St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE BONE LOC C 110MML HOLEX8

Facility

$312.50

Service Code	HCPCS C1713
Hospital Charge Code	64901933
Hospital Revenue Code	278
Min. Negotiated Rate	$156.25
Max. Negotiated Rate	$156.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.25
Rate for Payer: Hamaspik Choice Inc Medicare	$156.25

PLATE BONE LOC C 136MML HOLEX1

Facility

$312.50

Service Code	HCPCS C1713
Hospital Charge Code	64901754
Hospital Revenue Code	278
Min. Negotiated Rate	$156.25
Max. Negotiated Rate	$156.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.25
Rate for Payer: Hamaspik Choice Inc Medicare	$156.25

PLATE BONE LOC C 136MML HOLEX1

Facility

$312.50

Service Code	HCPCS C1713
Hospital Charge Code	64901754
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

PLATE BONE LOC C 137MML HOLEX7

Facility

$451.25

Service Code	HCPCS C1713
Hospital Charge Code	64903731
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$473.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$248.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$270.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$225.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$259.47
Rate for Payer: EmblemHealth Commercial	$225.62
Rate for Payer: Fidelis Medicare Advantage	$473.81
Rate for Payer: Group Health Inc Commercial	$225.62
Rate for Payer: Group Health Inc Medicare	$157.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.62
Rate for Payer: Hamaspik Choice Inc Medicare	$225.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$293.31

PLATE BONE LOC C 137MML HOLEX7

Facility

$451.25

Service Code	HCPCS C1713
Hospital Charge Code	64903731
Hospital Revenue Code	278
Min. Negotiated Rate	$225.62
Max. Negotiated Rate	$225.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.62
Rate for Payer: Hamaspik Choice Inc Medicare	$225.62

PLATE BONE LOC C 143MML HOLEX8

Facility

$1,430.00

Service Code	HCPCS C1713
Hospital Charge Code	64903642
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,501.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$786.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$858.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$715.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$822.25
Rate for Payer: EmblemHealth Commercial	$715.00
Rate for Payer: Fidelis Medicare Advantage	$1,501.50
Rate for Payer: Group Health Inc Commercial	$715.00
Rate for Payer: Group Health Inc Medicare	$500.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$715.00
Rate for Payer: Hamaspik Choice Inc Medicare	$715.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$929.50

PLATE BONE LOC C 143MML HOLEX8

Facility

$1,430.00

Service Code	HCPCS C1713
Hospital Charge Code	64903642
Hospital Revenue Code	278
Min. Negotiated Rate	$715.00
Max. Negotiated Rate	$715.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$715.00
Rate for Payer: Hamaspik Choice Inc Medicare	$715.00

PLATE BONE LOC C 151MML HOLEX8

Facility

$345.00

Service Code	HCPCS C1713
Hospital Charge Code	64902511
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 C 151MML HOLEX8

Facility

$345.00

Service Code	HCPCS C1713
Hospital Charge Code	64902511
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 C 155MML HOLEX8

Facility

$451.25

Service Code	HCPCS C1713
Hospital Charge Code	64902513
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$473.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$248.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$270.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$225.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$259.47
Rate for Payer: EmblemHealth Commercial	$225.62
Rate for Payer: Fidelis Medicare Advantage	$473.81
Rate for Payer: Group Health Inc Commercial	$225.62
Rate for Payer: Group Health Inc Medicare	$157.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.62
Rate for Payer: Hamaspik Choice Inc Medicare	$225.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$293.31

PLATE BONE LOC C 155MML HOLEX8

Facility

$451.25

Service Code	HCPCS C1713
Hospital Charge Code	64902513
Hospital Revenue Code	278
Min. Negotiated Rate	$225.62
Max. Negotiated Rate	$225.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.62
Rate for Payer: Hamaspik Choice Inc Medicare	$225.62

PLATE BONE LOC C 1MM STEP TIT

Facility

$5,290.00

Service Code	HCPCS C1713
Hospital Charge Code	64903735
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,554.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,909.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,174.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,645.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,041.75
Rate for Payer: EmblemHealth Commercial	$2,645.00
Rate for Payer: Fidelis Medicare Advantage	$5,554.50
Rate for Payer: Group Health Inc Commercial	$2,645.00
Rate for Payer: Group Health Inc Medicare	$1,851.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,645.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,645.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,438.50

PLATE BONE LOC C 1MM STEP TIT

Facility

$5,290.00

Service Code	HCPCS C1713
Hospital Charge Code	64903735
Hospital Revenue Code	278
Min. Negotiated Rate	$2,645.00
Max. Negotiated Rate	$2,645.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,645.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,645.00

