St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE BONE 2XLARGE 145MML HOLE

Facility

$3,575.00

Service Code	HCPCS C1713
Hospital Charge Code	64903056
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,753.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,966.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,145.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,787.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,055.62
Rate for Payer: EmblemHealth Commercial	$1,787.50
Rate for Payer: Fidelis Medicare Advantage	$3,753.75
Rate for Payer: Group Health Inc Commercial	$1,787.50
Rate for Payer: Group Health Inc Medicare	$1,251.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,787.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,787.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,323.75

PLATE BONE 3H TIB 5H RIGHT

Facility

$3,615.30

Service Code	HCPCS C1713
Hospital Charge Code	64905809
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,796.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,988.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,169.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,807.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,078.80
Rate for Payer: EmblemHealth Commercial	$1,807.65
Rate for Payer: Fidelis Medicare Advantage	$3,796.06
Rate for Payer: Group Health Inc Commercial	$1,807.65
Rate for Payer: Group Health Inc Medicare	$1,265.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,807.65
Rate for Payer: Hamaspik Choice Inc Medicare	$1,807.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,349.94

PLATE BONE 3H TIB 5H RIGHT

Facility

$3,615.30

Service Code	HCPCS C1713
Hospital Charge Code	64905809
Hospital Revenue Code	278
Min. Negotiated Rate	$1,807.65
Max. Negotiated Rate	$1,807.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,807.65
Rate for Payer: Hamaspik Choice Inc Medicare	$1,807.65

PLATE BONE 40.5MML HOLEX3 2MM

Facility

$939.25

Service Code	HCPCS C1713
Hospital Charge Code	64904114
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$986.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$516.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$563.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$469.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$540.07
Rate for Payer: EmblemHealth Commercial	$469.62
Rate for Payer: Fidelis Medicare Advantage	$986.21
Rate for Payer: Group Health Inc Commercial	$469.62
Rate for Payer: Group Health Inc Medicare	$328.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$469.62
Rate for Payer: Hamaspik Choice Inc Medicare	$469.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$610.51

PLATE BONE 40.5MML HOLEX3 2MM

Facility

$939.25

Service Code	HCPCS C1713
Hospital Charge Code	64904114
Hospital Revenue Code	278
Min. Negotiated Rate	$469.62
Max. Negotiated Rate	$469.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$469.62
Rate for Payer: Hamaspik Choice Inc Medicare	$469.62

PLATE BONE 56MML HOLEX9 TITANI

Facility

$1,950.00

Service Code	HCPCS C1713
Hospital Charge Code	64901781
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,047.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,072.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,170.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$975.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,121.25
Rate for Payer: EmblemHealth Commercial	$975.00
Rate for Payer: Fidelis Medicare Advantage	$2,047.50
Rate for Payer: Group Health Inc Commercial	$975.00
Rate for Payer: Group Health Inc Medicare	$682.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,267.50

PLATE BONE 56MML HOLEX9 TITANI

Facility

$1,950.00

Service Code	HCPCS C1713
Hospital Charge Code	64901781
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$975.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00

PLATE BONE 56MML HOLEX9 TITANI

Facility

$1,808.75

Service Code	HCPCS C1713
Hospital Charge Code	64902038
Hospital Revenue Code	278
Min. Negotiated Rate	$904.38
Max. Negotiated Rate	$904.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$904.38
Rate for Payer: Hamaspik Choice Inc Medicare	$904.38

PLATE BONE 56MML HOLEX9 TITANI

Facility

$1,808.75

Service Code	HCPCS C1713
Hospital Charge Code	64902038
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,899.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$994.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,085.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$904.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,040.03
Rate for Payer: EmblemHealth Commercial	$904.38
Rate for Payer: Fidelis Medicare Advantage	$1,899.19
Rate for Payer: Group Health Inc Commercial	$904.38
Rate for Payer: Group Health Inc Medicare	$633.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$904.38
Rate for Payer: Hamaspik Choice Inc Medicare	$904.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,175.69

PLATE BONE 56MML TITANIUM NARR

Facility

$1,950.00

Service Code	HCPCS C1713
Hospital Charge Code	64901851
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,047.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,072.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,170.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$975.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,121.25
Rate for Payer: EmblemHealth Commercial	$975.00
Rate for Payer: Fidelis Medicare Advantage	$2,047.50
Rate for Payer: Group Health Inc Commercial	$975.00
Rate for Payer: Group Health Inc Medicare	$682.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,267.50

PLATE BONE 56MML TITANIUM NARR

Facility

$1,950.00

Service Code	HCPCS C1713
Hospital Charge Code	64901851
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$975.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00

PLATE BONE 60.5MML HOLEX4 STAI

Facility

$1,717.63

Service Code	HCPCS C1713
Hospital Charge Code	64902209
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,803.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$944.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,030.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$858.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$987.64
Rate for Payer: EmblemHealth Commercial	$858.82
Rate for Payer: Fidelis Medicare Advantage	$1,803.51
Rate for Payer: Group Health Inc Commercial	$858.82
Rate for Payer: Group Health Inc Medicare	$601.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$858.82
Rate for Payer: Hamaspik Choice Inc Medicare	$858.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,116.46

PLATE BONE 60.5MML HOLEX4 STAI

Facility

$1,717.63

Service Code	HCPCS C1713
Hospital Charge Code	64902209
Hospital Revenue Code	278
Min. Negotiated Rate	$858.82
Max. Negotiated Rate	$858.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$858.82
Rate for Payer: Hamaspik Choice Inc Medicare	$858.82

