St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

GRAFTON GEL 1CC

Facility

$400.00

Service Code	HCPCS C1713
Hospital Charge Code	40202025
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$420.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$240.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.00
Rate for Payer: EmblemHealth Commercial	$200.00
Rate for Payer: Fidelis Medicare Advantage	$420.00
Rate for Payer: Group Health Inc Commercial	$200.00
Rate for Payer: Group Health Inc Medicare	$140.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$260.00

GRAFTON ORTHOBLEND SD 10CC

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	40202027
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

GRAFTON ORTHOBLEND SD 10CC

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	40202027
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: EmblemHealth Commercial	$1,500.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

GRAFTON ORTHOBLEND SD 5CC

Facility

$2,080.00

Service Code	HCPCS C1713
Hospital Charge Code	40202028
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,184.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,144.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,248.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,040.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,196.00
Rate for Payer: EmblemHealth Commercial	$1,040.00
Rate for Payer: Fidelis Medicare Advantage	$2,184.00
Rate for Payer: Group Health Inc Commercial	$1,040.00
Rate for Payer: Group Health Inc Medicare	$728.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,040.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,040.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,352.00

GRAFTON ORTHOBLEND SD 5CC

Facility

$2,080.00

Service Code	HCPCS C1713
Hospital Charge Code	40202028
Hospital Revenue Code	278
Min. Negotiated Rate	$1,040.00
Max. Negotiated Rate	$1,040.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,040.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,040.00

GRAFTON PASTE 5CC

Facility

$1,880.00

Service Code	HCPCS C1713
Hospital Charge Code	40202015
Hospital Revenue Code	278
Min. Negotiated Rate	$940.00
Max. Negotiated Rate	$940.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$940.00
Rate for Payer: Hamaspik Choice Inc Medicare	$940.00

GRAFTON PASTE 5CC

Facility

$1,880.00

Service Code	HCPCS C1713
Hospital Charge Code	40202015
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,974.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,034.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,128.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$940.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,081.00
Rate for Payer: EmblemHealth Commercial	$940.00
Rate for Payer: Fidelis Medicare Advantage	$1,974.00
Rate for Payer: Group Health Inc Commercial	$940.00
Rate for Payer: Group Health Inc Medicare	$658.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$940.00
Rate for Payer: Hamaspik Choice Inc Medicare	$940.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,222.00

GRAFTON PUTTY 1CC

Facility

$400.00

Service Code	HCPCS C1713
Hospital Charge Code	40202032
Hospital Revenue Code	278
Min. Negotiated Rate	$200.00
Max. Negotiated Rate	$200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$200.00

GRAFTON PUTTY 1CC

Facility

$400.00

Service Code	HCPCS C1713
Hospital Charge Code	40202032
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$420.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$240.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.00
Rate for Payer: EmblemHealth Commercial	$200.00
Rate for Payer: Fidelis Medicare Advantage	$420.00
Rate for Payer: Group Health Inc Commercial	$200.00
Rate for Payer: Group Health Inc Medicare	$140.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$260.00

GRAFT PERICARDIUM DEHYDRATED

Facility

$285.00

Service Code	HCPCS C1768
Hospital Charge Code	64906277
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$142.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50

GRAFT PERICARDIUM DEHYDRATED

Facility

$285.00

Service Code	HCPCS C1768
Hospital Charge Code	64906277
Hospital Revenue Code	278
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$322.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$156.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$171.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$142.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.88
Rate for Payer: EmblemHealth Commercial	$142.50
Rate for Payer: Fidelis Medicare Advantage	$299.25
Rate for Payer: Group Health Inc Commercial	$142.50
Rate for Payer: Group Health Inc Medicare	$99.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.25

GRAFT PRO DENSE 10CC

Facility

$13,967.50

Service Code	HCPCS C1781
Hospital Charge Code	64907483
Hospital Revenue Code	278
Min. Negotiated Rate	$6,983.75
Max. Negotiated Rate	$6,983.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,983.75
Rate for Payer: Hamaspik Choice Inc Medicare	$6,983.75

GRAFT PRO DENSE 10CC

Facility

$13,967.50

Service Code	HCPCS C1781
Hospital Charge Code	64907483
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$14,665.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7,682.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$8,380.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,983.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$8,031.31
Rate for Payer: EmblemHealth Commercial	$6,983.75
Rate for Payer: Fidelis Medicare Advantage	$14,665.88
Rate for Payer: Group Health Inc Commercial	$6,983.75
Rate for Payer: Group Health Inc Medicare	$4,888.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,983.75
Rate for Payer: Hamaspik Choice Inc Medicare	$6,983.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9,078.88

GRAFT PURAPLY 1.6

Facility

$296.88

Service Code	HCPCS Q4196
Hospital Charge Code	64906871
Hospital Revenue Code	636
Min. Negotiated Rate	$148.44
Max. Negotiated Rate	$148.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.44
Rate for Payer: Hamaspik Choice Inc Medicare	$148.44

GRAFT PURAPLY 1.6

Facility

$296.88

Service Code	HCPCS Q4196
Hospital Charge Code	64906871
Hospital Revenue Code	636
Min. Negotiated Rate	$103.91
Max. Negotiated Rate	$192.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$163.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$108.29
Rate for Payer: Aetna Government	$108.29
Rate for Payer: Brighton Health Commercial	$178.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$148.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.71
Rate for Payer: Group Health Inc Commercial	$148.44
Rate for Payer: Group Health Inc Medicare	$103.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.44
Rate for Payer: Hamaspik Choice Inc Medicare	$148.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$110.41
Rate for Payer: SOMOS Essential	$110.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$192.97

