St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PATCH HERNIA VENTRALEX MD 6.4CM

Facility

$1,422.50

Service Code	HCPCS C1781
Hospital Charge Code	64901345
Hospital Revenue Code	278
Min. Negotiated Rate	$711.25
Max. Negotiated Rate	$711.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$711.25
Rate for Payer: Hamaspik Choice Inc Medicare	$711.25

PATCH HERNIA VENTRALEX MD 6.4CM

Facility

$1,422.50

Service Code	HCPCS C1781
Hospital Charge Code	64901345
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,493.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$782.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$853.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$711.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$817.94
Rate for Payer: EmblemHealth Commercial	$711.25
Rate for Payer: Fidelis Medicare Advantage	$1,493.62
Rate for Payer: Group Health Inc Commercial	$711.25
Rate for Payer: Group Health Inc Medicare	$497.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$711.25
Rate for Payer: Hamaspik Choice Inc Medicare	$711.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$924.62

PATCH HERNIA VENTRALEX SM 4.3CM

Facility

$1,187.50

Service Code	HCPCS C1781
Hospital Charge Code	64901344
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,246.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$653.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$712.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$593.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$682.81
Rate for Payer: EmblemHealth Commercial	$593.75
Rate for Payer: Fidelis Medicare Advantage	$1,246.88
Rate for Payer: Group Health Inc Commercial	$593.75
Rate for Payer: Group Health Inc Medicare	$415.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$593.75
Rate for Payer: Hamaspik Choice Inc Medicare	$593.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$771.88

PATCH HERNIA VENTRALEX SM 4.3CM

Facility

$1,187.50

Service Code	HCPCS C1781
Hospital Charge Code	64901344
Hospital Revenue Code	278
Min. Negotiated Rate	$593.75
Max. Negotiated Rate	$593.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$593.75
Rate for Payer: Hamaspik Choice Inc Medicare	$593.75

PATCH HERNIA VENTRA LRG 8CM/3.2

Facility

$1,924.00

Service Code	HCPCS C1762
Hospital Charge Code	40200925
Hospital Revenue Code	278
Min. Negotiated Rate	$962.00
Max. Negotiated Rate	$962.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$962.00
Rate for Payer: Hamaspik Choice Inc Medicare	$962.00

PATCH HERNIA VENTRA LRG 8CM/3.2

Facility

$1,924.00

Service Code	HCPCS C1762
Hospital Charge Code	40200925
Hospital Revenue Code	278
Min. Negotiated Rate	$673.40
Max. Negotiated Rate	$2,020.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,058.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,879.82
Rate for Payer: Aetna Government	$1,879.82
Rate for Payer: Brighton Health Commercial	$1,154.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$962.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,106.30
Rate for Payer: EmblemHealth Commercial	$962.00
Rate for Payer: Fidelis Medicare Advantage	$2,020.20
Rate for Payer: Group Health Inc Commercial	$962.00
Rate for Payer: Group Health Inc Medicare	$673.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$962.00
Rate for Payer: Hamaspik Choice Inc Medicare	$962.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,250.60

PATCH HERNIA VENTRA MED STRAP2.5

Facility

$2,536.00

Service Code	HCPCS C1781
Hospital Charge Code	40209646
Hospital Revenue Code	278
Min. Negotiated Rate	$1,268.00
Max. Negotiated Rate	$1,268.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,268.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,268.00

PATCH HERNIA VENTRA MED STRAP2.5

Facility

$2,536.00

Service Code	HCPCS C1781
Hospital Charge Code	40209646
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$2,662.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,394.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,521.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,268.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,458.20
Rate for Payer: EmblemHealth Commercial	$1,268.00
Rate for Payer: Fidelis Medicare Advantage	$2,662.80
Rate for Payer: Group Health Inc Commercial	$1,268.00
Rate for Payer: Group Health Inc Medicare	$887.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,268.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,268.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,648.40

