St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

GRAFT VASCULAR GORE

Facility

$1,170.00

Service Code	HCPCS C1768
Hospital Charge Code	40200235
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 GORE (SB1401)

Facility

$2,620.00

Service Code	HCPCS C1768
Hospital Charge Code	64901290
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$2,751.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,441.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$1,572.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,310.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,506.50
Rate for Payer: EmblemHealth Commercial	$1,310.00
Rate for Payer: Fidelis Medicare Advantage	$2,751.00
Rate for Payer: Group Health Inc Commercial	$1,310.00
Rate for Payer: Group Health Inc Medicare	$917.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,310.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,310.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,703.00

GRAFT VASCULAR GORE (SB1401)

Facility

$2,620.00

Service Code	HCPCS C1768
Hospital Charge Code	64901290
Hospital Revenue Code	278
Min. Negotiated Rate	$1,310.00
Max. Negotiated Rate	$1,310.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,310.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,310.00

GRAFT VASCULAR GORE SRRT08070080L

Facility

$3,575.00

Service Code	HCPCS C1768
Hospital Charge Code	64901269
Hospital Revenue Code	278
Min. Negotiated Rate	$1,787.50
Max. Negotiated Rate	$1,787.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,787.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,787.50

GRAFT VASCULAR GORE SRRT08070080L

Facility

$3,575.00

Service Code	HCPCS C1768
Hospital Charge Code	64901269
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$3,753.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,966.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$2,145.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,787.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,055.62
Rate for Payer: EmblemHealth Commercial	$1,787.50
Rate for Payer: Fidelis Medicare Advantage	$3,753.75
Rate for Payer: Group Health Inc Commercial	$1,787.50
Rate for Payer: Group Health Inc Medicare	$1,251.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,787.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,787.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,323.75

GRAFT VASCULAR RINGED

Facility

$3,105.00

Service Code	HCPCS C1768
Hospital Charge Code	64901087
Hospital Revenue Code	278
Min. Negotiated Rate	$1,552.50
Max. Negotiated Rate	$1,552.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,552.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,552.50

GRAFT VASCULAR RINGED

Facility

$2,530.00

Service Code	HCPCS C1768
Hospital Charge Code	40200241
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$2,656.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,391.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$1,518.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,265.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,454.75
Rate for Payer: EmblemHealth Commercial	$1,265.00
Rate for Payer: Fidelis Medicare Advantage	$2,656.50
Rate for Payer: Group Health Inc Commercial	$1,265.00
Rate for Payer: Group Health Inc Medicare	$885.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,265.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,265.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,644.50

GRAFT VASCULAR RINGED

Facility

$2,530.00

Service Code	HCPCS C1768
Hospital Charge Code	40200241
Hospital Revenue Code	278
Min. Negotiated Rate	$1,265.00
Max. Negotiated Rate	$1,265.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,265.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,265.00

GRAFT VASCULAR RINGED

Facility

$3,105.00

Service Code	HCPCS C1768
Hospital Charge Code	64901087
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$3,260.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,707.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$1,863.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,552.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,785.38
Rate for Payer: EmblemHealth Commercial	$1,552.50
Rate for Payer: Fidelis Medicare Advantage	$3,260.25
Rate for Payer: Group Health Inc Commercial	$1,552.50
Rate for Payer: Group Health Inc Medicare	$1,086.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,552.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,552.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,018.25

GRAFT VASCULAR (SRR47010045L)

Facility

$1,707.50

Service Code	HCPCS C1768
Hospital Charge Code	64901203
Hospital Revenue Code	278
Min. Negotiated Rate	$853.75
Max. Negotiated Rate	$853.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$853.75
Rate for Payer: Hamaspik Choice Inc Medicare	$853.75

GRAFT VASCULAR (SRR47010045L)

Facility

$1,707.50

Service Code	HCPCS C1768
Hospital Charge Code	64901203
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$1,792.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$939.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$1,024.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$853.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$981.81
Rate for Payer: EmblemHealth Commercial	$853.75
Rate for Payer: Fidelis Medicare Advantage	$1,792.88
Rate for Payer: Group Health Inc Commercial	$853.75
Rate for Payer: Group Health Inc Medicare	$597.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$853.75
Rate for Payer: Hamaspik Choice Inc Medicare	$853.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,109.88

GRAFT VASCULAR THIN WALL

Facility

$238.00

Service Code	HCPCS C1768
Hospital Charge Code	40200242
Hospital Revenue Code	278
Min. Negotiated Rate	$83.30
Max. Negotiated Rate	$322.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$142.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$119.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.85
Rate for Payer: EmblemHealth Commercial	$119.00
Rate for Payer: Fidelis Medicare Advantage	$249.90
Rate for Payer: Group Health Inc Commercial	$119.00
Rate for Payer: Group Health Inc Medicare	$83.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.00
Rate for Payer: Hamaspik Choice Inc Medicare	$119.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.70

GRAFT VASCULAR THIN WALL

Facility

$238.00

Service Code	HCPCS C1768
Hospital Charge Code	40200242
Hospital Revenue Code	278
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$119.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.00
Rate for Payer: Hamaspik Choice Inc Medicare	$119.00

