St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ALLODERM 8X16CM MED THICK

Facility

$94.86

Service Code	HCPCS Q4116
Hospital Charge Code	64905950
Hospital Revenue Code	636
Min. Negotiated Rate	$21.47
Max. Negotiated Rate	$61.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.47
Rate for Payer: Aetna Government	$21.47
Rate for Payer: Brighton Health Commercial	$56.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$54.54
Rate for Payer: Group Health Inc Commercial	$47.43
Rate for Payer: Group Health Inc Medicare	$33.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.43
Rate for Payer: Hamaspik Choice Inc Medicare	$47.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$61.66

ALLODERM 8X16CM MED THICK

Facility

$94.86

Service Code	HCPCS Q4116
Hospital Charge Code	64905950
Hospital Revenue Code	636
Min. Negotiated Rate	$47.43
Max. Negotiated Rate	$47.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.43
Rate for Payer: Hamaspik Choice Inc Medicare	$47.43

ALLODERM 8X16CM THICK

Facility

$94.86

Service Code	HCPCS Q4116
Hospital Charge Code	64905937
Hospital Revenue Code	636
Min. Negotiated Rate	$47.43
Max. Negotiated Rate	$47.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.43
Rate for Payer: Hamaspik Choice Inc Medicare	$47.43

ALLODERM 8X16CM THICK

Facility

$94.86

Service Code	HCPCS Q4116
Hospital Charge Code	64905937
Hospital Revenue Code	636
Min. Negotiated Rate	$21.47
Max. Negotiated Rate	$61.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.47
Rate for Payer: Aetna Government	$21.47
Rate for Payer: Brighton Health Commercial	$56.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$54.54
Rate for Payer: Group Health Inc Commercial	$47.43
Rate for Payer: Group Health Inc Medicare	$33.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.43
Rate for Payer: Hamaspik Choice Inc Medicare	$47.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$61.66

ALLODERM 8X16 SQCM

Facility

$10,722.00

Service Code	HCPCS Q4116
Hospital Charge Code	40204563
Hospital Revenue Code	636
Min. Negotiated Rate	$21.47
Max. Negotiated Rate	$6,969.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,897.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.47
Rate for Payer: Aetna Government	$21.47
Rate for Payer: Brighton Health Commercial	$6,433.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,361.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,165.15
Rate for Payer: Group Health Inc Commercial	$5,361.00
Rate for Payer: Group Health Inc Medicare	$3,752.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,361.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,361.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,969.30

ALLODERM 8X16 SQCM

Facility

$10,722.00

Service Code	HCPCS Q4116
Hospital Charge Code	40204563
Hospital Revenue Code	636
Min. Negotiated Rate	$5,361.00
Max. Negotiated Rate	$5,361.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,361.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,361.00

ALLODERM 8X20CM MED THICK

Facility

$94.89

Service Code	HCPCS Q4116
Hospital Charge Code	64905952
Hospital Revenue Code	636
Min. Negotiated Rate	$21.47
Max. Negotiated Rate	$61.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.47
Rate for Payer: Aetna Government	$21.47
Rate for Payer: Brighton Health Commercial	$56.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$54.56
Rate for Payer: Group Health Inc Commercial	$47.44
Rate for Payer: Group Health Inc Medicare	$33.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.44
Rate for Payer: Hamaspik Choice Inc Medicare	$47.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$61.68

ALLODERM 8X20CM MED THICK

Facility

$94.89

Service Code	HCPCS Q4116
Hospital Charge Code	64905952
Hospital Revenue Code	636
Min. Negotiated Rate	$47.44
Max. Negotiated Rate	$47.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.44
Rate for Payer: Hamaspik Choice Inc Medicare	$47.44

