St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MESH 3X6

Facility

$70.00

Service Code	HCPCS C1781
Hospital Charge Code	40203658
Hospital Revenue Code	278
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.00
Rate for Payer: Hamaspik Choice Inc Medicare	$35.00

MESH 3X6

Facility

$70.00

Service Code	HCPCS C1781
Hospital Charge Code	40203658
Hospital Revenue Code	278
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$73.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$42.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.25
Rate for Payer: EmblemHealth Commercial	$35.00
Rate for Payer: Fidelis Medicare Advantage	$73.50
Rate for Payer: Group Health Inc Commercial	$35.00
Rate for Payer: Group Health Inc Medicare	$24.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.00
Rate for Payer: Hamaspik Choice Inc Medicare	$35.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$45.50

MESH 4.5 X 4.5 EPI (ES-4400)

Facility

$3,236.25

Service Code	HCPCS C1781
Hospital Charge Code	64901200
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$3,398.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,779.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,941.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,618.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,860.84
Rate for Payer: EmblemHealth Commercial	$1,618.12
Rate for Payer: Fidelis Medicare Advantage	$3,398.06
Rate for Payer: Group Health Inc Commercial	$1,618.12
Rate for Payer: Group Health Inc Medicare	$1,132.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,618.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,618.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,103.56

MESH 4.5 X 4.5 EPI (ES-4400)

Facility

$3,236.25

Service Code	HCPCS C1781
Hospital Charge Code	64901200
Hospital Revenue Code	278
Min. Negotiated Rate	$1,618.12
Max. Negotiated Rate	$1,618.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,618.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,618.12

MESH 500-1000

Facility

$1,663.70

Service Code	HCPCS C1781
Hospital Charge Code	40203062
Hospital Revenue Code	278
Min. Negotiated Rate	$831.85
Max. Negotiated Rate	$831.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$831.85
Rate for Payer: Hamaspik Choice Inc Medicare	$831.85

MESH 500-1000

Facility

$1,663.70

Service Code	HCPCS C1781
Hospital Charge Code	40203062
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,746.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$915.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$998.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$831.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$956.63
Rate for Payer: EmblemHealth Commercial	$831.85
Rate for Payer: Fidelis Medicare Advantage	$1,746.88
Rate for Payer: Group Health Inc Commercial	$831.85
Rate for Payer: Group Health Inc Medicare	$582.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$831.85
Rate for Payer: Hamaspik Choice Inc Medicare	$831.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,081.40

MESH 6X8

Facility

$1,720.00

Service Code	HCPCS C1781
Hospital Charge Code	40203056
Hospital Revenue Code	278
Min. Negotiated Rate	$860.00
Max. Negotiated Rate	$860.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$860.00
Rate for Payer: Hamaspik Choice Inc Medicare	$860.00

MESH 6X8

Facility

$1,720.00

Service Code	HCPCS C1781
Hospital Charge Code	40203056
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,806.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$946.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,032.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$860.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$989.00
Rate for Payer: EmblemHealth Commercial	$860.00
Rate for Payer: Fidelis Medicare Advantage	$1,806.00
Rate for Payer: Group Health Inc Commercial	$860.00
Rate for Payer: Group Health Inc Medicare	$602.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$860.00
Rate for Payer: Hamaspik Choice Inc Medicare	$860.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,118.00

MESH BARD COMPOSIX E/X 10X14

Facility

$4,125.00

Service Code	HCPCS C1781
Hospital Charge Code	64901278
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$4,331.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,268.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$2,475.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,062.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,371.88
Rate for Payer: EmblemHealth Commercial	$2,062.50
Rate for Payer: Fidelis Medicare Advantage	$4,331.25
Rate for Payer: Group Health Inc Commercial	$2,062.50
Rate for Payer: Group Health Inc Medicare	$1,443.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,062.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,062.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,681.25

MESH BARD COMPOSIX E/X 10X14

Facility

$4,125.00

Service Code	HCPCS C1781
Hospital Charge Code	64901278
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$2,062.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,062.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,062.50

MESH BILAYER INTE

Facility

$39,463.78

Service Code	HCPCS Q4104
Hospital Charge Code	64907426
Hospital Revenue Code	278
Min. Negotiated Rate	$19,731.89
Max. Negotiated Rate	$19,731.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,731.89
Rate for Payer: Hamaspik Choice Inc Medicare	$19,731.89

MESH BILAYER INTE

Facility

$39,463.78

Service Code	HCPCS Q4104
Hospital Charge Code	64907426
Hospital Revenue Code	278
Min. Negotiated Rate	$37.25
Max. Negotiated Rate	$41,436.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21,705.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.25
Rate for Payer: Aetna Government	$37.25
Rate for Payer: Brighton Health Commercial	$23,678.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19,731.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$22,691.67
Rate for Payer: EmblemHealth Commercial	$19,731.89
Rate for Payer: Fidelis Medicare Advantage	$41,436.97
Rate for Payer: Group Health Inc Commercial	$19,731.89
Rate for Payer: Group Health Inc Medicare	$13,812.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,731.89
Rate for Payer: Hamaspik Choice Inc Medicare	$19,731.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25,651.46

