St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MESH C-QUR TACSHIELD 5X5 OBLONG

Facility

$1,151.88

Service Code	HCPCS C1781
Hospital Charge Code	64902590
Hospital Revenue Code	278
Min. Negotiated Rate	$575.94
Max. Negotiated Rate	$575.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.94
Rate for Payer: Hamaspik Choice Inc Medicare	$575.94

MESH C-QUR TACSHIELD 5X5 OBLONG

Facility

$1,151.88

Service Code	HCPCS C1781
Hospital Charge Code	64902590
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,209.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$633.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$691.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$575.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$662.33
Rate for Payer: EmblemHealth Commercial	$575.94
Rate for Payer: Fidelis Medicare Advantage	$1,209.47
Rate for Payer: Group Health Inc Commercial	$575.94
Rate for Payer: Group Health Inc Medicare	$403.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.94
Rate for Payer: Hamaspik Choice Inc Medicare	$575.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$748.72

MESH C-QUR TACSHIELD 6X8 OBLONG

Facility

$2,150.00

Service Code	HCPCS C1781
Hospital Charge Code	64902588
Hospital Revenue Code	278
Min. Negotiated Rate	$1,075.00
Max. Negotiated Rate	$1,075.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,075.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,075.00

MESH C-QUR TACSHIELD 6X8 OBLONG

Facility

$2,150.00

Service Code	HCPCS C1781
Hospital Charge Code	64902588
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$2,257.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,182.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,290.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,075.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,236.25
Rate for Payer: EmblemHealth Commercial	$1,075.00
Rate for Payer: Fidelis Medicare Advantage	$2,257.50
Rate for Payer: Group Health Inc Commercial	$1,075.00
Rate for Payer: Group Health Inc Medicare	$752.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,075.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,075.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,397.50

MESH DELTA LP 1.7 55X55X0.5MM

Facility

$4,596.75

Service Code	HCPCS C1781
Hospital Charge Code	64903681
Hospital Revenue Code	278
Min. Negotiated Rate	$2,298.38
Max. Negotiated Rate	$2,298.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,298.38
Rate for Payer: Hamaspik Choice Inc Medicare	$2,298.38

MESH DELTA LP 1.7 55X55X0.5MM

Facility

$4,596.75

Service Code	HCPCS C1781
Hospital Charge Code	64903681
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$4,826.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,528.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$2,758.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,298.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,643.13
Rate for Payer: EmblemHealth Commercial	$2,298.38
Rate for Payer: Fidelis Medicare Advantage	$4,826.59
Rate for Payer: Group Health Inc Commercial	$2,298.38
Rate for Payer: Group Health Inc Medicare	$1,608.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,298.38
Rate for Payer: Hamaspik Choice Inc Medicare	$2,298.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,987.89

MESH DERMIS 40 X 70MM

Facility

$9,513.48

Service Code	HCPCS Q4122
Hospital Charge Code	64906959
Hospital Revenue Code	272
Min. Negotiated Rate	$79.56
Max. Negotiated Rate	$7,610.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,232.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$79.56
Rate for Payer: Aetna Government	$79.56
Rate for Payer: Brighton Health Commercial	$7,135.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,610.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,469.17
Rate for Payer: Group Health Inc Commercial	$4,756.74
Rate for Payer: Group Health Inc Medicare	$3,329.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,756.74
Rate for Payer: Hamaspik Choice Inc Medicare	$4,756.74

MESH DYANMIC 1.7,200X200X.6MM

Facility

$11,874.02

Service Code	HCPCS C1781
Hospital Charge Code	64906615
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$12,467.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,530.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$7,124.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,937.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,827.56
Rate for Payer: EmblemHealth Commercial	$5,937.01
Rate for Payer: Fidelis Medicare Advantage	$12,467.72
Rate for Payer: Group Health Inc Commercial	$5,937.01
Rate for Payer: Group Health Inc Medicare	$4,155.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,937.01
Rate for Payer: Hamaspik Choice Inc Medicare	$5,937.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,718.11

