St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE BONE LOC 172MML HOLE X10

Facility

$2,582.50

Service Code	HCPCS C1713
Hospital Charge Code	64903509
Hospital Revenue Code	278
Min. Negotiated Rate	$1,291.25
Max. Negotiated Rate	$1,291.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,291.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,291.25

PLATE BONE LOC 172MML HOLE X10

Facility

$2,582.50

Service Code	HCPCS C1713
Hospital Charge Code	64903509
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,711.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,420.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,549.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,291.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,484.94
Rate for Payer: EmblemHealth Commercial	$1,291.25
Rate for Payer: Fidelis Medicare Advantage	$2,711.62
Rate for Payer: Group Health Inc Commercial	$1,291.25
Rate for Payer: Group Health Inc Medicare	$903.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,291.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,291.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,678.62

PLATE BONE LOC 199MML HOLE X10

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	64903224
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 LOC 199MML HOLE X10

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	64903224
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 LOC 199MML HOLEX10

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	64901861
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 LOC 199MML HOLEX10

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	64901861
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 LOC 343MML HOLEX16

Facility

$3,060.00

Service Code	HCPCS C1713
Hospital Charge Code	64903781
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,213.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,683.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,836.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,530.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,759.50
Rate for Payer: EmblemHealth Commercial	$1,530.00
Rate for Payer: Fidelis Medicare Advantage	$3,213.00
Rate for Payer: Group Health Inc Commercial	$1,530.00
Rate for Payer: Group Health Inc Medicare	$1,071.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,530.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,530.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,989.00

PLATE BONE LOC 343MML HOLEX16

Facility

$3,060.00

Service Code	HCPCS C1713
Hospital Charge Code	64903781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,530.00
Max. Negotiated Rate	$1,530.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,530.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,530.00

PLATE BONE LOC 43MML HOLEX5 T

Facility

$1,441.38

Service Code	HCPCS C1713
Hospital Charge Code	64902997
Hospital Revenue Code	278
Min. Negotiated Rate	$720.69
Max. Negotiated Rate	$720.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$720.69
Rate for Payer: Hamaspik Choice Inc Medicare	$720.69

PLATE BONE LOC 43MML HOLEX5 T

Facility

$1,441.38

Service Code	HCPCS C1713
Hospital Charge Code	64902997
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,513.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$792.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$864.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$720.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$828.79
Rate for Payer: EmblemHealth Commercial	$720.69
Rate for Payer: Fidelis Medicare Advantage	$1,513.45
Rate for Payer: Group Health Inc Commercial	$720.69
Rate for Payer: Group Health Inc Medicare	$504.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$720.69
Rate for Payer: Hamaspik Choice Inc Medicare	$720.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$936.90

PLATE BONE LOC 43MML HOLEX5 TI

Facility

$1,676.50

Service Code	HCPCS C1713
Hospital Charge Code	64902996
Hospital Revenue Code	278
Min. Negotiated Rate	$838.25
Max. Negotiated Rate	$838.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$838.25
Rate for Payer: Hamaspik Choice Inc Medicare	$838.25

PLATE BONE LOC 43MML HOLEX5 TI

Facility

$1,676.50

Service Code	HCPCS C1713
Hospital Charge Code	64902996
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,760.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$922.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,005.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$838.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$963.99
Rate for Payer: EmblemHealth Commercial	$838.25
Rate for Payer: Fidelis Medicare Advantage	$1,760.32
Rate for Payer: Group Health Inc Commercial	$838.25
Rate for Payer: Group Health Inc Medicare	$586.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$838.25
Rate for Payer: Hamaspik Choice Inc Medicare	$838.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,089.72

PLATE BONE LOC 51MML HOLEX6

Facility

$1,618.50

Service Code	HCPCS C1713
Hospital Charge Code	64902835
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,699.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$890.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$971.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$809.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$930.64
Rate for Payer: EmblemHealth Commercial	$809.25
Rate for Payer: Fidelis Medicare Advantage	$1,699.42
Rate for Payer: Group Health Inc Commercial	$809.25
Rate for Payer: Group Health Inc Medicare	$566.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$809.25
Rate for Payer: Hamaspik Choice Inc Medicare	$809.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,052.02

PLATE BONE LOC 51MML HOLEX6

Facility

$1,618.50

Service Code	HCPCS C1713
Hospital Charge Code	64902835
Hospital Revenue Code	278
Min. Negotiated Rate	$809.25
Max. Negotiated Rate	$809.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$809.25
Rate for Payer: Hamaspik Choice Inc Medicare	$809.25

PLATE BONE LOC 51MML HOLEX6 1M

Facility

$1,618.50

Service Code	HCPCS C1713
Hospital Charge Code	64902722
Hospital Revenue Code	278
Min. Negotiated Rate	$809.25
Max. Negotiated Rate	$809.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$809.25
Rate for Payer: Hamaspik Choice Inc Medicare	$809.25

PLATE BONE LOC 51MML HOLEX6 1M

Facility

$1,618.50

Service Code	HCPCS C1713
Hospital Charge Code	64902722
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,699.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$890.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$971.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$809.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$930.64
Rate for Payer: EmblemHealth Commercial	$809.25
Rate for Payer: Fidelis Medicare Advantage	$1,699.42
Rate for Payer: Group Health Inc Commercial	$809.25
Rate for Payer: Group Health Inc Medicare	$566.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$809.25
Rate for Payer: Hamaspik Choice Inc Medicare	$809.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,052.02

PLATE BONE LOC 89MML HOLEX4 T

Facility

$2,356.25

Service Code	HCPCS C1713
Hospital Charge Code	64902406
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 89MML HOLEX4 T

Facility

$2,356.25

Service Code	HCPCS C1713
Hospital Charge Code	64902406
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 89MML HOLEX4 TI

Facility

$2,356.25

Service Code	HCPCS C1713
Hospital Charge Code	64902334
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 89MML HOLEX4 TI

Facility

$2,356.25

Service Code	HCPCS C1713
Hospital Charge Code	64902334
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 95MML HOLEX2 S

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	64902052
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 LOC 95MML HOLEX2 S

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	64902052
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 LOC 95MML HOLEX2 ST

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	64901943
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 LOC 95MML HOLEX2 ST

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	64901943
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 LOC C 110MML HOLEX8

Facility

$312.50

Service Code	HCPCS C1713
Hospital Charge Code	64901933
Hospital Revenue Code	278
Min. Negotiated Rate	$109.38
Max. Negotiated Rate	$328.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$171.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$187.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$156.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$179.69
Rate for Payer: EmblemHealth Commercial	$156.25
Rate for Payer: Fidelis Medicare Advantage	$328.12
Rate for Payer: Group Health Inc Commercial	$156.25
Rate for Payer: Group Health Inc Medicare	$109.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.25
Rate for Payer: Hamaspik Choice Inc Medicare	$156.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$203.12

Know your out-of-pocket cost for care.

All Charges