St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

GRAFT TISS ALLODERM 4CMX7CM THIN

Facility

$51.61

Service Code	HCPCS Q4116
Hospital Charge Code	64902185
Hospital Revenue Code	636
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$25.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.80
Rate for Payer: Hamaspik Choice Inc Medicare	$25.80

GRAFT TISS ALLODERM 4CMX7CM THIN

Facility

$51.61

Service Code	HCPCS Q4116
Hospital Charge Code	64902185
Hospital Revenue Code	636
Min. Negotiated Rate	$18.06
Max. Negotiated Rate	$33.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.47
Rate for Payer: Aetna Government	$21.47
Rate for Payer: Brighton Health Commercial	$30.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.68
Rate for Payer: Group Health Inc Commercial	$25.80
Rate for Payer: Group Health Inc Medicare	$18.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.80
Rate for Payer: Hamaspik Choice Inc Medicare	$25.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$33.55

GRAFT VASC STRTCH REM RNG 6MM

Facility

$2,410.00

Service Code	HCPCS C1768
Hospital Charge Code	40200229
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$2,530.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,325.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$1,446.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,205.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,385.75
Rate for Payer: EmblemHealth Commercial	$1,205.00
Rate for Payer: Fidelis Medicare Advantage	$2,530.50
Rate for Payer: Group Health Inc Commercial	$1,205.00
Rate for Payer: Group Health Inc Medicare	$843.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,205.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,205.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,566.50

GRAFT VASC STRTCH REM RNG 6MM

Facility

$2,410.00

Service Code	HCPCS C1768
Hospital Charge Code	40200229
Hospital Revenue Code	278
Min. Negotiated Rate	$1,205.00
Max. Negotiated Rate	$1,205.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,205.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,205.00

GRAFT VASCULAR 2

Facility

$1,555.00

Service Code	HCPCS C1768
Hospital Charge Code	64901099
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$1,632.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$855.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$933.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$777.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$894.12
Rate for Payer: EmblemHealth Commercial	$777.50
Rate for Payer: Fidelis Medicare Advantage	$1,632.75
Rate for Payer: Group Health Inc Commercial	$777.50
Rate for Payer: Group Health Inc Medicare	$544.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$777.50
Rate for Payer: Hamaspik Choice Inc Medicare	$777.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,010.75

GRAFT VASCULAR 2

Facility

$1,555.00

Service Code	HCPCS C1768
Hospital Charge Code	64901099
Hospital Revenue Code	278
Min. Negotiated Rate	$777.50
Max. Negotiated Rate	$777.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$777.50
Rate for Payer: Hamaspik Choice Inc Medicare	$777.50

GRAFT VASCULAR 3

Facility

$1,366.00

Service Code	HCPCS C1768
Hospital Charge Code	40200233
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$1,434.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$751.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$819.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$683.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$785.45
Rate for Payer: EmblemHealth Commercial	$683.00
Rate for Payer: Fidelis Medicare Advantage	$1,434.30
Rate for Payer: Group Health Inc Commercial	$683.00
Rate for Payer: Group Health Inc Medicare	$478.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$683.00
Rate for Payer: Hamaspik Choice Inc Medicare	$683.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$887.90

GRAFT VASCULAR 3

Facility

$1,366.00

Service Code	HCPCS C1768
Hospital Charge Code	40200233
Hospital Revenue Code	278
Min. Negotiated Rate	$683.00
Max. Negotiated Rate	$683.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$683.00
Rate for Payer: Hamaspik Choice Inc Medicare	$683.00

GRAFT VASCULAR 4

Facility

$1,868.00

Service Code	HCPCS C1768
Hospital Charge Code	40200234
Hospital Revenue Code	278
Min. Negotiated Rate	$934.00
Max. Negotiated Rate	$934.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$934.00
Rate for Payer: Hamaspik Choice Inc Medicare	$934.00

GRAFT VASCULAR 4

Facility

$1,868.00

Service Code	HCPCS C1768
Hospital Charge Code	40200234
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$1,961.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,027.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$1,120.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$934.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,074.10
Rate for Payer: EmblemHealth Commercial	$934.00
Rate for Payer: Fidelis Medicare Advantage	$1,961.40
Rate for Payer: Group Health Inc Commercial	$934.00
Rate for Payer: Group Health Inc Medicare	$653.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$934.00
Rate for Payer: Hamaspik Choice Inc Medicare	$934.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,214.20

GRAFT VASCULAR 5

Facility

$1,366.00

Service Code	HCPCS C1768
Hospital Charge Code	40200236
Hospital Revenue Code	278
Min. Negotiated Rate	$683.00
Max. Negotiated Rate	$683.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$683.00
Rate for Payer: Hamaspik Choice Inc Medicare	$683.00

GRAFT VASCULAR 5

Facility

$1,366.00

Service Code	HCPCS C1768
Hospital Charge Code	40200236
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$1,434.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$751.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$819.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$683.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$785.45
Rate for Payer: EmblemHealth Commercial	$683.00
Rate for Payer: Fidelis Medicare Advantage	$1,434.30
Rate for Payer: Group Health Inc Commercial	$683.00
Rate for Payer: Group Health Inc Medicare	$478.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$683.00
Rate for Payer: Hamaspik Choice Inc Medicare	$683.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$887.90

