St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

GOODE T-TUBE VENTLTION SHEP1.14MM

Facility

$112.00

Service Code	HCPCS A4649
Hospital Charge Code	40201148
Hospital Revenue Code	278
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$56.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.00
Rate for Payer: Hamaspik Choice Inc Medicare	$56.00

GORE BALL EXP ENDOPR 7X39X135

Facility

$6,510.00

Service Code	HCPCS C1784
Hospital Charge Code	40003457
Hospital Revenue Code	278
Min. Negotiated Rate	$21.79
Max. Negotiated Rate	$6,835.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,580.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.79
Rate for Payer: Aetna Government	$21.79
Rate for Payer: Brighton Health Commercial	$3,906.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,255.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,743.25
Rate for Payer: EmblemHealth Commercial	$3,255.00
Rate for Payer: Fidelis Medicare Advantage	$6,835.50
Rate for Payer: Group Health Inc Commercial	$3,255.00
Rate for Payer: Group Health Inc Medicare	$2,278.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,255.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,255.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,231.50

GORE BALL EXP ENDOPR 7X39X135

Facility

$6,510.00

Service Code	HCPCS C1784
Hospital Charge Code	40003457
Hospital Revenue Code	278
Min. Negotiated Rate	$3,255.00
Max. Negotiated Rate	$3,255.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,255.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,255.00

GORE BIO A FISTULA PLUG

Facility

$1,650.00

Service Code	HCPCS C1760
Hospital Charge Code	40208083
Hospital Revenue Code	278
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$1,732.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$907.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$73.50
Rate for Payer: Aetna Government	$73.50
Rate for Payer: Brighton Health Commercial	$990.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$825.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$948.75
Rate for Payer: EmblemHealth Commercial	$825.00
Rate for Payer: Fidelis Medicare Advantage	$1,732.50
Rate for Payer: Group Health Inc Commercial	$825.00
Rate for Payer: Group Health Inc Medicare	$577.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$825.00
Rate for Payer: Hamaspik Choice Inc Medicare	$825.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,072.50

GORE BIO A FISTULA PLUG

Facility

$1,650.00

Service Code	HCPCS C1760
Hospital Charge Code	40208083
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$825.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$825.00
Rate for Payer: Hamaspik Choice Inc Medicare	$825.00

GORE DRYSEAL FLX INTRO SHEAT 1633

Facility

$469.00

Service Code	HCPCS C1894
Hospital Charge Code	40005230
Hospital Revenue Code	278
Min. Negotiated Rate	$234.50
Max. Negotiated Rate	$234.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$234.50
Rate for Payer: Hamaspik Choice Inc Medicare	$234.50

GORE DRYSEAL FLX INTRO SHEAT 1633

Facility

$469.00

Service Code	HCPCS C1894
Hospital Charge Code	40005230
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$492.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$257.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Brighton Health Commercial	$281.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$234.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$269.68
Rate for Payer: EmblemHealth Commercial	$234.50
Rate for Payer: Fidelis Medicare Advantage	$492.45
Rate for Payer: Group Health Inc Commercial	$234.50
Rate for Payer: Group Health Inc Medicare	$164.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$234.50
Rate for Payer: Hamaspik Choice Inc Medicare	$234.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$304.85

GORE DYSEAL FLX INTRO SEATH1245

Facility

$690.00

Service Code	HCPCS C1894
Hospital Charge Code	40005232
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$724.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$379.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Brighton Health Commercial	$414.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$345.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$396.75
Rate for Payer: EmblemHealth Commercial	$345.00
Rate for Payer: Fidelis Medicare Advantage	$724.50
Rate for Payer: Group Health Inc Commercial	$345.00
Rate for Payer: Group Health Inc Medicare	$241.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$345.00
Rate for Payer: Hamaspik Choice Inc Medicare	$345.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$448.50

