St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE BONE L RT 5H MC PLUS

Facility

$130.20

Service Code	HCPCS C1713
Hospital Charge Code	40200724
Hospital Revenue Code	278
Min. Negotiated Rate	$45.57
Max. Negotiated Rate	$136.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$78.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.86
Rate for Payer: EmblemHealth Commercial	$65.10
Rate for Payer: Fidelis Medicare Advantage	$136.71
Rate for Payer: Group Health Inc Commercial	$65.10
Rate for Payer: Group Health Inc Medicare	$45.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.10
Rate for Payer: Hamaspik Choice Inc Medicare	$65.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$84.63

PLATE BONE L RT 5H MC PLUS

Facility

$130.20

Service Code	HCPCS C1713
Hospital Charge Code	40200724
Hospital Revenue Code	278
Min. Negotiated Rate	$65.10
Max. Negotiated Rate	$65.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.10
Rate for Payer: Hamaspik Choice Inc Medicare	$65.10

PLATE BONE MED 1.5MMH HOLEX13

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64904985
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 MED 1.5MMH HOLEX13

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64904985
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 MED 1.5MMH HOLEX16

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64902547
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 MED 1.5MMH HOLEX16

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64902547
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 MED 1.5MMH HOLEX2X2

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64902825
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 MED 1.5MMH HOLEX2X2

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64902825
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 MED 1.5MMH HOLEX3X2

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64902754
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 MED 1.5MMH HOLEX3X2

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64902754
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 MED 1.5MMH HOLEX4 T

Facility

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	64901989
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$682.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$357.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$390.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$325.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$373.75
Rate for Payer: EmblemHealth Commercial	$325.00
Rate for Payer: Fidelis Medicare Advantage	$682.50
Rate for Payer: Group Health Inc Commercial	$325.00
Rate for Payer: Group Health Inc Medicare	$227.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$325.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$422.50

PLATE BONE MED 1.5MMH HOLEX4 T

Facility

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	64901989
Hospital Revenue Code	278
Min. Negotiated Rate	$325.00
Max. Negotiated Rate	$325.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$325.00

PLATE BONE MED 1.5MMH HOLEX6 T

Facility

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	64903647
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$682.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$357.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$390.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$325.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$373.75
Rate for Payer: EmblemHealth Commercial	$325.00
Rate for Payer: Fidelis Medicare Advantage	$682.50
Rate for Payer: Group Health Inc Commercial	$325.00
Rate for Payer: Group Health Inc Medicare	$227.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$325.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$422.50

PLATE BONE MED 1.5MMH HOLEX6 T

Facility

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	64904415
Hospital Revenue Code	278
Min. Negotiated Rate	$325.00
Max. Negotiated Rate	$325.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$325.00

PLATE BONE MED 1.5MMH HOLEX6 T

Facility

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	64904415
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$682.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$357.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$390.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$325.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$373.75
Rate for Payer: EmblemHealth Commercial	$325.00
Rate for Payer: Fidelis Medicare Advantage	$682.50
Rate for Payer: Group Health Inc Commercial	$325.00
Rate for Payer: Group Health Inc Medicare	$227.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$325.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$422.50

PLATE BONE MED 1.5MMH HOLEX6 T

Facility

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	64903647
Hospital Revenue Code	278
Min. Negotiated Rate	$325.00
Max. Negotiated Rate	$325.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$325.00

PLATE BONE NON-LOC 103MML HOLE

Facility

$160.88

Service Code	HCPCS C1713
Hospital Charge Code	64902023
Hospital Revenue Code	278
Min. Negotiated Rate	$80.44
Max. Negotiated Rate	$80.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.44
Rate for Payer: Hamaspik Choice Inc Medicare	$80.44

PLATE BONE NON-LOC 103MML HOLE

Facility

$160.88

Service Code	HCPCS C1713
Hospital Charge Code	64902023
Hospital Revenue Code	278
Min. Negotiated Rate	$56.31
Max. Negotiated Rate	$168.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$88.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$96.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$92.51
Rate for Payer: EmblemHealth Commercial	$80.44
Rate for Payer: Fidelis Medicare Advantage	$168.92
Rate for Payer: Group Health Inc Commercial	$80.44
Rate for Payer: Group Health Inc Medicare	$56.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.44
Rate for Payer: Hamaspik Choice Inc Medicare	$80.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$104.57

PLATE BONE NON-LOC 38MML HOLEX

Facility

$101.50

Service Code	HCPCS C1713
Hospital Charge Code	64902489
Hospital Revenue Code	278
Min. Negotiated Rate	$50.75
Max. Negotiated Rate	$50.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.75
Rate for Payer: Hamaspik Choice Inc Medicare	$50.75

PLATE BONE NON-LOC 38MML HOLEX

Facility

$101.50

Service Code	HCPCS C1713
Hospital Charge Code	64902489
Hospital Revenue Code	278
Min. Negotiated Rate	$35.52
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$60.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.36
Rate for Payer: EmblemHealth Commercial	$50.75
Rate for Payer: Fidelis Medicare Advantage	$106.58
Rate for Payer: Group Health Inc Commercial	$50.75
Rate for Payer: Group Health Inc Medicare	$35.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.75
Rate for Payer: Hamaspik Choice Inc Medicare	$50.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.98

PLATE BONE NON-LOC 51MML HOLEX

Facility

$144.63

Service Code	HCPCS C1713
Hospital Charge Code	64902485
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 NON-LOC 51MML HOLEX

Facility

$144.63

Service Code	HCPCS C1713
Hospital Charge Code	64902485
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 NON-LOC 6H

Facility

$812.50

Service Code	HCPCS C1713
Hospital Charge Code	64905439
Hospital Revenue Code	278
Min. Negotiated Rate	$406.25
Max. Negotiated Rate	$406.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$406.25
Rate for Payer: Hamaspik Choice Inc Medicare	$406.25

PLATE BONE NON-LOC 6H

Facility

$812.50

Service Code	HCPCS C1713
Hospital Charge Code	64905439
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$853.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$446.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$487.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$406.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$467.19
Rate for Payer: EmblemHealth Commercial	$406.25
Rate for Payer: Fidelis Medicare Advantage	$853.12
Rate for Payer: Group Health Inc Commercial	$406.25
Rate for Payer: Group Health Inc Medicare	$284.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$406.25
Rate for Payer: Hamaspik Choice Inc Medicare	$406.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$528.12

PLATE BONE NON-LOC 77MML HOLEX

Facility

$144.63

Service Code	HCPCS C1713
Hospital Charge Code	64902713
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

Know your out-of-pocket cost for care.

All Charges