GRAFT PURAPLY 2 X 2

Facility

$296.88

Service Code	HCPCS Q4196
Hospital Charge Code	64906872
Hospital Revenue Code	636
Min. Negotiated Rate	$148.44
Max. Negotiated Rate	$148.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.44
Rate for Payer: Hamaspik Choice Inc Medicare	$148.44

GRAFT PURAPLY 2 X 2

Facility

$296.88

Service Code	HCPCS Q4196
Hospital Charge Code	64906872
Hospital Revenue Code	636
Min. Negotiated Rate	$103.91
Max. Negotiated Rate	$192.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$163.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$108.29
Rate for Payer: Aetna Government	$108.29
Rate for Payer: Brighton Health Commercial	$178.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$148.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.71
Rate for Payer: Group Health Inc Commercial	$148.44
Rate for Payer: Group Health Inc Medicare	$103.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.44
Rate for Payer: Hamaspik Choice Inc Medicare	$148.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$110.41
Rate for Payer: SOMOS Essential	$110.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$192.97

GRAFT PURAPLY 2 X 4

Facility

$296.88

Service Code	HCPCS Q4196
Hospital Charge Code	64906873
Hospital Revenue Code	636
Min. Negotiated Rate	$103.91
Max. Negotiated Rate	$192.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$163.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$108.29
Rate for Payer: Aetna Government	$108.29
Rate for Payer: Brighton Health Commercial	$178.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$148.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.71
Rate for Payer: Group Health Inc Commercial	$148.44
Rate for Payer: Group Health Inc Medicare	$103.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.44
Rate for Payer: Hamaspik Choice Inc Medicare	$148.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$110.41
Rate for Payer: SOMOS Essential	$110.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$192.97

GRAFT PURAPLY 2 X 4

Facility

$296.88

Service Code	HCPCS Q4196
Hospital Charge Code	64906873
Hospital Revenue Code	636
Min. Negotiated Rate	$148.44
Max. Negotiated Rate	$148.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.44
Rate for Payer: Hamaspik Choice Inc Medicare	$148.44

GRAFT PURAPLY 5 X 5

Facility

$296.88

Service Code	HCPCS Q4196
Hospital Charge Code	64906874
Hospital Revenue Code	636
Min. Negotiated Rate	$103.91
Max. Negotiated Rate	$192.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$163.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$108.29
Rate for Payer: Aetna Government	$108.29
Rate for Payer: Brighton Health Commercial	$178.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$148.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.71
Rate for Payer: Group Health Inc Commercial	$148.44
Rate for Payer: Group Health Inc Medicare	$103.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.44
Rate for Payer: Hamaspik Choice Inc Medicare	$148.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$110.41
Rate for Payer: SOMOS Essential	$110.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$192.97

GRAFT PURAPLY 5 X 5

Facility

$296.88

Service Code	HCPCS Q4196
Hospital Charge Code	64906874
Hospital Revenue Code	636
Min. Negotiated Rate	$148.44
Max. Negotiated Rate	$148.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.44
Rate for Payer: Hamaspik Choice Inc Medicare	$148.44

GRAFTS 100-699

Facility

$659.22

Hospital Charge Code	40203096
Hospital Revenue Code	272
Min. Negotiated Rate	$230.73
Max. Negotiated Rate	$527.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$362.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$329.61
Rate for Payer: Aetna Government	$329.61
Rate for Payer: Brighton Health Commercial	$494.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$527.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$448.27
Rate for Payer: Group Health Inc Commercial	$329.61
Rate for Payer: Group Health Inc Medicare	$230.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$329.61
Rate for Payer: Hamaspik Choice Inc Medicare	$329.61

GRAFTS 700-1399

Facility

$2,047.23

Hospital Charge Code	40203097
Hospital Revenue Code	272
Min. Negotiated Rate	$716.53
Max. Negotiated Rate	$1,637.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,125.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,023.62
Rate for Payer: Aetna Government	$1,023.62
Rate for Payer: Brighton Health Commercial	$1,535.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,637.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,392.12
Rate for Payer: Group Health Inc Commercial	$1,023.62
Rate for Payer: Group Health Inc Medicare	$716.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,023.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,023.62

GRAFT TISS ALLODERM 4CMX7CM

Facility

$83.48

Service Code	HCPCS Q4116
Hospital Charge Code	64902137
Hospital Revenue Code	636
Min. Negotiated Rate	$41.74
Max. Negotiated Rate	$41.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.74
Rate for Payer: Hamaspik Choice Inc Medicare	$41.74

GRAFT TISS ALLODERM 4CMX7CM

Facility

$83.48

Service Code	HCPCS Q4116
Hospital Charge Code	64902137
Hospital Revenue Code	636
Min. Negotiated Rate	$21.47
Max. Negotiated Rate	$54.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.47
Rate for Payer: Aetna Government	$21.47
Rate for Payer: Brighton Health Commercial	$50.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.00
Rate for Payer: Group Health Inc Commercial	$41.74
Rate for Payer: Group Health Inc Medicare	$29.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.74
Rate for Payer: Hamaspik Choice Inc Medicare	$41.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$54.26

Know your out-of-pocket cost for care.

All Charges