St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MEDPOR SURGICAL IMPLANT SHEET

Facility

$1,150.00

Service Code	HCPCS C1781
Hospital Charge Code	40209971
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,207.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$632.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$690.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$575.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$661.25
Rate for Payer: EmblemHealth Commercial	$575.00
Rate for Payer: Fidelis Medicare Advantage	$1,207.50
Rate for Payer: Group Health Inc Commercial	$575.00
Rate for Payer: Group Health Inc Medicare	$402.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$747.50

MEDPOR SURGICAL IMPLANT SHEET DIM

Facility

$1,850.00

Service Code	HCPCS C1781
Hospital Charge Code	40205807
Hospital Revenue Code	278
Min. Negotiated Rate	$925.00
Max. Negotiated Rate	$925.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$925.00
Rate for Payer: Hamaspik Choice Inc Medicare	$925.00

MEDPOR SURGICAL IMPLANT SHEET DIM

Facility

$1,850.00

Service Code	HCPCS C1781
Hospital Charge Code	40205807
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,942.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,017.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,110.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$925.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,063.75
Rate for Payer: EmblemHealth Commercial	$925.00
Rate for Payer: Fidelis Medicare Advantage	$1,942.50
Rate for Payer: Group Health Inc Commercial	$925.00
Rate for Payer: Group Health Inc Medicare	$647.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$925.00
Rate for Payer: Hamaspik Choice Inc Medicare	$925.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,202.50

MEDPOR SUR IMP SHEET DIM38X50X1.5

Facility

$560.00

Service Code	HCPCS C1781
Hospital Charge Code	40202234
Hospital Revenue Code	278
Min. Negotiated Rate	$280.00
Max. Negotiated Rate	$280.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$280.00
Rate for Payer: Hamaspik Choice Inc Medicare	$280.00

MEDPOR SUR IMP SHEET DIM38X50X1.5

Facility

$560.00

Service Code	HCPCS C1781
Hospital Charge Code	40202234
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$588.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$308.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$336.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$280.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$322.00
Rate for Payer: EmblemHealth Commercial	$280.00
Rate for Payer: Fidelis Medicare Advantage	$588.00
Rate for Payer: Group Health Inc Commercial	$280.00
Rate for Payer: Group Health Inc Medicare	$196.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$280.00
Rate for Payer: Hamaspik Choice Inc Medicare	$280.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$364.00

MEDPOR SUR IMP SHEET DIM50X30X0.4

Facility

$560.00

Service Code	HCPCS C1781
Hospital Charge Code	40202235
Hospital Revenue Code	278
Min. Negotiated Rate	$280.00
Max. Negotiated Rate	$280.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$280.00
Rate for Payer: Hamaspik Choice Inc Medicare	$280.00

MEDPOR SUR IMP SHEET DIM50X30X0.4

Facility

$560.00

Service Code	HCPCS C1781
Hospital Charge Code	40202235
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$588.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$308.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$336.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$280.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$322.00
Rate for Payer: EmblemHealth Commercial	$280.00
Rate for Payer: Fidelis Medicare Advantage	$588.00
Rate for Payer: Group Health Inc Commercial	$280.00
Rate for Payer: Group Health Inc Medicare	$196.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$280.00
Rate for Payer: Hamaspik Choice Inc Medicare	$280.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$364.00

MEDPOR TITAN 3D LEFT SM

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	64904449
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$2,812.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,812.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,812.50

MEDPOR TITAN 3D LEFT SM

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	64904449
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,906.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,093.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,375.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,812.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,234.38
Rate for Payer: EmblemHealth Commercial	$2,812.50
Rate for Payer: Fidelis Medicare Advantage	$5,906.25
Rate for Payer: Group Health Inc Commercial	$2,812.50
Rate for Payer: Group Health Inc Medicare	$1,968.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,812.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,812.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,656.25

MEDPOR TITAN 3D OF LEFT

Facility

$5,962.50

Service Code	HCPCS C1713
Hospital Charge Code	64904963
Hospital Revenue Code	278
Min. Negotiated Rate	$2,981.25
Max. Negotiated Rate	$2,981.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,981.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,981.25

MEDPOR TITAN 3D OF LEFT

Facility

$5,962.50

Service Code	HCPCS C1713
Hospital Charge Code	64904963
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,260.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,279.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,577.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,981.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,428.44
Rate for Payer: EmblemHealth Commercial	$2,981.25
Rate for Payer: Fidelis Medicare Advantage	$6,260.62
Rate for Payer: Group Health Inc Commercial	$2,981.25
Rate for Payer: Group Health Inc Medicare	$2,086.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,981.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,981.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,875.62

MEDPOR TITAN 3D OF,LEFT LRGE

Facility

$5,962.50

Service Code	HCPCS C1713
Hospital Charge Code	64905088
Hospital Revenue Code	278
Min. Negotiated Rate	$2,981.25
Max. Negotiated Rate	$2,981.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,981.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,981.25

