St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

EXPANDER TISSUE 350CC

Facility

$1,850.00

Service Code	HCPCS C1789
Hospital Charge Code	40202283
Hospital Revenue Code	278
Min. Negotiated Rate	$925.00
Max. Negotiated Rate	$925.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$925.00
Rate for Payer: Hamaspik Choice Inc Medicare	$925.00

EXPANDER TISSUE 350CC

Facility

$1,850.00

Service Code	HCPCS C1789
Hospital Charge Code	40202283
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,942.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,017.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,110.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$925.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,063.75
Rate for Payer: EmblemHealth Commercial	$925.00
Rate for Payer: Fidelis Medicare Advantage	$1,942.50
Rate for Payer: Group Health Inc Commercial	$925.00
Rate for Payer: Group Health Inc Medicare	$647.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$925.00
Rate for Payer: Hamaspik Choice Inc Medicare	$925.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,202.50

EXPANDER TISSUE 400CC

Facility

$1,850.00

Service Code	HCPCS C1789
Hospital Charge Code	40202282
Hospital Revenue Code	278
Min. Negotiated Rate	$925.00
Max. Negotiated Rate	$925.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$925.00
Rate for Payer: Hamaspik Choice Inc Medicare	$925.00

EXPANDER TISSUE 400CC

Facility

$1,850.00

Service Code	HCPCS C1789
Hospital Charge Code	40202282
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,942.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,017.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,110.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$925.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,063.75
Rate for Payer: EmblemHealth Commercial	$925.00
Rate for Payer: Fidelis Medicare Advantage	$1,942.50
Rate for Payer: Group Health Inc Commercial	$925.00
Rate for Payer: Group Health Inc Medicare	$647.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$925.00
Rate for Payer: Hamaspik Choice Inc Medicare	$925.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,202.50

EXPANDER TISSUE RND SALINE 400CC

Facility

$1,150.00

Service Code	HCPCS C1789
Hospital Charge Code	40202284
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,207.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$632.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$690.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$575.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$661.25
Rate for Payer: EmblemHealth Commercial	$575.00
Rate for Payer: Fidelis Medicare Advantage	$1,207.50
Rate for Payer: Group Health Inc Commercial	$575.00
Rate for Payer: Group Health Inc Medicare	$402.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$747.50

EXPANDER TISSUE RND SALINE 400CC

Facility

$1,150.00

Service Code	HCPCS C1789
Hospital Charge Code	40202284
Hospital Revenue Code	278
Min. Negotiated Rate	$575.00
Max. Negotiated Rate	$575.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00

EXPANDER TISSUE RND SALINE 550CC

Facility

$1,800.00

Service Code	HCPCS C1789
Hospital Charge Code	40202285
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,890.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$990.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,080.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$900.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,035.00
Rate for Payer: EmblemHealth Commercial	$900.00
Rate for Payer: Fidelis Medicare Advantage	$1,890.00
Rate for Payer: Group Health Inc Commercial	$900.00
Rate for Payer: Group Health Inc Medicare	$630.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$900.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,170.00

EXPANDER TISSUE RND SALINE 550CC

Facility

$1,800.00

Service Code	HCPCS C1789
Hospital Charge Code	40202285
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$900.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$900.00

EXPANDER TISSUE ROUND SALINE350CC

Facility

$900.00

Service Code	HCPCS C1789
Hospital Charge Code	40205115
Hospital Revenue Code	278
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$945.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$495.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$540.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$450.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$517.50
Rate for Payer: EmblemHealth Commercial	$450.00
Rate for Payer: Fidelis Medicare Advantage	$945.00
Rate for Payer: Group Health Inc Commercial	$450.00
Rate for Payer: Group Health Inc Medicare	$315.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$450.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$585.00

EXPANDER TISSUE ROUND SALINE350CC

Facility

$900.00

Service Code	HCPCS C1789
Hospital Charge Code	40205115
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$450.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$450.00

EXPAND TIS BRST CON PROF 275CC

Facility

$3,562.50

Service Code	HCPCS C1789
Hospital Charge Code	64902140
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$3,740.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,959.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$2,137.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,781.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,048.44
Rate for Payer: EmblemHealth Commercial	$1,781.25
Rate for Payer: Fidelis Medicare Advantage	$3,740.62
Rate for Payer: Group Health Inc Commercial	$1,781.25
Rate for Payer: Group Health Inc Medicare	$1,246.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,781.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,781.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,315.62

EXPAND TIS BRST CON PROF 275CC

Facility

$3,562.50

Service Code	HCPCS C1789
Hospital Charge Code	64902140
Hospital Revenue Code	278
Min. Negotiated Rate	$1,781.25
Max. Negotiated Rate	$1,781.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,781.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,781.25

EXPAND TIS BRST CON PROF 350CC

Facility

$3,675.00

Service Code	HCPCS C1789
Hospital Charge Code	64902492
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$1,837.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,837.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,837.50

EXPAND TIS BRST CON PROF 350CC

Facility

$3,675.00

Service Code	HCPCS C1789
Hospital Charge Code	64902492
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$3,858.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,021.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$2,205.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,837.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,113.12
Rate for Payer: EmblemHealth Commercial	$1,837.50
Rate for Payer: Fidelis Medicare Advantage	$3,858.75
Rate for Payer: Group Health Inc Commercial	$1,837.50
Rate for Payer: Group Health Inc Medicare	$1,286.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,837.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,837.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,388.75

