St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DURAGEN DURAL GRAFT MATRIX

Facility

$2,518.08

Hospital Charge Code	40209926
Hospital Revenue Code	272
Min. Negotiated Rate	$881.33
Max. Negotiated Rate	$2,014.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,384.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,259.04
Rate for Payer: Aetna Government	$1,259.04
Rate for Payer: Brighton Health Commercial	$1,888.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,014.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,712.29
Rate for Payer: Group Health Inc Commercial	$1,259.04
Rate for Payer: Group Health Inc Medicare	$881.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,259.04
Rate for Payer: Hamaspik Choice Inc Medicare	$1,259.04

DURAGEN + DURAL REGENART MATRIX

Facility

$938.00

Hospital Charge Code	40209927
Hospital Revenue Code	272
Min. Negotiated Rate	$328.30
Max. Negotiated Rate	$750.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$515.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$469.00
Rate for Payer: Aetna Government	$469.00
Rate for Payer: Brighton Health Commercial	$703.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$750.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$637.84
Rate for Payer: Group Health Inc Commercial	$469.00
Rate for Payer: Group Health Inc Medicare	$328.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$469.00
Rate for Payer: Hamaspik Choice Inc Medicare	$469.00

DURAGEN +DURAL REGEN MATRIX 1X1

Facility

$574.00

Hospital Charge Code	40205795
Hospital Revenue Code	272
Min. Negotiated Rate	$200.90
Max. Negotiated Rate	$459.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$315.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$287.00
Rate for Payer: Aetna Government	$287.00
Rate for Payer: Brighton Health Commercial	$430.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$459.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$390.32
Rate for Payer: Group Health Inc Commercial	$287.00
Rate for Payer: Group Health Inc Medicare	$200.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$287.00
Rate for Payer: Hamaspik Choice Inc Medicare	$287.00

DURAGEN + DURAL REGEN MATRIX 3X3

Facility

$1,752.00

Hospital Charge Code	40205796
Hospital Revenue Code	272
Min. Negotiated Rate	$613.20
Max. Negotiated Rate	$1,401.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$963.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$876.00
Rate for Payer: Aetna Government	$876.00
Rate for Payer: Brighton Health Commercial	$1,314.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,401.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,191.36
Rate for Payer: Group Health Inc Commercial	$876.00
Rate for Payer: Group Health Inc Medicare	$613.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$876.00
Rate for Payer: Hamaspik Choice Inc Medicare	$876.00

DURAGEN INTEGRA

Facility

$161.67

Service Code	HCPCS Q4108
Hospital Charge Code	64904471
Hospital Revenue Code	636
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$105.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$88.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.75
Rate for Payer: Aetna Government	$36.75
Rate for Payer: Brighton Health Commercial	$97.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$92.96
Rate for Payer: Group Health Inc Commercial	$80.84
Rate for Payer: Group Health Inc Medicare	$56.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.84
Rate for Payer: Hamaspik Choice Inc Medicare	$80.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$52.66
Rate for Payer: SOMOS Essential	$52.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.09

DURAGEN INTEGRA

Facility

$161.67

Service Code	HCPCS Q4108
Hospital Charge Code	64904471
Hospital Revenue Code	636
Min. Negotiated Rate	$80.84
Max. Negotiated Rate	$80.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.84
Rate for Payer: Hamaspik Choice Inc Medicare	$80.84

DURAGEN PLUS 1X1 DURAL REGENER

Facility

$717.50

Service Code	HCPCS Q4100
Hospital Charge Code	64902496
Hospital Revenue Code	636
Min. Negotiated Rate	$358.75
Max. Negotiated Rate	$358.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$358.75
Rate for Payer: Hamaspik Choice Inc Medicare	$358.75

DURAGEN PLUS 1X1 DURAL REGENER

Facility

$717.50

Service Code	HCPCS Q4100
Hospital Charge Code	64902496
Hospital Revenue Code	636
Min. Negotiated Rate	$9.74
Max. Negotiated Rate	$466.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$394.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.74
Rate for Payer: Aetna Government	$9.74
Rate for Payer: Brighton Health Commercial	$430.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$358.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$412.56
Rate for Payer: Group Health Inc Commercial	$358.75
Rate for Payer: Group Health Inc Medicare	$251.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$358.75
Rate for Payer: Hamaspik Choice Inc Medicare	$358.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$466.38

DURAGEN PLUS 1X3 DURAL REGENER

Facility

$390.83

Service Code	HCPCS Q4100
Hospital Charge Code	64902495
Hospital Revenue Code	636
Min. Negotiated Rate	$9.74
Max. Negotiated Rate	$254.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$214.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.74
Rate for Payer: Aetna Government	$9.74
Rate for Payer: Brighton Health Commercial	$234.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$195.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$224.73
Rate for Payer: Group Health Inc Commercial	$195.42
Rate for Payer: Group Health Inc Medicare	$136.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$195.42
Rate for Payer: Hamaspik Choice Inc Medicare	$195.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$254.04