GRAFT VASCULAR V07010L

Facility

$437.50

Service Code	HCPCS C1768
Hospital Charge Code	64901095
Hospital Revenue Code	278
Min. Negotiated Rate	$153.12
Max. Negotiated Rate	$459.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$240.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$262.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$218.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$251.56
Rate for Payer: EmblemHealth Commercial	$218.75
Rate for Payer: Fidelis Medicare Advantage	$459.38
Rate for Payer: Group Health Inc Commercial	$218.75
Rate for Payer: Group Health Inc Medicare	$153.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$218.75
Rate for Payer: Hamaspik Choice Inc Medicare	$218.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$284.38

GRAFT VASCULAR V07010L

Facility

$437.50

Service Code	HCPCS C1768
Hospital Charge Code	64901095
Hospital Revenue Code	278
Min. Negotiated Rate	$218.75
Max. Negotiated Rate	$218.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$218.75
Rate for Payer: Hamaspik Choice Inc Medicare	$218.75

GRAFT VASCULAR V47040L

Facility

$1,220.00

Service Code	HCPCS C1768
Hospital Charge Code	64901090
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$1,281.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$671.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$732.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$610.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$701.50
Rate for Payer: EmblemHealth Commercial	$610.00
Rate for Payer: Fidelis Medicare Advantage	$1,281.00
Rate for Payer: Group Health Inc Commercial	$610.00
Rate for Payer: Group Health Inc Medicare	$427.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$610.00
Rate for Payer: Hamaspik Choice Inc Medicare	$610.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$793.00

GRAFT VASCULAR V47040L

Facility

$1,220.00

Service Code	HCPCS C1768
Hospital Charge Code	64901090
Hospital Revenue Code	278
Min. Negotiated Rate	$610.00
Max. Negotiated Rate	$610.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$610.00
Rate for Payer: Hamaspik Choice Inc Medicare	$610.00

GRAFT ZENITH ILLIA ZSLE-13-74-ZT

Facility

$8,182.50

Service Code	HCPCS C1768
Hospital Charge Code	64905826
Hospital Revenue Code	278
Min. Negotiated Rate	$4,091.25
Max. Negotiated Rate	$4,091.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,091.25
Rate for Payer: Hamaspik Choice Inc Medicare	$4,091.25

GRAFT ZENITH ILLIA ZSLE-13-74-ZT

Facility

$8,182.50

Service Code	HCPCS C1768
Hospital Charge Code	64905826
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$8,591.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,500.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$4,909.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,091.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,704.94
Rate for Payer: EmblemHealth Commercial	$4,091.25
Rate for Payer: Fidelis Medicare Advantage	$8,591.62
Rate for Payer: Group Health Inc Commercial	$4,091.25
Rate for Payer: Group Health Inc Medicare	$2,863.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,091.25
Rate for Payer: Hamaspik Choice Inc Medicare	$4,091.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,318.62

GRAFT ZENITH ILLIA ZSLE-16-74-ZT

Facility

$8,182.50

Service Code	HCPCS C1768
Hospital Charge Code	64905828
Hospital Revenue Code	278
Min. Negotiated Rate	$4,091.25
Max. Negotiated Rate	$4,091.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,091.25
Rate for Payer: Hamaspik Choice Inc Medicare	$4,091.25

GRAFT ZENITH ILLIA ZSLE-16-74-ZT

Facility

$8,182.50

Service Code	HCPCS C1768
Hospital Charge Code	64905828
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$8,591.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,500.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$4,909.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,091.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,704.94
Rate for Payer: EmblemHealth Commercial	$4,091.25
Rate for Payer: Fidelis Medicare Advantage	$8,591.62
Rate for Payer: Group Health Inc Commercial	$4,091.25
Rate for Payer: Group Health Inc Medicare	$2,863.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,091.25
Rate for Payer: Hamaspik Choice Inc Medicare	$4,091.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,318.62

GRAFT ZENITH TFFB-32-82-ZT

Facility

$22,432.50

Service Code	HCPCS C1768
Hospital Charge Code	64905824
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$23,554.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12,337.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$13,459.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11,216.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$12,898.69
Rate for Payer: EmblemHealth Commercial	$11,216.25
Rate for Payer: Fidelis Medicare Advantage	$23,554.12
Rate for Payer: Group Health Inc Commercial	$11,216.25
Rate for Payer: Group Health Inc Medicare	$7,851.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,216.25
Rate for Payer: Hamaspik Choice Inc Medicare	$11,216.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14,581.12

GRAFT ZENITH TFFB-32-82-ZT

Facility

$22,432.50

Service Code	HCPCS C1768
Hospital Charge Code	64905824
Hospital Revenue Code	278
Min. Negotiated Rate	$11,216.25
Max. Negotiated Rate	$11,216.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,216.25
Rate for Payer: Hamaspik Choice Inc Medicare	$11,216.25

GRAFT ZENITH TH ENDO

Facility

$38,750.00

Service Code	HCPCS C1768
Hospital Charge Code	64904852
Hospital Revenue Code	278
Min. Negotiated Rate	$19,375.00
Max. Negotiated Rate	$19,375.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$19,375.00

GRAFT ZENITH TH ENDO

Facility

$38,750.00

Service Code	HCPCS C1768
Hospital Charge Code	64904852
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$40,687.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21,312.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$23,250.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19,375.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$22,281.25
Rate for Payer: EmblemHealth Commercial	$19,375.00
Rate for Payer: Fidelis Medicare Advantage	$40,687.50
Rate for Payer: Group Health Inc Commercial	$19,375.00
Rate for Payer: Group Health Inc Medicare	$13,562.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$19,375.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25,187.50

Know your out-of-pocket cost for care.

All Charges