St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PATCH VENTRIO HERNIA SM CIR 3

Facility

$1,725.00

Service Code	HCPCS C1781
Hospital Charge Code	64902678
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,811.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$948.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,035.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$862.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$991.88
Rate for Payer: EmblemHealth Commercial	$862.50
Rate for Payer: Fidelis Medicare Advantage	$1,811.25
Rate for Payer: Group Health Inc Commercial	$862.50
Rate for Payer: Group Health Inc Medicare	$603.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$862.50
Rate for Payer: Hamaspik Choice Inc Medicare	$862.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,121.25

PATCH VENTRIO HERNIA SM CIR 3

Facility

$1,725.00

Service Code	HCPCS C1781
Hospital Charge Code	64902678
Hospital Revenue Code	278
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$862.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$862.50
Rate for Payer: Hamaspik Choice Inc Medicare	$862.50

PATCH VENTRIO HERNIA SM OVAL

Facility

$2,125.00

Service Code	HCPCS C1781
Hospital Charge Code	64902674
Hospital Revenue Code	278
Min. Negotiated Rate	$1,062.50
Max. Negotiated Rate	$1,062.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,062.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,062.50

PATCH VENTRIO HERNIA SM OVAL

Facility

$2,125.00

Service Code	HCPCS C1781
Hospital Charge Code	64902674
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$2,231.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,168.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,275.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,062.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,221.88
Rate for Payer: EmblemHealth Commercial	$1,062.50
Rate for Payer: Fidelis Medicare Advantage	$2,231.25
Rate for Payer: Group Health Inc Commercial	$1,062.50
Rate for Payer: Group Health Inc Medicare	$743.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,062.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,062.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,381.25

PATCH VENTRIO ST HERN 7.7X9.7

Facility

$5,237.50

Service Code	HCPCS C1781
Hospital Charge Code	64902610
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$5,499.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,880.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$3,142.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,618.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,011.56
Rate for Payer: EmblemHealth Commercial	$2,618.75
Rate for Payer: Fidelis Medicare Advantage	$5,499.38
Rate for Payer: Group Health Inc Commercial	$2,618.75
Rate for Payer: Group Health Inc Medicare	$1,833.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,618.75
Rate for Payer: Hamaspik Choice Inc Medicare	$2,618.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,404.38

PATCH VENTRIO ST HERN 7.7X9.7

Facility

$5,237.50

Service Code	HCPCS C1781
Hospital Charge Code	64902610
Hospital Revenue Code	278
Min. Negotiated Rate	$2,618.75
Max. Negotiated Rate	$2,618.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,618.75
Rate for Payer: Hamaspik Choice Inc Medicare	$2,618.75

PATCH VENTRIO ST HERNIA MD OVAL

Facility

$3,187.50

Service Code	HCPCS C1781
Hospital Charge Code	64902551
Hospital Revenue Code	278
Min. Negotiated Rate	$1,593.75
Max. Negotiated Rate	$1,593.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,593.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,593.75

PATCH VENTRIO ST HERNIA MD OVAL

Facility

$3,187.50

Service Code	HCPCS C1781
Hospital Charge Code	64902551
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$3,346.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,753.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,912.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,593.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,832.81
Rate for Payer: EmblemHealth Commercial	$1,593.75
Rate for Payer: Fidelis Medicare Advantage	$3,346.88
Rate for Payer: Group Health Inc Commercial	$1,593.75
Rate for Payer: Group Health Inc Medicare	$1,115.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,593.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,593.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,071.88

PATELLA

Facility

$2,230.95

Service Code	HCPCS C1776
Hospital Charge Code	40203099
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,342.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,227.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,338.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,115.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,282.80
Rate for Payer: EmblemHealth Commercial	$1,115.48
Rate for Payer: Fidelis Medicare Advantage	$2,342.50
Rate for Payer: Group Health Inc Commercial	$1,115.48
Rate for Payer: Group Health Inc Medicare	$780.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,115.48
Rate for Payer: Hamaspik Choice Inc Medicare	$1,115.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,450.12

PATELLA

Facility

$2,230.95

Service Code	HCPCS C1776
Hospital Charge Code	40203099
Hospital Revenue Code	278
Min. Negotiated Rate	$1,115.48
Max. Negotiated Rate	$1,115.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,115.48
Rate for Payer: Hamaspik Choice Inc Medicare	$1,115.48

PATELLA 8MM

Facility

$2,996.00

Service Code	HCPCS C1776
Hospital Charge Code	40202121
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,145.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,647.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,797.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,498.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,722.70
Rate for Payer: EmblemHealth Commercial	$1,498.00
Rate for Payer: Fidelis Medicare Advantage	$3,145.80
Rate for Payer: Group Health Inc Commercial	$1,498.00
Rate for Payer: Group Health Inc Medicare	$1,048.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,498.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,498.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,947.40

