St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MESH MIDFACE INLAY MOD HALF SZ

Facility

$332.50

Service Code	HCPCS C1781
Hospital Charge Code	40202012
Hospital Revenue Code	278
Min. Negotiated Rate	$166.25
Max. Negotiated Rate	$166.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$166.25
Rate for Payer: Hamaspik Choice Inc Medicare	$166.25

MESH PERFIX PLUG 1.6X2 X-LARGE

Facility

$768.65

Service Code	HCPCS C1781
Hospital Charge Code	64901355
Hospital Revenue Code	278
Min. Negotiated Rate	$384.32
Max. Negotiated Rate	$384.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$384.32
Rate for Payer: Hamaspik Choice Inc Medicare	$384.32

MESH PERFIX PLUG 1.6X2 X-LARGE

Facility

$768.65

Service Code	HCPCS C1781
Hospital Charge Code	64901355
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$807.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$422.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$461.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$384.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$441.97
Rate for Payer: EmblemHealth Commercial	$384.32
Rate for Payer: Fidelis Medicare Advantage	$807.08
Rate for Payer: Group Health Inc Commercial	$384.32
Rate for Payer: Group Health Inc Medicare	$269.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$384.32
Rate for Payer: Hamaspik Choice Inc Medicare	$384.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$499.62

MESH PERFIX PLUG LARGE

Facility

$659.20

Service Code	HCPCS C1781
Hospital Charge Code	64901176
Hospital Revenue Code	278
Min. Negotiated Rate	$329.60
Max. Negotiated Rate	$329.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$329.60
Rate for Payer: Hamaspik Choice Inc Medicare	$329.60

MESH PERFIX PLUG LARGE

Facility

$659.20

Service Code	HCPCS C1781
Hospital Charge Code	64901176
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$692.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$362.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$395.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$329.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$379.04
Rate for Payer: EmblemHealth Commercial	$329.60
Rate for Payer: Fidelis Medicare Advantage	$692.16
Rate for Payer: Group Health Inc Commercial	$329.60
Rate for Payer: Group Health Inc Medicare	$230.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$329.60
Rate for Payer: Hamaspik Choice Inc Medicare	$329.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$428.48

MESH PERFIX PLUG MEDIUM

Facility

$640.33

Service Code	HCPCS C1781
Hospital Charge Code	64901321
Hospital Revenue Code	278
Min. Negotiated Rate	$320.16
Max. Negotiated Rate	$320.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$320.16
Rate for Payer: Hamaspik Choice Inc Medicare	$320.16

MESH PERFIX PLUG MEDIUM

Facility

$640.33

Service Code	HCPCS C1781
Hospital Charge Code	64901321
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$672.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$352.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$384.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$320.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$368.19
Rate for Payer: EmblemHealth Commercial	$320.16
Rate for Payer: Fidelis Medicare Advantage	$672.35
Rate for Payer: Group Health Inc Commercial	$320.16
Rate for Payer: Group Health Inc Medicare	$224.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$320.16
Rate for Payer: Hamaspik Choice Inc Medicare	$320.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$416.21

MESH PERFIX PLUG MEDIUM (0112760)

Facility

$652.78

Service Code	HCPCS C1781
Hospital Charge Code	64901178
Hospital Revenue Code	278
Min. Negotiated Rate	$326.39
Max. Negotiated Rate	$326.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$326.39
Rate for Payer: Hamaspik Choice Inc Medicare	$326.39

MESH PERFIX PLUG MEDIUM (0112760)

Facility

$652.78

Service Code	HCPCS C1781
Hospital Charge Code	64901178
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$685.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$359.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$391.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$326.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$375.35
Rate for Payer: EmblemHealth Commercial	$326.39
Rate for Payer: Fidelis Medicare Advantage	$685.42
Rate for Payer: Group Health Inc Commercial	$326.39
Rate for Payer: Group Health Inc Medicare	$228.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$326.39
Rate for Payer: Hamaspik Choice Inc Medicare	$326.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$424.31

MESH PERFIX PLUG MED KNITTED POLY

Facility

$1,014.00

Service Code	HCPCS C1781
Hospital Charge Code	40209642
Hospital Revenue Code	278
Min. Negotiated Rate	$507.00
Max. Negotiated Rate	$507.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$507.00
Rate for Payer: Hamaspik Choice Inc Medicare	$507.00

MESH PERFIX PLUG MED KNITTED POLY

Facility

$1,014.00

Service Code	HCPCS C1781
Hospital Charge Code	40209642
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,064.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$557.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$608.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$507.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$583.05
Rate for Payer: EmblemHealth Commercial	$507.00
Rate for Payer: Fidelis Medicare Advantage	$1,064.70
Rate for Payer: Group Health Inc Commercial	$507.00
Rate for Payer: Group Health Inc Medicare	$354.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$507.00
Rate for Payer: Hamaspik Choice Inc Medicare	$507.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$659.10

MESH PERFIX PLUGXLARGE 1.6X2.0

Facility

$1,150.00

Service Code	HCPCS C1781
Hospital Charge Code	40200342
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

