St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE LEFT NARROW

Facility

$1,950.00

Service Code	HCPCS C1713
Hospital Charge Code	64904055
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 LEFT NARROW

Facility

$1,950.00

Service Code	HCPCS C1713
Hospital Charge Code	64904055
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 LEFT POSTERI

Facility

$8,555.00

Service Code	HCPCS C1713
Hospital Charge Code	64907479
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$8,982.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,705.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$5,133.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,277.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,919.12
Rate for Payer: EmblemHealth Commercial	$4,277.50
Rate for Payer: Fidelis Medicare Advantage	$8,982.75
Rate for Payer: Group Health Inc Commercial	$4,277.50
Rate for Payer: Group Health Inc Medicare	$2,994.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,277.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,277.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,560.75

PLATE LEFT POSTERI

Facility

$8,555.00

Service Code	HCPCS C1713
Hospital Charge Code	64907479
Hospital Revenue Code	278
Min. Negotiated Rate	$4,277.50
Max. Negotiated Rate	$4,277.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,277.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,277.50

PLATE LEFT STD

Facility

$3,075.00

Service Code	HCPCS C1713
Hospital Charge Code	64903709
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,228.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,691.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,845.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,537.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,768.12
Rate for Payer: EmblemHealth Commercial	$1,537.50
Rate for Payer: Fidelis Medicare Advantage	$3,228.75
Rate for Payer: Group Health Inc Commercial	$1,537.50
Rate for Payer: Group Health Inc Medicare	$1,076.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,537.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,537.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,998.75

PLATE LEFT STD

Facility

$3,075.00

Service Code	HCPCS C1713
Hospital Charge Code	64903709
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$1,537.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,537.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,537.50

PLATELETS,LEUKOCYTES REDUCED

Facility

$1,337.50

Service Code	HCPCS P9031
Hospital Charge Code	40701177
Hospital Revenue Code	384
Rate for Payer: Cash Price	$158.85

PLATELETS,LEUKOCYTES REDUCED

Facility

$1,337.50

Service Code	HCPCS P9031
Hospital Charge Code	40701177
Hospital Revenue Code	384
Min. Negotiated Rate	$111.20
Max. Negotiated Rate	$1,070.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$735.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$158.85
Rate for Payer: Aetna Government	$158.85
Rate for Payer: Affinity Essential Plan 1&2	$111.20
Rate for Payer: Affinity Essential Plan 3&4	$111.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$111.20
Rate for Payer: Brighton Health Commercial	$158.85
Rate for Payer: Cash Price	$158.85
Rate for Payer: Cash Price	$158.85
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$158.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,070.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$909.50
Rate for Payer: Elderplan Medicare Advantage	$158.85
Rate for Payer: EmblemHealth Commercial	$158.85
Rate for Payer: Fidelis Essential Plan Aliesa	$135.02
Rate for Payer: Fidelis Essential Plan QHP	$141.38
Rate for Payer: Fidelis Medicare Advantage	$158.85
Rate for Payer: Fidelis Qualified Health Plan	$141.38
Rate for Payer: Group Health Inc Commercial	$158.85
Rate for Payer: Group Health Inc Medicare	$158.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$668.75
Rate for Payer: Hamaspik Choice Inc Medicare	$158.85
Rate for Payer: Healthfirst Medicare Advantage	$135.02
Rate for Payer: Healthfirst QHP	$158.85
Rate for Payer: Humana Medicare	$162.03
Rate for Payer: Senior Whole Health Medicare Advantage	$158.85
Rate for Payer: United Healthcare Commercial	$668.75
Rate for Payer: United Healthcare Medicare Advantage	$158.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$158.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$127.08
Rate for Payer: Wellcare Medicare	$142.96