PATELLA 8MM

Facility

$2,996.00

Service Code	HCPCS C1776
Hospital Charge Code	40202121
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.00
Max. Negotiated Rate	$1,498.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,498.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,498.00

PATELLA ALL POLY VE 35MM DI

Facility

$2,750.00

Service Code	HCPCS C1776
Hospital Charge Code	64905892
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.00
Max. Negotiated Rate	$1,375.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,375.00

PATELLA ALL POLY VE 35MM DI

Facility

$2,750.00

Service Code	HCPCS C1776
Hospital Charge Code	64905892
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,887.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,512.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,650.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,375.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,581.25
Rate for Payer: EmblemHealth Commercial	$1,375.00
Rate for Payer: Fidelis Medicare Advantage	$2,887.50
Rate for Payer: Group Health Inc Commercial	$1,375.00
Rate for Payer: Group Health Inc Medicare	$962.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,375.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,787.50

PATELLA A-POLY VE 35MM DIA

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64905883
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,100.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,100.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,200.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,150.00
Rate for Payer: EmblemHealth Commercial	$1,000.00
Rate for Payer: Fidelis Medicare Advantage	$2,100.00
Rate for Payer: Group Health Inc Commercial	$1,000.00
Rate for Payer: Group Health Inc Medicare	$700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,300.00

PATELLA A-POLY VE 35MM DIA

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64905883
Hospital Revenue Code	278
Min. Negotiated Rate	$1,000.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00

PATELLA ASYMMETRIC TRI

Facility

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	64907223
Hospital Revenue Code	278
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$875.00

PATELLA ASYMMETRIC TRI

Facility

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	64907223
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,837.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$962.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,050.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$875.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,006.25
Rate for Payer: EmblemHealth Commercial	$875.00
Rate for Payer: Fidelis Medicare Advantage	$1,837.50
Rate for Payer: Group Health Inc Commercial	$875.00
Rate for Payer: Group Health Inc Medicare	$612.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$875.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,137.50

PATELLA CRSLNK ALLPOLY VE 32MMDIA

Facility

$2,200.00

Service Code	HCPCS C1776
Hospital Charge Code	40204603
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,320.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,265.00
Rate for Payer: EmblemHealth Commercial	$1,100.00
Rate for Payer: Fidelis Medicare Advantage	$2,310.00
Rate for Payer: Group Health Inc Commercial	$1,100.00
Rate for Payer: Group Health Inc Medicare	$770.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,430.00

PATELLA CRSLNK ALLPOLY VE 32MMDIA

Facility

$2,200.00

Service Code	HCPCS C1776
Hospital Charge Code	40204603
Hospital Revenue Code	278
Min. Negotiated Rate	$1,100.00
Max. Negotiated Rate	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00

PATELLA,CRSLNK ALL POLY VE32MMDIA

Facility

$2,200.00

Service Code	HCPCS C1776
Hospital Charge Code	40007522
Hospital Revenue Code	278
Min. Negotiated Rate	$1,100.00
Max. Negotiated Rate	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00

PATELLA,CRSLNK ALL POLY VE32MMDIA

Facility

$2,200.00

Service Code	HCPCS C1776
Hospital Charge Code	40007522
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,320.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,265.00
Rate for Payer: EmblemHealth Commercial	$1,100.00
Rate for Payer: Fidelis Medicare Advantage	$2,310.00
Rate for Payer: Group Health Inc Commercial	$1,100.00
Rate for Payer: Group Health Inc Medicare	$770.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,430.00

PATELLA CUTTER

Facility

$842.00

Hospital Charge Code	40202144
Hospital Revenue Code	270
Min. Negotiated Rate	$294.70
Max. Negotiated Rate	$673.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$463.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$421.00
Rate for Payer: Aetna Government	$421.00
Rate for Payer: Brighton Health Commercial	$631.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$673.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$572.56
Rate for Payer: Group Health Inc Commercial	$421.00
Rate for Payer: Group Health Inc Medicare	$294.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$421.00
Rate for Payer: Hamaspik Choice Inc Medicare	$421.00

PATELLA MED 35MM CEM

Facility

$1,100.00

Service Code	HCPCS C1776
Hospital Charge Code	40005149
Hospital Revenue Code	278
Min. Negotiated Rate	$550.00
Max. Negotiated Rate	$550.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$550.00

PATELLA MED 35MM CEM

Facility

$1,100.00

Service Code	HCPCS C1776
Hospital Charge Code	40005149
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,155.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$605.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$660.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$550.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$632.50
Rate for Payer: EmblemHealth Commercial	$550.00
Rate for Payer: Fidelis Medicare Advantage	$1,155.00
Rate for Payer: Group Health Inc Commercial	$550.00
Rate for Payer: Group Health Inc Medicare	$385.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$550.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$715.00

Know your out-of-pocket cost for care.

All Charges