PLATE BONE 64MML HOLEX5 STAINL

Facility

$144.63

Service Code	HCPCS C1713
Hospital Charge Code	64902715
Hospital Revenue Code	278
Min. Negotiated Rate	$72.32
Max. Negotiated Rate	$72.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.32
Rate for Payer: Hamaspik Choice Inc Medicare	$72.32

PLATE BONE 64MML HOLEX5 STAINL

Facility

$144.63

Service Code	HCPCS C1713
Hospital Charge Code	64902715
Hospital Revenue Code	278
Min. Negotiated Rate	$50.62
Max. Negotiated Rate	$151.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$79.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$86.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$72.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$83.16
Rate for Payer: EmblemHealth Commercial	$72.32
Rate for Payer: Fidelis Medicare Advantage	$151.86
Rate for Payer: Group Health Inc Commercial	$72.32
Rate for Payer: Group Health Inc Medicare	$50.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.32
Rate for Payer: Hamaspik Choice Inc Medicare	$72.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$94.01

PLATE BONE 6H 8MM ORBITA

Facility

$242.88

Service Code	HCPCS C1713
Hospital Charge Code	40200723
Hospital Revenue Code	278
Min. Negotiated Rate	$85.01
Max. Negotiated Rate	$255.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$133.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$145.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$121.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$139.66
Rate for Payer: EmblemHealth Commercial	$121.44
Rate for Payer: Fidelis Medicare Advantage	$255.02
Rate for Payer: Group Health Inc Commercial	$121.44
Rate for Payer: Group Health Inc Medicare	$85.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$121.44
Rate for Payer: Hamaspik Choice Inc Medicare	$121.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$157.87

PLATE BONE 6H 8MM ORBITA

Facility

$242.88

Service Code	HCPCS C1713
Hospital Charge Code	40200723
Hospital Revenue Code	278
Min. Negotiated Rate	$121.44
Max. Negotiated Rate	$121.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$121.44
Rate for Payer: Hamaspik Choice Inc Medicare	$121.44

PLATE BONE 75MML HOLEX6

Facility

$3,375.00

Service Code	HCPCS C1713
Hospital Charge Code	64905192
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,543.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,856.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,025.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,687.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,940.62
Rate for Payer: EmblemHealth Commercial	$1,687.50
Rate for Payer: Fidelis Medicare Advantage	$3,543.75
Rate for Payer: Group Health Inc Commercial	$1,687.50
Rate for Payer: Group Health Inc Medicare	$1,181.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,687.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,193.75

PLATE BONE 75MML HOLEX6

Facility

$3,375.00

Service Code	HCPCS C1713
Hospital Charge Code	64905192
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$1,687.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,687.50

PLATE BONE 77MML HOLEX3 2MM TH

Facility

$1,376.38

Service Code	HCPCS C1713
Hospital Charge Code	64902228
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,445.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$757.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$825.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$688.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$791.42
Rate for Payer: EmblemHealth Commercial	$688.19
Rate for Payer: Fidelis Medicare Advantage	$1,445.20
Rate for Payer: Group Health Inc Commercial	$688.19
Rate for Payer: Group Health Inc Medicare	$481.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$688.19
Rate for Payer: Hamaspik Choice Inc Medicare	$688.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$894.65

PLATE BONE 77MML HOLEX3 2MM TH

Facility

$1,376.38

Service Code	HCPCS C1713
Hospital Charge Code	64902228
Hospital Revenue Code	278
Min. Negotiated Rate	$688.19
Max. Negotiated Rate	$688.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$688.19
Rate for Payer: Hamaspik Choice Inc Medicare	$688.19

PLATE BONE 89MML HOLEX4 2MM TH

Facility

$1,370.20

Service Code	HCPCS C1713
Hospital Charge Code	64902264
Hospital Revenue Code	278
Min. Negotiated Rate	$685.10
Max. Negotiated Rate	$685.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$685.10
Rate for Payer: Hamaspik Choice Inc Medicare	$685.10

PLATE BONE 89MML HOLEX4 2MM TH

Facility

$1,370.20

Service Code	HCPCS C1713
Hospital Charge Code	64902264
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,438.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$753.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$822.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$685.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$787.86
Rate for Payer: EmblemHealth Commercial	$685.10
Rate for Payer: Fidelis Medicare Advantage	$1,438.71
Rate for Payer: Group Health Inc Commercial	$685.10
Rate for Payer: Group Health Inc Medicare	$479.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$685.10
Rate for Payer: Hamaspik Choice Inc Medicare	$685.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$890.63

PLATE BONE 90MML HOLEX7 TT

Facility

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64905264
Hospital Revenue Code	278
Min. Negotiated Rate	$73.94
Max. Negotiated Rate	$73.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.94
Rate for Payer: Hamaspik Choice Inc Medicare	$73.94

PLATE BONE 90MML HOLEX7 TT

Facility

$147.88

Service Code	HCPCS C1713
Hospital Charge Code	64905264
Hospital Revenue Code	278
Min. Negotiated Rate	$51.76
Max. Negotiated Rate	$155.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$81.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$88.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$73.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$85.03
Rate for Payer: EmblemHealth Commercial	$73.94
Rate for Payer: Fidelis Medicare Advantage	$155.27
Rate for Payer: Group Health Inc Commercial	$73.94
Rate for Payer: Group Health Inc Medicare	$51.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.94
Rate for Payer: Hamaspik Choice Inc Medicare	$73.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$96.12

Know your out-of-pocket cost for care.

All Charges