St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE BONE SM 1.5MMH HOLEX10 T

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64903626
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 SM 1.5MMH HOLEX10 T

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64903626
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 SM 1MMH HOLEX6 TITA

Facility

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	64904923
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 SM 1MMH HOLEX6 TITA

Facility

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	64904923
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 SM 1MMH HOLEX7 TITA

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64904749
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 SM 1MMH HOLEX7 TITA

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64904749
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 SM 1MMH HOLEX8 TITA

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64903624
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 SM 1MMH HOLEX8 TITA

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64903624
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 SM 1MMH HOLEX9 TITA

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64904843
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 SM 1MMH HOLEX9 TITA

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	64904843
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 STANDARD 60MML X 1

Facility

$1,950.00

Service Code	HCPCS C1713
Hospital Charge Code	64904470
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,047.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,072.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,170.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$975.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,121.25
Rate for Payer: EmblemHealth Commercial	$975.00
Rate for Payer: Fidelis Medicare Advantage	$2,047.50
Rate for Payer: Group Health Inc Commercial	$975.00
Rate for Payer: Group Health Inc Medicare	$682.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,267.50

PLATE BONE STANDARD 60MML X 1

Facility

$1,950.00

Service Code	HCPCS C1713
Hospital Charge Code	64904470
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$975.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00

PLATE BONE T 5H MCPLUS

Facility

$335.00

Service Code	HCPCS C1713
Hospital Charge Code	40200726
Hospital Revenue Code	278
Min. Negotiated Rate	$117.25
Max. Negotiated Rate	$351.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$184.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$201.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$167.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$192.62
Rate for Payer: EmblemHealth Commercial	$167.50
Rate for Payer: Fidelis Medicare Advantage	$351.75
Rate for Payer: Group Health Inc Commercial	$167.50
Rate for Payer: Group Health Inc Medicare	$117.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$167.50
Rate for Payer: Hamaspik Choice Inc Medicare	$167.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$217.75

PLATE BONE T 5H MCPLUS

Facility

$335.00

Service Code	HCPCS C1713
Hospital Charge Code	40200726
Hospital Revenue Code	278
Min. Negotiated Rate	$167.50
Max. Negotiated Rate	$167.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$167.50
Rate for Payer: Hamaspik Choice Inc Medicare	$167.50

PLATE BRD STR 3 HL

Facility

$4,140.00

Service Code	HCPCS C1713
Hospital Charge Code	64907385
Hospital Revenue Code	278
Min. Negotiated Rate	$2,070.00
Max. Negotiated Rate	$2,070.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,070.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,070.00

PLATE BRD STR 3 HL

Facility

$4,140.00

Service Code	HCPCS C1713
Hospital Charge Code	64907385
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,347.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,277.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,484.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,070.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,380.50
Rate for Payer: EmblemHealth Commercial	$2,070.00
Rate for Payer: Fidelis Medicare Advantage	$4,347.00
Rate for Payer: Group Health Inc Commercial	$2,070.00
Rate for Payer: Group Health Inc Medicare	$1,449.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,070.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,070.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,691.00

PLATE BRIGADE 36MM LORDO

Facility

$14,582.50

Service Code	HCPCS C1713
Hospital Charge Code	64905331
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$15,311.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8,020.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$8,749.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,291.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$8,384.94
Rate for Payer: EmblemHealth Commercial	$7,291.25
Rate for Payer: Fidelis Medicare Advantage	$15,311.62
Rate for Payer: Group Health Inc Commercial	$7,291.25
Rate for Payer: Group Health Inc Medicare	$5,103.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,291.25
Rate for Payer: Hamaspik Choice Inc Medicare	$7,291.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9,478.62

PLATE BRIGADE 36MM LORDO

Facility

$14,582.50

Service Code	HCPCS C1713
Hospital Charge Code	64905331
Hospital Revenue Code	278
Min. Negotiated Rate	$7,291.25
Max. Negotiated Rate	$7,291.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,291.25
Rate for Payer: Hamaspik Choice Inc Medicare	$7,291.25

PLATE BRIGADE , 40MM LORDOTIC

Facility

$14,582.50

Service Code	HCPCS C1713
Hospital Charge Code	64905182
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$15,311.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8,020.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$8,749.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,291.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$8,384.94
Rate for Payer: EmblemHealth Commercial	$7,291.25
Rate for Payer: Fidelis Medicare Advantage	$15,311.62
Rate for Payer: Group Health Inc Commercial	$7,291.25
Rate for Payer: Group Health Inc Medicare	$5,103.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,291.25
Rate for Payer: Hamaspik Choice Inc Medicare	$7,291.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9,478.62

PLATE BRIGADE , 40MM LORDOTIC

Facility

$14,582.50

Service Code	HCPCS C1713
Hospital Charge Code	64905182
Hospital Revenue Code	278
Min. Negotiated Rate	$7,291.25
Max. Negotiated Rate	$7,291.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,291.25
Rate for Payer: Hamaspik Choice Inc Medicare	$7,291.25

PLATE BURR ABRASIVE 42MM

Facility

$685.23

Service Code	HCPCS C1713
Hospital Charge Code	64901528
Hospital Revenue Code	278
Min. Negotiated Rate	$342.62
Max. Negotiated Rate	$342.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$342.62
Rate for Payer: Hamaspik Choice Inc Medicare	$342.62

PLATE BURR ABRASIVE 42MM

Facility

$685.23

Service Code	HCPCS C1713
Hospital Charge Code	64901528
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$719.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$376.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$411.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$342.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$394.01
Rate for Payer: EmblemHealth Commercial	$342.62
Rate for Payer: Fidelis Medicare Advantage	$719.49
Rate for Payer: Group Health Inc Commercial	$342.62
Rate for Payer: Group Health Inc Medicare	$239.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$342.62
Rate for Payer: Hamaspik Choice Inc Medicare	$342.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$445.40

PLATE BURR HOLE COVER 10MM DIA

Facility

$338.12

Service Code	HCPCS C1713
Hospital Charge Code	64906636
Hospital Revenue Code	278
Min. Negotiated Rate	$118.34
Max. Negotiated Rate	$355.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$185.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$202.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$169.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$194.42
Rate for Payer: EmblemHealth Commercial	$169.06
Rate for Payer: Fidelis Medicare Advantage	$355.03
Rate for Payer: Group Health Inc Commercial	$169.06
Rate for Payer: Group Health Inc Medicare	$118.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.06
Rate for Payer: Hamaspik Choice Inc Medicare	$169.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$219.78

PLATE BURR HOLE COVER 10MM DIA

Facility

$338.12

Service Code	HCPCS C1713
Hospital Charge Code	64906636
Hospital Revenue Code	278
Min. Negotiated Rate	$169.06
Max. Negotiated Rate	$169.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.06
Rate for Payer: Hamaspik Choice Inc Medicare	$169.06

PLATE BURR HOLE COVER 14MM DIA

Facility

$337.70

Service Code	HCPCS C1713
Hospital Charge Code	64906634
Hospital Revenue Code	278
Min. Negotiated Rate	$118.20
Max. Negotiated Rate	$354.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$185.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$202.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$168.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$194.18
Rate for Payer: EmblemHealth Commercial	$168.85
Rate for Payer: Fidelis Medicare Advantage	$354.58
Rate for Payer: Group Health Inc Commercial	$168.85
Rate for Payer: Group Health Inc Medicare	$118.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.85
Rate for Payer: Hamaspik Choice Inc Medicare	$168.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$219.50

Know your out-of-pocket cost for care.

All Charges