St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE MEDGRIP

Facility

$4,509.00

Service Code	HCPCS C1713
Hospital Charge Code	64902200
Hospital Revenue Code	278
Min. Negotiated Rate	$2,254.50
Max. Negotiated Rate	$2,254.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,254.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,254.50

PLATE MEDIA TRYPTICASE SOY AGAR

Facility

$5.90

Hospital Charge Code	64902609
Hospital Revenue Code	270
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$4.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.95
Rate for Payer: Aetna Government	$2.95
Rate for Payer: Brighton Health Commercial	$4.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.01
Rate for Payer: Group Health Inc Commercial	$2.95
Rate for Payer: Group Health Inc Medicare	$2.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.95
Rate for Payer: Hamaspik Choice Inc Medicare	$2.95

PLATE MEDIGRIP

Facility

$3,494.00

Service Code	HCPCS C1713
Hospital Charge Code	40202432
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,668.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,921.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,096.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,747.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,009.05
Rate for Payer: EmblemHealth Commercial	$1,747.00
Rate for Payer: Fidelis Medicare Advantage	$3,668.70
Rate for Payer: Group Health Inc Commercial	$1,747.00
Rate for Payer: Group Health Inc Medicare	$1,222.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,747.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,747.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,271.10

PLATE MEDIGRIP

Facility

$3,494.00

Service Code	HCPCS C1713
Hospital Charge Code	40202432
Hospital Revenue Code	278
Min. Negotiated Rate	$1,747.00
Max. Negotiated Rate	$1,747.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,747.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,747.00

PLATE MICR L-SHP RT LG CP TIT

Facility

$438.33

Service Code	HCPCS C1713
Hospital Charge Code	64901726
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$460.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$241.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$263.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$219.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$252.04
Rate for Payer: EmblemHealth Commercial	$219.16
Rate for Payer: Fidelis Medicare Advantage	$460.25
Rate for Payer: Group Health Inc Commercial	$219.16
Rate for Payer: Group Health Inc Medicare	$153.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$219.16
Rate for Payer: Hamaspik Choice Inc Medicare	$219.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$284.91

PLATE MICR L-SHP RT LG CP TIT

Facility

$438.33

Service Code	HCPCS C1713
Hospital Charge Code	64901726
Hospital Revenue Code	278
Min. Negotiated Rate	$219.16
Max. Negotiated Rate	$219.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$219.16
Rate for Payer: Hamaspik Choice Inc Medicare	$219.16

PLATE MICRO 4-HOLE

Facility

$225.00

Service Code	HCPCS C1713
Hospital Charge Code	64901976
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.50
Rate for Payer: Hamaspik Choice Inc Medicare	$112.50

PLATE MICRO 4-HOLE

Facility

$225.00

Service Code	HCPCS C1713
Hospital Charge Code	64901976
Hospital Revenue Code	278
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$236.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$123.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$135.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$112.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$129.38
Rate for Payer: EmblemHealth Commercial	$112.50
Rate for Payer: Fidelis Medicare Advantage	$236.25
Rate for Payer: Group Health Inc Commercial	$112.50
Rate for Payer: Group Health Inc Medicare	$78.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.50
Rate for Payer: Hamaspik Choice Inc Medicare	$112.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$146.25

PLATE MICRO DOUBLE Y-SHAPE

Facility

$565.00

Service Code	HCPCS C1713
Hospital Charge Code	64902289
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$593.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$310.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$339.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$282.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$324.88
Rate for Payer: EmblemHealth Commercial	$282.50
Rate for Payer: Fidelis Medicare Advantage	$593.25
Rate for Payer: Group Health Inc Commercial	$282.50
Rate for Payer: Group Health Inc Medicare	$197.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$282.50
Rate for Payer: Hamaspik Choice Inc Medicare	$282.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$367.25

PLATE MICRO DOUBLE Y-SHAPE

Facility

$565.00

Service Code	HCPCS C1713
Hospital Charge Code	64902289
Hospital Revenue Code	278
Min. Negotiated Rate	$282.50
Max. Negotiated Rate	$282.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$282.50
Rate for Payer: Hamaspik Choice Inc Medicare	$282.50

PLATE MICR Y-SHP LNG CP TIT

Facility

$469.48

Service Code	HCPCS C1713
Hospital Charge Code	64901728
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$492.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$258.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$281.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$234.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$269.95
Rate for Payer: EmblemHealth Commercial	$234.74
Rate for Payer: Fidelis Medicare Advantage	$492.95
Rate for Payer: Group Health Inc Commercial	$234.74
Rate for Payer: Group Health Inc Medicare	$164.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$234.74
Rate for Payer: Hamaspik Choice Inc Medicare	$234.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$305.16

PLATE MICR Y-SHP LNG CP TIT

Facility

$469.48

Service Code	HCPCS C1713
Hospital Charge Code	64901728
Hospital Revenue Code	278
Min. Negotiated Rate	$234.74
Max. Negotiated Rate	$234.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$234.74
Rate for Payer: Hamaspik Choice Inc Medicare	$234.74

PLATE MINI 16 HOLES

Facility

$318.80

Service Code	HCPCS C1713
Hospital Charge Code	64906716
Hospital Revenue Code	278
Min. Negotiated Rate	$111.58
Max. Negotiated Rate	$334.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$175.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$191.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$159.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$183.31
Rate for Payer: EmblemHealth Commercial	$159.40
Rate for Payer: Fidelis Medicare Advantage	$334.74
Rate for Payer: Group Health Inc Commercial	$159.40
Rate for Payer: Group Health Inc Medicare	$111.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.40
Rate for Payer: Hamaspik Choice Inc Medicare	$159.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$207.22