EXPAND TISS BRST 450CC SILTX

Facility

$3,675.00

Service Code	HCPCS C1789
Hospital Charge Code	64902142
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$1,837.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,837.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,837.50

EXPAND TISS BRST 450CC SILTX

Facility

$3,675.00

Service Code	HCPCS C1789
Hospital Charge Code	64902142
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$3,858.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,021.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$2,205.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,837.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,113.12
Rate for Payer: EmblemHealth Commercial	$1,837.50
Rate for Payer: Fidelis Medicare Advantage	$3,858.75
Rate for Payer: Group Health Inc Commercial	$1,837.50
Rate for Payer: Group Health Inc Medicare	$1,286.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,837.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,837.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,388.75

EXPAND TISS BRST 550CC SILTEX

Facility

$3,162.50

Service Code	HCPCS C1789
Hospital Charge Code	64904731
Hospital Revenue Code	278
Min. Negotiated Rate	$1,581.25
Max. Negotiated Rate	$1,581.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,581.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,581.25

EXPAND TISS BRST 550CC SILTEX

Facility

$3,162.50

Service Code	HCPCS C1789
Hospital Charge Code	64904731
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$3,320.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,739.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,897.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,581.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,818.44
Rate for Payer: EmblemHealth Commercial	$1,581.25
Rate for Payer: Fidelis Medicare Advantage	$3,320.62
Rate for Payer: Group Health Inc Commercial	$1,581.25
Rate for Payer: Group Health Inc Medicare	$1,106.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,581.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,581.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,055.62

EXPAND TISS SMTH RD HI 450CC

Facility

$2,450.00

Hospital Charge Code	64904890
Hospital Revenue Code	270
Min. Negotiated Rate	$857.50
Max. Negotiated Rate	$1,960.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,347.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,225.00
Rate for Payer: Aetna Government	$1,225.00
Rate for Payer: Brighton Health Commercial	$1,837.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,960.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,666.00
Rate for Payer: Group Health Inc Commercial	$1,225.00
Rate for Payer: Group Health Inc Medicare	$857.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,225.00

EXPAND TISS SMTH RD HI PROF 550CC

Facility

$2,375.00

Hospital Charge Code	64904903
Hospital Revenue Code	270
Min. Negotiated Rate	$831.25
Max. Negotiated Rate	$1,900.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,306.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,187.50
Rate for Payer: Aetna Government	$1,187.50
Rate for Payer: Brighton Health Commercial	$1,781.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,900.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,615.00
Rate for Payer: Group Health Inc Commercial	$1,187.50
Rate for Payer: Group Health Inc Medicare	$831.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,187.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,187.50

EXPAND TISS SMTH RD MOD 400CC

Facility

$1,962.50

Service Code	HCPCS C1789
Hospital Charge Code	64904728
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$2,060.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,079.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,177.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$981.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,128.44
Rate for Payer: EmblemHealth Commercial	$981.25
Rate for Payer: Fidelis Medicare Advantage	$2,060.62
Rate for Payer: Group Health Inc Commercial	$981.25
Rate for Payer: Group Health Inc Medicare	$686.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$981.25
Rate for Payer: Hamaspik Choice Inc Medicare	$981.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,275.62

EXPAND TISS SMTH RD MOD 400CC

Facility

$1,962.50

Service Code	HCPCS C1789
Hospital Charge Code	64904728
Hospital Revenue Code	278
Min. Negotiated Rate	$981.25
Max. Negotiated Rate	$981.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$981.25
Rate for Payer: Hamaspik Choice Inc Medicare	$981.25

EXPAND TISS SMTH RD MOD 450CC

Facility

$1,962.50

Service Code	HCPCS C1789
Hospital Charge Code	64904726
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$2,060.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,079.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,177.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$981.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,128.44
Rate for Payer: EmblemHealth Commercial	$981.25
Rate for Payer: Fidelis Medicare Advantage	$2,060.62
Rate for Payer: Group Health Inc Commercial	$981.25
Rate for Payer: Group Health Inc Medicare	$686.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$981.25
Rate for Payer: Hamaspik Choice Inc Medicare	$981.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,275.62

EXPAND TISS SMTH RD MOD 450CC

Facility

$1,962.50

Service Code	HCPCS C1789
Hospital Charge Code	64904726
Hospital Revenue Code	278
Min. Negotiated Rate	$981.25
Max. Negotiated Rate	$981.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$981.25
Rate for Payer: Hamaspik Choice Inc Medicare	$981.25

EXP LAP , ANTRECTOMY

Facility

$4,224.49

Service Code	HCPCS 43631
Hospital Charge Code	40011190
Hospital Revenue Code	360
Min. Negotiated Rate	$1,478.57
Max. Negotiated Rate	$3,168.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,323.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,723.49
Rate for Payer: Aetna Government	$1,723.49
Rate for Payer: Brighton Health Commercial	$3,168.37
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: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$2,112.24
Rate for Payer: Group Health Inc Medicare	$1,478.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,112.24
Rate for Payer: Hamaspik Choice Inc Medicare	$2,112.24
Rate for Payer: United Healthcare Commercial	$1,496.00

Know your out-of-pocket cost for care.

All Charges