PLATELETS,PHERESIS,LEUKOCYTE REDU

Facility

$1,550.00

Service Code	HCPCS P9035
Hospital Charge Code	40701176
Hospital Revenue Code	384
Min. Negotiated Rate	$401.30
Max. Negotiated Rate	$1,240.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$852.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$573.28
Rate for Payer: Aetna Government	$573.28
Rate for Payer: Affinity Essential Plan 1&2	$401.30
Rate for Payer: Affinity Essential Plan 3&4	$401.30
Rate for Payer: Affinity Medicaid/CHP/HARP	$401.30
Rate for Payer: Brighton Health Commercial	$573.28
Rate for Payer: Cash Price	$573.28
Rate for Payer: Cash Price	$573.28
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$573.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,240.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,054.00
Rate for Payer: Elderplan Medicare Advantage	$573.28
Rate for Payer: EmblemHealth Commercial	$573.28
Rate for Payer: Fidelis Essential Plan Aliesa	$487.29
Rate for Payer: Fidelis Essential Plan QHP	$510.22
Rate for Payer: Fidelis Medicare Advantage	$573.28
Rate for Payer: Fidelis Qualified Health Plan	$510.22
Rate for Payer: Group Health Inc Commercial	$573.28
Rate for Payer: Group Health Inc Medicare	$573.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$775.00
Rate for Payer: Hamaspik Choice Inc Medicare	$573.28
Rate for Payer: Healthfirst Medicare Advantage	$487.29
Rate for Payer: Healthfirst QHP	$573.28
Rate for Payer: Humana Medicare	$584.75
Rate for Payer: Senior Whole Health Medicare Advantage	$573.28
Rate for Payer: United Healthcare Commercial	$775.00
Rate for Payer: United Healthcare Medicare Advantage	$573.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$573.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$458.62
Rate for Payer: Wellcare Medicare	$515.95

PLATELETS,PHERESIS,LEUKOCYTE REDU

Facility

$1,550.00

Service Code	HCPCS P9035
Hospital Charge Code	40701176
Hospital Revenue Code	384
Rate for Payer: Cash Price	$573.28

PLATELETS,PHERSIS,PATHOGEN-REDUCE

Facility

$1,737.50

Service Code	HCPCS P9073
Hospital Charge Code	40701174
Hospital Revenue Code	384
Min. Negotiated Rate	$468.37
Max. Negotiated Rate	$1,390.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$955.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$669.10
Rate for Payer: Aetna Government	$669.10
Rate for Payer: Affinity Essential Plan 1&2	$468.37
Rate for Payer: Affinity Essential Plan 3&4	$468.37
Rate for Payer: Affinity Medicaid/CHP/HARP	$468.37
Rate for Payer: Brighton Health Commercial	$669.10
Rate for Payer: Cash Price	$669.10
Rate for Payer: Cash Price	$669.10
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$669.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,390.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,181.50
Rate for Payer: Elderplan Medicare Advantage	$669.10
Rate for Payer: EmblemHealth Commercial	$669.10
Rate for Payer: Fidelis Essential Plan Aliesa	$568.74
Rate for Payer: Fidelis Essential Plan QHP	$595.50
Rate for Payer: Fidelis Medicare Advantage	$669.10
Rate for Payer: Fidelis Qualified Health Plan	$595.50
Rate for Payer: Group Health Inc Commercial	$669.10
Rate for Payer: Group Health Inc Medicare	$669.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$868.75
Rate for Payer: Hamaspik Choice Inc Medicare	$669.10
Rate for Payer: Healthfirst Medicare Advantage	$568.74
Rate for Payer: Healthfirst QHP	$669.10
Rate for Payer: Humana Medicare	$682.48
Rate for Payer: Senior Whole Health Medicare Advantage	$669.10
Rate for Payer: United Healthcare Commercial	$868.75
Rate for Payer: United Healthcare Medicare Advantage	$669.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$669.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$535.28
Rate for Payer: Wellcare Medicare	$602.19

PLATELETS,PHERSIS,PATHOGEN-REDUCE

Facility

$1,737.50

Service Code	HCPCS P9073
Hospital Charge Code	40701174
Hospital Revenue Code	384
Rate for Payer: Cash Price	$669.10

PLATE LEV 1 20MM OZARK

Facility

$4,389.38

Service Code	HCPCS C1713
Hospital Charge Code	64907521
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,608.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,414.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,633.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,194.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,523.89
Rate for Payer: EmblemHealth Commercial	$2,194.69
Rate for Payer: Fidelis Medicare Advantage	$4,608.85
Rate for Payer: Group Health Inc Commercial	$2,194.69
Rate for Payer: Group Health Inc Medicare	$1,536.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,194.69
Rate for Payer: Hamaspik Choice Inc Medicare	$2,194.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,853.10

PLATE LEV 1 20MM OZARK

Facility

$4,389.38

Service Code	HCPCS C1713
Hospital Charge Code	64907521
Hospital Revenue Code	278
Min. Negotiated Rate	$2,194.69
Max. Negotiated Rate	$2,194.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,194.69
Rate for Payer: Hamaspik Choice Inc Medicare	$2,194.69

PLATE LEVERAGE 8MM GRAFT

Facility

$3,687.50

Service Code	HCPCS C1713
Hospital Charge Code	64903863
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,871.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,028.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,212.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,843.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,120.31
Rate for Payer: EmblemHealth Commercial	$1,843.75
Rate for Payer: Fidelis Medicare Advantage	$3,871.88
Rate for Payer: Group Health Inc Commercial	$1,843.75
Rate for Payer: Group Health Inc Medicare	$1,290.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,843.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,843.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,396.88

