St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MESH 100-499

Facility

$630.28

Service Code	HCPCS C1781
Hospital Charge Code	40203061
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$661.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$346.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$378.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$315.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$362.41
Rate for Payer: EmblemHealth Commercial	$315.14
Rate for Payer: Fidelis Medicare Advantage	$661.79
Rate for Payer: Group Health Inc Commercial	$315.14
Rate for Payer: Group Health Inc Medicare	$220.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$315.14
Rate for Payer: Hamaspik Choice Inc Medicare	$315.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$409.68

MESH 1.0 1.2MM DYNMC90X90X6

Facility

$3,225.50

Service Code	HCPCS C1781
Hospital Charge Code	64904388
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$3,386.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,774.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,935.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,612.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,854.66
Rate for Payer: EmblemHealth Commercial	$1,612.75
Rate for Payer: Fidelis Medicare Advantage	$3,386.78
Rate for Payer: Group Health Inc Commercial	$1,612.75
Rate for Payer: Group Health Inc Medicare	$1,128.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,612.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,612.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,096.58

MESH 1.0 1.2MM DYNMC90X90X6

Facility

$3,225.50

Service Code	HCPCS C1781
Hospital Charge Code	64904388
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.75
Max. Negotiated Rate	$1,612.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,612.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,612.75

MESH 10X15

Facility

$1,077.30

Service Code	HCPCS C1781
Hospital Charge Code	40203654
Hospital Revenue Code	278
Min. Negotiated Rate	$538.65
Max. Negotiated Rate	$538.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$538.65
Rate for Payer: Hamaspik Choice Inc Medicare	$538.65

MESH 10X15

Facility

$1,077.30

Service Code	HCPCS C1781
Hospital Charge Code	40203654
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,131.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$592.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$646.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$538.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$619.45
Rate for Payer: EmblemHealth Commercial	$538.65
Rate for Payer: Fidelis Medicare Advantage	$1,131.16
Rate for Payer: Group Health Inc Commercial	$538.65
Rate for Payer: Group Health Inc Medicare	$377.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$538.65
Rate for Payer: Hamaspik Choice Inc Medicare	$538.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$700.24

MESH 1.7MM DYNAMC 90X90X.6M-00645

Facility

$1,595.65

Service Code	HCPCS C1781
Hospital Charge Code	64906406
Hospital Revenue Code	278
Min. Negotiated Rate	$797.82
Max. Negotiated Rate	$797.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$797.82
Rate for Payer: Hamaspik Choice Inc Medicare	$797.82

MESH 1.7MM DYNAMC 90X90X.6M-00645

Facility

$1,595.65

Service Code	HCPCS C1781
Hospital Charge Code	64906406
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,675.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$877.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$957.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$797.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$917.50
Rate for Payer: EmblemHealth Commercial	$797.82
Rate for Payer: Fidelis Medicare Advantage	$1,675.43
Rate for Payer: Group Health Inc Commercial	$797.82
Rate for Payer: Group Health Inc Medicare	$558.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$797.82
Rate for Payer: Hamaspik Choice Inc Medicare	$797.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,037.17

MESH 1.7MM DYNAMIC 90X90X.3MM

Facility

$3,225.05

Service Code	HCPCS C1781
Hospital Charge Code	64901879
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$3,386.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,773.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,935.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,612.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,854.40
Rate for Payer: EmblemHealth Commercial	$1,612.52
Rate for Payer: Fidelis Medicare Advantage	$3,386.30
Rate for Payer: Group Health Inc Commercial	$1,612.52
Rate for Payer: Group Health Inc Medicare	$1,128.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,612.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1,612.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,096.28

MESH 1.7MM DYNAMIC 90X90X.3MM

Facility

$3,225.05

Service Code	HCPCS C1781
Hospital Charge Code	64901879
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.52
Max. Negotiated Rate	$1,612.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,612.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1,612.52

MESH 1.7MM DYNAMIC 90X90X.6MM

Facility

$3,225.05

Service Code	HCPCS C1781
Hospital Charge Code	64901880
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.52
Max. Negotiated Rate	$1,612.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,612.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1,612.52

MESH 1.7MM DYNAMIC 90X90X.6MM

Facility

$3,225.05

Service Code	HCPCS C1781
Hospital Charge Code	64901880
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$3,386.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,773.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,935.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,612.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,854.40
Rate for Payer: EmblemHealth Commercial	$1,612.52
Rate for Payer: Fidelis Medicare Advantage	$3,386.30
Rate for Payer: Group Health Inc Commercial	$1,612.52
Rate for Payer: Group Health Inc Medicare	$1,128.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,612.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1,612.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,096.28

MESH 3D MAX LARGE RIGHT

Facility

$584.53

Service Code	HCPCS C1781
Hospital Charge Code	64901349
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$613.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$321.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$350.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$292.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$336.10
Rate for Payer: EmblemHealth Commercial	$292.26
Rate for Payer: Fidelis Medicare Advantage	$613.76
Rate for Payer: Group Health Inc Commercial	$292.26
Rate for Payer: Group Health Inc Medicare	$204.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$292.26
Rate for Payer: Hamaspik Choice Inc Medicare	$292.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$379.94

MESH 3D MAX LARGE RIGHT

Facility

$584.53

Service Code	HCPCS C1781
Hospital Charge Code	64901349
Hospital Revenue Code	278
Min. Negotiated Rate	$292.26
Max. Negotiated Rate	$292.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$292.26
Rate for Payer: Hamaspik Choice Inc Medicare	$292.26

