St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

Mastotomy with exploration or drainage of abscess, deep

Facility

$2,915.00

Service Code	CPT 19020
Hospital Revenue Code	360
Min. Negotiated Rate	$1,312.42
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,874.89
Rate for Payer: Aetna Government	$1,874.89
Rate for Payer: Affinity Essential Plan 1&2	$1,312.42
Rate for Payer: Affinity Essential Plan 3&4	$1,312.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,312.42
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,874.89
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	$1,874.89
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,593.66
Rate for Payer: Fidelis Essential Plan QHP	$1,668.65
Rate for Payer: Fidelis Medicare Advantage	$1,874.89
Rate for Payer: Fidelis Qualified Health Plan	$1,668.65
Rate for Payer: Group Health Inc Commercial	$1,874.89
Rate for Payer: Group Health Inc Medicare	$1,874.89
Rate for Payer: Hamaspik Choice Inc Medicare	$1,874.89
Rate for Payer: Healthfirst Medicare Advantage	$1,593.66
Rate for Payer: Healthfirst QHP	$1,874.89
Rate for Payer: Humana Medicare	$1,912.39
Rate for Payer: Senior Whole Health Medicare Advantage	$1,874.89
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$1,874.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,874.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,499.91
Rate for Payer: Wellcare Medicare	$1,781.15

MASTRISTEM MICROMETRIX, 1 MG

Facility

$5.82

Service Code	HCPCS Q4118
Hospital Charge Code	30305415
Hospital Revenue Code	636
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$2.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.91
Rate for Payer: Hamaspik Choice Inc Medicare	$2.91

MASTRISTEM MICROMETRIX, 1 MG

Facility

$5.82

Service Code	HCPCS Q4118
Hospital Charge Code	30305415
Hospital Revenue Code	636
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$3.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.65
Rate for Payer: Aetna Government	$2.65
Rate for Payer: Brighton Health Commercial	$3.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.35
Rate for Payer: Group Health Inc Commercial	$2.91
Rate for Payer: Group Health Inc Medicare	$2.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.91
Rate for Payer: Hamaspik Choice Inc Medicare	$2.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.71
Rate for Payer: SOMOS Essential	$2.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.78

MASTRISTEM WOUND MATRIX PER SQ CM

Facility

$9.88

Service Code	HCPCS Q4118
Hospital Charge Code	30305416
Hospital Revenue Code	636
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$4.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.94
Rate for Payer: Hamaspik Choice Inc Medicare	$4.94

MASTRISTEM WOUND MATRIX PER SQ CM

Facility

$9.88

Service Code	HCPCS Q4118
Hospital Charge Code	42500216
Hospital Revenue Code	636
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$6.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.65
Rate for Payer: Aetna Government	$2.65
Rate for Payer: Brighton Health Commercial	$5.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.68
Rate for Payer: Group Health Inc Commercial	$4.94
Rate for Payer: Group Health Inc Medicare	$3.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.94
Rate for Payer: Hamaspik Choice Inc Medicare	$4.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.71
Rate for Payer: SOMOS Essential	$2.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.42

MASTRISTEM WOUND MATRIX PER SQ CM

Facility

$9.88

Service Code	HCPCS Q4118
Hospital Charge Code	30305416
Hospital Revenue Code	636
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$6.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.65
Rate for Payer: Aetna Government	$2.65
Rate for Payer: Brighton Health Commercial	$5.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.68
Rate for Payer: Group Health Inc Commercial	$4.94
Rate for Payer: Group Health Inc Medicare	$3.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.94
Rate for Payer: Hamaspik Choice Inc Medicare	$4.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.71
Rate for Payer: SOMOS Essential	$2.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.42

MASTRISTEM WOUND MATRIX PER SQ CM

Facility

$9.88

Service Code	HCPCS Q4118
Hospital Charge Code	42500216
Hospital Revenue Code	636
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$4.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.94
Rate for Payer: Hamaspik Choice Inc Medicare	$4.94

MATERIALS/SUPPLIES

Facility

$8.15

Service Code	HCPCS 99070
Hospital Charge Code	30301318
Hospital Revenue Code	270
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$10.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.26
Rate for Payer: Aetna Government	$10.26
Rate for Payer: Brighton Health Commercial	$6.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.54
Rate for Payer: Group Health Inc Commercial	$4.08
Rate for Payer: Group Health Inc Medicare	$2.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.08
Rate for Payer: Hamaspik Choice Inc Medicare	$4.08

MATERNAL HIV-1 AB

Facility

$22.23

Service Code	HCPCS 86701
Hospital Charge Code	40728199
Hospital Revenue Code	302
Rate for Payer: Cash Price	$8.89