GRAFT VASCULAR 6

Facility

$3,168.00

Service Code	HCPCS C1768
Hospital Charge Code	40200237
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$3,326.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,742.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$1,900.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,584.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,821.60
Rate for Payer: EmblemHealth Commercial	$1,584.00
Rate for Payer: Fidelis Medicare Advantage	$3,326.40
Rate for Payer: Group Health Inc Commercial	$1,584.00
Rate for Payer: Group Health Inc Medicare	$1,108.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,584.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,584.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,059.20

GRAFT VASCULAR 6

Facility

$3,168.00

Service Code	HCPCS C1768
Hospital Charge Code	40200237
Hospital Revenue Code	278
Min. Negotiated Rate	$1,584.00
Max. Negotiated Rate	$1,584.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,584.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,584.00

GRAFT VASCULAR 7

Facility

$268.00

Service Code	HCPCS C1768
Hospital Charge Code	40200238
Hospital Revenue Code	278
Min. Negotiated Rate	$93.80
Max. Negotiated Rate	$322.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$147.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$160.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$134.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$154.10
Rate for Payer: EmblemHealth Commercial	$134.00
Rate for Payer: Fidelis Medicare Advantage	$281.40
Rate for Payer: Group Health Inc Commercial	$134.00
Rate for Payer: Group Health Inc Medicare	$93.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.00
Rate for Payer: Hamaspik Choice Inc Medicare	$134.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$174.20

GRAFT VASCULAR 7

Facility

$268.00

Service Code	HCPCS C1768
Hospital Charge Code	40200238
Hospital Revenue Code	278
Min. Negotiated Rate	$134.00
Max. Negotiated Rate	$134.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.00
Rate for Payer: Hamaspik Choice Inc Medicare	$134.00

GRAFT VASCULAR 8

Facility

$1,170.00

Service Code	HCPCS C1768
Hospital Charge Code	40200239
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$1,228.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$643.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$702.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$585.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$672.75
Rate for Payer: EmblemHealth Commercial	$585.00
Rate for Payer: Fidelis Medicare Advantage	$1,228.50
Rate for Payer: Group Health Inc Commercial	$585.00
Rate for Payer: Group Health Inc Medicare	$409.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$585.00
Rate for Payer: Hamaspik Choice Inc Medicare	$585.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$760.50

GRAFT VASCULAR 8

Facility

$1,170.00

Service Code	HCPCS C1768
Hospital Charge Code	40200239
Hospital Revenue Code	278
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$585.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$585.00
Rate for Payer: Hamaspik Choice Inc Medicare	$585.00

GRAFT VASCULAR 8MM 80CM

Facility

$2,277.50

Service Code	HCPCS C1768
Hospital Charge Code	64901173
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$2,391.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,252.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$1,366.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,138.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,309.56
Rate for Payer: EmblemHealth Commercial	$1,138.75
Rate for Payer: Fidelis Medicare Advantage	$2,391.38
Rate for Payer: Group Health Inc Commercial	$1,138.75
Rate for Payer: Group Health Inc Medicare	$797.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,138.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,138.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,480.38

GRAFT VASCULAR 8MM 80CM

Facility

$1,426.00

Service Code	HCPCS C1768
Hospital Charge Code	40200240
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$1,497.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$784.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$855.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$713.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$819.95
Rate for Payer: EmblemHealth Commercial	$713.00
Rate for Payer: Fidelis Medicare Advantage	$1,497.30
Rate for Payer: Group Health Inc Commercial	$713.00
Rate for Payer: Group Health Inc Medicare	$499.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$713.00
Rate for Payer: Hamaspik Choice Inc Medicare	$713.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$926.90

GRAFT VASCULAR 8MM 80CM

Facility

$1,426.00

Service Code	HCPCS C1768
Hospital Charge Code	40200240
Hospital Revenue Code	278
Min. Negotiated Rate	$713.00
Max. Negotiated Rate	$713.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$713.00
Rate for Payer: Hamaspik Choice Inc Medicare	$713.00

GRAFT VASCULAR 8MM 80CM

Facility

$2,277.50

Service Code	HCPCS C1768
Hospital Charge Code	64901173
Hospital Revenue Code	278
Min. Negotiated Rate	$1,138.75
Max. Negotiated Rate	$1,138.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,138.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,138.75

GRAFT VASCULAR FEP RINGED

Facility

$3,362.50

Service Code	HCPCS C1768
Hospital Charge Code	64901184
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$3,530.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,849.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$2,017.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,681.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,933.44
Rate for Payer: EmblemHealth Commercial	$1,681.25
Rate for Payer: Fidelis Medicare Advantage	$3,530.62
Rate for Payer: Group Health Inc Commercial	$1,681.25
Rate for Payer: Group Health Inc Medicare	$1,176.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,681.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,681.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,185.62

GRAFT VASCULAR FEP RINGED

Facility

$3,362.50

Service Code	HCPCS C1768
Hospital Charge Code	64901184
Hospital Revenue Code	278
Min. Negotiated Rate	$1,681.25
Max. Negotiated Rate	$1,681.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,681.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,681.25

GRAFT VASCULAR GORE

Facility

$1,170.00

Service Code	HCPCS C1768
Hospital Charge Code	40200235
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$1,228.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$643.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$702.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$585.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$672.75
Rate for Payer: EmblemHealth Commercial	$585.00
Rate for Payer: Fidelis Medicare Advantage	$1,228.50
Rate for Payer: Group Health Inc Commercial	$585.00
Rate for Payer: Group Health Inc Medicare	$409.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$585.00
Rate for Payer: Hamaspik Choice Inc Medicare	$585.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$760.50

Know your out-of-pocket cost for care.

All Charges