St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE BONE NON-LOC 77MML HOLEX

Facility

$144.63

Service Code	HCPCS C1713
Hospital Charge Code	64902713
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 8H

Facility

$812.50

Service Code	HCPCS C1713
Hospital Charge Code	64905441
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 8H

Facility

$812.50

Service Code	HCPCS C1713
Hospital Charge Code	64905441
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 90MML HOLEX

Facility

$144.63

Service Code	HCPCS C1713
Hospital Charge Code	64901755
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 90MML HOLEX

Facility

$144.63

Service Code	HCPCS C1713
Hospital Charge Code	64901755
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 NONLOCK 6 HOLE SM

Facility

$487.50

Service Code	HCPCS C1713
Hospital Charge Code	64905019
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$243.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$243.75

PLATE BONE NONLOCK 6 HOLE SM

Facility

$487.50

Service Code	HCPCS C1713
Hospital Charge Code	64905019
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$511.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$268.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$292.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$243.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$280.31
Rate for Payer: EmblemHealth Commercial	$243.75
Rate for Payer: Fidelis Medicare Advantage	$511.88
Rate for Payer: Group Health Inc Commercial	$243.75
Rate for Payer: Group Health Inc Medicare	$170.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$243.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$316.88

PLATE BONE NONLOCK 7 HOLE SM

Facility

$569.00

Service Code	HCPCS C1713
Hospital Charge Code	64905017
Hospital Revenue Code	278
Min. Negotiated Rate	$284.50
Max. Negotiated Rate	$284.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$284.50
Rate for Payer: Hamaspik Choice Inc Medicare	$284.50

PLATE BONE NONLOCK 7 HOLE SM

Facility

$569.00

Service Code	HCPCS C1713
Hospital Charge Code	64905017
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$597.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$312.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$341.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$284.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$327.18
Rate for Payer: EmblemHealth Commercial	$284.50
Rate for Payer: Fidelis Medicare Advantage	$597.45
Rate for Payer: Group Health Inc Commercial	$284.50
Rate for Payer: Group Health Inc Medicare	$199.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$284.50
Rate for Payer: Hamaspik Choice Inc Medicare	$284.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$369.85

PLATE BONE NONLOCKING MED 2.3

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64905152
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 NONLOCKING MED 2.3

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64905152
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 NONLOCK MED 2.3 H8

Facility

$812.50

Service Code	HCPCS C1713
Hospital Charge Code	64905368
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 NONLOCK MED 2.3 H8

Facility

$812.50

Service Code	HCPCS C1713
Hospital Charge Code	64905368
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 NONLOCK MED .55 4H

Facility

$487.50

Service Code	HCPCS C1713
Hospital Charge Code	64905258
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$511.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$268.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$292.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$243.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$280.31
Rate for Payer: EmblemHealth Commercial	$243.75
Rate for Payer: Fidelis Medicare Advantage	$511.88
Rate for Payer: Group Health Inc Commercial	$243.75
Rate for Payer: Group Health Inc Medicare	$170.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$243.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$316.88

PLATE BONE NONLOCK MED .55 4H

Facility

$487.50

Service Code	HCPCS C1713
Hospital Charge Code	64905258
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$243.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$243.75

PLATE BONE NON-LOC MED 1MMH HO

Facility

$812.50

Service Code	HCPCS C1713
Hospital Charge Code	64904082
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 MED 1MMH HO

Facility

$812.50

Service Code	HCPCS C1713
Hospital Charge Code	64904082
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 SM 0.55MMH

Facility

$812.50

Service Code	HCPCS C1713
Hospital Charge Code	64904618
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 SM 0.55MMH

Facility

$812.50

Service Code	HCPCS C1713
Hospital Charge Code	64904618
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 XSM 0.55MMH

Facility

$487.50

Service Code	HCPCS C1713
Hospital Charge Code	64902564
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$243.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$243.75

PLATE BONE NON-LOC XSM 0.55MMH

Facility

$487.50

Service Code	HCPCS C1713
Hospital Charge Code	64902564
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$511.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$268.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$292.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$243.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$280.31
Rate for Payer: EmblemHealth Commercial	$243.75
Rate for Payer: Fidelis Medicare Advantage	$511.88
Rate for Payer: Group Health Inc Commercial	$243.75
Rate for Payer: Group Health Inc Medicare	$170.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$243.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$316.88

PLATE BONE REG 8H NMINI

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	40200725
Hospital Revenue Code	278
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$207.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$108.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$118.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$99.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$113.85
Rate for Payer: EmblemHealth Commercial	$99.00
Rate for Payer: Fidelis Medicare Advantage	$207.90
Rate for Payer: Group Health Inc Commercial	$99.00
Rate for Payer: Group Health Inc Medicare	$69.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.00
Rate for Payer: Hamaspik Choice Inc Medicare	$99.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$128.70

PLATE BONE REG 8H NMINI

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	40200725
Hospital Revenue Code	278
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$99.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.00
Rate for Payer: Hamaspik Choice Inc Medicare	$99.00

PLATE BONE REPLANTATION 1.5MMH

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64904975
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 REPLANTATION 1.5MMH

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64904975
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