St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TISSUE MATRIX PER SQ CM - 1

Facility

$23.63

Service Code	HCPCS Q4116
Hospital Charge Code	40203102
Hospital Revenue Code	636
Min. Negotiated Rate	$8.27
Max. Negotiated Rate	$21.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.47
Rate for Payer: Aetna Government	$21.47
Rate for Payer: Brighton Health Commercial	$14.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.59
Rate for Payer: Group Health Inc Commercial	$11.82
Rate for Payer: Group Health Inc Medicare	$8.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.82
Rate for Payer: Hamaspik Choice Inc Medicare	$11.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.36

TISSUE MATRIX PER SQ CM - 2

Facility

$126.60

Service Code	HCPCS Q4116
Hospital Charge Code	40203108
Hospital Revenue Code	636
Min. Negotiated Rate	$63.30
Max. Negotiated Rate	$63.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.30
Rate for Payer: Hamaspik Choice Inc Medicare	$63.30

TISSUE MATRIX PER SQ CM - 2

Facility

$126.60

Service Code	HCPCS Q4116
Hospital Charge Code	40203108
Hospital Revenue Code	636
Min. Negotiated Rate	$21.47
Max. Negotiated Rate	$82.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$69.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.47
Rate for Payer: Aetna Government	$21.47
Rate for Payer: Brighton Health Commercial	$75.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$63.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$72.80
Rate for Payer: Group Health Inc Commercial	$63.30
Rate for Payer: Group Health Inc Medicare	$44.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.30
Rate for Payer: Hamaspik Choice Inc Medicare	$63.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$82.29

TISSUE MEND 4X4

Facility

$5,000.00

Hospital Charge Code	40209861
Hospital Revenue Code	272
Min. Negotiated Rate	$1,750.00
Max. Negotiated Rate	$4,000.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,750.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,500.00
Rate for Payer: Aetna Government	$2,500.00
Rate for Payer: Brighton Health Commercial	$3,750.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,400.00
Rate for Payer: Group Health Inc Commercial	$2,500.00
Rate for Payer: Group Health Inc Medicare	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,500.00

TISSUE TRANSGLUTAM AB IGA

Facility

$28.83

Service Code	HCPCS 83516
Hospital Charge Code	40608384
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$21.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.53
Rate for Payer: Aetna Government	$11.53
Rate for Payer: Brighton Health Commercial	$21.62
Rate for Payer: Cash Price	$11.53
Rate for Payer: Cash Price	$11.53
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$11.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.52
Rate for Payer: Elderplan Medicare Advantage	$11.53
Rate for Payer: EmblemHealth Commercial	$11.53
Rate for Payer: Fidelis Essential Plan Aliesa	$9.80
Rate for Payer: Fidelis Essential Plan QHP	$10.26
Rate for Payer: Fidelis Medicare Advantage	$11.53
Rate for Payer: Fidelis Qualified Health Plan	$10.26
Rate for Payer: Group Health Inc Commercial	$11.53
Rate for Payer: Group Health Inc Medicare	$11.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.42
Rate for Payer: Hamaspik Choice Inc Medicare	$11.53
Rate for Payer: Healthfirst Medicare Advantage	$11.53
Rate for Payer: Healthfirst QHP	$11.53
Rate for Payer: Senior Whole Health Medicare Advantage	$11.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.22
Rate for Payer: Wellcare Medicare	$10.38

TISSUE TRANSGLUTAM AB IGA

Facility

$28.83

Service Code	HCPCS 83516
Hospital Charge Code	40608384
Hospital Revenue Code	301
Rate for Payer: Cash Price	$11.53