GORE DYSEAL FLX INTRO SEATH1245

Facility

$690.00

Service Code	HCPCS C1894
Hospital Charge Code	40005232
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$345.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$345.00
Rate for Payer: Hamaspik Choice Inc Medicare	$345.00

GORE DYSEAL FLX INTRO SEATH1833

Facility

$634.00

Service Code	HCPCS C1894
Hospital Charge Code	40005231
Hospital Revenue Code	278
Min. Negotiated Rate	$317.00
Max. Negotiated Rate	$317.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$317.00
Rate for Payer: Hamaspik Choice Inc Medicare	$317.00

GORE DYSEAL FLX INTRO SEATH1833

Facility

$634.00

Service Code	HCPCS C1894
Hospital Charge Code	40005231
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$665.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$348.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Brighton Health Commercial	$380.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$317.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$364.55
Rate for Payer: EmblemHealth Commercial	$317.00
Rate for Payer: Fidelis Medicare Advantage	$665.70
Rate for Payer: Group Health Inc Commercial	$317.00
Rate for Payer: Group Health Inc Medicare	$221.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$317.00
Rate for Payer: Hamaspik Choice Inc Medicare	$317.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$412.10

GORE EXCLD AAA ENDOPROSTHES-PLC00

Facility

$4,857.00

Service Code	HCPCS C1877
Hospital Charge Code	40005236
Hospital Revenue Code	278
Min. Negotiated Rate	$127.45
Max. Negotiated Rate	$5,099.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,671.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Brighton Health Commercial	$2,914.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,428.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,792.78
Rate for Payer: EmblemHealth Commercial	$2,428.50
Rate for Payer: Fidelis Medicare Advantage	$5,099.85
Rate for Payer: Group Health Inc Commercial	$2,428.50
Rate for Payer: Group Health Inc Medicare	$1,699.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,428.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,428.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,157.05

GORE EXCLD AAA ENDOPROSTHES-PLC00

Facility

$4,857.00

Service Code	HCPCS C1877
Hospital Charge Code	40005236
Hospital Revenue Code	278
Min. Negotiated Rate	$2,428.50
Max. Negotiated Rate	$2,428.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,428.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,428.50

GORE EXCLUD AAA ENDOPROST-RLT1218

Facility

$11,846.00

Service Code	HCPCS C1877
Hospital Charge Code	40005235
Hospital Revenue Code	278
Min. Negotiated Rate	$5,923.00
Max. Negotiated Rate	$5,923.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,923.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,923.00

GORE EXCLUD AAA ENDOPROST-RLT1218

Facility

$11,846.00

Service Code	HCPCS C1877
Hospital Charge Code	40005235
Hospital Revenue Code	278
Min. Negotiated Rate	$127.45
Max. Negotiated Rate	$12,438.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,515.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Brighton Health Commercial	$7,107.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,923.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,811.45
Rate for Payer: EmblemHealth Commercial	$5,923.00
Rate for Payer: Fidelis Medicare Advantage	$12,438.30
Rate for Payer: Group Health Inc Commercial	$5,923.00
Rate for Payer: Group Health Inc Medicare	$4,146.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,923.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,923.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,699.90

GORE EXCLUD ENDOPROSTHES-CEB1210A

Facility

$11,576.00

Service Code	HCPCS C1877
Hospital Charge Code	40005233
Hospital Revenue Code	278
Min. Negotiated Rate	$5,788.00
Max. Negotiated Rate	$5,788.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,788.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,788.00

GORE EXCLUD ENDOPROSTHES-CEB1210A

Facility

$11,576.00

Service Code	HCPCS C1877
Hospital Charge Code	40005233
Hospital Revenue Code	278
Min. Negotiated Rate	$127.45
Max. Negotiated Rate	$12,154.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,366.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Brighton Health Commercial	$6,945.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,788.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,656.20
Rate for Payer: EmblemHealth Commercial	$5,788.00
Rate for Payer: Fidelis Medicare Advantage	$12,154.80
Rate for Payer: Group Health Inc Commercial	$5,788.00
Rate for Payer: Group Health Inc Medicare	$4,051.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,788.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,788.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,524.40

