St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MESH COMPOSIX ELLIPTICAL 6X8

Facility

$2,244.80

Service Code	HCPCS C1781
Hospital Charge Code	64901208
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$2,357.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,234.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,346.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,122.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,290.76
Rate for Payer: EmblemHealth Commercial	$1,122.40
Rate for Payer: Fidelis Medicare Advantage	$2,357.04
Rate for Payer: Group Health Inc Commercial	$1,122.40
Rate for Payer: Group Health Inc Medicare	$785.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,122.40
Rate for Payer: Hamaspik Choice Inc Medicare	$1,122.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,459.12

MESH COMPOSIX ELLIPTICAL 6X8 BARD

Facility

$1,795.84

Service Code	HCPCS C1781
Hospital Charge Code	40200798
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,885.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$987.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,077.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$897.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,032.61
Rate for Payer: EmblemHealth Commercial	$897.92
Rate for Payer: Fidelis Medicare Advantage	$1,885.63
Rate for Payer: Group Health Inc Commercial	$897.92
Rate for Payer: Group Health Inc Medicare	$628.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$897.92
Rate for Payer: Hamaspik Choice Inc Medicare	$897.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,167.30

MESH COMPOSIX ELLIPTICAL 6X8 BARD

Facility

$1,795.84

Service Code	HCPCS C1781
Hospital Charge Code	40200798
Hospital Revenue Code	278
Min. Negotiated Rate	$897.92
Max. Negotiated Rate	$897.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$897.92
Rate for Payer: Hamaspik Choice Inc Medicare	$897.92

MESH COMPOSIX E/X 4X6 ELLIPSE

Facility

$1,064.00

Service Code	HCPCS C1781
Hospital Charge Code	40200927
Hospital Revenue Code	278
Min. Negotiated Rate	$532.00
Max. Negotiated Rate	$532.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$532.00
Rate for Payer: Hamaspik Choice Inc Medicare	$532.00

MESH COMPOSIX E/X 4X6 ELLIPSE

Facility

$1,064.00

Service Code	HCPCS C1781
Hospital Charge Code	40200927
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,117.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$585.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$638.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$532.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$611.80
Rate for Payer: EmblemHealth Commercial	$532.00
Rate for Payer: Fidelis Medicare Advantage	$1,117.20
Rate for Payer: Group Health Inc Commercial	$532.00
Rate for Payer: Group Health Inc Medicare	$372.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$532.00
Rate for Payer: Hamaspik Choice Inc Medicare	$532.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$691.60

MESH COMPOSIX E/X 7X9 ELLIPSE

Facility

$2,632.00

Service Code	HCPCS C1781
Hospital Charge Code	40209632
Hospital Revenue Code	278
Min. Negotiated Rate	$1,316.00
Max. Negotiated Rate	$1,316.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,316.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,316.00

MESH COMPOSIX E/X 7X9 ELLIPSE

Facility

$2,632.00

Service Code	HCPCS C1781
Hospital Charge Code	40200929
Hospital Revenue Code	278
Min. Negotiated Rate	$1,316.00
Max. Negotiated Rate	$1,316.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,316.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,316.00

MESH COMPOSIX E/X 7X9 ELLIPSE

Facility

$2,632.00

Service Code	HCPCS C1781
Hospital Charge Code	40200929
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$2,763.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,447.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,579.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,316.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,513.40
Rate for Payer: EmblemHealth Commercial	$1,316.00
Rate for Payer: Fidelis Medicare Advantage	$2,763.60
Rate for Payer: Group Health Inc Commercial	$1,316.00
Rate for Payer: Group Health Inc Medicare	$921.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,316.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,316.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,710.80

MESH COMPOSIX E/X 7X9 ELLIPSE

Facility

$2,632.00

Service Code	HCPCS C1781
Hospital Charge Code	40209632
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$2,763.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,447.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,579.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,316.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,513.40
Rate for Payer: EmblemHealth Commercial	$1,316.00
Rate for Payer: Fidelis Medicare Advantage	$2,763.60
Rate for Payer: Group Health Inc Commercial	$1,316.00
Rate for Payer: Group Health Inc Medicare	$921.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,316.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,316.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,710.80

MESH COMPOSIX L/P 10.2X13.2

Facility

$4,036.00

Service Code	HCPCS C1781
Hospital Charge Code	40209633
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 L/P 10.2X13.2

Facility

$4,036.00

Service Code	HCPCS C1781
Hospital Charge Code	40209633
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 L/P 4.5 X 11.4 CM

Facility

$2,840.00

Service Code	HCPCS C1781
Hospital Charge Code	40208089
Hospital Revenue Code	278
Min. Negotiated Rate	$1,420.00
Max. Negotiated Rate	$1,420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,420.00

MESH COMPOSIX L/P 4.5 X 11.4 CM

Facility

$2,840.00

Service Code	HCPCS C1781
Hospital Charge Code	40208089
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$2,982.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,562.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,704.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,420.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,633.00
Rate for Payer: EmblemHealth Commercial	$1,420.00
Rate for Payer: Fidelis Medicare Advantage	$2,982.00
Rate for Payer: Group Health Inc Commercial	$1,420.00
Rate for Payer: Group Health Inc Medicare	$994.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,420.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,846.00

