St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MICRO PLATE L-SHAPE LEFT MEDIUM

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40209905
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00

MICRO PLATE L-SHAPE LEFT MEDIUM

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40209905
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$315.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$180.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$172.50
Rate for Payer: EmblemHealth Commercial	$150.00
Rate for Payer: Fidelis Medicare Advantage	$315.00
Rate for Payer: Group Health Inc Commercial	$150.00
Rate for Payer: Group Health Inc Medicare	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$195.00

MICRO PLATE L-SHAPE RIGHT MEDIUM

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40209906
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$315.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$180.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$172.50
Rate for Payer: EmblemHealth Commercial	$150.00
Rate for Payer: Fidelis Medicare Advantage	$315.00
Rate for Payer: Group Health Inc Commercial	$150.00
Rate for Payer: Group Health Inc Medicare	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$195.00

MICRO PLATE L-SHAPE RIGHT MEDIUM

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40209906
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00

MICRO PLATE LSHAPE RT LONG CP TIT

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40209403
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$315.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$180.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$172.50
Rate for Payer: EmblemHealth Commercial	$150.00
Rate for Payer: Fidelis Medicare Advantage	$315.00
Rate for Payer: Group Health Inc Commercial	$150.00
Rate for Payer: Group Health Inc Medicare	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$195.00

MICRO PLATE LSHAPE RT LONG CP TIT

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40209403
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00

MICROPLATE STRGHT 4HL REGULAR

Facility

$152.00

Service Code	HCPCS C1713
Hospital Charge Code	40209424
Hospital Revenue Code	278
Min. Negotiated Rate	$76.00
Max. Negotiated Rate	$76.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.00
Rate for Payer: Hamaspik Choice Inc Medicare	$76.00

MICROPLATE STRGHT 4HL REGULAR

Facility

$152.00

Service Code	HCPCS C1713
Hospital Charge Code	40209424
Hospital Revenue Code	278
Min. Negotiated Rate	$53.20
Max. Negotiated Rate	$159.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$83.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$91.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$76.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$87.40
Rate for Payer: EmblemHealth Commercial	$76.00
Rate for Payer: Fidelis Medicare Advantage	$159.60
Rate for Payer: Group Health Inc Commercial	$76.00
Rate for Payer: Group Health Inc Medicare	$53.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.00
Rate for Payer: Hamaspik Choice Inc Medicare	$76.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$98.80

MICROPLATE STRGHT 4H MED CP TIT

Facility

$156.00

Service Code	HCPCS C1713
Hospital Charge Code	40209441
Hospital Revenue Code	278
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$78.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.00
Rate for Payer: Hamaspik Choice Inc Medicare	$78.00

MICROPLATE STRGHT 4H MED CP TIT

Facility

$156.00

Service Code	HCPCS C1713
Hospital Charge Code	40209441
Hospital Revenue Code	278
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$163.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$93.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$89.70
Rate for Payer: EmblemHealth Commercial	$78.00
Rate for Payer: Fidelis Medicare Advantage	$163.80
Rate for Payer: Group Health Inc Commercial	$78.00
Rate for Payer: Group Health Inc Medicare	$54.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.00
Rate for Payer: Hamaspik Choice Inc Medicare	$78.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$101.40

MICRO PLT LSHAPE 100 LFT LONG 3X2

Facility

$344.00

Service Code	HCPCS C1713
Hospital Charge Code	40209903
Hospital Revenue Code	278
Min. Negotiated Rate	$172.00
Max. Negotiated Rate	$172.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.00
Rate for Payer: Hamaspik Choice Inc Medicare	$172.00

MICRO PLT LSHAPE 100 LFT LONG 3X2

Facility

$344.00

Service Code	HCPCS C1713
Hospital Charge Code	40209903
Hospital Revenue Code	278
Min. Negotiated Rate	$120.40
Max. Negotiated Rate	$361.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$189.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$206.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$172.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$197.80
Rate for Payer: EmblemHealth Commercial	$172.00
Rate for Payer: Fidelis Medicare Advantage	$361.20
Rate for Payer: Group Health Inc Commercial	$172.00
Rate for Payer: Group Health Inc Medicare	$120.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.00
Rate for Payer: Hamaspik Choice Inc Medicare	$172.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$223.60

MICROPLT ORBITAL 10H CP TIT .3MM

Facility

$374.00

Service Code	HCPCS C1713
Hospital Charge Code	40209416
Hospital Revenue Code	278
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$392.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$205.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$224.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$187.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$215.05
Rate for Payer: EmblemHealth Commercial	$187.00
Rate for Payer: Fidelis Medicare Advantage	$392.70
Rate for Payer: Group Health Inc Commercial	$187.00
Rate for Payer: Group Health Inc Medicare	$130.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00
Rate for Payer: Hamaspik Choice Inc Medicare	$187.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$243.10