MESH PERFIX PLUGXLARGE 1.6X2.0

Facility

$1,150.00

Service Code	HCPCS C1781
Hospital Charge Code	40200342
Hospital Revenue Code	278
Min. Negotiated Rate	$575.00
Max. Negotiated Rate	$575.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00

MESH # PHSE 6

Facility

$2,540.00

Service Code	HCPCS C1781
Hospital Charge Code	40202002
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$2,667.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,397.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,524.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,270.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,460.50
Rate for Payer: EmblemHealth Commercial	$1,270.00
Rate for Payer: Fidelis Medicare Advantage	$2,667.00
Rate for Payer: Group Health Inc Commercial	$1,270.00
Rate for Payer: Group Health Inc Medicare	$889.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,270.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,270.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,651.00

MESH # PHSE 6

Facility

$2,540.00

Service Code	HCPCS C1781
Hospital Charge Code	40202002
Hospital Revenue Code	278
Min. Negotiated Rate	$1,270.00
Max. Negotiated Rate	$1,270.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,270.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,270.00

MESH PHSL 6

Facility

$1,247.02

Service Code	HCPCS C1781
Hospital Charge Code	40209965
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,309.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$685.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$748.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$623.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$717.04
Rate for Payer: EmblemHealth Commercial	$623.51
Rate for Payer: Fidelis Medicare Advantage	$1,309.37
Rate for Payer: Group Health Inc Commercial	$623.51
Rate for Payer: Group Health Inc Medicare	$436.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$623.51
Rate for Payer: Hamaspik Choice Inc Medicare	$623.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$810.56

MESH PHSL 6

Facility

$1,247.02

Service Code	HCPCS C1781
Hospital Charge Code	40209965
Hospital Revenue Code	278
Min. Negotiated Rate	$623.51
Max. Negotiated Rate	$623.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$623.51
Rate for Payer: Hamaspik Choice Inc Medicare	$623.51

MESH PHSL 6

Facility

$1,126.85

Service Code	HCPCS C1781
Hospital Charge Code	64901185
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,183.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$619.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$676.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$563.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$647.94
Rate for Payer: EmblemHealth Commercial	$563.42
Rate for Payer: Fidelis Medicare Advantage	$1,183.19
Rate for Payer: Group Health Inc Commercial	$563.42
Rate for Payer: Group Health Inc Medicare	$394.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$563.42
Rate for Payer: Hamaspik Choice Inc Medicare	$563.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$732.45

MESH PHSL 6

Facility

$1,126.85

Service Code	HCPCS C1781
Hospital Charge Code	64901185
Hospital Revenue Code	278
Min. Negotiated Rate	$563.42
Max. Negotiated Rate	$563.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$563.42
Rate for Payer: Hamaspik Choice Inc Medicare	$563.42

MESH # PHSM 6

Facility

$2,774.00

Service Code	HCPCS C1781
Hospital Charge Code	40202003
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.00
Max. Negotiated Rate	$1,387.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,387.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,387.00

MESH # PHSM 6

Facility

$2,774.00

Service Code	HCPCS C1781
Hospital Charge Code	40202003
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$2,912.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,525.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,664.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,387.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,595.05
Rate for Payer: EmblemHealth Commercial	$1,387.00
Rate for Payer: Fidelis Medicare Advantage	$2,912.70
Rate for Payer: Group Health Inc Commercial	$1,387.00
Rate for Payer: Group Health Inc Medicare	$970.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,387.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,387.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,803.10

MESH PREFORM STIFF

Facility

$8,925.00

Service Code	HCPCS C1781
Hospital Charge Code	64907118
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$4,462.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,462.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,462.50

MESH PREFORM STIFF

Facility

$8,925.00

Service Code	HCPCS C1781
Hospital Charge Code	64907118
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$9,371.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,908.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$5,355.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,462.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,131.88
Rate for Payer: EmblemHealth Commercial	$4,462.50
Rate for Payer: Fidelis Medicare Advantage	$9,371.25
Rate for Payer: Group Health Inc Commercial	$4,462.50
Rate for Payer: Group Health Inc Medicare	$3,123.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,462.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,462.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,801.25

MESH, PROLENE, 12X12(PML)

Facility

$306.92

Service Code	HCPCS C1781
Hospital Charge Code	64901163
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$322.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$168.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$184.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$153.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$176.48
Rate for Payer: EmblemHealth Commercial	$153.46
Rate for Payer: Fidelis Medicare Advantage	$322.27
Rate for Payer: Group Health Inc Commercial	$153.46
Rate for Payer: Group Health Inc Medicare	$107.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$153.46
Rate for Payer: Hamaspik Choice Inc Medicare	$153.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$199.50

MESH, PROLENE, 12X12(PML)

Facility

$306.92

Service Code	HCPCS C1781
Hospital Charge Code	64901163
Hospital Revenue Code	278
Min. Negotiated Rate	$153.46
Max. Negotiated Rate	$153.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$153.46
Rate for Payer: Hamaspik Choice Inc Medicare	$153.46

Know your out-of-pocket cost for care.

All Charges