MESH 3DMAX LF LARGE

Facility

$454.00

Service Code	HCPCS C1781
Hospital Charge Code	40209625
Hospital Revenue Code	278
Min. Negotiated Rate	$227.00
Max. Negotiated Rate	$227.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$227.00
Rate for Payer: Hamaspik Choice Inc Medicare	$227.00

MESH 3DMAX LF LARGE

Facility

$454.00

Service Code	HCPCS C1781
Hospital Charge Code	40209625
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$476.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$249.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$272.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$227.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$261.05
Rate for Payer: EmblemHealth Commercial	$227.00
Rate for Payer: Fidelis Medicare Advantage	$476.70
Rate for Payer: Group Health Inc Commercial	$227.00
Rate for Payer: Group Health Inc Medicare	$158.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$227.00
Rate for Payer: Hamaspik Choice Inc Medicare	$227.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$295.10

MESH 3DMAX LF MED

Facility

$539.00

Service Code	HCPCS C1781
Hospital Charge Code	40209627
Hospital Revenue Code	278
Min. Negotiated Rate	$269.50
Max. Negotiated Rate	$269.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$269.50
Rate for Payer: Hamaspik Choice Inc Medicare	$269.50

MESH 3DMAX LF MED

Facility

$539.00

Service Code	HCPCS C1781
Hospital Charge Code	40209627
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$565.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$296.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$323.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$269.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$309.92
Rate for Payer: EmblemHealth Commercial	$269.50
Rate for Payer: Fidelis Medicare Advantage	$565.95
Rate for Payer: Group Health Inc Commercial	$269.50
Rate for Payer: Group Health Inc Medicare	$188.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$269.50
Rate for Payer: Hamaspik Choice Inc Medicare	$269.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$350.35

MESH 3DMAX LF MED 0115310

Facility

$548.47

Service Code	HCPCS C1781
Hospital Charge Code	64901181
Hospital Revenue Code	278
Min. Negotiated Rate	$274.24
Max. Negotiated Rate	$274.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$274.24
Rate for Payer: Hamaspik Choice Inc Medicare	$274.24

MESH 3DMAX LF MED 0115310

Facility

$548.47

Service Code	HCPCS C1781
Hospital Charge Code	64901181
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$575.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$301.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$329.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$274.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$315.37
Rate for Payer: EmblemHealth Commercial	$274.24
Rate for Payer: Fidelis Medicare Advantage	$575.89
Rate for Payer: Group Health Inc Commercial	$274.24
Rate for Payer: Group Health Inc Medicare	$191.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$274.24
Rate for Payer: Hamaspik Choice Inc Medicare	$274.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$356.51

MESH 3DMAX MED PRE-FORMED

Facility

$452.00

Service Code	HCPCS C1781
Hospital Charge Code	40209628
Hospital Revenue Code	278
Min. Negotiated Rate	$226.00
Max. Negotiated Rate	$226.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$226.00
Rate for Payer: Hamaspik Choice Inc Medicare	$226.00

MESH 3DMAX MED PRE-FORMED

Facility

$452.00

Service Code	HCPCS C1781
Hospital Charge Code	40209628
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$474.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$248.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$271.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$226.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$259.90
Rate for Payer: EmblemHealth Commercial	$226.00
Rate for Payer: Fidelis Medicare Advantage	$474.60
Rate for Payer: Group Health Inc Commercial	$226.00
Rate for Payer: Group Health Inc Medicare	$158.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$226.00
Rate for Payer: Hamaspik Choice Inc Medicare	$226.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$293.80

MESH 3DMAX RT LARGE

Facility

$587.50

Service Code	HCPCS C1781
Hospital Charge Code	40209626
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$616.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$323.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$352.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$293.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$337.81
Rate for Payer: EmblemHealth Commercial	$293.75
Rate for Payer: Fidelis Medicare Advantage	$616.88
Rate for Payer: Group Health Inc Commercial	$293.75
Rate for Payer: Group Health Inc Medicare	$205.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$293.75
Rate for Payer: Hamaspik Choice Inc Medicare	$293.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$381.88

MESH 3DMAX RT LARGE

Facility

$587.50

Service Code	HCPCS C1781
Hospital Charge Code	40209626
Hospital Revenue Code	278
Min. Negotiated Rate	$293.75
Max. Negotiated Rate	$293.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$293.75
Rate for Payer: Hamaspik Choice Inc Medicare	$293.75

MESH 3DMAX RT MED PRE-FORMED

Facility

$287.20

Service Code	HCPCS C1781
Hospital Charge Code	64901179
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$301.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$172.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$143.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$165.14
Rate for Payer: EmblemHealth Commercial	$143.60
Rate for Payer: Fidelis Medicare Advantage	$301.56
Rate for Payer: Group Health Inc Commercial	$143.60
Rate for Payer: Group Health Inc Medicare	$100.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.60
Rate for Payer: Hamaspik Choice Inc Medicare	$143.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$186.68

MESH 3DMAX RT MED PRE-FORMED

Facility

$287.20

Service Code	HCPCS C1781
Hospital Charge Code	64901179
Hospital Revenue Code	278
Min. Negotiated Rate	$143.60
Max. Negotiated Rate	$143.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.60
Rate for Payer: Hamaspik Choice Inc Medicare	$143.60

Know your out-of-pocket cost for care.

All Charges