MESH BILAYER WOUND MATRIX

Facility

$15,862.50

Service Code	HCPCS Q4104
Hospital Charge Code	64907438
Hospital Revenue Code	278
Min. Negotiated Rate	$37.25
Max. Negotiated Rate	$16,655.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8,724.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.25
Rate for Payer: Aetna Government	$37.25
Rate for Payer: Brighton Health Commercial	$9,517.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,931.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$9,120.94
Rate for Payer: EmblemHealth Commercial	$7,931.25
Rate for Payer: Fidelis Medicare Advantage	$16,655.62
Rate for Payer: Group Health Inc Commercial	$7,931.25
Rate for Payer: Group Health Inc Medicare	$5,551.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,931.25
Rate for Payer: Hamaspik Choice Inc Medicare	$7,931.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10,310.62

MESH BILAYER WOUND MATRIX

Facility

$15,862.50

Service Code	HCPCS Q4104
Hospital Charge Code	64907438
Hospital Revenue Code	278
Min. Negotiated Rate	$7,931.25
Max. Negotiated Rate	$7,931.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,931.25
Rate for Payer: Hamaspik Choice Inc Medicare	$7,931.25

MESH COMPOSITE E/X 10X14

Facility

$4,724.00

Service Code	HCPCS C1781
Hospital Charge Code	40200341
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$4,960.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,598.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$2,834.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,362.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,716.30
Rate for Payer: EmblemHealth Commercial	$2,362.00
Rate for Payer: Fidelis Medicare Advantage	$4,960.20
Rate for Payer: Group Health Inc Commercial	$2,362.00
Rate for Payer: Group Health Inc Medicare	$1,653.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,362.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,362.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,070.60

MESH COMPOSITE E/X 10X14

Facility

$4,724.00

Service Code	HCPCS C1781
Hospital Charge Code	40200341
Hospital Revenue Code	278
Min. Negotiated Rate	$2,362.00
Max. Negotiated Rate	$2,362.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,362.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,362.00

MESH COMPOSIX 10X13 ELLIPSE

Facility

$4,036.00

Service Code	HCPCS C1781
Hospital Charge Code	40209629
Hospital Revenue Code	278
Min. Negotiated Rate	$2,018.00
Max. Negotiated Rate	$2,018.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,018.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,018.00

MESH COMPOSIX 10X13 ELLIPSE

Facility

$4,036.00

Service Code	HCPCS C1781
Hospital Charge Code	40209629
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$4,237.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,219.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$2,421.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,018.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,320.70
Rate for Payer: EmblemHealth Commercial	$2,018.00
Rate for Payer: Fidelis Medicare Advantage	$4,237.80
Rate for Payer: Group Health Inc Commercial	$2,018.00
Rate for Payer: Group Health Inc Medicare	$1,412.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,018.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,018.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,623.40

MESH COMPOSIX 6 X 8 EX POLY

Facility

$2,957.50

Service Code	HCPCS C1781
Hospital Charge Code	64901295
Hospital Revenue Code	278
Min. Negotiated Rate	$1,478.75
Max. Negotiated Rate	$1,478.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,478.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,478.75

MESH COMPOSIX 6 X 8 EX POLY

Facility

$2,957.50

Service Code	HCPCS C1781
Hospital Charge Code	64901295
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$3,105.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,626.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,774.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,478.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,700.56
Rate for Payer: EmblemHealth Commercial	$1,478.75
Rate for Payer: Fidelis Medicare Advantage	$3,105.38
Rate for Payer: Group Health Inc Commercial	$1,478.75
Rate for Payer: Group Health Inc Medicare	$1,035.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,478.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,478.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,922.38

MESH COMPOSIX 6X8 E/X POLY

Facility

$1,874.00

Service Code	HCPCS C1781
Hospital Charge Code	40209630
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,967.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,030.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,124.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$937.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,077.55
Rate for Payer: EmblemHealth Commercial	$937.00
Rate for Payer: Fidelis Medicare Advantage	$1,967.70
Rate for Payer: Group Health Inc Commercial	$937.00
Rate for Payer: Group Health Inc Medicare	$655.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$937.00
Rate for Payer: Hamaspik Choice Inc Medicare	$937.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,218.10

MESH COMPOSIX 6X8 E/X POLY

Facility

$1,874.00

Service Code	HCPCS C1781
Hospital Charge Code	40209630
Hospital Revenue Code	278
Min. Negotiated Rate	$937.00
Max. Negotiated Rate	$937.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$937.00
Rate for Payer: Hamaspik Choice Inc Medicare	$937.00

MESH COMPOSIX 8X10

Facility

$2,480.00

Service Code	HCPCS C1781
Hospital Charge Code	40200797
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$2,604.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,364.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,488.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,240.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,426.00
Rate for Payer: EmblemHealth Commercial	$1,240.00
Rate for Payer: Fidelis Medicare Advantage	$2,604.00
Rate for Payer: Group Health Inc Commercial	$1,240.00
Rate for Payer: Group Health Inc Medicare	$868.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,240.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,240.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,612.00

MESH COMPOSIX 8X10

Facility

$2,480.00

Service Code	HCPCS C1781
Hospital Charge Code	40200797
Hospital Revenue Code	278
Min. Negotiated Rate	$1,240.00
Max. Negotiated Rate	$1,240.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,240.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,240.00

MESH COMPOSIX ELLIPTICAL 6X8

Facility

$2,244.80

Service Code	HCPCS C1781
Hospital Charge Code	64901208
Hospital Revenue Code	278
Min. Negotiated Rate	$1,122.40
Max. Negotiated Rate	$1,122.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,122.40
Rate for Payer: Hamaspik Choice Inc Medicare	$1,122.40

Know your out-of-pocket cost for care.

All Charges