MATERNAL HIV-1 AB

Facility

$22.23

Service Code	HCPCS 86701
Hospital Charge Code	40728199
Hospital Revenue Code	302
Min. Negotiated Rate	$7.11
Max. Negotiated Rate	$1,010.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.89
Rate for Payer: Aetna Government	$8.89
Rate for Payer: Affinity Essential Plan 1&2	$22.72
Rate for Payer: Affinity Essential Plan 3&4	$22.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.10
Rate for Payer: Amida Care Medicaid	$10.10
Rate for Payer: Brighton Health Commercial	$16.67
Rate for Payer: Cash Price	$8.89
Rate for Payer: Cash Price	$8.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.96
Rate for Payer: Elderplan Medicare Advantage	$8.89
Rate for Payer: EmblemHealth Commercial	$8.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,010.00
Rate for Payer: Fidelis Essential Plan Aliesa	$10.10
Rate for Payer: Fidelis Essential Plan QHP	$10.10
Rate for Payer: Fidelis Medicare Advantage	$8.89
Rate for Payer: Fidelis Qualified Health Plan	$10.60
Rate for Payer: Group Health Inc Commercial	$8.89
Rate for Payer: Group Health Inc Medicare	$8.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.10
Rate for Payer: Hamaspik Choice Inc Medicare	$8.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$10.10
Rate for Payer: Healthfirst Essential Plan	$22.72
Rate for Payer: Healthfirst Medicare Advantage	$8.89
Rate for Payer: Healthfirst QHP	$10.10
Rate for Payer: Humana Medicare	$9.07
Rate for Payer: Senior Whole Health Medicare Advantage	$8.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10.10
Rate for Payer: SOMOS Essential	$10.10
Rate for Payer: United Healthcare Commercial	$11.25
Rate for Payer: United Healthcare Essential Plan 1&2	$22.72
Rate for Payer: United Healthcare Essential Plan 3&4	$11.11
Rate for Payer: United Healthcare Medicaid	$10.10
Rate for Payer: United Healthcare Medicare Advantage	$8.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$7.11
Rate for Payer: Wellcare Medicare	$8.00

MATERNIT21 PLUS CORE(CHR21,18,13S

Facility

$0.01

Service Code	HCPCS 81420
Hospital Charge Code	40601027
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$774.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$759.05
Rate for Payer: Aetna Government	$759.05
Rate for Payer: Affinity Essential Plan 1&2	$531.34
Rate for Payer: Affinity Essential Plan 3&4	$531.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$531.34
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cash Price	$759.05
Rate for Payer: Cash Price	$759.05
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$759.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Elderplan Medicare Advantage	$759.05
Rate for Payer: EmblemHealth Commercial	$759.05
Rate for Payer: Fidelis Essential Plan Aliesa	$645.19
Rate for Payer: Fidelis Essential Plan QHP	$675.55
Rate for Payer: Fidelis Medicare Advantage	$759.05
Rate for Payer: Fidelis Qualified Health Plan	$675.55
Rate for Payer: Group Health Inc Commercial	$759.05
Rate for Payer: Group Health Inc Medicare	$759.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$759.05
Rate for Payer: Healthfirst Medicare Advantage	$759.05
Rate for Payer: Healthfirst QHP	$759.05
Rate for Payer: Humana Medicare	$774.23
Rate for Payer: Senior Whole Health Medicare Advantage	$759.05
Rate for Payer: United Healthcare Commercial	$722.10
Rate for Payer: United Healthcare Medicare Advantage	$759.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$759.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$607.24
Rate for Payer: Wellcare Medicare	$683.14

MATERNIT21 PLUS CORE(CHR21,18,13S

Facility

$0.01

Service Code	HCPCS 81420
Hospital Charge Code	40601027
Hospital Revenue Code	301
Rate for Payer: Cash Price	$759.05

MATERNIT GENOME

Facility

$0.01

Service Code	HCPCS 81422
Hospital Charge Code	40601028
Hospital Revenue Code	310
Rate for Payer: Cash Price	$759.05

MATERNIT GENOME

Facility

$0.01

Service Code	HCPCS 81422
Hospital Charge Code	40601028
Hospital Revenue Code	310
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$774.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$759.05
Rate for Payer: Aetna Government	$759.05
Rate for Payer: Affinity Essential Plan 1&2	$531.34
Rate for Payer: Affinity Essential Plan 3&4	$531.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$531.34
Rate for Payer: Brighton Health Commercial	$759.05
Rate for Payer: Cash Price	$759.05
Rate for Payer: Cash Price	$759.05
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$759.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Elderplan Medicare Advantage	$759.05
Rate for Payer: EmblemHealth Commercial	$759.05
Rate for Payer: Fidelis Essential Plan Aliesa	$645.19
Rate for Payer: Fidelis Essential Plan QHP	$675.55
Rate for Payer: Fidelis Medicare Advantage	$759.05
Rate for Payer: Fidelis Qualified Health Plan	$675.55
Rate for Payer: Group Health Inc Commercial	$759.05
Rate for Payer: Group Health Inc Medicare	$759.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$759.05
Rate for Payer: Healthfirst Medicare Advantage	$759.05
Rate for Payer: Healthfirst QHP	$759.05
Rate for Payer: Humana Medicare	$774.23
Rate for Payer: Senior Whole Health Medicare Advantage	$759.05
Rate for Payer: United Healthcare Medicare Advantage	$759.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$759.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$607.24
Rate for Payer: Wellcare Medicare	$683.14

