St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ATRIAL LEAD 4592 53 CM

Facility

$1,300.00

Service Code	HCPCS C1713
Hospital Charge Code	40200398
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,365.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$715.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$780.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$650.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$747.50
Rate for Payer: EmblemHealth Commercial	$650.00
Rate for Payer: Fidelis Medicare Advantage	$1,365.00
Rate for Payer: Group Health Inc Commercial	$650.00
Rate for Payer: Group Health Inc Medicare	$455.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$650.00
Rate for Payer: Hamaspik Choice Inc Medicare	$650.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$845.00

ATRIUM C-QUR MESH 25.4 X 35.5CM

Facility

$3,410.00

Service Code	HCPCS C1781
Hospital Charge Code	40206279
Hospital Revenue Code	278
Min. Negotiated Rate	$1,705.00
Max. Negotiated Rate	$1,705.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,705.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,705.00

ATRIUM C-QUR MESH 25.4 X 35.5CM

Facility

$3,410.00

Service Code	HCPCS C1781
Hospital Charge Code	40206279
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$3,580.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,875.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$2,046.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,705.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,960.75
Rate for Payer: EmblemHealth Commercial	$1,705.00
Rate for Payer: Fidelis Medicare Advantage	$3,580.50
Rate for Payer: Group Health Inc Commercial	$1,705.00
Rate for Payer: Group Health Inc Medicare	$1,193.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,705.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,705.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,216.50

ATRIUM C-QUR MESH 8.9X 8.9

Facility

$570.00

Service Code	HCPCS C1781
Hospital Charge Code	40209638
Hospital Revenue Code	278
Min. Negotiated Rate	$285.00
Max. Negotiated Rate	$285.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$285.00
Rate for Payer: Hamaspik Choice Inc Medicare	$285.00

ATRIUM C-QUR MESH 8.9X 8.9

Facility

$570.00

Service Code	HCPCS C1781
Hospital Charge Code	40209638
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$598.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$313.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$342.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$285.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$327.75
Rate for Payer: EmblemHealth Commercial	$285.00
Rate for Payer: Fidelis Medicare Advantage	$598.50
Rate for Payer: Group Health Inc Commercial	$285.00
Rate for Payer: Group Health Inc Medicare	$199.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$285.00
Rate for Payer: Hamaspik Choice Inc Medicare	$285.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$370.50

ATRIUM C-QUR TAC MESH 7.5CMX15CM

Facility

$986.10

Service Code	HCPCS C1781
Hospital Charge Code	40206289
Hospital Revenue Code	278
Min. Negotiated Rate	$493.05
Max. Negotiated Rate	$493.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$493.05
Rate for Payer: Hamaspik Choice Inc Medicare	$493.05

ATRIUM C-QUR TAC MESH 7.5CMX15CM

Facility

$986.10

Service Code	HCPCS C1781
Hospital Charge Code	40206289
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,035.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$542.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$591.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$493.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$567.01
Rate for Payer: EmblemHealth Commercial	$493.05
Rate for Payer: Fidelis Medicare Advantage	$1,035.40
Rate for Payer: Group Health Inc Commercial	$493.05
Rate for Payer: Group Health Inc Medicare	$345.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$493.05
Rate for Payer: Hamaspik Choice Inc Medicare	$493.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$640.96

ATRIUM C-QUR TACSHIELD MESH

Facility

$2,810.00

Service Code	HCPCS C1781
Hospital Charge Code	40206235
Hospital Revenue Code	278
Min. Negotiated Rate	$1,405.00
Max. Negotiated Rate	$1,405.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,405.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,405.00

ATRIUM C-QUR TACSHIELD MESH

Facility

$2,810.00

Service Code	HCPCS C1781
Hospital Charge Code	40206235
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$2,950.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,545.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,686.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,405.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,615.75
Rate for Payer: EmblemHealth Commercial	$1,405.00
Rate for Payer: Fidelis Medicare Advantage	$2,950.50
Rate for Payer: Group Health Inc Commercial	$1,405.00
Rate for Payer: Group Health Inc Medicare	$983.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,405.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,405.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,826.50

ATRIUM C-QUR TACSHIELD MESH 8X12

Facility

$896.00

Service Code	HCPCS C1781
Hospital Charge Code	40206244
Hospital Revenue Code	278
Min. Negotiated Rate	$448.00
Max. Negotiated Rate	$448.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$448.00
Rate for Payer: Hamaspik Choice Inc Medicare	$448.00

ATRIUM C-QUR TACSHIELD MESH 8X12

Facility

$896.00

Service Code	HCPCS C1781
Hospital Charge Code	40206244
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$940.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$492.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$537.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$448.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$515.20
Rate for Payer: EmblemHealth Commercial	$448.00
Rate for Payer: Fidelis Medicare Advantage	$940.80
Rate for Payer: Group Health Inc Commercial	$448.00
Rate for Payer: Group Health Inc Medicare	$313.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$448.00
Rate for Payer: Hamaspik Choice Inc Medicare	$448.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$582.40

ATRIUM C-QUR V-PATCH MESH

Facility

$735.30

Service Code	HCPCS C1781
Hospital Charge Code	40205189
Hospital Revenue Code	278
Min. Negotiated Rate	$367.65
Max. Negotiated Rate	$367.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$367.65
Rate for Payer: Hamaspik Choice Inc Medicare	$367.65

ATRIUM C-QUR V-PATCH MESH

Facility

$735.30

Service Code	HCPCS C1781
Hospital Charge Code	40205189
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$772.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$404.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$441.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$367.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$422.80
Rate for Payer: EmblemHealth Commercial	$367.65
Rate for Payer: Fidelis Medicare Advantage	$772.06
Rate for Payer: Group Health Inc Commercial	$367.65
Rate for Payer: Group Health Inc Medicare	$257.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$367.65
Rate for Payer: Hamaspik Choice Inc Medicare	$367.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$477.94

