St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLASTER PADDING

Facility

$4.25

Hospital Charge Code	40207625
Hospital Revenue Code	270
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$3.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.12
Rate for Payer: Aetna Government	$2.12
Rate for Payer: Brighton Health Commercial	$3.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.89
Rate for Payer: Group Health Inc Commercial	$2.12
Rate for Payer: Group Health Inc Medicare	$1.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2.12

PLASTER ROLL

Facility

$6.03

Hospital Charge Code	40207624
Hospital Revenue Code	270
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$4.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.02
Rate for Payer: Aetna Government	$3.02
Rate for Payer: Brighton Health Commercial	$4.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.10
Rate for Payer: Group Health Inc Commercial	$3.02
Rate for Payer: Group Health Inc Medicare	$2.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.02
Rate for Payer: Hamaspik Choice Inc Medicare	$3.02

Plastic operation of penis for straightening of chordee (eg, hypospadias), with or without mobilization of urethra

Facility

$4,112.10

Service Code	CPT 54300
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$4,112.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,031.47
Rate for Payer: Aetna Government	$4,031.47
Rate for Payer: Affinity Essential Plan 1&2	$2,822.03
Rate for Payer: Affinity Essential Plan 3&4	$2,822.03
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,822.03
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4,031.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$4,031.47
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,426.75
Rate for Payer: Fidelis Essential Plan QHP	$3,588.01
Rate for Payer: Fidelis Medicare Advantage	$4,031.47
Rate for Payer: Fidelis Qualified Health Plan	$3,588.01
Rate for Payer: Group Health Inc Commercial	$4,031.47
Rate for Payer: Group Health Inc Medicare	$4,031.47
Rate for Payer: Hamaspik Choice Inc Medicare	$4,031.47
Rate for Payer: Healthfirst Medicare Advantage	$3,426.75
Rate for Payer: Healthfirst QHP	$4,031.47
Rate for Payer: Humana Medicare	$4,112.10
Rate for Payer: Senior Whole Health Medicare Advantage	$4,031.47
Rate for Payer: United Healthcare Commercial	$2,683.00
Rate for Payer: United Healthcare Medicare Advantage	$4,031.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,031.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,225.18
Rate for Payer: Wellcare Medicare	$3,829.90

Plastic operation on penis to correct angulation

Facility

$4,112.10

Service Code	CPT 54360
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$4,112.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,031.47
Rate for Payer: Aetna Government	$4,031.47
Rate for Payer: Affinity Essential Plan 1&2	$2,822.03
Rate for Payer: Affinity Essential Plan 3&4	$2,822.03
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,822.03
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4,031.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$4,031.47
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,426.75
Rate for Payer: Fidelis Essential Plan QHP	$3,588.01
Rate for Payer: Fidelis Medicare Advantage	$4,031.47
Rate for Payer: Fidelis Qualified Health Plan	$3,588.01
Rate for Payer: Group Health Inc Commercial	$4,031.47
Rate for Payer: Group Health Inc Medicare	$4,031.47
Rate for Payer: Hamaspik Choice Inc Medicare	$4,031.47
Rate for Payer: Healthfirst Medicare Advantage	$3,426.75
Rate for Payer: Healthfirst QHP	$4,031.47
Rate for Payer: Humana Medicare	$4,112.10
Rate for Payer: Senior Whole Health Medicare Advantage	$4,031.47
Rate for Payer: United Healthcare Commercial	$2,683.00
Rate for Payer: United Healthcare Medicare Advantage	$4,031.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,031.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,225.18
Rate for Payer: Wellcare Medicare	$3,829.90

PLASTIC SUTURE TRAY ER (RU)

Facility

$38.63

Hospital Charge Code	40207807
Hospital Revenue Code	270
Min. Negotiated Rate	$13.52
Max. Negotiated Rate	$30.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.32
Rate for Payer: Aetna Government	$19.32
Rate for Payer: Brighton Health Commercial	$28.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.27
Rate for Payer: Group Health Inc Commercial	$19.32
Rate for Payer: Group Health Inc Medicare	$13.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.32
Rate for Payer: Hamaspik Choice Inc Medicare	$19.32