ALLODERM 9.6 SQCM CM1516

Facility

$11,052.00

Service Code	HCPCS Q4116
Hospital Charge Code	40204564
Hospital Revenue Code	636
Min. Negotiated Rate	$21.47
Max. Negotiated Rate	$7,183.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,078.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.47
Rate for Payer: Aetna Government	$21.47
Rate for Payer: Brighton Health Commercial	$6,631.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,526.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,354.90
Rate for Payer: Group Health Inc Commercial	$5,526.00
Rate for Payer: Group Health Inc Medicare	$3,868.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,526.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,526.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,183.80

ALLODERM 9.6 SQCM CM1516

Facility

$11,052.00

Service Code	HCPCS Q4116
Hospital Charge Code	40204564
Hospital Revenue Code	636
Min. Negotiated Rate	$5,526.00
Max. Negotiated Rate	$5,526.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,526.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,526.00

ALLODERM 9.6 SQCM CM152OP

Facility

$11,388.00

Service Code	HCPCS Q4116
Hospital Charge Code	40204565
Hospital Revenue Code	636
Min. Negotiated Rate	$5,694.00
Max. Negotiated Rate	$5,694.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,694.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,694.00

ALLODERM 9.6 SQCM CM152OP

Facility

$11,388.00

Service Code	HCPCS Q4116
Hospital Charge Code	40204565
Hospital Revenue Code	636
Min. Negotiated Rate	$21.47
Max. Negotiated Rate	$7,402.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,263.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.47
Rate for Payer: Aetna Government	$21.47
Rate for Payer: Brighton Health Commercial	$6,832.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,694.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,548.10
Rate for Payer: Group Health Inc Commercial	$5,694.00
Rate for Payer: Group Health Inc Medicare	$3,985.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,694.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,694.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,402.20

ALLODERM CONTOUR 9.6X19.3 MED

Facility

$11,388.00

Service Code	HCPCS Q4116
Hospital Charge Code	40007777
Hospital Revenue Code	636
Min. Negotiated Rate	$5,694.00
Max. Negotiated Rate	$5,694.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,694.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,694.00

ALLODERM CONTOUR 9.6X19.3 MED

Facility

$11,388.00

Service Code	HCPCS Q4116
Hospital Charge Code	40007777
Hospital Revenue Code	636
Min. Negotiated Rate	$21.47
Max. Negotiated Rate	$7,402.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,263.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.47
Rate for Payer: Aetna Government	$21.47
Rate for Payer: Brighton Health Commercial	$6,832.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,694.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,548.10
Rate for Payer: Group Health Inc Commercial	$5,694.00
Rate for Payer: Group Health Inc Medicare	$3,985.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,694.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,694.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,402.20

ALLODERM CONTOUR MED 132CMX1.0MM

Facility

$11,052.00

Service Code	HCPCS Q4116
Hospital Charge Code	40007778
Hospital Revenue Code	636
Min. Negotiated Rate	$21.47
Max. Negotiated Rate	$7,183.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,078.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.47
Rate for Payer: Aetna Government	$21.47
Rate for Payer: Brighton Health Commercial	$6,631.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,526.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,354.90
Rate for Payer: Group Health Inc Commercial	$5,526.00
Rate for Payer: Group Health Inc Medicare	$3,868.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,526.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,526.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,183.80

ALLODERM CONTOUR MED 132CMX1.0MM

Facility

$11,052.00

Service Code	HCPCS Q4116
Hospital Charge Code	40007778
Hospital Revenue Code	636
Min. Negotiated Rate	$5,526.00
Max. Negotiated Rate	$5,526.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,526.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,526.00

ALLODERM CONTOUR MED THIN

Facility

$57.56

Service Code	HCPCS Q4116
Hospital Charge Code	64905426
Hospital Revenue Code	636
Min. Negotiated Rate	$20.15
Max. Negotiated Rate	$37.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.47
Rate for Payer: Aetna Government	$21.47
Rate for Payer: Brighton Health Commercial	$34.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.10
Rate for Payer: Group Health Inc Commercial	$28.78
Rate for Payer: Group Health Inc Medicare	$20.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.78
Rate for Payer: Hamaspik Choice Inc Medicare	$28.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$37.41

