St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

IMPLANT BREAST PROSTHESIS SILICON

Facility

$1,800.00

Service Code	HCPCS L8600
Hospital Charge Code	40019714
Hospital Revenue Code	278
Min. Negotiated Rate	$326.16
Max. Negotiated Rate	$1,890.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$990.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$326.16
Rate for Payer: Aetna Government	$326.16
Rate for Payer: Brighton Health Commercial	$1,080.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$900.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,035.00
Rate for Payer: EmblemHealth Commercial	$900.00
Rate for Payer: Fidelis Medicare Advantage	$1,890.00
Rate for Payer: Group Health Inc Commercial	$900.00
Rate for Payer: Group Health Inc Medicare	$630.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$900.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,170.00

IMPLANT BREAST PROSTHESIS SILICON

Facility

$1,800.00

Service Code	HCPCS L8600
Hospital Charge Code	40019714
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$900.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$900.00

IMPLANT BRIGADE 14X34X24 12

Facility

$17,490.00

Hospital Charge Code	64905329
Hospital Revenue Code	272
Min. Negotiated Rate	$6,121.50
Max. Negotiated Rate	$13,992.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9,619.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8,745.00
Rate for Payer: Aetna Government	$8,745.00
Rate for Payer: Brighton Health Commercial	$13,117.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13,992.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$11,893.20
Rate for Payer: Group Health Inc Commercial	$8,745.00
Rate for Payer: Group Health Inc Medicare	$6,121.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,745.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8,745.00

IMPLANT CAGE PIVOX 12X50X6

Facility

$13,750.00

Hospital Charge Code	64905859
Hospital Revenue Code	272
Min. Negotiated Rate	$4,812.50
Max. Negotiated Rate	$11,000.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7,562.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,875.00
Rate for Payer: Aetna Government	$6,875.00
Rate for Payer: Brighton Health Commercial	$10,312.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$9,350.00
Rate for Payer: Group Health Inc Commercial	$6,875.00
Rate for Payer: Group Health Inc Medicare	$4,812.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,875.00

IMPLANT CONNECTING BAR

Facility

$1,000.00

Service Code	HCPCS D6055
Hospital Charge Code	42301430
Hospital Revenue Code	361
Min. Negotiated Rate	$202.08
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$550.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$202.08
Rate for Payer: Aetna Government	$202.08
Rate for Payer: Brighton Health Commercial	$750.00
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	$500.00
Rate for Payer: Group Health Inc Medicare	$350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$500.00

IMPLANT CONTAGEN

Facility

$700.00

Service Code	HCPCS C1762
Hospital Charge Code	40201112
Hospital Revenue Code	278
Min. Negotiated Rate	$350.00
Max. Negotiated Rate	$350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00

IMPLANT CONTAGEN

Facility

$700.00

Service Code	HCPCS C1762
Hospital Charge Code	40201112
Hospital Revenue Code	278
Min. Negotiated Rate	$245.00
Max. Negotiated Rate	$1,879.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$385.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,879.82
Rate for Payer: Aetna Government	$1,879.82
Rate for Payer: Brighton Health Commercial	$420.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$402.50
Rate for Payer: EmblemHealth Commercial	$350.00
Rate for Payer: Fidelis Medicare Advantage	$735.00
Rate for Payer: Group Health Inc Commercial	$350.00
Rate for Payer: Group Health Inc Medicare	$245.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$455.00

IMPLANT CONTOUR LG SELECT

Facility

$11,474.00

Hospital Charge Code	64906944
Hospital Revenue Code	272
Min. Negotiated Rate	$4,015.90
Max. Negotiated Rate	$9,179.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,310.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,737.00
Rate for Payer: Aetna Government	$5,737.00
Rate for Payer: Brighton Health Commercial	$8,605.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9,179.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,802.32
Rate for Payer: Group Health Inc Commercial	$5,737.00
Rate for Payer: Group Health Inc Medicare	$4,015.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,737.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,737.00

IMPLANT, CUSTOM CRAIN TT LEFT LRG

Facility

$5,962.50

Service Code	HCPCS C1713
Hospital Charge Code	64905671
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,260.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,279.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,577.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,981.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,428.44
Rate for Payer: EmblemHealth Commercial	$2,981.25
Rate for Payer: Fidelis Medicare Advantage	$6,260.62
Rate for Payer: Group Health Inc Commercial	$2,981.25
Rate for Payer: Group Health Inc Medicare	$2,086.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,981.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,981.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,875.62

IMPLANT, CUSTOM CRAIN TT LEFT LRG

Facility

$5,962.50

Service Code	HCPCS C1713
Hospital Charge Code	64905671
Hospital Revenue Code	278
Min. Negotiated Rate	$2,981.25
Max. Negotiated Rate	$2,981.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,981.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,981.25

IMPLANT DERMSPN SM MD-HT 250-300

Facility

$1,150.00

Service Code	HCPCS C1789
Hospital Charge Code	64906448
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,207.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$632.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$690.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$575.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$661.25
Rate for Payer: EmblemHealth Commercial	$575.00
Rate for Payer: Fidelis Medicare Advantage	$1,207.50
Rate for Payer: Group Health Inc Commercial	$575.00
Rate for Payer: Group Health Inc Medicare	$402.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$747.50

IMPLANT DERMSPN SM MD-HT 250-300

Facility

$1,150.00

Service Code	HCPCS C1789
Hospital Charge Code	64906448
Hospital Revenue Code	278
Min. Negotiated Rate	$575.00
Max. Negotiated Rate	$575.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00

