St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ALLODERM REGEN TIS MATRIX 4X7THN

Facility

$41.29

Service Code	HCPCS Q4116
Hospital Charge Code	40205394
Hospital Revenue Code	636
Min. Negotiated Rate	$20.64
Max. Negotiated Rate	$20.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.64
Rate for Payer: Hamaspik Choice Inc Medicare	$20.64

ALLODERM REGEN TISSUE MATRIX 3X7

Facility

$47.62

Service Code	HCPCS Q4116
Hospital Charge Code	40201100
Hospital Revenue Code	636
Min. Negotiated Rate	$16.67
Max. Negotiated Rate	$30.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.47
Rate for Payer: Aetna Government	$21.47
Rate for Payer: Brighton Health Commercial	$28.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.38
Rate for Payer: Group Health Inc Commercial	$23.81
Rate for Payer: Group Health Inc Medicare	$16.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.81
Rate for Payer: Hamaspik Choice Inc Medicare	$23.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.95

ALLODERM REGEN TISSUE MATRIX 3X7

Facility

$47.62

Service Code	HCPCS Q4116
Hospital Charge Code	40201100
Hospital Revenue Code	636
Min. Negotiated Rate	$23.81
Max. Negotiated Rate	$23.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.81
Rate for Payer: Hamaspik Choice Inc Medicare	$23.81

ALLODERM REGEN TISSUE MATRIX 4X7

Facility

$66.79

Service Code	HCPCS Q4116
Hospital Charge Code	40201101
Hospital Revenue Code	636
Min. Negotiated Rate	$33.40
Max. Negotiated Rate	$33.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.40
Rate for Payer: Hamaspik Choice Inc Medicare	$33.40

ALLODERM REGEN TISSUE MATRIX 4X7

Facility

$66.79

Service Code	HCPCS Q4116
Hospital Charge Code	40201101
Hospital Revenue Code	636
Min. Negotiated Rate	$21.47
Max. Negotiated Rate	$43.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$36.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.47
Rate for Payer: Aetna Government	$21.47
Rate for Payer: Brighton Health Commercial	$40.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$38.40
Rate for Payer: Group Health Inc Commercial	$33.40
Rate for Payer: Group Health Inc Medicare	$23.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.40
Rate for Payer: Hamaspik Choice Inc Medicare	$33.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$43.41

ALLODERM REGEN TISSUE MATRIX 8X16

Facility

$228.12

Service Code	HCPCS Q4116
Hospital Charge Code	40204560
Hospital Revenue Code	636
Min. Negotiated Rate	$21.47
Max. Negotiated Rate	$148.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$125.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.47
Rate for Payer: Aetna Government	$21.47
Rate for Payer: Brighton Health Commercial	$136.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$114.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$131.17
Rate for Payer: Group Health Inc Commercial	$114.06
Rate for Payer: Group Health Inc Medicare	$79.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.06
Rate for Payer: Hamaspik Choice Inc Medicare	$114.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$148.28

ALLODERM REGEN TISSUE MATRIX 8X16

Facility

$228.12

Service Code	HCPCS Q4116
Hospital Charge Code	40204560
Hospital Revenue Code	636
Min. Negotiated Rate	$114.06
Max. Negotiated Rate	$114.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.06
Rate for Payer: Hamaspik Choice Inc Medicare	$114.06

ALLODERM (RTU) 8CM X 16CM - THIN

Facility

$101.74

Service Code	HCPCS Q4116
Hospital Charge Code	64903652
Hospital Revenue Code	636
Min. Negotiated Rate	$50.87
Max. Negotiated Rate	$50.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.87
Rate for Payer: Hamaspik Choice Inc Medicare	$50.87

ALLODERM (RTU) 8CM X 16CM - THIN

Facility

$101.74

Service Code	HCPCS Q4116
Hospital Charge Code	64903652
Hospital Revenue Code	636
Min. Negotiated Rate	$21.47
Max. Negotiated Rate	$66.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.47
Rate for Payer: Aetna Government	$21.47
Rate for Payer: Brighton Health Commercial	$61.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.50
Rate for Payer: Group Health Inc Commercial	$50.87
Rate for Payer: Group Health Inc Medicare	$35.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.87
Rate for Payer: Hamaspik Choice Inc Medicare	$50.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.13

ALLODERM RTU 8 X 16 THICK

Facility

$102.32

Service Code	HCPCS Q4116
Hospital Charge Code	64903241
Hospital Revenue Code	636
Min. Negotiated Rate	$21.47
Max. Negotiated Rate	$66.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.47
Rate for Payer: Aetna Government	$21.47
Rate for Payer: Brighton Health Commercial	$61.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$51.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.83
Rate for Payer: Group Health Inc Commercial	$51.16
Rate for Payer: Group Health Inc Medicare	$35.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.16
Rate for Payer: Hamaspik Choice Inc Medicare	$51.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.51

ALLODERM RTU 8 X 16 THICK

Facility

$102.32

Service Code	HCPCS Q4116
Hospital Charge Code	64903241
Hospital Revenue Code	636
Min. Negotiated Rate	$51.16
Max. Negotiated Rate	$51.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.16
Rate for Payer: Hamaspik Choice Inc Medicare	$51.16

ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$228,608.26

Service Code	MSDRG 014
Min. Negotiated Rate	$77,311.16
Max. Negotiated Rate	$228,608.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$168,990.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$166,260.55
Rate for Payer: Aetna Government	$166,260.55
Rate for Payer: Brighton Health Commercial	$166,183.05
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$169,585.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$197,918.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$163,330.66
Rate for Payer: Elderplan Medicare Advantage	$157,947.52
Rate for Payer: EmblemHealth Commercial	$98,277.20
Rate for Payer: Fidelis Medicare Advantage	$166,260.55
Rate for Payer: Group Health Inc Commercial	$166,260.55
Rate for Payer: Group Health Inc Medicare	$166,260.55
Rate for Payer: Hamaspik Choice Inc Medicare	$166,260.55
Rate for Payer: Healthfirst Medicare Advantage	$77,311.16
Rate for Payer: Humana Medicare	$228,608.26
Rate for Payer: Senior Whole Health Medicare Advantage	$166,260.55
Rate for Payer: United Healthcare Commercial	$227,922.92
Rate for Payer: United Healthcare Medicare Advantage	$166,260.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$166,260.55
Rate for Payer: Wellcare Medicare	$157,947.52

ALLOMAX 1MM GRAFT 3.9X5.9

Facility

$571.20

Service Code	HCPCS Q4100
Hospital Charge Code	64903687
Hospital Revenue Code	636
Min. Negotiated Rate	$9.74
Max. Negotiated Rate	$371.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$314.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.74
Rate for Payer: Aetna Government	$9.74
Rate for Payer: Brighton Health Commercial	$342.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$285.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$328.44
Rate for Payer: Group Health Inc Commercial	$285.60
Rate for Payer: Group Health Inc Medicare	$199.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$285.60
Rate for Payer: Hamaspik Choice Inc Medicare	$285.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$371.28

ALLOMAX 1MM GRAFT 3.9X5.9

Facility

$571.20

Service Code	HCPCS Q4100
Hospital Charge Code	64903687
Hospital Revenue Code	636
Min. Negotiated Rate	$285.60
Max. Negotiated Rate	$285.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$285.60
Rate for Payer: Hamaspik Choice Inc Medicare	$285.60

ALLOPURE COTTON 6MM

Facility

$6,150.00

Service Code	HCPCS C1713
Hospital Charge Code	64904445
Hospital Revenue Code	278
Min. Negotiated Rate	$3,075.00
Max. Negotiated Rate	$3,075.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,075.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,075.00

ALLOPURE COTTON 6MM

Facility

$6,150.00

Service Code	HCPCS C1713
Hospital Charge Code	64904445
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,457.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,382.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,690.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,075.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,536.25
Rate for Payer: EmblemHealth Commercial	$3,075.00
Rate for Payer: Fidelis Medicare Advantage	$6,457.50
Rate for Payer: Group Health Inc Commercial	$3,075.00
Rate for Payer: Group Health Inc Medicare	$2,152.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,075.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,075.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,997.50

ALLOPURE EVANS 8MM

Facility

$7,487.50

Service Code	HCPCS C1713
Hospital Charge Code	64904443
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$7,861.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,118.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,492.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,743.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,305.31
Rate for Payer: EmblemHealth Commercial	$3,743.75
Rate for Payer: Fidelis Medicare Advantage	$7,861.88
Rate for Payer: Group Health Inc Commercial	$3,743.75
Rate for Payer: Group Health Inc Medicare	$2,620.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,743.75
Rate for Payer: Hamaspik Choice Inc Medicare	$3,743.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,866.88

ALLOPURE EVANS 8MM

Facility

$7,487.50

Service Code	HCPCS C1713
Hospital Charge Code	64904443
Hospital Revenue Code	278
Min. Negotiated Rate	$3,743.75
Max. Negotiated Rate	$3,743.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,743.75
Rate for Payer: Hamaspik Choice Inc Medicare	$3,743.75

ALLOPURINOL 100 MG PO TABS [310]

Facility

$0.48

Service Code	NDC 53489015601
Hospital Charge Code	53489015601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.24
Rate for Payer: Aetna Government	$0.24
Rate for Payer: Brighton Health Commercial	$0.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.33
Rate for Payer: Group Health Inc Commercial	$0.24
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24
Rate for Payer: Hamaspik Choice Inc Medicare	$0.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.31

ALLOPURINOL 100 MG PO TABS [310]

Facility

$0.40

Service Code	NDC 00904704161
Hospital Charge Code	00904704161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.26

ALLOPURINOL 100 MG PO TABS [310]

Facility

$0.30

Service Code	NDC 63739041010
Hospital Charge Code	63739041010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.19

ALLOPURINOL 100 MG PO TABS [310]

Facility

$0.48

Service Code	NDC 00591554301
Hospital Charge Code	00591554301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.24
Rate for Payer: Aetna Government	$0.24
Rate for Payer: Brighton Health Commercial	$0.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.33
Rate for Payer: Group Health Inc Commercial	$0.24
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24
Rate for Payer: Hamaspik Choice Inc Medicare	$0.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.31

ALLOPURINOL 100 MG TAB

Facility

$0.11

Hospital Charge Code	41652666
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

ALLOPURINOL 100 MG TAB

Facility

$0.11

Hospital Charge Code	41642666
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

ALLOPURINOL 1 MG/ML SUSP

Facility

$2.00

Hospital Charge Code	41642019
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

Know your out-of-pocket cost for care.

All Charges