TISS XPNDR PLMT BRST RCNSTJ

Facility

$41,958.28

Service Code	HCPCS 19357
Hospital Charge Code	40063228
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$31,468.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,880.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20,378.37
Rate for Payer: Aetna Government	$20,378.37
Rate for Payer: Brighton Health Commercial	$31,468.71
Rate for Payer: Cash Price	$20,378.37
Rate for Payer: Cash Price	$20,378.37
Rate for Payer: Cash Price	$20,378.37
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$20,378.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$20,378.37
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$17,321.61
Rate for Payer: Fidelis Essential Plan QHP	$18,136.75
Rate for Payer: Fidelis Medicare Advantage	$20,378.37
Rate for Payer: Fidelis Qualified Health Plan	$18,136.75
Rate for Payer: Group Health Inc Commercial	$20,378.37
Rate for Payer: Group Health Inc Medicare	$20,378.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,979.14
Rate for Payer: Hamaspik Choice Inc Medicare	$20,378.37
Rate for Payer: Healthfirst Medicare Advantage	$17,321.61
Rate for Payer: Healthfirst QHP	$20,378.37
Rate for Payer: Senior Whole Health Medicare Advantage	$20,378.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20,378.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,302.70
Rate for Payer: Wellcare Medicare	$19,359.45

TISS XPNDR PLMT BRST RCNSTJ

Facility

$41,958.28

Service Code	HCPCS 19357
Hospital Charge Code	40063228
Hospital Revenue Code	360
Rate for Payer: Cash Price	$20,378.37

TITAN ASSEMBLY KIT

Facility

$1,325.00

Hospital Charge Code	64905594
Hospital Revenue Code	270
Min. Negotiated Rate	$463.75
Max. Negotiated Rate	$1,060.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$728.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$662.50
Rate for Payer: Aetna Government	$662.50
Rate for Payer: Brighton Health Commercial	$993.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,060.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$901.00
Rate for Payer: Group Health Inc Commercial	$662.50
Rate for Payer: Group Health Inc Medicare	$463.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$662.50
Rate for Payer: Hamaspik Choice Inc Medicare	$662.50

TITAN CL RESERVOIR ER8075

Facility

$4,825.00

Service Code	HCPCS C1813
Hospital Charge Code	64903196
Hospital Revenue Code	278
Min. Negotiated Rate	$1,688.75
Max. Negotiated Rate	$5,066.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,653.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,775.00
Rate for Payer: Aetna Government	$3,775.00
Rate for Payer: Brighton Health Commercial	$2,895.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,412.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,774.38
Rate for Payer: EmblemHealth Commercial	$2,412.50
Rate for Payer: Fidelis Medicare Advantage	$5,066.25
Rate for Payer: Group Health Inc Commercial	$2,412.50
Rate for Payer: Group Health Inc Medicare	$1,688.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,412.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,412.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,136.25

TITAN CL RESERVOIR ER8075

Facility

$4,825.00

Service Code	HCPCS C1813
Hospital Charge Code	64903196
Hospital Revenue Code	278
Min. Negotiated Rate	$2,412.50
Max. Negotiated Rate	$2,412.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,412.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,412.50

TITANIUM ADAPTER

Facility

$26.58

Hospital Charge Code	42905245
Hospital Revenue Code	801
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$21.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.29
Rate for Payer: Aetna Government	$13.29
Rate for Payer: Brighton Health Commercial	$19.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.07
Rate for Payer: Group Health Inc Commercial	$13.29
Rate for Payer: Group Health Inc Medicare	$9.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.29
Rate for Payer: Hamaspik Choice Inc Medicare	$13.29

TITANIUM HEMOSTATIC MIRCOCLIP

Facility

$4.31

Hospital Charge Code	64905476
Hospital Revenue Code	270
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$3.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.16
Rate for Payer: Aetna Government	$2.16
Rate for Payer: Brighton Health Commercial	$3.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.93
Rate for Payer: Group Health Inc Commercial	$2.16
Rate for Payer: Group Health Inc Medicare	$1.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.16
Rate for Payer: Hamaspik Choice Inc Medicare	$2.16

TITAN OFW MTB RIGHT

Facility

$3,262.50

Hospital Charge Code	64905370
Hospital Revenue Code	270
Min. Negotiated Rate	$1,141.88
Max. Negotiated Rate	$2,610.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,794.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,631.25
Rate for Payer: Aetna Government	$1,631.25
Rate for Payer: Brighton Health Commercial	$2,446.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,610.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,218.50
Rate for Payer: Group Health Inc Commercial	$1,631.25
Rate for Payer: Group Health Inc Medicare	$1,141.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,631.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,631.25