ATRIUM C-QUR V-PATCH MESH 16.4

Facility

$978.25

Service Code	HCPCS C1781
Hospital Charge Code	40205900
Hospital Revenue Code	278
Min. Negotiated Rate	$489.12
Max. Negotiated Rate	$489.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$489.12
Rate for Payer: Hamaspik Choice Inc Medicare	$489.12

ATRIUM C-QUR V-PATCH MESH 16.4

Facility

$978.25

Service Code	HCPCS C1781
Hospital Charge Code	40205900
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,027.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$538.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$586.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$489.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$562.49
Rate for Payer: EmblemHealth Commercial	$489.12
Rate for Payer: Fidelis Medicare Advantage	$1,027.16
Rate for Payer: Group Health Inc Commercial	$489.12
Rate for Payer: Group Health Inc Medicare	$342.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$489.12
Rate for Payer: Hamaspik Choice Inc Medicare	$489.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$635.86

ATRIUM D-QUR MESH 15X20CM

Facility

$1,453.50

Service Code	HCPCS C1781
Hospital Charge Code	40205225
Hospital Revenue Code	278
Min. Negotiated Rate	$726.75
Max. Negotiated Rate	$726.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$726.75
Rate for Payer: Hamaspik Choice Inc Medicare	$726.75

ATRIUM D-QUR MESH 15X20CM

Facility

$1,453.50

Service Code	HCPCS C1781
Hospital Charge Code	40205225
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,526.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$799.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$872.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$726.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$835.76
Rate for Payer: EmblemHealth Commercial	$726.75
Rate for Payer: Fidelis Medicare Advantage	$1,526.18
Rate for Payer: Group Health Inc Commercial	$726.75
Rate for Payer: Group Health Inc Medicare	$508.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$726.75
Rate for Payer: Hamaspik Choice Inc Medicare	$726.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$944.78

ATRIUM MEDICAL PROLOOP MESH MED

Facility

$316.94

Service Code	HCPCS C1781
Hospital Charge Code	40205677
Hospital Revenue Code	278
Min. Negotiated Rate	$158.47
Max. Negotiated Rate	$158.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$158.47
Rate for Payer: Hamaspik Choice Inc Medicare	$158.47

ATRIUM MEDICAL PROLOOP MESH MED

Facility

$316.94

Service Code	HCPCS C1781
Hospital Charge Code	40205677
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$332.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$174.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$190.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$158.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$182.24
Rate for Payer: EmblemHealth Commercial	$158.47
Rate for Payer: Fidelis Medicare Advantage	$332.79
Rate for Payer: Group Health Inc Commercial	$158.47
Rate for Payer: Group Health Inc Medicare	$110.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$158.47
Rate for Payer: Hamaspik Choice Inc Medicare	$158.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$206.01

ATRIUM PRO-LITE MESH 30.5X 45.7CM

Facility

$361.00

Service Code	HCPCS C1781
Hospital Charge Code	40205765
Hospital Revenue Code	278
Min. Negotiated Rate	$180.50
Max. Negotiated Rate	$180.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$180.50
Rate for Payer: Hamaspik Choice Inc Medicare	$180.50

ATRIUM PRO-LITE MESH 30.5X 45.7CM

Facility

$361.00

Service Code	HCPCS C1781
Hospital Charge Code	40205765
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$379.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$198.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$216.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$180.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$207.58
Rate for Payer: EmblemHealth Commercial	$180.50
Rate for Payer: Fidelis Medicare Advantage	$379.05
Rate for Payer: Group Health Inc Commercial	$180.50
Rate for Payer: Group Health Inc Medicare	$126.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$180.50
Rate for Payer: Hamaspik Choice Inc Medicare	$180.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$234.65

ATRIUM PRO-LITE MESH 6X6

Facility

$128.00

Service Code	HCPCS C1781
Hospital Charge Code	40206253
Hospital Revenue Code	278
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$134.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$76.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$64.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$73.60
Rate for Payer: EmblemHealth Commercial	$64.00
Rate for Payer: Fidelis Medicare Advantage	$134.40
Rate for Payer: Group Health Inc Commercial	$64.00
Rate for Payer: Group Health Inc Medicare	$44.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.00
Rate for Payer: Hamaspik Choice Inc Medicare	$64.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$83.20

ATRIUM PRO-LITE MESH 6X6

Facility

$128.00

Service Code	HCPCS C1781
Hospital Charge Code	40206253
Hospital Revenue Code	278
Min. Negotiated Rate	$64.00
Max. Negotiated Rate	$64.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.00
Rate for Payer: Hamaspik Choice Inc Medicare	$64.00

ATRIUM V-PATCH MESH 8.0 X8.0CM LG

Facility

$1,146.60

Service Code	HCPCS C1781
Hospital Charge Code	40200003
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,203.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$630.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$687.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$573.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$659.30
Rate for Payer: EmblemHealth Commercial	$573.30
Rate for Payer: Fidelis Medicare Advantage	$1,203.93
Rate for Payer: Group Health Inc Commercial	$573.30
Rate for Payer: Group Health Inc Medicare	$401.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$573.30
Rate for Payer: Hamaspik Choice Inc Medicare	$573.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$745.29

ATRIUM V-PATCH MESH 8.0 X8.0CM LG

Facility

$1,146.60

Service Code	HCPCS C1781
Hospital Charge Code	40200003
Hospital Revenue Code	278
Min. Negotiated Rate	$573.30
Max. Negotiated Rate	$573.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$573.30
Rate for Payer: Hamaspik Choice Inc Medicare	$573.30

Know your out-of-pocket cost for care.

All Charges