DURAGEN PLUS 1X3 DURAL REGENER

Facility

$390.83

Service Code	HCPCS Q4100
Hospital Charge Code	64902495
Hospital Revenue Code	636
Min. Negotiated Rate	$195.42
Max. Negotiated Rate	$195.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$195.42
Rate for Payer: Hamaspik Choice Inc Medicare	$195.42

DURAGEN PLUS 2X2 DURAL REGENER

Facility

$301.88

Service Code	HCPCS Q4100
Hospital Charge Code	64902498
Hospital Revenue Code	636
Min. Negotiated Rate	$9.74
Max. Negotiated Rate	$196.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$166.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.74
Rate for Payer: Aetna Government	$9.74
Rate for Payer: Brighton Health Commercial	$181.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$150.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.58
Rate for Payer: Group Health Inc Commercial	$150.94
Rate for Payer: Group Health Inc Medicare	$105.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.94
Rate for Payer: Hamaspik Choice Inc Medicare	$150.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$196.22

DURAGEN PLUS 2X2 DURAL REGENER

Facility

$301.88

Service Code	HCPCS Q4100
Hospital Charge Code	64902498
Hospital Revenue Code	636
Min. Negotiated Rate	$150.94
Max. Negotiated Rate	$150.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.94
Rate for Payer: Hamaspik Choice Inc Medicare	$150.94

DURAGEN PLUS 4 X 5

Facility

$184.25

Service Code	HCPCS Q4100
Hospital Charge Code	64902542
Hospital Revenue Code	636
Min. Negotiated Rate	$92.12
Max. Negotiated Rate	$92.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.12
Rate for Payer: Hamaspik Choice Inc Medicare	$92.12

DURAGEN PLUS 4 X 5

Facility

$184.25

Service Code	HCPCS Q4100
Hospital Charge Code	64902542
Hospital Revenue Code	636
Min. Negotiated Rate	$9.74
Max. Negotiated Rate	$119.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$101.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.74
Rate for Payer: Aetna Government	$9.74
Rate for Payer: Brighton Health Commercial	$110.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$92.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.94
Rate for Payer: Group Health Inc Commercial	$92.12
Rate for Payer: Group Health Inc Medicare	$64.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.12
Rate for Payer: Hamaspik Choice Inc Medicare	$92.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$119.76

DURAGEN SUTURABLE 1X3 DURAL GRAFT

Facility

$261.67

Service Code	HCPCS Q4108
Hospital Charge Code	64904356
Hospital Revenue Code	636
Min. Negotiated Rate	$130.84
Max. Negotiated Rate	$130.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.84
Rate for Payer: Hamaspik Choice Inc Medicare	$130.84

DURAGEN SUTURABLE 1X3 DURAL GRAFT

Facility

$261.67

Service Code	HCPCS Q4108
Hospital Charge Code	64904356
Hospital Revenue Code	636
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$170.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$143.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.75
Rate for Payer: Aetna Government	$36.75
Rate for Payer: Brighton Health Commercial	$157.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$130.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$150.46
Rate for Payer: Group Health Inc Commercial	$130.84
Rate for Payer: Group Health Inc Medicare	$91.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.84
Rate for Payer: Hamaspik Choice Inc Medicare	$130.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$52.66
Rate for Payer: SOMOS Essential	$52.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$170.09

DURAGEN SUTURABLE 2X2 DURAL GRAF

Facility

$822.00

Hospital Charge Code	40205925
Hospital Revenue Code	272
Min. Negotiated Rate	$287.70
Max. Negotiated Rate	$657.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$452.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$411.00
Rate for Payer: Aetna Government	$411.00
Rate for Payer: Brighton Health Commercial	$616.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$657.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$558.96
Rate for Payer: Group Health Inc Commercial	$411.00
Rate for Payer: Group Health Inc Medicare	$287.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$411.00
Rate for Payer: Hamaspik Choice Inc Medicare	$411.00

DURAGEN SUTURABLE 3X3DURAL GRAFT

Facility

$1,972.80

Hospital Charge Code	40209941
Hospital Revenue Code	272
Min. Negotiated Rate	$690.48
Max. Negotiated Rate	$1,578.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,085.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$986.40
Rate for Payer: Aetna Government	$986.40
Rate for Payer: Brighton Health Commercial	$1,479.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,578.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,341.50
Rate for Payer: Group Health Inc Commercial	$986.40
Rate for Payer: Group Health Inc Medicare	$690.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$986.40
Rate for Payer: Hamaspik Choice Inc Medicare	$986.40