PLATE BONE LOC C 214MML HOLEX1

Facility

$375.00

Service Code	HCPCS C1713
Hospital Charge Code	64903601
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$393.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$206.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$225.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$187.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$215.62
Rate for Payer: EmblemHealth Commercial	$187.50
Rate for Payer: Fidelis Medicare Advantage	$393.75
Rate for Payer: Group Health Inc Commercial	$187.50
Rate for Payer: Group Health Inc Medicare	$131.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.50
Rate for Payer: Hamaspik Choice Inc Medicare	$187.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$243.75

PLATE BONE LOC C 214MML HOLEX1

Facility

$375.00

Service Code	HCPCS C1713
Hospital Charge Code	64903601
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.50
Rate for Payer: Hamaspik Choice Inc Medicare	$187.50

PLATE BONE LOC C 263MML HOLEX1

Facility

$502.50

Service Code	HCPCS C1713
Hospital Charge Code	64903617
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$527.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$276.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$301.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$251.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$288.94
Rate for Payer: EmblemHealth Commercial	$251.25
Rate for Payer: Fidelis Medicare Advantage	$527.62
Rate for Payer: Group Health Inc Commercial	$251.25
Rate for Payer: Group Health Inc Medicare	$175.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.25
Rate for Payer: Hamaspik Choice Inc Medicare	$251.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$326.62

PLATE BONE LOC C 263MML HOLEX1

Facility

$502.50

Service Code	HCPCS C1713
Hospital Charge Code	64903617
Hospital Revenue Code	278
Min. Negotiated Rate	$251.25
Max. Negotiated Rate	$251.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.25
Rate for Payer: Hamaspik Choice Inc Medicare	$251.25

PLATE BONE LOC C 79MML HOLEX4

Facility

$1,131.00

Service Code	HCPCS C1713
Hospital Charge Code	64903886
Hospital Revenue Code	278
Min. Negotiated Rate	$565.50
Max. Negotiated Rate	$565.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$565.50
Rate for Payer: Hamaspik Choice Inc Medicare	$565.50

PLATE BONE LOC C 79MML HOLEX4

Facility

$1,131.00

Service Code	HCPCS C1713
Hospital Charge Code	64903886
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,187.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$622.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$678.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$565.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$650.32
Rate for Payer: EmblemHealth Commercial	$565.50
Rate for Payer: Fidelis Medicare Advantage	$1,187.55
Rate for Payer: Group Health Inc Commercial	$565.50
Rate for Payer: Group Health Inc Medicare	$395.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$565.50
Rate for Payer: Hamaspik Choice Inc Medicare	$565.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$735.15

PLATE BONE LOC C 84MML HOLEX6

Facility

$281.25

Service Code	HCPCS C1713
Hospital Charge Code	64902387
Hospital Revenue Code	278
Min. Negotiated Rate	$98.44
Max. Negotiated Rate	$295.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$154.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$168.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$140.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.72
Rate for Payer: EmblemHealth Commercial	$140.62
Rate for Payer: Fidelis Medicare Advantage	$295.31
Rate for Payer: Group Health Inc Commercial	$140.62
Rate for Payer: Group Health Inc Medicare	$98.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.62
Rate for Payer: Hamaspik Choice Inc Medicare	$140.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$182.81

PLATE BONE LOC C 84MML HOLEX6

Facility

$281.25

Service Code	HCPCS C1713
Hospital Charge Code	64902387
Hospital Revenue Code	278
Min. Negotiated Rate	$140.62
Max. Negotiated Rate	$140.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.62
Rate for Payer: Hamaspik Choice Inc Medicare	$140.62

PLATE BONE LOC C 97MML HOLEX7

Facility

$281.25

Service Code	HCPCS C1713
Hospital Charge Code	64901858
Hospital Revenue Code	278
Min. Negotiated Rate	$140.62
Max. Negotiated Rate	$140.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.62
Rate for Payer: Hamaspik Choice Inc Medicare	$140.62

PLATE BONE LOC C 97MML HOLEX7

Facility

$281.25

Service Code	HCPCS C1713
Hospital Charge Code	64901858
Hospital Revenue Code	278
Min. Negotiated Rate	$98.44
Max. Negotiated Rate	$295.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$154.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$168.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$140.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.72
Rate for Payer: EmblemHealth Commercial	$140.62
Rate for Payer: Fidelis Medicare Advantage	$295.31
Rate for Payer: Group Health Inc Commercial	$140.62
Rate for Payer: Group Health Inc Medicare	$98.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.62
Rate for Payer: Hamaspik Choice Inc Medicare	$140.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$182.81

PLATE BONE LOCK 1.7 4X2H

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64905840
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 LOCK 1.7 4X2H

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64905840
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

Know your out-of-pocket cost for care.

All Charges