IMPLANT DERMSPN SM MD-HT 310-370

Facility

$1,150.00

Service Code	HCPCS C1789
Hospital Charge Code	64906449
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,207.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$632.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$690.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$575.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$661.25
Rate for Payer: EmblemHealth Commercial	$575.00
Rate for Payer: Fidelis Medicare Advantage	$1,207.50
Rate for Payer: Group Health Inc Commercial	$575.00
Rate for Payer: Group Health Inc Medicare	$402.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$747.50

IMPLANT DERMSPN SM MD-HT 310-370

Facility

$1,150.00

Service Code	HCPCS C1789
Hospital Charge Code	64906449
Hospital Revenue Code	278
Min. Negotiated Rate	$575.00
Max. Negotiated Rate	$575.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00

IMPLANT DERMSPN SM MD-HT 380-450

Facility

$2,300.00

Service Code	HCPCS C1789
Hospital Charge Code	64906450
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$2,415.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,265.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,380.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,322.50
Rate for Payer: EmblemHealth Commercial	$1,150.00
Rate for Payer: Fidelis Medicare Advantage	$2,415.00
Rate for Payer: Group Health Inc Commercial	$1,150.00
Rate for Payer: Group Health Inc Medicare	$805.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,495.00

IMPLANT DERMSPN SM MD-HT 380-450

Facility

$2,300.00

Service Code	HCPCS C1789
Hospital Charge Code	64906450
Hospital Revenue Code	278
Min. Negotiated Rate	$1,150.00
Max. Negotiated Rate	$1,150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,150.00

IMPLANT DERMSPN SM MD-HT 460-550

Facility

$2,875.00

Service Code	HCPCS C1789
Hospital Charge Code	64906451
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$3,018.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,581.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,725.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,437.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,653.12
Rate for Payer: EmblemHealth Commercial	$1,437.50
Rate for Payer: Fidelis Medicare Advantage	$3,018.75
Rate for Payer: Group Health Inc Commercial	$1,437.50
Rate for Payer: Group Health Inc Medicare	$1,006.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,437.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,437.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,868.75

IMPLANT DERMSPN SM MD-HT 460-550

Facility

$2,875.00

Service Code	HCPCS C1789
Hospital Charge Code	64906451
Hospital Revenue Code	278
Min. Negotiated Rate	$1,437.50
Max. Negotiated Rate	$1,437.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,437.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,437.50

IMPLANT DERMSPN SM MD-HT 500-600

Facility

$1,150.00

Service Code	HCPCS C1789
Hospital Charge Code	64906452
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,207.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$632.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$690.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$575.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$661.25
Rate for Payer: EmblemHealth Commercial	$575.00
Rate for Payer: Fidelis Medicare Advantage	$1,207.50
Rate for Payer: Group Health Inc Commercial	$575.00
Rate for Payer: Group Health Inc Medicare	$402.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$747.50

IMPLANT DERMSPN SM MD-HT 500-600

Facility

$1,150.00

Service Code	HCPCS C1789
Hospital Charge Code	64906452
Hospital Revenue Code	278
Min. Negotiated Rate	$575.00
Max. Negotiated Rate	$575.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00

IMPLANT DERMSPN SM MD-HT 580-690

Facility

$1,150.00

Service Code	HCPCS C1789
Hospital Charge Code	64906453
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,207.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$632.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$690.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$575.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$661.25
Rate for Payer: EmblemHealth Commercial	$575.00
Rate for Payer: Fidelis Medicare Advantage	$1,207.50
Rate for Payer: Group Health Inc Commercial	$575.00
Rate for Payer: Group Health Inc Medicare	$402.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$747.50

IMPLANT DERMSPN SM MD-HT 580-690

Facility

$1,150.00

Service Code	HCPCS C1789
Hospital Charge Code	64906453
Hospital Revenue Code	278
Min. Negotiated Rate	$575.00
Max. Negotiated Rate	$575.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00

IMPLANT FACIAL ID ORTHOG -3 PLATE

Facility

$21,832.02

Hospital Charge Code	64907476
Hospital Revenue Code	279
Min. Negotiated Rate	$7,641.21
Max. Negotiated Rate	$17,465.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12,007.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10,916.01
Rate for Payer: Aetna Government	$10,916.01
Rate for Payer: Brighton Health Commercial	$16,374.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17,465.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$14,845.77
Rate for Payer: Group Health Inc Commercial	$10,916.01
Rate for Payer: Group Health Inc Medicare	$7,641.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,916.01
Rate for Payer: Hamaspik Choice Inc Medicare	$10,916.01

IMPLANT FBLCKLFT3.8X130(AR-8973L

Facility

$5,990.00

Service Code	HCPCS C1776
Hospital Charge Code	64906564
Hospital Revenue Code	278
Min. Negotiated Rate	$2,995.00
Max. Negotiated Rate	$2,995.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,995.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,995.00

IMPLANT FBLCKLFT3.8X130(AR-8973L

Facility

$5,990.00

Service Code	HCPCS C1776
Hospital Charge Code	64906564
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,289.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,294.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,594.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,995.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,444.25
Rate for Payer: EmblemHealth Commercial	$2,995.00
Rate for Payer: Fidelis Medicare Advantage	$6,289.50
Rate for Payer: Group Health Inc Commercial	$2,995.00
Rate for Payer: Group Health Inc Medicare	$2,096.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,995.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,995.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,893.50

Know your out-of-pocket cost for care.

All Charges