DURAGEN SUTURABLE 4X5 DURAL GRAFT

Facility

$133.38

Service Code	HCPCS Q4108
Hospital Charge Code	64904359
Hospital Revenue Code	636
Min. Negotiated Rate	$66.69
Max. Negotiated Rate	$66.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.69
Rate for Payer: Hamaspik Choice Inc Medicare	$66.69

DURAGEN SUTURABLE 4X5 DURAL GRAFT

Facility

$133.38

Service Code	HCPCS Q4108
Hospital Charge Code	64904359
Hospital Revenue Code	636
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$86.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$73.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.75
Rate for Payer: Aetna Government	$36.75
Rate for Payer: Brighton Health Commercial	$80.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$66.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.69
Rate for Payer: Group Health Inc Commercial	$66.69
Rate for Payer: Group Health Inc Medicare	$46.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.69
Rate for Payer: Hamaspik Choice Inc Medicare	$66.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$52.66
Rate for Payer: SOMOS Essential	$52.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$86.70

DURAGEN SUTURABLE 4X5DURAL GRAFT

Facility

$2,948.00

Hospital Charge Code	40209938
Hospital Revenue Code	272
Min. Negotiated Rate	$1,031.80
Max. Negotiated Rate	$2,358.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,621.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,474.00
Rate for Payer: Aetna Government	$1,474.00
Rate for Payer: Brighton Health Commercial	$2,211.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,358.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,004.64
Rate for Payer: Group Health Inc Commercial	$1,474.00
Rate for Payer: Group Health Inc Medicare	$1,031.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,474.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,474.00

DURASEAL DURAL SEALANT SYSTEM

Facility

$12,082.00

Service Code	HCPCS C1713
Hospital Charge Code	40209708
Hospital Revenue Code	278
Min. Negotiated Rate	$6,041.00
Max. Negotiated Rate	$6,041.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,041.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,041.00

DURASEAL DURAL SEALANT SYSTEM

Facility

$12,082.00

Service Code	HCPCS C1713
Hospital Charge Code	40209708
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$12,686.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,645.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$7,249.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,041.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,947.15
Rate for Payer: EmblemHealth Commercial	$6,041.00
Rate for Payer: Fidelis Medicare Advantage	$12,686.10
Rate for Payer: Group Health Inc Commercial	$6,041.00
Rate for Payer: Group Health Inc Medicare	$4,228.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,041.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,041.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,853.30

DURVALUMAB 120MG/2.4ML INJ

Facility

$177.88

Service Code	HCPCS J9173
Hospital Charge Code	41657857
Hospital Revenue Code	636
Min. Negotiated Rate	$88.94
Max. Negotiated Rate	$88.94
Rate for Payer: Cash Price	$80.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$88.94
Rate for Payer: Hamaspik Choice Inc Medicare	$88.94

DURVALUMAB 120MG/2.4ML INJ

Facility

$177.88

Service Code	HCPCS J9173
Hospital Charge Code	41657857
Hospital Revenue Code	636
Min. Negotiated Rate	$56.49
Max. Negotiated Rate	$115.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$97.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$80.71
Rate for Payer: Aetna Government	$80.71
Rate for Payer: Affinity Essential Plan 1&2	$56.49
Rate for Payer: Affinity Essential Plan 3&4	$56.49
Rate for Payer: Affinity Medicaid/CHP/HARP	$56.49
Rate for Payer: Brighton Health Commercial	$106.73
Rate for Payer: Cash Price	$80.71
Rate for Payer: Cash Price	$80.71
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$80.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$88.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.28
Rate for Payer: Elderplan Medicare Advantage	$80.71
Rate for Payer: EmblemHealth Commercial	$80.71
Rate for Payer: Fidelis CHP/HARP/Medicaid	$80.71
Rate for Payer: Fidelis Essential Plan Aliesa	$80.71
Rate for Payer: Fidelis Essential Plan QHP	$84.74
Rate for Payer: Fidelis Medicare Advantage	$80.71
Rate for Payer: Fidelis Qualified Health Plan	$84.74
Rate for Payer: Group Health Inc Commercial	$80.71
Rate for Payer: Group Health Inc Medicare	$80.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$88.94
Rate for Payer: Hamaspik Choice Inc Medicare	$88.94
Rate for Payer: Healthfirst Medicare Advantage	$68.60
Rate for Payer: Healthfirst QHP	$80.71
Rate for Payer: Humana Medicare	$82.32
Rate for Payer: Senior Whole Health Medicare Advantage	$80.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$85.35
Rate for Payer: SOMOS Essential	$85.35
Rate for Payer: United Healthcare Commercial	$78.90
Rate for Payer: United Healthcare Medicare Advantage	$80.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$115.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$64.56
Rate for Payer: Wellcare Medicare	$76.67

Know your out-of-pocket cost for care.

All Charges