PLATE 1000-1999

Facility

$2,999.13

Service Code	HCPCS C1713
Hospital Charge Code	40203088
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,149.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,649.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,799.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,499.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,724.50
Rate for Payer: EmblemHealth Commercial	$1,499.56
Rate for Payer: Fidelis Medicare Advantage	$3,149.09
Rate for Payer: Group Health Inc Commercial	$1,499.56
Rate for Payer: Group Health Inc Medicare	$1,049.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,499.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1,499.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,949.43

PLATE 1000-1999

Facility

$2,999.13

Service Code	HCPCS C1713
Hospital Charge Code	40203088
Hospital Revenue Code	278
Min. Negotiated Rate	$1,499.56
Max. Negotiated Rate	$1,499.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,499.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1,499.56

PLATE 100-499

Facility

$464.23

Service Code	HCPCS C1713
Hospital Charge Code	40203086
Hospital Revenue Code	278
Min. Negotiated Rate	$232.12
Max. Negotiated Rate	$232.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$232.12
Rate for Payer: Hamaspik Choice Inc Medicare	$232.12

PLATE 100-499

Facility

$464.23

Service Code	HCPCS C1713
Hospital Charge Code	40203086
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$487.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$255.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$278.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$232.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$266.93
Rate for Payer: EmblemHealth Commercial	$232.12
Rate for Payer: Fidelis Medicare Advantage	$487.44
Rate for Payer: Group Health Inc Commercial	$232.12
Rate for Payer: Group Health Inc Medicare	$162.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$232.12
Rate for Payer: Hamaspik Choice Inc Medicare	$232.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$301.75

PLATE 10 HOLE

Facility

$812.00

Service Code	HCPCS C1713
Hospital Charge Code	40200161
Hospital Revenue Code	278
Min. Negotiated Rate	$406.00
Max. Negotiated Rate	$406.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$406.00
Rate for Payer: Hamaspik Choice Inc Medicare	$406.00

PLATE 10 HOLE

Facility

$812.00

Service Code	HCPCS C1713
Hospital Charge Code	40200161
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$852.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$446.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$487.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$406.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$466.90
Rate for Payer: EmblemHealth Commercial	$406.00
Rate for Payer: Fidelis Medicare Advantage	$852.60
Rate for Payer: Group Health Inc Commercial	$406.00
Rate for Payer: Group Health Inc Medicare	$284.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$406.00
Rate for Payer: Hamaspik Choice Inc Medicare	$406.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$527.80

PLATE 10 HOLE 2.7/3.5

Facility

$5,230.00

Service Code	HCPCS C1713
Hospital Charge Code	64903575
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,491.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,876.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,138.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,615.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,007.25
Rate for Payer: EmblemHealth Commercial	$2,615.00
Rate for Payer: Fidelis Medicare Advantage	$5,491.50
Rate for Payer: Group Health Inc Commercial	$2,615.00
Rate for Payer: Group Health Inc Medicare	$1,830.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,615.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,615.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,399.50

PLATE 10 HOLE 2.7/3.5

Facility

$5,230.00

Service Code	HCPCS C1713
Hospital Charge Code	64903575
Hospital Revenue Code	278
Min. Negotiated Rate	$2,615.00
Max. Negotiated Rate	$2,615.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,615.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,615.00

PLATE 10 HOLE -627510

Facility

$4,758.00

Service Code	HCPCS C1713
Hospital Charge Code	64906794
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,995.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,616.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,854.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,379.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,735.85
Rate for Payer: EmblemHealth Commercial	$2,379.00
Rate for Payer: Fidelis Medicare Advantage	$4,995.90
Rate for Payer: Group Health Inc Commercial	$2,379.00
Rate for Payer: Group Health Inc Medicare	$1,665.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,379.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,379.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,092.70

PLATE 10 HOLE -627510

Facility

$4,758.00

Service Code	HCPCS C1713
Hospital Charge Code	64906794
Hospital Revenue Code	278
Min. Negotiated Rate	$2,379.00
Max. Negotiated Rate	$2,379.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,379.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,379.00

PLATE 10 HOLE COMPRESSION-629560S

Facility

$928.20

Service Code	HCPCS C1713
Hospital Charge Code	64906378
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$974.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$510.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$556.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$464.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$533.72
Rate for Payer: EmblemHealth Commercial	$464.10
Rate for Payer: Fidelis Medicare Advantage	$974.61
Rate for Payer: Group Health Inc Commercial	$464.10
Rate for Payer: Group Health Inc Medicare	$324.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$464.10
Rate for Payer: Hamaspik Choice Inc Medicare	$464.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$603.33