MATERNITY 21

Facility

$1,897.63

Service Code	HCPCS 81420
Hospital Charge Code	40605650
Hospital Revenue Code	310
Rate for Payer: Cash Price	$759.05

MATERNITY 21

Facility

$1,897.63

Service Code	HCPCS 81420
Hospital Charge Code	40605650
Hospital Revenue Code	310
Min. Negotiated Rate	$531.34
Max. Negotiated Rate	$1,518.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,043.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$759.05
Rate for Payer: Aetna Government	$759.05
Rate for Payer: Affinity Essential Plan 1&2	$531.34
Rate for Payer: Affinity Essential Plan 3&4	$531.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$531.34
Rate for Payer: Brighton Health Commercial	$759.05
Rate for Payer: Cash Price	$759.05
Rate for Payer: Cash Price	$759.05
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$759.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,518.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,290.39
Rate for Payer: Elderplan Medicare Advantage	$759.05
Rate for Payer: EmblemHealth Commercial	$759.05
Rate for Payer: Fidelis Essential Plan Aliesa	$645.19
Rate for Payer: Fidelis Essential Plan QHP	$675.55
Rate for Payer: Fidelis Medicare Advantage	$759.05
Rate for Payer: Fidelis Qualified Health Plan	$675.55
Rate for Payer: Group Health Inc Commercial	$759.05
Rate for Payer: Group Health Inc Medicare	$759.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$948.82
Rate for Payer: Hamaspik Choice Inc Medicare	$759.05
Rate for Payer: Healthfirst Medicare Advantage	$759.05
Rate for Payer: Healthfirst QHP	$759.05
Rate for Payer: Humana Medicare	$774.23
Rate for Payer: Senior Whole Health Medicare Advantage	$759.05
Rate for Payer: United Healthcare Medicare Advantage	$759.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$759.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$607.24
Rate for Payer: Wellcare Medicare	$683.14

Maternity C-Section

Facility

$7,145.00

Service Code	MSDRG 789
Min. Negotiated Rate	$7,145.00
Max. Negotiated Rate	$7,145.00
Rate for Payer: EmblemHealth Commercial	$7,145.00

Maternity C-Section

Facility

$7,145.00

Service Code	MSDRG 794
Min. Negotiated Rate	$7,145.00
Max. Negotiated Rate	$7,145.00
Rate for Payer: EmblemHealth Commercial	$7,145.00

Maternity C-Section

Facility

$7,145.00

Service Code	MSDRG 792
Min. Negotiated Rate	$7,145.00
Max. Negotiated Rate	$7,145.00
Rate for Payer: EmblemHealth Commercial	$7,145.00

Maternity C-Section

Facility

$7,145.00

Service Code	MSDRG 793
Min. Negotiated Rate	$7,145.00
Max. Negotiated Rate	$7,145.00
Rate for Payer: EmblemHealth Commercial	$7,145.00

Maternity C-Section

Facility

$7,145.00

Service Code	MSDRG 795
Min. Negotiated Rate	$7,145.00
Max. Negotiated Rate	$7,145.00
Rate for Payer: EmblemHealth Commercial	$7,145.00

Maternity C-Section

Facility

$7,145.00

Service Code	MSDRG 791
Min. Negotiated Rate	$7,145.00
Max. Negotiated Rate	$7,145.00
Rate for Payer: EmblemHealth Commercial	$7,145.00

Maternity C-Section

Facility

$7,145.00

Service Code	MSDRG 790
Min. Negotiated Rate	$7,145.00
Max. Negotiated Rate	$7,145.00
Rate for Payer: EmblemHealth Commercial	$7,145.00

Maternity Normal Delivery

Facility

$5,045.00

Service Code	MSDRG 789
Min. Negotiated Rate	$5,045.00
Max. Negotiated Rate	$5,045.00
Rate for Payer: EmblemHealth Commercial	$5,045.00

Maternity Normal Delivery

Facility

$5,045.00

Service Code	MSDRG 795
Min. Negotiated Rate	$5,045.00
Max. Negotiated Rate	$5,045.00
Rate for Payer: EmblemHealth Commercial	$5,045.00

Know your out-of-pocket cost for care.

All Charges