St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

IMPLANTABLE LOOP RECORDER SYSTEM

Facility

$69.63

Service Code	HCPCS 93291 TC
Hospital Charge Code	30305903
Hospital Revenue Code	480
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$34.43
Rate for Payer: Aetna Government	$34.43
Rate for Payer: Affinity Essential Plan 1&2	$24.10
Rate for Payer: Affinity Essential Plan 3&4	$24.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$24.10
Rate for Payer: Brighton Health Commercial	$52.22
Rate for Payer: Cash Price	$34.43
Rate for Payer: Cash Price	$34.43
Rate for Payer: Cash Price	$34.43
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$34.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$55.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.35
Rate for Payer: Elderplan Medicare Advantage	$34.43
Rate for Payer: EmblemHealth Commercial	$34.43
Rate for Payer: Fidelis Essential Plan Aliesa	$29.27
Rate for Payer: Fidelis Essential Plan QHP	$30.64
Rate for Payer: Fidelis Medicare Advantage	$34.43
Rate for Payer: Fidelis Qualified Health Plan	$30.64
Rate for Payer: Group Health Inc Commercial	$34.43
Rate for Payer: Group Health Inc Medicare	$34.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.82
Rate for Payer: Hamaspik Choice Inc Medicare	$34.43
Rate for Payer: Healthfirst Medicare Advantage	$29.27
Rate for Payer: Healthfirst QHP	$34.43
Rate for Payer: Humana Medicare	$35.12
Rate for Payer: Senior Whole Health Medicare Advantage	$34.43
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare Medicare Advantage	$34.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34.43
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27.54
Rate for Payer: Wellcare Medicare	$32.71

IMPLANTABLE LOOP RECORDER SYSTEM

Facility

$69.63

Service Code	HCPCS 93291 TC
Hospital Charge Code	30305903
Hospital Revenue Code	480
Rate for Payer: Cash Price	$34.43

IMPLANT ABUT. SUPPORT PORC. CROWN

Facility

$2,000.00

Service Code	HCPCS D6058
Hospital Charge Code	42303321
Hospital Revenue Code	361
Min. Negotiated Rate	$387.42
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,100.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$387.42
Rate for Payer: Aetna Government	$387.42
Rate for Payer: Brighton Health Commercial	$1,500.00
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: Group Health Inc Commercial	$1,000.00
Rate for Payer: Group Health Inc Medicare	$700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00

IMPLANT BREAST 375CC

Facility

$1,962.50

Service Code	HCPCS C1789
Hospital Charge Code	64902638
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

IMPLANT BREAST 375CC

Facility

$1,962.50

Service Code	HCPCS C1789
Hospital Charge Code	64902638
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

IMPLANT BREAST 425CC

Facility

$1,962.50

Service Code	HCPCS C1789
Hospital Charge Code	64902640
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

IMPLANT BREAST 425CC

Facility

$1,962.50

Service Code	HCPCS C1789
Hospital Charge Code	64902640
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

IMPLANT BREAST CC 10721 MP

Facility

$1,790.00

Service Code	HCPCS C1789
Hospital Charge Code	64906671
Hospital Revenue Code	278
Min. Negotiated Rate	$895.00
Max. Negotiated Rate	$895.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$895.00
Rate for Payer: Hamaspik Choice Inc Medicare	$895.00

IMPLANT BREAST CC 10721 MP

Facility

$1,790.00

Service Code	HCPCS C1789
Hospital Charge Code	64906671
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,879.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$984.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,074.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$895.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,029.25
Rate for Payer: EmblemHealth Commercial	$895.00
Rate for Payer: Fidelis Medicare Advantage	$1,879.50
Rate for Payer: Group Health Inc Commercial	$895.00
Rate for Payer: Group Health Inc Medicare	$626.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$895.00
Rate for Payer: Hamaspik Choice Inc Medicare	$895.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,163.50

IMPLANT BREAST GEL HIGH 350CC

Facility

$2,450.00

Service Code	HCPCS C1789
Hospital Charge Code	64902694
Hospital Revenue Code	278
Min. Negotiated Rate	$1,225.00
Max. Negotiated Rate	$1,225.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,225.00

IMPLANT BREAST GEL HIGH 350CC

Facility

$2,450.00

Service Code	HCPCS C1789
Hospital Charge Code	64902694
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$2,572.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,347.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,470.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,225.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,408.75
Rate for Payer: EmblemHealth Commercial	$1,225.00
Rate for Payer: Fidelis Medicare Advantage	$2,572.50
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
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,592.50

IMPLANT BREAST GEL HIGH 800CC

Facility

$1,962.50

Service Code	HCPCS C1789
Hospital Charge Code	64902696
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

IMPLANT BREAST GEL HIGH 800CC

Facility

$1,962.50

Service Code	HCPCS C1789
Hospital Charge Code	64902696
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

IMPLANT BREAST GEL HIGH PRO 650CC

Facility

$2,450.00

Service Code	HCPCS C1789
Hospital Charge Code	64902637
Hospital Revenue Code	278
Min. Negotiated Rate	$1,225.00
Max. Negotiated Rate	$1,225.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,225.00

IMPLANT BREAST GEL HIGH PRO 650CC

Facility

$2,450.00

Service Code	HCPCS C1789
Hospital Charge Code	64902637
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$2,572.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,347.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,470.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,225.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,408.75
Rate for Payer: EmblemHealth Commercial	$1,225.00
Rate for Payer: Fidelis Medicare Advantage	$2,572.50
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
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,592.50

IMPLANT BREAST GEL MOD 500CC

Facility

$1,962.50

Service Code	HCPCS C1789
Hospital Charge Code	64902690
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

IMPLANT BREAST GEL MOD 500CC

Facility

$1,962.50

Service Code	HCPCS C1789
Hospital Charge Code	64902690
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

IMPLANT BREAST GEL MOD 700CC

Facility

$2,312.50

Service Code	HCPCS C1789
Hospital Charge Code	64902692
Hospital Revenue Code	278
Min. Negotiated Rate	$1,156.25
Max. Negotiated Rate	$1,156.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,156.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,156.25

IMPLANT BREAST GEL MOD 700CC

Facility

$2,312.50

Service Code	HCPCS C1789
Hospital Charge Code	64902692
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$2,428.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,271.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,387.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,156.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,329.69
Rate for Payer: EmblemHealth Commercial	$1,156.25
Rate for Payer: Fidelis Medicare Advantage	$2,428.12
Rate for Payer: Group Health Inc Commercial	$1,156.25
Rate for Payer: Group Health Inc Medicare	$809.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,156.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,156.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,503.12

IMPLANT BREAST GEL SM RD MOD A

Facility

$1,962.50

Service Code	HCPCS C1789
Hospital Charge Code	64902254
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

IMPLANT BREAST GEL SM RD MOD A

Facility

$1,962.50

Service Code	HCPCS C1789
Hospital Charge Code	64902254
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

IMPLANT BREAST GEL SM RD MOD B

Facility

$1,962.50

Service Code	HCPCS C1789
Hospital Charge Code	64902255
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

IMPLANT BREAST GEL SM RD MOD B

Facility

$1,962.50

Service Code	HCPCS C1789
Hospital Charge Code	64902255
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

IMPLANT BREAST GEL SM RD MOD C

Facility

$1,962.50

Service Code	HCPCS C1789
Hospital Charge Code	64902257
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

IMPLANT BREAST GEL SM RD MOD C

Facility

$1,962.50

Service Code	HCPCS C1789
Hospital Charge Code	64902257
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

Know your out-of-pocket cost for care.

All Charges