commercial	$4,022.50
Rate for Payer: Group Health Inc Medicare	$2,815.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,022.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,022.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,229.25

PLATE BONE 166MML HOLEX6 DISTA

Facility

$8,045.00

Service Code	HCPCS C1713
Hospital Charge Code	64904028
Hospital Revenue Code	278
Min. Negotiated Rate	$4,022.50
Max. Negotiated Rate	$4,022.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,022.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,022.50

PLATE BONE 173MML HOLEX8/5 SHA

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	64901860
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,630.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,377.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,503.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,252.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,440.38
Rate for Payer: EmblemHealth Commercial	$1,252.50
Rate for Payer: Fidelis Medicare Advantage	$2,630.25
Rate for Payer: Group Health Inc Commercial	$1,252.50
Rate for Payer: Group Health Inc Medicare	$876.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,252.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,252.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,628.25

PLATE BONE 173MML HOLEX8/5 SHA

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	64901860
Hospital Revenue Code	278
Min. Negotiated Rate	$1,252.50
Max. Negotiated Rate	$1,252.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,252.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,252.50

PLATE BONE 1.7MM T-SH 5H 10MM

Facility

$362.00

Service Code	HCPCS C1713
Hospital Charge Code	40200722
Hospital Revenue Code	278
Min. Negotiated Rate	$126.70
Max. Negotiated Rate	$380.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$199.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$217.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$181.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$208.15
Rate for Payer: EmblemHealth Commercial	$181.00
Rate for Payer: Fidelis Medicare Advantage	$380.10
Rate for Payer: Group Health Inc Commercial	$181.00
Rate for Payer: Group Health Inc Medicare	$126.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$181.00
Rate for Payer: Hamaspik Choice Inc Medicare	$181.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$235.30

PLATE BONE 1.7MM T-SH 5H 10MM

Facility

$362.00

Service Code	HCPCS C1713
Hospital Charge Code	40200722
Hospital Revenue Code	278
Min. Negotiated Rate	$181.00
Max. Negotiated Rate	$181.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$181.00
Rate for Payer: Hamaspik Choice Inc Medicare	$181.00

PLATE BONE 180MML HOLEX14 2MM

Facility

$1,373.13

Service Code	HCPCS C1713
Hospital Charge Code	64904145
Hospital Revenue Code	278
Min. Negotiated Rate	$686.56
Max. Negotiated Rate	$686.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$686.56
Rate for Payer: Hamaspik Choice Inc Medicare	$686.56

PLATE BONE 180MML HOLEX14 2MM

Facility

$1,373.13

Service Code	HCPCS C1713
Hospital Charge Code	64904145
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,441.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$755.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$823.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$686.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$789.55
Rate for Payer: EmblemHealth Commercial	$686.56
Rate for Payer: Fidelis Medicare Advantage	$1,441.79
Rate for Payer: Group Health Inc Commercial	$686.56
Rate for Payer: Group Health Inc Medicare	$480.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$686.56
Rate for Payer: Hamaspik Choice Inc Medicare	$686.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$892.53

PLATE BONE 238MML HOLEX10 RIGH

Facility

$8,045.00

Service Code	HCPCS C1713
Hospital Charge Code	64903868
Hospital Revenue Code	278
Min. Negotiated Rate	$4,022.50
Max. Negotiated Rate	$4,022.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,022.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,022.50

PLATE BONE 238MML HOLEX10 RIGH

Facility

$8,045.00

Service Code	HCPCS C1713
Hospital Charge Code	64903868
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$8,447.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,424.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,827.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,022.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,625.88
Rate for Payer: EmblemHealth Commercial	$4,022.50
Rate for Payer: Fidelis Medicare Advantage	$8,447.25
Rate for Payer: Group Health Inc Commercial	$4,022.50
Rate for Payer: Group Health Inc Medicare	$2,815.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,022.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,022.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,229.25

PLATE BONE 2XL 100ML HOLEX6

Facility

$3,087.50

Service Code	HCPCS C1713
Hospital Charge Code	64905196
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,241.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,698.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,852.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,543.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,775.31
Rate for Payer: EmblemHealth Commercial	$1,543.75
Rate for Payer: Fidelis Medicare Advantage	$3,241.88
Rate for Payer: Group Health Inc Commercial	$1,543.75
Rate for Payer: Group Health Inc Medicare	$1,080.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,543.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,543.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,006.88

PLATE BONE 2XL 100ML HOLEX6

Facility

$3,087.50

Service Code	HCPCS C1713
Hospital Charge Code	64905196
Hospital Revenue Code	278
Min. Negotiated Rate	$1,543.75
Max. Negotiated Rate	$1,543.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,543.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,543.75

PLATE BONE 2XLARGE 145MML HOLE

Facility

$3,575.00

Service Code	HCPCS C1713
Hospital Charge Code	64903056
Hospital Revenue Code	278
Min. Negotiated Rate	$1,787.50
Max. Negotiated Rate	$1,787.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,787.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,787.50

Know your out-of-pocket cost for care.

All Charges