St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE BONE 92.5MML HOLEX6 STAI

Facility

$1,807.00

Service Code	HCPCS C1713
Hospital Charge Code	64904394
Hospital Revenue Code	278
Min. Negotiated Rate	$903.50
Max. Negotiated Rate	$903.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$903.50
Rate for Payer: Hamaspik Choice Inc Medicare	$903.50

PLATE BONE 92.5MML HOLEX6 STAI

Facility

$1,807.00

Service Code	HCPCS C1713
Hospital Charge Code	64904394
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,897.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$993.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,084.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$903.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,039.02
Rate for Payer: EmblemHealth Commercial	$903.50
Rate for Payer: Fidelis Medicare Advantage	$1,897.35
Rate for Payer: Group Health Inc Commercial	$903.50
Rate for Payer: Group Health Inc Medicare	$632.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$903.50
Rate for Payer: Hamaspik Choice Inc Medicare	$903.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,174.55

PLATE BONE 95MML HOLEX2 F-SHAP

Facility

$5,839.88

Service Code	HCPCS C1713
Hospital Charge Code	64903654
Hospital Revenue Code	278
Min. Negotiated Rate	$2,919.94
Max. Negotiated Rate	$2,919.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,919.94
Rate for Payer: Hamaspik Choice Inc Medicare	$2,919.94

PLATE BONE 95MML HOLEX2 F-SHAP

Facility

$5,839.88

Service Code	HCPCS C1713
Hospital Charge Code	64903654
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,131.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,211.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,503.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,919.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,357.93
Rate for Payer: EmblemHealth Commercial	$2,919.94
Rate for Payer: Fidelis Medicare Advantage	$6,131.87
Rate for Payer: Group Health Inc Commercial	$2,919.94
Rate for Payer: Group Health Inc Medicare	$2,043.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,919.94
Rate for Payer: Hamaspik Choice Inc Medicare	$2,919.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,795.92

PLATE BONE 95MML HOLEX2 F-SHP

Facility

$6,585.00

Service Code	HCPCS C1713
Hospital Charge Code	64903168
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,914.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,621.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,951.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,292.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,786.38
Rate for Payer: EmblemHealth Commercial	$3,292.50
Rate for Payer: Fidelis Medicare Advantage	$6,914.25
Rate for Payer: Group Health Inc Commercial	$3,292.50
Rate for Payer: Group Health Inc Medicare	$2,304.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,292.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,292.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,280.25

PLATE BONE 95MML HOLEX2 F-SHP

Facility

$6,585.00

Service Code	HCPCS C1713
Hospital Charge Code	64903168
Hospital Revenue Code	278
Min. Negotiated Rate	$3,292.50
Max. Negotiated Rate	$3,292.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,292.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,292.50

PLATE BONE 96MML HOLEX7 2MM TH

Facility

$939.25

Service Code	HCPCS C1713
Hospital Charge Code	64902493
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 96MML HOLEX7 2MM TH

Facility

$939.25

Service Code	HCPCS C1713
Hospital Charge Code	64902493
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 97MML HOLEX5 2MM TH

Facility

$702.00

Service Code	HCPCS C1713
Hospital Charge Code	64904091
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$737.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$386.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$421.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$351.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$403.65
Rate for Payer: EmblemHealth Commercial	$351.00
Rate for Payer: Fidelis Medicare Advantage	$737.10
Rate for Payer: Group Health Inc Commercial	$351.00
Rate for Payer: Group Health Inc Medicare	$245.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$351.00
Rate for Payer: Hamaspik Choice Inc Medicare	$351.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$456.30

PLATE BONE 97MML HOLEX5 2MM TH

Facility

$702.00

Service Code	HCPCS C1713
Hospital Charge Code	64904091
Hospital Revenue Code	278
Min. Negotiated Rate	$351.00
Max. Negotiated Rate	$351.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$351.00
Rate for Payer: Hamaspik Choice Inc Medicare	$351.00

PLATE BONE COMP 2.3 M 5H

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64905836
Hospital Revenue Code	278
Min. Negotiated Rate	$528.12
Max. Negotiated Rate	$528.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$528.12
Rate for Payer: Hamaspik Choice Inc Medicare	$528.12

PLATE BONE COMP 2.3 M 5H

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64905836
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,109.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$580.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$633.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$528.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$607.34
Rate for Payer: EmblemHealth Commercial	$528.12
Rate for Payer: Fidelis Medicare Advantage	$1,109.06
Rate for Payer: Group Health Inc Commercial	$528.12
Rate for Payer: Group Health Inc Medicare	$369.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$528.12
Rate for Payer: Hamaspik Choice Inc Medicare	$528.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$686.56

PLATE BONE COMPRESS 17 2.4

Facility

$5,558.40

Service Code	HCPCS C1713
Hospital Charge Code	64904143
Hospital Revenue Code	278
Min. Negotiated Rate	$2,779.20
Max. Negotiated Rate	$2,779.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,779.20
Rate for Payer: Hamaspik Choice Inc Medicare	$2,779.20

PLATE BONE COMPRESS 17 2.4

Facility

$5,558.40

Service Code	HCPCS C1713
Hospital Charge Code	64904143
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,836.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,057.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,335.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,779.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,196.08
Rate for Payer: EmblemHealth Commercial	$2,779.20
Rate for Payer: Fidelis Medicare Advantage	$5,836.32
Rate for Payer: Group Health Inc Commercial	$2,779.20
Rate for Payer: Group Health Inc Medicare	$1,945.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,779.20
Rate for Payer: Hamaspik Choice Inc Medicare	$2,779.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,612.96