PLATE MINI 16 HOLES

Facility

$318.80

Service Code	HCPCS C1713
Hospital Charge Code	64906716
Hospital Revenue Code	278
Min. Negotiated Rate	$159.40
Max. Negotiated Rate	$159.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.40
Rate for Payer: Hamaspik Choice Inc Medicare	$159.40

PLATE MINI 2.0MM 4H TIT W/BAR

Facility

$204.88

Service Code	HCPCS C1713
Hospital Charge Code	64901389
Hospital Revenue Code	278
Min. Negotiated Rate	$102.44
Max. Negotiated Rate	$102.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$102.44
Rate for Payer: Hamaspik Choice Inc Medicare	$102.44

PLATE MINI 2.0MM 4H TIT W/BAR

Facility

$204.88

Service Code	HCPCS C1713
Hospital Charge Code	64901389
Hospital Revenue Code	278
Min. Negotiated Rate	$71.71
Max. Negotiated Rate	$215.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$112.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$122.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$102.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$117.81
Rate for Payer: EmblemHealth Commercial	$102.44
Rate for Payer: Fidelis Medicare Advantage	$215.12
Rate for Payer: Group Health Inc Commercial	$102.44
Rate for Payer: Group Health Inc Medicare	$71.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$102.44
Rate for Payer: Hamaspik Choice Inc Medicare	$102.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$133.17

PLATE MINI 4H LONG CP TIT

Facility

$222.50

Service Code	HCPCS C1713
Hospital Charge Code	64901733
Hospital Revenue Code	278
Min. Negotiated Rate	$111.25
Max. Negotiated Rate	$111.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.25
Rate for Payer: Hamaspik Choice Inc Medicare	$111.25

PLATE MINI 4H LONG CP TIT

Facility

$222.50

Service Code	HCPCS C1713
Hospital Charge Code	64901733
Hospital Revenue Code	278
Min. Negotiated Rate	$77.88
Max. Negotiated Rate	$233.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$122.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$133.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$111.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$127.94
Rate for Payer: EmblemHealth Commercial	$111.25
Rate for Payer: Fidelis Medicare Advantage	$233.62
Rate for Payer: Group Health Inc Commercial	$111.25
Rate for Payer: Group Health Inc Medicare	$77.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.25
Rate for Payer: Hamaspik Choice Inc Medicare	$111.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$144.62

PLATE MINI 4-HOLE

Facility

$185.58

Service Code	HCPCS C1713
Hospital Charge Code	64901363
Hospital Revenue Code	278
Min. Negotiated Rate	$92.79
Max. Negotiated Rate	$92.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.79
Rate for Payer: Hamaspik Choice Inc Medicare	$92.79

PLATE MINI 4-HOLE

Facility

$185.58

Service Code	HCPCS C1713
Hospital Charge Code	64901363
Hospital Revenue Code	278
Min. Negotiated Rate	$64.95
Max. Negotiated Rate	$194.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$102.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$111.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$92.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$106.71
Rate for Payer: EmblemHealth Commercial	$92.79
Rate for Payer: Fidelis Medicare Advantage	$194.86
Rate for Payer: Group Health Inc Commercial	$92.79
Rate for Payer: Group Health Inc Medicare	$64.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.79
Rate for Payer: Hamaspik Choice Inc Medicare	$92.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$120.63

PLATE MINI 4 HOLE 1.5

Facility

$1,528.55

Service Code	HCPCS C1713
Hospital Charge Code	64904387
Hospital Revenue Code	278
Min. Negotiated Rate	$764.28
Max. Negotiated Rate	$764.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$764.28
Rate for Payer: Hamaspik Choice Inc Medicare	$764.28

PLATE MINI 4 HOLE 1.5

Facility

$1,528.55

Service Code	HCPCS C1713
Hospital Charge Code	64904387
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,604.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$840.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$917.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$764.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$878.92
Rate for Payer: EmblemHealth Commercial	$764.28
Rate for Payer: Fidelis Medicare Advantage	$1,604.98
Rate for Payer: Group Health Inc Commercial	$764.28
Rate for Payer: Group Health Inc Medicare	$534.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$764.28
Rate for Payer: Hamaspik Choice Inc Medicare	$764.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$993.56

PLATE MINI 4-HOLE REGULAR

Facility

$222.50

Service Code	HCPCS C1713
Hospital Charge Code	64901821
Hospital Revenue Code	278
Min. Negotiated Rate	$111.25
Max. Negotiated Rate	$111.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.25
Rate for Payer: Hamaspik Choice Inc Medicare	$111.25

PLATE MINI 4-HOLE REGULAR

Facility

$222.50

Service Code	HCPCS C1713
Hospital Charge Code	64901821
Hospital Revenue Code	278
Min. Negotiated Rate	$77.88
Max. Negotiated Rate	$233.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$122.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$133.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$111.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$127.94
Rate for Payer: EmblemHealth Commercial	$111.25
Rate for Payer: Fidelis Medicare Advantage	$233.62
Rate for Payer: Group Health Inc Commercial	$111.25
Rate for Payer: Group Health Inc Medicare	$77.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.25
Rate for Payer: Hamaspik Choice Inc Medicare	$111.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$144.62

PLATE MINI 6 HOLE

Facility

$228.38

Service Code	HCPCS C1713
Hospital Charge Code	64901405
Hospital Revenue Code	278
Min. Negotiated Rate	$79.93
Max. Negotiated Rate	$239.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$125.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$137.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$114.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$131.32
Rate for Payer: EmblemHealth Commercial	$114.19
Rate for Payer: Fidelis Medicare Advantage	$239.80
Rate for Payer: Group Health Inc Commercial	$114.19
Rate for Payer: Group Health Inc Medicare	$79.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.19
Rate for Payer: Hamaspik Choice Inc Medicare	$114.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$148.45

Know your out-of-pocket cost for care.

All Charges