PATCH HERNIA VENTRA SM STRAP 1.7

Facility

$1,124.00

Service Code	HCPCS C1762
Hospital Charge Code	40209647
Hospital Revenue Code	278
Min. Negotiated Rate	$393.40
Max. Negotiated Rate	$1,879.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$618.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,879.82
Rate for Payer: Aetna Government	$1,879.82
Rate for Payer: Brighton Health Commercial	$674.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$562.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$646.30
Rate for Payer: EmblemHealth Commercial	$562.00
Rate for Payer: Fidelis Medicare Advantage	$1,180.20
Rate for Payer: Group Health Inc Commercial	$562.00
Rate for Payer: Group Health Inc Medicare	$393.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$562.00
Rate for Payer: Hamaspik Choice Inc Medicare	$562.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$730.60

PATCH HERNIA VENTRA SM STRAP 1.7

Facility

$1,124.00

Service Code	HCPCS C1762
Hospital Charge Code	40209647
Hospital Revenue Code	278
Min. Negotiated Rate	$562.00
Max. Negotiated Rate	$562.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$562.00
Rate for Payer: Hamaspik Choice Inc Medicare	$562.00

PATCH OR APPLICATION TEST(S)

Facility

$2,752.98

Service Code	HCPCS 95044
Hospital Charge Code	42201731
Hospital Revenue Code	924
Min. Negotiated Rate	$846.36
Max. Negotiated Rate	$2,202.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,514.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,209.08
Rate for Payer: Aetna Government	$1,209.08
Rate for Payer: Affinity Essential Plan 1&2	$846.36
Rate for Payer: Affinity Essential Plan 3&4	$846.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$846.36
Rate for Payer: Brighton Health Commercial	$2,064.74
Rate for Payer: Cash Price	$1,209.08
Rate for Payer: Cash Price	$1,209.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,209.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,202.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,872.03
Rate for Payer: Elderplan Medicare Advantage	$1,209.08
Rate for Payer: EmblemHealth Commercial	$1,209.08
Rate for Payer: Fidelis Essential Plan Aliesa	$1,027.72
Rate for Payer: Fidelis Essential Plan QHP	$1,076.08
Rate for Payer: Fidelis Medicare Advantage	$1,209.08
Rate for Payer: Fidelis Qualified Health Plan	$1,076.08
Rate for Payer: Group Health Inc Commercial	$1,209.08
Rate for Payer: Group Health Inc Medicare	$1,209.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,376.49
Rate for Payer: Hamaspik Choice Inc Medicare	$1,209.08
Rate for Payer: Healthfirst Medicare Advantage	$1,027.72
Rate for Payer: Healthfirst QHP	$1,209.08
Rate for Payer: Humana Medicare	$1,233.26
Rate for Payer: Senior Whole Health Medicare Advantage	$1,209.08
Rate for Payer: United Healthcare Commercial	$1,376.49
Rate for Payer: United Healthcare Medicare Advantage	$1,209.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,209.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$967.26
Rate for Payer: Wellcare Medicare	$1,148.63

PATCH OR APPLICATION TEST(S)

Facility

$2,752.98

Service Code	HCPCS 95044
Hospital Charge Code	42201731
Hospital Revenue Code	924
Rate for Payer: Cash Price	$1,209.08

PATCH VASC 1CM X 6CML BO

Facility

$398.00

Hospital Charge Code	40004880
Hospital Revenue Code	270
Min. Negotiated Rate	$139.30
Max. Negotiated Rate	$318.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$218.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$199.00
Rate for Payer: Aetna Government	$199.00
Rate for Payer: Brighton Health Commercial	$298.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$318.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$270.64
Rate for Payer: Group Health Inc Commercial	$199.00
Rate for Payer: Group Health Inc Medicare	$139.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$199.00
Rate for Payer: Hamaspik Choice Inc Medicare	$199.00

PATCH VENTRALEX HERNIA LG RD 3.2

Facility

$1,962.50

Service Code	HCPCS C1781
Hospital Charge Code	64902672
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$2,060.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,079.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,177.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$981.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,128.44
Rate for Payer: EmblemHealth Commercial	$981.25
Rate for Payer: Fidelis Medicare Advantage	$2,060.62
Rate for Payer: Group Health Inc Commercial	$981.25
Rate for Payer: Group Health Inc Medicare	$686.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$981.25
Rate for Payer: Hamaspik Choice Inc Medicare	$981.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,275.62

PATCH VENTRALEX HERNIA LG RD 3.2

Facility

$1,962.50

Service Code	HCPCS C1781
Hospital Charge Code	64902672
Hospital Revenue Code	278
Min. Negotiated Rate	$981.25
Max. Negotiated Rate	$981.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$981.25
Rate for Payer: Hamaspik Choice Inc Medicare	$981.25