PLATE BONE C SM 10.3MMW X 78MM

Facility

$325.00

Service Code	HCPCS C1713
Hospital Charge Code	64904179
Hospital Revenue Code	278
Min. Negotiated Rate	$162.50
Max. Negotiated Rate	$162.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.50
Rate for Payer: Hamaspik Choice Inc Medicare	$162.50

PLATE BONE C SM 10.3MMW X 78MM

Facility

$325.00

Service Code	HCPCS C1713
Hospital Charge Code	64904179
Hospital Revenue Code	278
Min. Negotiated Rate	$113.75
Max. Negotiated Rate	$341.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$178.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$195.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$162.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$186.88
Rate for Payer: EmblemHealth Commercial	$162.50
Rate for Payer: Fidelis Medicare Advantage	$341.25
Rate for Payer: Group Health Inc Commercial	$162.50
Rate for Payer: Group Health Inc Medicare	$113.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.50
Rate for Payer: Hamaspik Choice Inc Medicare	$162.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$211.25

PLATE BONE C SM 10.3MMW X 91MM

Facility

$276.50

Service Code	HCPCS C1713
Hospital Charge Code	64902613
Hospital Revenue Code	278
Min. Negotiated Rate	$138.25
Max. Negotiated Rate	$138.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.25
Rate for Payer: Hamaspik Choice Inc Medicare	$138.25

PLATE BONE C SM 10.3MMW X 91MM

Facility

$276.50

Service Code	HCPCS C1713
Hospital Charge Code	64902613
Hospital Revenue Code	278
Min. Negotiated Rate	$96.78
Max. Negotiated Rate	$290.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$152.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$165.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$138.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$158.99
Rate for Payer: EmblemHealth Commercial	$138.25
Rate for Payer: Fidelis Medicare Advantage	$290.32
Rate for Payer: Group Health Inc Commercial	$138.25
Rate for Payer: Group Health Inc Medicare	$96.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.25
Rate for Payer: Hamaspik Choice Inc Medicare	$138.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$179.72

PLATE BONE DIS FEM

Facility

$8,108.20

Service Code	HCPCS C1713
Hospital Charge Code	64907245
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$8,513.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,459.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,864.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,054.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,662.22
Rate for Payer: EmblemHealth Commercial	$4,054.10
Rate for Payer: Fidelis Medicare Advantage	$8,513.61
Rate for Payer: Group Health Inc Commercial	$4,054.10
Rate for Payer: Group Health Inc Medicare	$2,837.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,054.10
Rate for Payer: Hamaspik Choice Inc Medicare	$4,054.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,270.33

PLATE BONE DIS FEM

Facility

$8,108.20

Service Code	HCPCS C1713
Hospital Charge Code	64907245
Hospital Revenue Code	278
Min. Negotiated Rate	$4,054.10
Max. Negotiated Rate	$4,054.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,054.10
Rate for Payer: Hamaspik Choice Inc Medicare	$4,054.10

PLATE BONE EXTRA SHORT NARROW

Facility

$3,476.25

Service Code	HCPCS C1713
Hospital Charge Code	64904730
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,650.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,911.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,085.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,738.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,998.84
Rate for Payer: EmblemHealth Commercial	$1,738.12
Rate for Payer: Fidelis Medicare Advantage	$3,650.06
Rate for Payer: Group Health Inc Commercial	$1,738.12
Rate for Payer: Group Health Inc Medicare	$1,216.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,738.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,738.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,259.56

PLATE BONE EXTRA SHORT NARROW

Facility

$3,476.25

Service Code	HCPCS C1713
Hospital Charge Code	64904730
Hospital Revenue Code	278
Min. Negotiated Rate	$1,738.12
Max. Negotiated Rate	$1,738.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,738.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,738.12

PLATE BONE EXTRA SHORT NARRW

Facility

$3,476.25

Service Code	HCPCS C1713
Hospital Charge Code	64904755
Hospital Revenue Code	278
Min. Negotiated Rate	$1,738.12
Max. Negotiated Rate	$1,738.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,738.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,738.12

PLATE BONE EXTRA SHORT NARRW

Facility

$3,476.25

Service Code	HCPCS C1713
Hospital Charge Code	64904755
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,650.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,911.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,085.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,738.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,998.84
Rate for Payer: EmblemHealth Commercial	$1,738.12
Rate for Payer: Fidelis Medicare Advantage	$3,650.06
Rate for Payer: Group Health Inc Commercial	$1,738.12
Rate for Payer: Group Health Inc Medicare	$1,216.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,738.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,738.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,259.56

PLATE BONE EXTRA SHORT VARIAX

Facility

$3,476.25

Service Code	HCPCS C1713
Hospital Charge Code	64904517
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,650.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,911.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,085.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,738.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,998.84
Rate for Payer: EmblemHealth Commercial	$1,738.12
Rate for Payer: Fidelis Medicare Advantage	$3,650.06
Rate for Payer: Group Health Inc Commercial	$1,738.12
Rate for Payer: Group Health Inc Medicare	$1,216.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,738.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,738.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,259.56

Know your out-of-pocket cost for care.

All Charges