PLATE LEVERAGE 8MM GRAFT

Facility

$3,687.50

Service Code	HCPCS C1713
Hospital Charge Code	64903863
Hospital Revenue Code	278
Min. Negotiated Rate	$1,843.75
Max. Negotiated Rate	$1,843.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,843.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,843.75

PLATE LEVERAGE 8MM TRAD

Facility

$2,544.10

Service Code	HCPCS C1713
Hospital Charge Code	64904211
Hospital Revenue Code	278
Min. Negotiated Rate	$1,272.05
Max. Negotiated Rate	$1,272.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,272.05
Rate for Payer: Hamaspik Choice Inc Medicare	$1,272.05

PLATE LEVERAGE 8MM TRAD

Facility

$2,544.10

Service Code	HCPCS C1713
Hospital Charge Code	64904211
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,671.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,399.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,526.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,272.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,462.86
Rate for Payer: EmblemHealth Commercial	$1,272.05
Rate for Payer: Fidelis Medicare Advantage	$2,671.30
Rate for Payer: Group Health Inc Commercial	$1,272.05
Rate for Payer: Group Health Inc Medicare	$890.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,272.05
Rate for Payer: Hamaspik Choice Inc Medicare	$1,272.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,653.66

PLATE LG W/ TAB UN3 (53-34230)

Facility

$266.17

Service Code	HCPCS C1713
Hospital Charge Code	64906509
Hospital Revenue Code	278
Min. Negotiated Rate	$133.08
Max. Negotiated Rate	$133.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.08
Rate for Payer: Hamaspik Choice Inc Medicare	$133.08

PLATE LG W/ TAB UN3 (53-34230)

Facility

$266.17

Service Code	HCPCS C1713
Hospital Charge Code	64906509
Hospital Revenue Code	278
Min. Negotiated Rate	$93.16
Max. Negotiated Rate	$279.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$146.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$159.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.05
Rate for Payer: EmblemHealth Commercial	$133.08
Rate for Payer: Fidelis Medicare Advantage	$279.48
Rate for Payer: Group Health Inc Commercial	$133.08
Rate for Payer: Group Health Inc Medicare	$93.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.08
Rate for Payer: Hamaspik Choice Inc Medicare	$133.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$173.01

PLATE LIGHT SACRAL 23MM LEV1

Facility

$15,662.50

Service Code	HCPCS C1713
Hospital Charge Code	64905304
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$16,445.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8,614.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$9,397.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,831.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$9,005.94
Rate for Payer: EmblemHealth Commercial	$7,831.25
Rate for Payer: Fidelis Medicare Advantage	$16,445.62
Rate for Payer: Group Health Inc Commercial	$7,831.25
Rate for Payer: Group Health Inc Medicare	$5,481.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,831.25
Rate for Payer: Hamaspik Choice Inc Medicare	$7,831.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10,180.62

PLATE LIGHT SACRAL 23MM LEV1

Facility

$15,662.50

Service Code	HCPCS C1713
Hospital Charge Code	64905304
Hospital Revenue Code	278
Min. Negotiated Rate	$7,831.25
Max. Negotiated Rate	$7,831.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,831.25
Rate for Payer: Hamaspik Choice Inc Medicare	$7,831.25

PLATE LIGHT UNIVSL 23MM LEV1

Facility

$15,662.50

Service Code	HCPCS C1713
Hospital Charge Code	64905302
Hospital Revenue Code	278
Min. Negotiated Rate	$7,831.25
Max. Negotiated Rate	$7,831.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,831.25
Rate for Payer: Hamaspik Choice Inc Medicare	$7,831.25

PLATE LIGHT UNIVSL 23MM LEV1

Facility

$15,662.50

Service Code	HCPCS C1713
Hospital Charge Code	64905302
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$16,445.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8,614.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$9,397.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,831.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$9,005.94
Rate for Payer: EmblemHealth Commercial	$7,831.25
Rate for Payer: Fidelis Medicare Advantage	$16,445.62
Rate for Payer: Group Health Inc Commercial	$7,831.25
Rate for Payer: Group Health Inc Medicare	$5,481.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,831.25
Rate for Payer: Hamaspik Choice Inc Medicare	$7,831.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10,180.62

PLATE, LINDORF 3MM

Facility

$718.98

Service Code	HCPCS C1713
Hospital Charge Code	64905705
Hospital Revenue Code	278
Min. Negotiated Rate	$359.49
Max. Negotiated Rate	$359.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$359.49
Rate for Payer: Hamaspik Choice Inc Medicare	$359.49

Know your out-of-pocket cost for care.

All Charges