MESH DYANMIC 1.7,200X200X.6MM

Facility

$11,874.02

Service Code	HCPCS C1781
Hospital Charge Code	64906615
Hospital Revenue Code	278
Min. Negotiated Rate	$5,937.01
Max. Negotiated Rate	$5,937.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,937.01
Rate for Payer: Hamaspik Choice Inc Medicare	$5,937.01

MESH DYNAMIC 120X120X.3MM

Facility

$4,153.24

Service Code	HCPCS C1781
Hospital Charge Code	64906612
Hospital Revenue Code	278
Min. Negotiated Rate	$2,076.62
Max. Negotiated Rate	$2,076.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,076.62
Rate for Payer: Hamaspik Choice Inc Medicare	$2,076.62

MESH DYNAMIC 120X120X.3MM

Facility

$4,153.24

Service Code	HCPCS C1781
Hospital Charge Code	64906612
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$4,360.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,284.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$2,491.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,076.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,388.11
Rate for Payer: EmblemHealth Commercial	$2,076.62
Rate for Payer: Fidelis Medicare Advantage	$4,360.90
Rate for Payer: Group Health Inc Commercial	$2,076.62
Rate for Payer: Group Health Inc Medicare	$1,453.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,076.62
Rate for Payer: Hamaspik Choice Inc Medicare	$2,076.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,699.61

MESH DYNAMIC 40X40X.3MM

Facility

$2,066.68

Service Code	HCPCS C1781
Hospital Charge Code	64906611
Hospital Revenue Code	278
Min. Negotiated Rate	$1,033.34
Max. Negotiated Rate	$1,033.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,033.34
Rate for Payer: Hamaspik Choice Inc Medicare	$1,033.34

MESH DYNAMIC 40X40X.3MM

Facility

$2,066.68

Service Code	HCPCS C1781
Hospital Charge Code	64906611
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$2,170.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,136.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,240.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,033.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,188.34
Rate for Payer: EmblemHealth Commercial	$1,033.34
Rate for Payer: Fidelis Medicare Advantage	$2,170.01
Rate for Payer: Group Health Inc Commercial	$1,033.34
Rate for Payer: Group Health Inc Medicare	$723.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,033.34
Rate for Payer: Hamaspik Choice Inc Medicare	$1,033.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,343.34

MESHED PIGSKIN FROZEN MI101

Facility

$128.29

Hospital Charge Code	40207636
Hospital Revenue Code	270
Min. Negotiated Rate	$44.90
Max. Negotiated Rate	$102.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.14
Rate for Payer: Aetna Government	$64.14
Rate for Payer: Brighton Health Commercial	$96.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$102.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$87.24
Rate for Payer: Group Health Inc Commercial	$64.14
Rate for Payer: Group Health Inc Medicare	$44.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.14
Rate for Payer: Hamaspik Choice Inc Medicare	$64.14

MESHED PIGSKIN FROZEN MI102

Facility

$214.04

Hospital Charge Code	40207637
Hospital Revenue Code	270
Min. Negotiated Rate	$74.91
Max. Negotiated Rate	$171.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$117.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$107.02
Rate for Payer: Aetna Government	$107.02
Rate for Payer: Brighton Health Commercial	$160.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$171.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$145.55
Rate for Payer: Group Health Inc Commercial	$107.02
Rate for Payer: Group Health Inc Medicare	$74.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.02
Rate for Payer: Hamaspik Choice Inc Medicare	$107.02

MESH FLOWABLE WOUND MATRIX

Facility

$11,987.50

Service Code	HCPCS Q4114
Hospital Charge Code	64907437
Hospital Revenue Code	278
Min. Negotiated Rate	$5,993.75
Max. Negotiated Rate	$5,993.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,993.75
Rate for Payer: Hamaspik Choice Inc Medicare	$5,993.75