MICROPLT ORBITAL 10H CP TIT .3MM

Facility

$374.00

Service Code	HCPCS C1713
Hospital Charge Code	40209416
Hospital Revenue Code	278
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$187.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00
Rate for Payer: Hamaspik Choice Inc Medicare	$187.00

MICRO PLT STRAIGHT 6H MED CP TIT

Facility

$200.00

Service Code	HCPCS C1713
Hospital Charge Code	40200031
Hospital Revenue Code	278
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$100.00

MICRO PLT STRAIGHT 6H MED CP TIT

Facility

$200.00

Service Code	HCPCS C1713
Hospital Charge Code	40200031
Hospital Revenue Code	278
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$210.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$120.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$115.00
Rate for Payer: EmblemHealth Commercial	$100.00
Rate for Payer: Fidelis Medicare Advantage	$210.00
Rate for Payer: Group Health Inc Commercial	$100.00
Rate for Payer: Group Health Inc Medicare	$70.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$130.00

MICROPLT STRGHT 6H REG CP TITAN

Facility

$178.00

Service Code	HCPCS C1713
Hospital Charge Code	40209427
Hospital Revenue Code	278
Min. Negotiated Rate	$62.30
Max. Negotiated Rate	$186.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$97.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$106.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$89.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.35
Rate for Payer: EmblemHealth Commercial	$89.00
Rate for Payer: Fidelis Medicare Advantage	$186.90
Rate for Payer: Group Health Inc Commercial	$89.00
Rate for Payer: Group Health Inc Medicare	$62.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.00
Rate for Payer: Hamaspik Choice Inc Medicare	$89.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$115.70

MICROPLT STRGHT 6H REG CP TITAN

Facility

$178.00

Service Code	HCPCS C1713
Hospital Charge Code	40209427
Hospital Revenue Code	278
Min. Negotiated Rate	$89.00
Max. Negotiated Rate	$89.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.00
Rate for Payer: Hamaspik Choice Inc Medicare	$89.00

MICROPLT STRGHT 8H REG CP TITAN

Facility

$196.00

Service Code	HCPCS C1713
Hospital Charge Code	40209419
Hospital Revenue Code	278
Min. Negotiated Rate	$68.60
Max. Negotiated Rate	$205.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$107.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$117.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$98.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$112.70
Rate for Payer: EmblemHealth Commercial	$98.00
Rate for Payer: Fidelis Medicare Advantage	$205.80
Rate for Payer: Group Health Inc Commercial	$98.00
Rate for Payer: Group Health Inc Medicare	$68.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$98.00
Rate for Payer: Hamaspik Choice Inc Medicare	$98.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$127.40

MICROPLT STRGHT 8H REG CP TITAN

Facility

$196.00

Service Code	HCPCS C1713
Hospital Charge Code	40209419
Hospital Revenue Code	278
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$98.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$98.00
Rate for Payer: Hamaspik Choice Inc Medicare	$98.00

MICRO-PREMIE LEADS

Facility

$15.51

Hospital Charge Code	64903702
Hospital Revenue Code	270
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$12.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.76
Rate for Payer: Aetna Government	$7.76
Rate for Payer: Brighton Health Commercial	$11.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.55
Rate for Payer: Group Health Inc Commercial	$7.76
Rate for Payer: Group Health Inc Medicare	$5.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.76
Rate for Payer: Hamaspik Choice Inc Medicare	$7.76

MICROPUNCTURE 5 FR

Facility

$161.00

Hospital Charge Code	64905731
Hospital Revenue Code	270
Min. Negotiated Rate	$56.35
Max. Negotiated Rate	$128.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$88.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$80.50
Rate for Payer: Aetna Government	$80.50
Rate for Payer: Brighton Health Commercial	$120.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$128.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$109.48
Rate for Payer: Group Health Inc Commercial	$80.50
Rate for Payer: Group Health Inc Medicare	$56.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.50
Rate for Payer: Hamaspik Choice Inc Medicare	$80.50

MICROSAW OSTEO

Facility

$1,497.50

Hospital Charge Code	64907337
Hospital Revenue Code	279
Min. Negotiated Rate	$524.12
Max. Negotiated Rate	$1,198.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$823.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$748.75
Rate for Payer: Aetna Government	$748.75
Rate for Payer: Brighton Health Commercial	$1,123.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,198.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,018.30
Rate for Payer: Group Health Inc Commercial	$748.75
Rate for Payer: Group Health Inc Medicare	$524.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$748.75
Rate for Payer: Hamaspik Choice Inc Medicare	$748.75

MICROSLIDE 45 DEG CORNERS

Facility

$345.00

Hospital Charge Code	64903738
Hospital Revenue Code	270
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$276.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$189.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$172.50
Rate for Payer: Aetna Government	$172.50
Rate for Payer: Brighton Health Commercial	$258.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$276.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.60
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

MICROSLIDE CONSULTATION

Facility

$101.25

Service Code	HCPCS 88321
Hospital Charge Code	40635462
Hospital Revenue Code	312
Rate for Payer: Cash Price	$46.38

Know your out-of-pocket cost for care.

All Charges