ALLODERM CONTOUR MED THIN

Facility

$57.56

Service Code	HCPCS Q4116
Hospital Charge Code	64905426
Hospital Revenue Code	636
Min. Negotiated Rate	$28.78
Max. Negotiated Rate	$28.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.78
Rate for Payer: Hamaspik Choice Inc Medicare	$28.78

ALLODERM CONT'R THICK MED

Facility

$98.01

Service Code	HCPCS Q4116
Hospital Charge Code	64905948
Hospital Revenue Code	636
Min. Negotiated Rate	$21.47
Max. Negotiated Rate	$63.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.47
Rate for Payer: Aetna Government	$21.47
Rate for Payer: Brighton Health Commercial	$58.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$49.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$56.36
Rate for Payer: Group Health Inc Commercial	$49.00
Rate for Payer: Group Health Inc Medicare	$34.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.00
Rate for Payer: Hamaspik Choice Inc Medicare	$49.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$63.71

ALLODERM CONT'R THICK MED

Facility

$98.01

Service Code	HCPCS Q4116
Hospital Charge Code	64905948
Hospital Revenue Code	636
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$49.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.00
Rate for Payer: Hamaspik Choice Inc Medicare	$49.00

ALLODERM CONT'R THICK MED 132CM

Facility

$97.67

Service Code	HCPCS Q4116
Hospital Charge Code	64905954
Hospital Revenue Code	636
Min. Negotiated Rate	$21.47
Max. Negotiated Rate	$63.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.47
Rate for Payer: Aetna Government	$21.47
Rate for Payer: Brighton Health Commercial	$58.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$56.16
Rate for Payer: Group Health Inc Commercial	$48.84
Rate for Payer: Group Health Inc Medicare	$34.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.84
Rate for Payer: Hamaspik Choice Inc Medicare	$48.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$63.49

ALLODERM CONT'R THICK MED 132CM

Facility

$97.67

Service Code	HCPCS Q4116
Hospital Charge Code	64905954
Hospital Revenue Code	636
Min. Negotiated Rate	$48.84
Max. Negotiated Rate	$48.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.84
Rate for Payer: Hamaspik Choice Inc Medicare	$48.84

ALLODERM CONT'R THICK SMALL 77CM

Facility

$97.69

Service Code	HCPCS Q4116
Hospital Charge Code	64905956
Hospital Revenue Code	636
Min. Negotiated Rate	$48.84
Max. Negotiated Rate	$48.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.84
Rate for Payer: Hamaspik Choice Inc Medicare	$48.84

ALLODERM CONT'R THICK SMALL 77CM

Facility

$97.69

Service Code	HCPCS Q4116
Hospital Charge Code	64905956
Hospital Revenue Code	636
Min. Negotiated Rate	$21.47
Max. Negotiated Rate	$63.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.47
Rate for Payer: Aetna Government	$21.47
Rate for Payer: Brighton Health Commercial	$58.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$56.17
Rate for Payer: Group Health Inc Commercial	$48.84
Rate for Payer: Group Health Inc Medicare	$34.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.84
Rate for Payer: Hamaspik Choice Inc Medicare	$48.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$63.50

ALLODERM REGEN TIS MATRIX 4X7THN

Facility

$41.29

Service Code	HCPCS Q4116
Hospital Charge Code	40205394
Hospital Revenue Code	636
Min. Negotiated Rate	$14.45
Max. Negotiated Rate	$26.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.47
Rate for Payer: Aetna Government	$21.47
Rate for Payer: Brighton Health Commercial	$24.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.74
Rate for Payer: Group Health Inc Commercial	$20.64
Rate for Payer: Group Health Inc Medicare	$14.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.64
Rate for Payer: Hamaspik Choice Inc Medicare	$20.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.84

Know your out-of-pocket cost for care.

All Charges