St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

PLATE BONE HOLEX 11 10MM LEFT

Facility

$724.73

Service Code	HCPCS C1713
Hospital Charge Code	64904967
Hospital Revenue Code	278
Min. Negotiated Rate	$362.36
Max. Negotiated Rate	$362.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$362.36
Rate for Payer: Hamaspik Choice Inc Medicare	$362.36

PLATE BONE HOLEX 11 10MM LEFT

Facility

$724.73

Service Code	HCPCS C1713
Hospital Charge Code	64904967
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$760.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$398.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$434.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$362.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$416.72
Rate for Payer: EmblemHealth Commercial	$362.36
Rate for Payer: Fidelis Medicare Advantage	$760.97
Rate for Payer: Group Health Inc Commercial	$362.36
Rate for Payer: Group Health Inc Medicare	$253.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$362.36
Rate for Payer: Hamaspik Choice Inc Medicare	$362.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$471.07

PLATE BONE HOLEX 11 10MM RIGHT

Facility

$724.73

Service Code	HCPCS C1713
Hospital Charge Code	64904965
Hospital Revenue Code	278
Min. Negotiated Rate	$362.36
Max. Negotiated Rate	$362.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$362.36
Rate for Payer: Hamaspik Choice Inc Medicare	$362.36

PLATE BONE HOLEX 11 10MM RIGHT

Facility

$724.73

Service Code	HCPCS C1713
Hospital Charge Code	64904965
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$760.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$398.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$434.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$362.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$416.72
Rate for Payer: EmblemHealth Commercial	$362.36
Rate for Payer: Fidelis Medicare Advantage	$760.97
Rate for Payer: Group Health Inc Commercial	$362.36
Rate for Payer: Group Health Inc Medicare	$253.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$362.36
Rate for Payer: Hamaspik Choice Inc Medicare	$362.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$471.07

PLATE BONE HOLEX 11 8MM LFT

Facility

$712.78

Service Code	HCPCS C1713
Hospital Charge Code	64905136
Hospital Revenue Code	278
Min. Negotiated Rate	$356.39
Max. Negotiated Rate	$356.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$356.39
Rate for Payer: Hamaspik Choice Inc Medicare	$356.39

PLATE BONE HOLEX 11 8MM LFT

Facility

$712.78

Service Code	HCPCS C1713
Hospital Charge Code	64905136
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$748.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$392.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$427.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$356.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$409.85
Rate for Payer: EmblemHealth Commercial	$356.39
Rate for Payer: Fidelis Medicare Advantage	$748.42
Rate for Payer: Group Health Inc Commercial	$356.39
Rate for Payer: Group Health Inc Medicare	$249.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$356.39
Rate for Payer: Hamaspik Choice Inc Medicare	$356.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$463.31

PLATE BONE HOLEX 11 8MM RGHT

Facility

$712.78

Service Code	HCPCS C1713
Hospital Charge Code	64905135
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$748.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$392.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$427.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$356.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$409.85
Rate for Payer: EmblemHealth Commercial	$356.39
Rate for Payer: Fidelis Medicare Advantage	$748.42
Rate for Payer: Group Health Inc Commercial	$356.39
Rate for Payer: Group Health Inc Medicare	$249.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$356.39
Rate for Payer: Hamaspik Choice Inc Medicare	$356.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$463.31

PLATE BONE HOLEX 11 8MM RGHT

Facility

$712.78

Service Code	HCPCS C1713
Hospital Charge Code	64905135
Hospital Revenue Code	278
Min. Negotiated Rate	$356.39
Max. Negotiated Rate	$356.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$356.39
Rate for Payer: Hamaspik Choice Inc Medicare	$356.39

PLATE BONE HOLEX12 LEFT DISTAL

Facility

$8,795.00

Service Code	HCPCS C1713
Hospital Charge Code	64903122
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$9,234.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,837.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$5,277.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,397.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,057.12
Rate for Payer: EmblemHealth Commercial	$4,397.50
Rate for Payer: Fidelis Medicare Advantage	$9,234.75
Rate for Payer: Group Health Inc Commercial	$4,397.50
Rate for Payer: Group Health Inc Medicare	$3,078.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,397.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,397.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,716.75

PLATE BONE HOLEX12 LEFT DISTAL

Facility

$8,795.00

Service Code	HCPCS C1713
Hospital Charge Code	64903122
Hospital Revenue Code	278
Min. Negotiated Rate	$4,397.50
Max. Negotiated Rate	$4,397.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,397.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,397.50

PLATE BONE HOLEX2 UN2

Facility

$336.00

Service Code	HCPCS C1713
Hospital Charge Code	64904129
Hospital Revenue Code	278
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$352.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$184.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$201.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$168.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$193.20
Rate for Payer: EmblemHealth Commercial	$168.00
Rate for Payer: Fidelis Medicare Advantage	$352.80
Rate for Payer: Group Health Inc Commercial	$168.00
Rate for Payer: Group Health Inc Medicare	$117.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.00
Rate for Payer: Hamaspik Choice Inc Medicare	$168.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$218.40

PLATE BONE HOLEX2 UN2

Facility

$336.00

Service Code	HCPCS C1713
Hospital Charge Code	64904129
Hospital Revenue Code	278
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$168.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.00
Rate for Payer: Hamaspik Choice Inc Medicare	$168.00