TI UNIVERSAL PLATE 8 HOLES

Facility

$1,700.00

Service Code	HCPCS C1713
Hospital Charge Code	40209498
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,785.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$935.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,020.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$850.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$977.50
Rate for Payer: EmblemHealth Commercial	$850.00
Rate for Payer: Fidelis Medicare Advantage	$1,785.00
Rate for Payer: Group Health Inc Commercial	$850.00
Rate for Payer: Group Health Inc Medicare	$595.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$850.00
Rate for Payer: Hamaspik Choice Inc Medicare	$850.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,105.00

TI UNIVERSAL PLATE 8 HOLES

Facility

$1,700.00

Service Code	HCPCS C1713
Hospital Charge Code	40209498
Hospital Revenue Code	278
Min. Negotiated Rate	$850.00
Max. Negotiated Rate	$850.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$850.00
Rate for Payer: Hamaspik Choice Inc Medicare	$850.00

TIXAGEVIMAB & CILGAVIMAB 150 & 150 MG/1.5ML IM SOLN [401115]

Facility

$0.00

Service Code	NDC 00310744202
Hospital Charge Code	00310744202
Hospital Revenue Code	250
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.00
Rate for Payer: Aetna Government	$0.00
Rate for Payer: Brighton Health Commercial	$0.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.00
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.00

TIXAGEVIMAB + CILGAVIMAB-EVUSHELD

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41650326
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TIXAGEVIMAB + CILGAVIMAB-EVUSHELD

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41640326
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

TIXAGEVIMAB + CILGAVIMAB-EVUSHELD

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41640326
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TIXAGEVIMAB + CILGAVIMAB-EVUSHELD

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41650326
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

T-LYMPHOCYTE HELPER/SUPPRESSOR

Facility

$94.33

Service Code	HCPCS 86359
Hospital Charge Code	40629228
Hospital Revenue Code	300
Min. Negotiated Rate	$30.18
Max. Negotiated Rate	$70.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.73
Rate for Payer: Aetna Government	$37.73
Rate for Payer: Brighton Health Commercial	$70.75
Rate for Payer: Cash Price	$37.73
Rate for Payer: Cash Price	$37.73
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$37.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$59.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$50.73
Rate for Payer: Elderplan Medicare Advantage	$37.73
Rate for Payer: EmblemHealth Commercial	$37.73
Rate for Payer: Fidelis Essential Plan Aliesa	$32.07
Rate for Payer: Fidelis Essential Plan QHP	$33.58
Rate for Payer: Fidelis Medicare Advantage	$37.73
Rate for Payer: Fidelis Qualified Health Plan	$33.58
Rate for Payer: Group Health Inc Commercial	$37.73
Rate for Payer: Group Health Inc Medicare	$37.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.16
Rate for Payer: Hamaspik Choice Inc Medicare	$37.73
Rate for Payer: Healthfirst Medicare Advantage	$37.73
Rate for Payer: Healthfirst QHP	$37.73
Rate for Payer: Senior Whole Health Medicare Advantage	$37.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$37.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30.18
Rate for Payer: Wellcare Medicare	$33.96

T-LYMPHOCYTE HELPER/SUPPRESSOR

Facility

$94.33

Service Code	HCPCS 86359
Hospital Charge Code	40629228
Hospital Revenue Code	300
Rate for Payer: Cash Price	$37.73

TM CR FEMORAL 62.5MM RT-INTERLOCK

Facility

$4,640.00

Service Code	HCPCS C1776
Hospital Charge Code	40209908
Hospital Revenue Code	278
Min. Negotiated Rate	$2,320.00
Max. Negotiated Rate	$2,320.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,320.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,320.00

TM CR FEMORAL 62.5MM RT-INTERLOCK

Facility

$4,640.00

Service Code	HCPCS C1776
Hospital Charge Code	40209908
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,872.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,552.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,784.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,320.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,668.00
Rate for Payer: EmblemHealth Commercial	$2,320.00
Rate for Payer: Fidelis Medicare Advantage	$4,872.00
Rate for Payer: Group Health Inc Commercial	$2,320.00
Rate for Payer: Group Health Inc Medicare	$1,624.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,320.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,320.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,016.00

Know your out-of-pocket cost for care.

All Charges