GORE EXCLUD ENDOPROSTHES-HGB1007A

Facility

$3,231.00

Service Code	HCPCS C1877
Hospital Charge Code	40005234
Hospital Revenue Code	278
Min. Negotiated Rate	$1,615.50
Max. Negotiated Rate	$1,615.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,615.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,615.50

GORE EXCLUD ENDOPROSTHES-HGB1007A

Facility

$3,231.00

Service Code	HCPCS C1877
Hospital Charge Code	40005234
Hospital Revenue Code	278
Min. Negotiated Rate	$127.45
Max. Negotiated Rate	$3,392.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,777.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Brighton Health Commercial	$1,938.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,615.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,857.82
Rate for Payer: EmblemHealth Commercial	$1,615.50
Rate for Payer: Fidelis Medicare Advantage	$3,392.55
Rate for Payer: Group Health Inc Commercial	$1,615.50
Rate for Payer: Group Health Inc Medicare	$1,130.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,615.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,615.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,100.15

GORE-PROPATEN VASCULAR GRAFT

Facility

$3,294.00

Service Code	HCPCS C1768
Hospital Charge Code	40200230
Hospital Revenue Code	278
Min. Negotiated Rate	$1,647.00
Max. Negotiated Rate	$1,647.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,647.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,647.00

GORE-PROPATEN VASCULAR GRAFT

Facility

$3,294.00

Service Code	HCPCS C1768
Hospital Charge Code	40200230
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$3,458.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,811.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$1,976.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,647.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,894.05
Rate for Payer: EmblemHealth Commercial	$1,647.00
Rate for Payer: Fidelis Medicare Advantage	$3,458.70
Rate for Payer: Group Health Inc Commercial	$1,647.00
Rate for Payer: Group Health Inc Medicare	$1,152.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,647.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,647.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,141.10

GORE-TEX GRAFT VASCULAR S0701

Facility

$324.00

Service Code	HCPCS C1768
Hospital Charge Code	40205455
Hospital Revenue Code	278
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$340.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$178.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$194.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$162.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$186.30
Rate for Payer: EmblemHealth Commercial	$162.00
Rate for Payer: Fidelis Medicare Advantage	$340.20
Rate for Payer: Group Health Inc Commercial	$162.00
Rate for Payer: Group Health Inc Medicare	$113.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.00
Rate for Payer: Hamaspik Choice Inc Medicare	$162.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$210.60

GORE-TEX GRAFT VASCULAR S0701

Facility

$324.00

Service Code	HCPCS C1768
Hospital Charge Code	40205455
Hospital Revenue Code	278
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$162.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.00
Rate for Payer: Hamaspik Choice Inc Medicare	$162.00

GORE-TEX GRFT VAS 10X60CMX10CM

Facility

$960.00

Service Code	HCPCS C1768
Hospital Charge Code	40208161
Hospital Revenue Code	278
Min. Negotiated Rate	$480.00
Max. Negotiated Rate	$480.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$480.00
Rate for Payer: Hamaspik Choice Inc Medicare	$480.00

GORE-TEX GRFT VAS 10X60CMX10CM

Facility

$960.00

Service Code	HCPCS C1768
Hospital Charge Code	40208161
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$1,008.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$528.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$576.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$480.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$552.00
Rate for Payer: EmblemHealth Commercial	$480.00
Rate for Payer: Fidelis Medicare Advantage	$1,008.00
Rate for Payer: Group Health Inc Commercial	$480.00
Rate for Payer: Group Health Inc Medicare	$336.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$480.00
Rate for Payer: Hamaspik Choice Inc Medicare	$480.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$624.00

Know your out-of-pocket cost for care.

All Charges