PATCH VENTRALEX HERNIA MD RD 2.5

Facility

$1,745.00

Service Code	HCPCS C1781
Hospital Charge Code	64902670
Hospital Revenue Code	278
Min. Negotiated Rate	$872.50
Max. Negotiated Rate	$872.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$872.50
Rate for Payer: Hamaspik Choice Inc Medicare	$872.50

PATCH VENTRALEX HERNIA MD RD 2.5

Facility

$1,745.00

Service Code	HCPCS C1781
Hospital Charge Code	64902670
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,832.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$959.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,047.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$872.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,003.38
Rate for Payer: EmblemHealth Commercial	$872.50
Rate for Payer: Fidelis Medicare Advantage	$1,832.25
Rate for Payer: Group Health Inc Commercial	$872.50
Rate for Payer: Group Health Inc Medicare	$610.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$872.50
Rate for Payer: Hamaspik Choice Inc Medicare	$872.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,134.25

PATCH VENTRALEX HERNIA SM RD 1.7

Facility

$1,462.50

Service Code	HCPCS C1781
Hospital Charge Code	64902668
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,535.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$804.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$877.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$731.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$840.94
Rate for Payer: EmblemHealth Commercial	$731.25
Rate for Payer: Fidelis Medicare Advantage	$1,535.62
Rate for Payer: Group Health Inc Commercial	$731.25
Rate for Payer: Group Health Inc Medicare	$511.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$731.25
Rate for Payer: Hamaspik Choice Inc Medicare	$731.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$950.62

PATCH VENTRALEX HERNIA SM RD 1.7

Facility

$1,462.50

Service Code	HCPCS C1781
Hospital Charge Code	64902668
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$731.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$731.25
Rate for Payer: Hamaspik Choice Inc Medicare	$731.25

PATCH VENTRIO HERNIA LG OV

Facility

$3,975.00

Service Code	HCPCS C1781
Hospital Charge Code	64902676
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$4,173.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,186.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$2,385.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,987.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,285.62
Rate for Payer: EmblemHealth Commercial	$1,987.50
Rate for Payer: Fidelis Medicare Advantage	$4,173.75
Rate for Payer: Group Health Inc Commercial	$1,987.50
Rate for Payer: Group Health Inc Medicare	$1,391.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,987.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,987.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,583.75

PATCH VENTRIO HERNIA LG OV

Facility

$3,975.00

Service Code	HCPCS C1781
Hospital Charge Code	64902676
Hospital Revenue Code	278
Min. Negotiated Rate	$1,987.50
Max. Negotiated Rate	$1,987.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,987.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,987.50

PATCH VENTRIO HERNIA LG RD 4.5

Facility

$2,400.00

Service Code	HCPCS C1781
Hospital Charge Code	64902612
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,200.00

PATCH VENTRIO HERNIA LG RD 4.5

Facility

$2,400.00

Service Code	HCPCS C1781
Hospital Charge Code	64902612
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$2,520.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,320.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,440.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,380.00
Rate for Payer: EmblemHealth Commercial	$1,200.00
Rate for Payer: Fidelis Medicare Advantage	$2,520.00
Rate for Payer: Group Health Inc Commercial	$1,200.00
Rate for Payer: Group Health Inc Medicare	$840.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,560.00

PATCH VENTRIO HERNIA MIDLINE

Facility

$6,225.00

Service Code	HCPCS C1781
Hospital Charge Code	64902680
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$6,536.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,423.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$3,735.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,112.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,579.38
Rate for Payer: EmblemHealth Commercial	$3,112.50
Rate for Payer: Fidelis Medicare Advantage	$6,536.25
Rate for Payer: Group Health Inc Commercial	$3,112.50
Rate for Payer: Group Health Inc Medicare	$2,178.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,112.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,112.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,046.25

PATCH VENTRIO HERNIA MIDLINE

Facility

$6,225.00

Service Code	HCPCS C1781
Hospital Charge Code	64902680
Hospital Revenue Code	278
Min. Negotiated Rate	$3,112.50
Max. Negotiated Rate	$3,112.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,112.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,112.50

Know your out-of-pocket cost for care.

All Charges