MEDPOR TITAN 3D OF,LEFT LRGE

Facility

$5,962.50

Service Code	HCPCS C1713
Hospital Charge Code	64905088
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,260.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,279.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,577.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,981.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,428.44
Rate for Payer: EmblemHealth Commercial	$2,981.25
Rate for Payer: Fidelis Medicare Advantage	$6,260.62
Rate for Payer: Group Health Inc Commercial	$2,981.25
Rate for Payer: Group Health Inc Medicare	$2,086.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,981.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,981.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,875.62

MEDPOR TITAN 3D RIGHT SM

Facility

$5,962.50

Service Code	HCPCS C1713
Hospital Charge Code	64904447
Hospital Revenue Code	278
Min. Negotiated Rate	$2,981.25
Max. Negotiated Rate	$2,981.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,981.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,981.25

MEDPOR TITAN 3D RIGHT SM

Facility

$5,962.50

Service Code	HCPCS C1713
Hospital Charge Code	64904447
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,260.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,279.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,577.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,981.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,428.44
Rate for Payer: EmblemHealth Commercial	$2,981.25
Rate for Payer: Fidelis Medicare Advantage	$6,260.62
Rate for Payer: Group Health Inc Commercial	$2,981.25
Rate for Payer: Group Health Inc Medicare	$2,086.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,981.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,981.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,875.62

MEDPOR TITN SURGICAL IMPLANT

Facility

$2,176.00

Service Code	HCPCS C1781
Hospital Charge Code	40202744
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$2,284.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,196.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,305.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,088.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,251.20
Rate for Payer: EmblemHealth Commercial	$1,088.00
Rate for Payer: Fidelis Medicare Advantage	$2,284.80
Rate for Payer: Group Health Inc Commercial	$1,088.00
Rate for Payer: Group Health Inc Medicare	$761.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,088.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,088.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,414.40

MEDPOR TITN SURGICAL IMPLANT

Facility

$2,176.00

Service Code	HCPCS C1781
Hospital Charge Code	40202744
Hospital Revenue Code	278
Min. Negotiated Rate	$1,088.00
Max. Negotiated Rate	$1,088.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,088.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,088.00

MEDREC. KIT PT CARE JACKSON TABLE

Facility

$800.00

Hospital Charge Code	40009360
Hospital Revenue Code	272
Min. Negotiated Rate	$280.00
Max. Negotiated Rate	$640.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$440.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$400.00
Rate for Payer: Aetna Government	$400.00
Rate for Payer: Brighton Health Commercial	$600.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$640.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$544.00
Rate for Payer: Group Health Inc Commercial	$400.00
Rate for Payer: Group Health Inc Medicare	$280.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$400.00
Rate for Payer: Hamaspik Choice Inc Medicare	$400.00

MEDREC. KIT PT CARE JACKSON TABLE

Facility

$800.00

Hospital Charge Code	40203376
Hospital Revenue Code	272
Min. Negotiated Rate	$280.00
Max. Negotiated Rate	$640.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$440.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$400.00
Rate for Payer: Aetna Government	$400.00
Rate for Payer: Brighton Health Commercial	$600.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$640.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$544.00
Rate for Payer: Group Health Inc Commercial	$400.00
Rate for Payer: Group Health Inc Medicare	$280.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$400.00
Rate for Payer: Hamaspik Choice Inc Medicare	$400.00

MEDRON CAPSURE 65CM LEAD 5076-65

Facility

$900.00

Service Code	HCPCS C1898
Hospital Charge Code	66573144
Hospital Revenue Code	278
Min. Negotiated Rate	$98.92
Max. Negotiated Rate	$945.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$495.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$98.92
Rate for Payer: Aetna Government	$98.92
Rate for Payer: Brighton Health Commercial	$540.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$450.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$517.50
Rate for Payer: EmblemHealth Commercial	$450.00
Rate for Payer: Fidelis Medicare Advantage	$945.00
Rate for Payer: Group Health Inc Commercial	$450.00
Rate for Payer: Group Health Inc Medicare	$315.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$450.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$585.00

MEDRON CAPSURE 65CM LEAD 5076-65

Facility

$900.00

Service Code	HCPCS C1898
Hospital Charge Code	66573144
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$450.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$450.00

MEDROXYPROGESTERONE 10 MG TAB

Facility

$0.22

Hospital Charge Code	41644229
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

MEDROXYPROGESTERONE 10 MG TAB

Facility

$0.22

Hospital Charge Code	41654229
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

MEDROXYPROGESTERONE 2.5 MG TAB

Facility

$0.10

Hospital Charge Code	41641134
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

MEDROXYPROGESTERONE 2.5 MG TAB

Facility

$0.10

Hospital Charge Code	41651134
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

Know your out-of-pocket cost for care.

All Charges