PLATE 10 HOLE COMPRESSION-629560S

Facility

$928.20

Service Code	HCPCS C1713
Hospital Charge Code	64906378
Hospital Revenue Code	278
Min. Negotiated Rate	$464.10
Max. Negotiated Rate	$464.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$464.10
Rate for Payer: Hamaspik Choice Inc Medicare	$464.10

PLATE 10 HOLE CRVD UPPERFACE

Facility

$444.95

Service Code	HCPCS C1713
Hospital Charge Code	64901536
Hospital Revenue Code	278
Min. Negotiated Rate	$222.48
Max. Negotiated Rate	$222.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$222.48
Rate for Payer: Hamaspik Choice Inc Medicare	$222.48

PLATE 10 HOLE CRVD UPPERFACE

Facility

$444.95

Service Code	HCPCS C1713
Hospital Charge Code	64901536
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$467.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$244.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$266.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$222.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$255.85
Rate for Payer: EmblemHealth Commercial	$222.48
Rate for Payer: Fidelis Medicare Advantage	$467.20
Rate for Payer: Group Health Inc Commercial	$222.48
Rate for Payer: Group Health Inc Medicare	$155.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$222.48
Rate for Payer: Hamaspik Choice Inc Medicare	$222.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$289.22

PLATE 10 HOLE LAT

Facility

$2,436.53

Service Code	HCPCS C1713
Hospital Charge Code	64907062
Hospital Revenue Code	278
Min. Negotiated Rate	$1,218.26
Max. Negotiated Rate	$1,218.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,218.26
Rate for Payer: Hamaspik Choice Inc Medicare	$1,218.26

PLATE 10 HOLE LAT

Facility

$2,436.53

Service Code	HCPCS C1713
Hospital Charge Code	64907062
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,558.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,340.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,461.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,218.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,401.00
Rate for Payer: EmblemHealth Commercial	$1,218.26
Rate for Payer: Fidelis Medicare Advantage	$2,558.36
Rate for Payer: Group Health Inc Commercial	$1,218.26
Rate for Payer: Group Health Inc Medicare	$852.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,218.26
Rate for Payer: Hamaspik Choice Inc Medicare	$1,218.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,583.74

PLATE 10 HOLE RECON PLATE

Facility

$812.00

Service Code	HCPCS C1713
Hospital Charge Code	40200162
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$852.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$446.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$487.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$406.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$466.90
Rate for Payer: EmblemHealth Commercial	$406.00
Rate for Payer: Fidelis Medicare Advantage	$852.60
Rate for Payer: Group Health Inc Commercial	$406.00
Rate for Payer: Group Health Inc Medicare	$284.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$406.00
Rate for Payer: Hamaspik Choice Inc Medicare	$406.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$527.80

PLATE 10 HOLE RECON PLATE

Facility

$812.00

Service Code	HCPCS C1713
Hospital Charge Code	40200162
Hospital Revenue Code	278
Min. Negotiated Rate	$406.00
Max. Negotiated Rate	$406.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$406.00
Rate for Payer: Hamaspik Choice Inc Medicare	$406.00

PLATE 11 HOLE 4 LEFT

Facility

$685.13

Service Code	HCPCS C1713
Hospital Charge Code	64904489
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$719.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$376.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$411.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$342.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$393.95
Rate for Payer: EmblemHealth Commercial	$342.56
Rate for Payer: Fidelis Medicare Advantage	$719.39
Rate for Payer: Group Health Inc Commercial	$342.56
Rate for Payer: Group Health Inc Medicare	$239.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$342.56
Rate for Payer: Hamaspik Choice Inc Medicare	$342.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$445.33

PLATE 11 HOLE 4 LEFT

Facility

$685.13

Service Code	HCPCS C1713
Hospital Charge Code	64904489
Hospital Revenue Code	278
Min. Negotiated Rate	$342.56
Max. Negotiated Rate	$342.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$342.56
Rate for Payer: Hamaspik Choice Inc Medicare	$342.56

Know your out-of-pocket cost for care.

All Charges