MESH COMPOSIX L/P 7.2X9.2

Facility

$2,484.00

Service Code	HCPCS C1781
Hospital Charge Code	40209635
Hospital Revenue Code	278
Min. Negotiated Rate	$1,242.00
Max. Negotiated Rate	$1,242.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,242.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,242.00

MESH COMPOSIX L/P 7.2X9.2

Facility

$2,484.00

Service Code	HCPCS C1781
Hospital Charge Code	40209635
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$2,608.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,366.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,490.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,242.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,428.30
Rate for Payer: EmblemHealth Commercial	$1,242.00
Rate for Payer: Fidelis Medicare Advantage	$2,608.20
Rate for Payer: Group Health Inc Commercial	$1,242.00
Rate for Payer: Group Health Inc Medicare	$869.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,242.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,242.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,614.60

MESH CONTOURBL 100X100X025MM

Facility

$3,790.00

Service Code	HCPCS C1781
Hospital Charge Code	40200799
Hospital Revenue Code	278
Min. Negotiated Rate	$1,895.00
Max. Negotiated Rate	$1,895.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,895.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,895.00

MESH CONTOURBL 100X100X025MM

Facility

$3,790.00

Service Code	HCPCS C1781
Hospital Charge Code	40200799
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$3,979.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,084.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$2,274.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,895.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,179.25
Rate for Payer: EmblemHealth Commercial	$1,895.00
Rate for Payer: Fidelis Medicare Advantage	$3,979.50
Rate for Payer: Group Health Inc Commercial	$1,895.00
Rate for Payer: Group Health Inc Medicare	$1,326.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,895.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,895.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,463.50

MESH C-QUR TACSHIELD 10.8X13.7OVL

Facility

$4,989.88

Service Code	HCPCS C1781
Hospital Charge Code	64902582
Hospital Revenue Code	278
Min. Negotiated Rate	$2,494.94
Max. Negotiated Rate	$2,494.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,494.94
Rate for Payer: Hamaspik Choice Inc Medicare	$2,494.94

MESH C-QUR TACSHIELD 10.8X13.7OVL

Facility

$4,989.88

Service Code	HCPCS C1781
Hospital Charge Code	64902582
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$5,239.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,744.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$2,993.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,494.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,869.18
Rate for Payer: EmblemHealth Commercial	$2,494.94
Rate for Payer: Fidelis Medicare Advantage	$5,239.37
Rate for Payer: Group Health Inc Commercial	$2,494.94
Rate for Payer: Group Health Inc Medicare	$1,746.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,494.94
Rate for Payer: Hamaspik Choice Inc Medicare	$2,494.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,243.42

MESH C-QUR TACSHIELD 3X6 OBLONG

Facility

$1,232.63

Service Code	HCPCS C1781
Hospital Charge Code	64902584
Hospital Revenue Code	278
Min. Negotiated Rate	$616.32
Max. Negotiated Rate	$616.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$616.32
Rate for Payer: Hamaspik Choice Inc Medicare	$616.32

MESH C-QUR TACSHIELD 3X6 OBLONG

Facility

$1,232.63

Service Code	HCPCS C1781
Hospital Charge Code	64902584
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,294.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$677.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$739.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$616.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$708.76
Rate for Payer: EmblemHealth Commercial	$616.32
Rate for Payer: Fidelis Medicare Advantage	$1,294.26
Rate for Payer: Group Health Inc Commercial	$616.32
Rate for Payer: Group Health Inc Medicare	$431.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$616.32
Rate for Payer: Hamaspik Choice Inc Medicare	$616.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$801.21

MESH C-QUR TACSHIELD 4.5 ROUND

Facility

$1,515.25

Service Code	HCPCS C1781
Hospital Charge Code	64902581
Hospital Revenue Code	278
Min. Negotiated Rate	$757.62
Max. Negotiated Rate	$757.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$757.62
Rate for Payer: Hamaspik Choice Inc Medicare	$757.62

MESH C-QUR TACSHIELD 4.5 ROUND

Facility

$1,515.25

Service Code	HCPCS C1781
Hospital Charge Code	64902581
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,591.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$833.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$909.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$757.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$871.27
Rate for Payer: EmblemHealth Commercial	$757.62
Rate for Payer: Fidelis Medicare Advantage	$1,591.01
Rate for Payer: Group Health Inc Commercial	$757.62
Rate for Payer: Group Health Inc Medicare	$530.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$757.62
Rate for Payer: Hamaspik Choice Inc Medicare	$757.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$984.91

MESH C-QUR TACSHIELD 4X6 OBLONG

Facility

$1,346.63

Service Code	HCPCS C1781
Hospital Charge Code	64902586
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,413.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$740.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$807.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$673.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$774.31
Rate for Payer: EmblemHealth Commercial	$673.32
Rate for Payer: Fidelis Medicare Advantage	$1,413.96
Rate for Payer: Group Health Inc Commercial	$673.32
Rate for Payer: Group Health Inc Medicare	$471.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$673.32
Rate for Payer: Hamaspik Choice Inc Medicare	$673.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$875.31

MESH C-QUR TACSHIELD 4X6 OBLONG

Facility

$1,346.63

Service Code	HCPCS C1781
Hospital Charge Code	64902586
Hospital Revenue Code	278
Min. Negotiated Rate	$673.32
Max. Negotiated Rate	$673.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$673.32
Rate for Payer: Hamaspik Choice Inc Medicare	$673.32

Know your out-of-pocket cost for care.

All Charges