MESH FLOWABLE WOUND MATRIX

Facility

$11,987.50

Service Code	HCPCS Q4114
Hospital Charge Code	64907437
Hospital Revenue Code	278
Min. Negotiated Rate	$1,487.83
Max. Negotiated Rate	$12,586.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,593.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,487.83
Rate for Payer: Aetna Government	$1,487.83
Rate for Payer: Brighton Health Commercial	$7,192.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,993.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,892.81
Rate for Payer: EmblemHealth Commercial	$5,993.75
Rate for Payer: Fidelis Medicare Advantage	$12,586.88
Rate for Payer: Group Health Inc Commercial	$5,993.75
Rate for Payer: Group Health Inc Medicare	$4,195.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,993.75
Rate for Payer: Hamaspik Choice Inc Medicare	$5,993.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,791.88

MESH KNITTED POLY 1X4

Facility

$464.00

Service Code	HCPCS C1781
Hospital Charge Code	40209637
Hospital Revenue Code	278
Min. Negotiated Rate	$232.00
Max. Negotiated Rate	$232.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$232.00
Rate for Payer: Hamaspik Choice Inc Medicare	$232.00

MESH KNITTED POLY 1X4

Facility

$464.00

Service Code	HCPCS C1781
Hospital Charge Code	40209637
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$487.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$255.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$278.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$232.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$266.80
Rate for Payer: EmblemHealth Commercial	$232.00
Rate for Payer: Fidelis Medicare Advantage	$487.20
Rate for Payer: Group Health Inc Commercial	$232.00
Rate for Payer: Group Health Inc Medicare	$162.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$232.00
Rate for Payer: Hamaspik Choice Inc Medicare	$232.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$301.60

MESH KNIT VICRYL 6X6

Facility

$2,406.56

Service Code	HCPCS C1781
Hospital Charge Code	40200900
Hospital Revenue Code	278
Min. Negotiated Rate	$1,203.28
Max. Negotiated Rate	$1,203.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,203.28
Rate for Payer: Hamaspik Choice Inc Medicare	$1,203.28

MESH KNIT VICRYL 6X6

Facility

$2,406.56

Service Code	HCPCS C1781
Hospital Charge Code	40200900
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$2,526.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,323.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,443.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,203.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,383.77
Rate for Payer: EmblemHealth Commercial	$1,203.28
Rate for Payer: Fidelis Medicare Advantage	$2,526.89
Rate for Payer: Group Health Inc Commercial	$1,203.28
Rate for Payer: Group Health Inc Medicare	$842.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,203.28
Rate for Payer: Hamaspik Choice Inc Medicare	$1,203.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,564.26

MESH KUGEL OVAL W/EPTFE

Facility

$3,270.00

Service Code	HCPCS C1781
Hospital Charge Code	40201114
Hospital Revenue Code	278
Min. Negotiated Rate	$1,635.00
Max. Negotiated Rate	$1,635.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,635.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,635.00

MESH KUGEL OVAL W/EPTFE

Facility

$3,270.00

Service Code	HCPCS C1781
Hospital Charge Code	40201114
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$3,433.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,798.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,962.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,635.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,880.25
Rate for Payer: EmblemHealth Commercial	$1,635.00
Rate for Payer: Fidelis Medicare Advantage	$3,433.50
Rate for Payer: Group Health Inc Commercial	$1,635.00
Rate for Payer: Group Health Inc Medicare	$1,144.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,635.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,635.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,125.50

MESH KUGEL OVAL XLGE W/EPTFE

Facility

$4,000.00

Service Code	HCPCS C1781
Hospital Charge Code	40200901
Hospital Revenue Code	278
Min. Negotiated Rate	$2,000.00
Max. Negotiated Rate	$2,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,000.00

MESH KUGEL OVAL XLGE W/EPTFE

Facility

$4,000.00

Service Code	HCPCS C1781
Hospital Charge Code	40200901
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$4,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,200.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$2,400.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,300.00
Rate for Payer: EmblemHealth Commercial	$2,000.00
Rate for Payer: Fidelis Medicare Advantage	$4,200.00
Rate for Payer: Group Health Inc Commercial	$2,000.00
Rate for Payer: Group Health Inc Medicare	$1,400.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,600.00

Know your out-of-pocket cost for care.

All Charges