PLATE BONE HOLEX6 CRANIO-MAXI

Facility

$560.83

Service Code	HCPCS C1713
Hospital Charge Code	64904149
Hospital Revenue Code	278
Min. Negotiated Rate	$280.42
Max. Negotiated Rate	$280.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$280.42
Rate for Payer: Hamaspik Choice Inc Medicare	$280.42

PLATE BONE HOLEX6 CRANIO-MAXI

Facility

$560.83

Service Code	HCPCS C1713
Hospital Charge Code	64904149
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$588.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$308.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$336.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$280.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$322.48
Rate for Payer: EmblemHealth Commercial	$280.42
Rate for Payer: Fidelis Medicare Advantage	$588.87
Rate for Payer: Group Health Inc Commercial	$280.42
Rate for Payer: Group Health Inc Medicare	$196.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$280.42
Rate for Payer: Hamaspik Choice Inc Medicare	$280.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$364.54

PLATE BONE LOC 112MML HOLEX5 S

Facility

$2,437.50

Service Code	HCPCS C1713
Hospital Charge Code	64902748
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,559.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,340.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,462.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,218.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,401.56
Rate for Payer: EmblemHealth Commercial	$1,218.75
Rate for Payer: Fidelis Medicare Advantage	$2,559.38
Rate for Payer: Group Health Inc Commercial	$1,218.75
Rate for Payer: Group Health Inc Medicare	$853.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,218.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,218.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,584.38

PLATE BONE LOC 112MML HOLEX5 S

Facility

$2,437.50

Service Code	HCPCS C1713
Hospital Charge Code	64902748
Hospital Revenue Code	278
Min. Negotiated Rate	$1,218.75
Max. Negotiated Rate	$1,218.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,218.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,218.75

PLATE BONE LOC 113MML HOLEX6 T

Facility

$2,356.25

Service Code	HCPCS C1713
Hospital Charge Code	64902220
Hospital Revenue Code	278
Min. Negotiated Rate	$1,178.12
Max. Negotiated Rate	$1,178.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,178.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,178.12

PLATE BONE LOC 113MML HOLEX6 T

Facility

$2,356.25

Service Code	HCPCS C1713
Hospital Charge Code	64902220
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,474.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,295.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,413.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,178.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,354.84
Rate for Payer: EmblemHealth Commercial	$1,178.12
Rate for Payer: Fidelis Medicare Advantage	$2,474.06
Rate for Payer: Group Health Inc Commercial	$1,178.12
Rate for Payer: Group Health Inc Medicare	$824.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,178.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,178.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,531.56

PLATE BONE LOC 128MML HOLEX10

Facility

$345.00

Service Code	HCPCS C1713
Hospital Charge Code	64901932
Hospital Revenue Code	278
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$172.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.50
Rate for Payer: Hamaspik Choice Inc Medicare	$172.50

PLATE BONE LOC 128MML HOLEX10

Facility

$345.00

Service Code	HCPCS C1713
Hospital Charge Code	64901932
Hospital Revenue Code	278
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$362.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$189.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$207.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$172.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$198.38
Rate for Payer: EmblemHealth Commercial	$172.50
Rate for Payer: Fidelis Medicare Advantage	$362.25
Rate for Payer: Group Health Inc Commercial	$172.50
Rate for Payer: Group Health Inc Medicare	$120.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.50
Rate for Payer: Hamaspik Choice Inc Medicare	$172.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$224.25

PLATE BONE LOC 137MML HOLEX8

Facility

$3,006.25

Service Code	HCPCS C1713
Hospital Charge Code	64902957
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,156.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,653.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,803.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,503.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,728.59
Rate for Payer: EmblemHealth Commercial	$1,503.12
Rate for Payer: Fidelis Medicare Advantage	$3,156.56
Rate for Payer: Group Health Inc Commercial	$1,503.12
Rate for Payer: Group Health Inc Medicare	$1,052.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,503.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,503.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,954.06

PLATE BONE LOC 137MML HOLEX8

Facility

$3,006.25

Service Code	HCPCS C1713
Hospital Charge Code	64902957
Hospital Revenue Code	278
Min. Negotiated Rate	$1,503.12
Max. Negotiated Rate	$1,503.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,503.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,503.12

PLATE BONE LOC 137MML HOLEX8 T

Facility

$3,006.25

Service Code	HCPCS C1713
Hospital Charge Code	64902620
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,156.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,653.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,803.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,503.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,728.59
Rate for Payer: EmblemHealth Commercial	$1,503.12
Rate for Payer: Fidelis Medicare Advantage	$3,156.56
Rate for Payer: Group Health Inc Commercial	$1,503.12
Rate for Payer: Group Health Inc Medicare	$1,052.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,503.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,503.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,954.06

PLATE BONE LOC 137MML HOLEX8 T

Facility

$3,006.25

Service Code	HCPCS C1713
Hospital Charge Code	64902620
Hospital Revenue Code	278
Min. Negotiated Rate	$1,503.12
Max. Negotiated Rate	$1,503.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,503.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,503.12

Know your out-of-pocket cost for care.

All Charges