St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LOMBARD TEST

Facility

$69.63

Service Code	HCPCS 92700
Hospital Charge Code	42004508
Hospital Revenue Code	471
Rate for Payer: Cash Price	$34.43

LOMBARD TEST

Facility

$69.63

Service Code	HCPCS 92700
Hospital Charge Code	42004508
Hospital Revenue Code	471
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$158.00
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	$158.00
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

LONESTAR RETRACTOR SYSTEM

Facility

$271.79

Hospital Charge Code	64905823
Hospital Revenue Code	270
Min. Negotiated Rate	$95.13
Max. Negotiated Rate	$217.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$149.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$135.90
Rate for Payer: Aetna Government	$135.90
Rate for Payer: Brighton Health Commercial	$203.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.82
Rate for Payer: Group Health Inc Commercial	$135.90
Rate for Payer: Group Health Inc Medicare	$95.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$135.90
Rate for Payer: Hamaspik Choice Inc Medicare	$135.90

LONG CALIBRATED DRILL 4.9MM

Facility

$293.76

Service Code	HCPCS C1713
Hospital Charge Code	40006464
Hospital Revenue Code	278
Min. Negotiated Rate	$146.88
Max. Negotiated Rate	$146.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.88
Rate for Payer: Hamaspik Choice Inc Medicare	$146.88

LONG CALIBRATED DRILL 4.9MM

Facility

$293.76

Service Code	HCPCS C1713
Hospital Charge Code	40006464
Hospital Revenue Code	278
Min. Negotiated Rate	$102.82
Max. Negotiated Rate	$308.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$161.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$176.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$146.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$168.91
Rate for Payer: EmblemHealth Commercial	$146.88
Rate for Payer: Fidelis Medicare Advantage	$308.45
Rate for Payer: Group Health Inc Commercial	$146.88
Rate for Payer: Group Health Inc Medicare	$102.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.88
Rate for Payer: Hamaspik Choice Inc Medicare	$146.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$190.94

LONG CALI DRILL 4.9MM CANN

Facility

$1,555.20

Service Code	HCPCS C1713
Hospital Charge Code	40006465
Hospital Revenue Code	278
Min. Negotiated Rate	$777.60
Max. Negotiated Rate	$777.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$777.60
Rate for Payer: Hamaspik Choice Inc Medicare	$777.60

LONG CALI DRILL 4.9MM CANN

Facility

$1,555.20

Service Code	HCPCS C1713
Hospital Charge Code	40006465
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,632.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$855.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$933.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$777.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$894.24
Rate for Payer: EmblemHealth Commercial	$777.60
Rate for Payer: Fidelis Medicare Advantage	$1,632.96
Rate for Payer: Group Health Inc Commercial	$777.60
Rate for Payer: Group Health Inc Medicare	$544.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$777.60
Rate for Payer: Hamaspik Choice Inc Medicare	$777.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,010.88

LONG CEMENTED STEM

Facility

$8,208.00

Service Code	HCPCS C1713
Hospital Charge Code	40201190
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$8,618.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,514.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,924.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,104.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,719.60
Rate for Payer: EmblemHealth Commercial	$4,104.00
Rate for Payer: Fidelis Medicare Advantage	$8,618.40
Rate for Payer: Group Health Inc Commercial	$4,104.00
Rate for Payer: Group Health Inc Medicare	$2,872.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,104.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,104.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,335.20

LONG CEMENTED STEM

Facility

$8,208.00

Service Code	HCPCS C1713
Hospital Charge Code	40201190
Hospital Revenue Code	278
Min. Negotiated Rate	$4,104.00
Max. Negotiated Rate	$4,104.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,104.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,104.00

LONG NAIL 11 X 420 MM

Facility

$3,146.00

Service Code	HCPCS C1713
Hospital Charge Code	40201191
Hospital Revenue Code	278
Min. Negotiated Rate	$1,573.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,573.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,573.00

LONG NAIL 11 X 420 MM

Facility

$3,146.00

Service Code	HCPCS C1713
Hospital Charge Code	40201191
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,303.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,730.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,887.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,573.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,808.95
Rate for Payer: EmblemHealth Commercial	$1,573.00
Rate for Payer: Fidelis Medicare Advantage	$3,303.30
Rate for Payer: Group Health Inc Commercial	$1,573.00
Rate for Payer: Group Health Inc Medicare	$1,101.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,573.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,573.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,044.90

LONG STRUT

Facility

$4,562.50

Hospital Charge Code	64903985
Hospital Revenue Code	279
Min. Negotiated Rate	$1,596.88
Max. Negotiated Rate	$3,650.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,509.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,281.25
Rate for Payer: Aetna Government	$2,281.25
Rate for Payer: Brighton Health Commercial	$3,421.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,650.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,102.50
Rate for Payer: Group Health Inc Commercial	$2,281.25
Rate for Payer: Group Health Inc Medicare	$1,596.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,281.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,281.25

LOOP CUTTING MONO POLAR 24 FR

Facility

$358.06

Hospital Charge Code	64906759
Hospital Revenue Code	279
Min. Negotiated Rate	$125.32
Max. Negotiated Rate	$286.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$196.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$179.03
Rate for Payer: Aetna Government	$179.03
Rate for Payer: Brighton Health Commercial	$268.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$286.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$243.48
Rate for Payer: Group Health Inc Commercial	$179.03
Rate for Payer: Group Health Inc Medicare	$125.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.03
Rate for Payer: Hamaspik Choice Inc Medicare	$179.03

LOOP OSTOMY ROD 90MM

Facility

$8.00

Hospital Charge Code	64904384
Hospital Revenue Code	270
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$6.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.00
Rate for Payer: Aetna Government	$4.00
Rate for Payer: Brighton Health Commercial	$6.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.44
Rate for Payer: Group Health Inc Commercial	$4.00
Rate for Payer: Group Health Inc Medicare	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00

LOOPS BLUE MAXI

Facility

$13.99

Hospital Charge Code	64902707
Hospital Revenue Code	270
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$11.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.00
Rate for Payer: Aetna Government	$7.00
Rate for Payer: Brighton Health Commercial	$10.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.51
Rate for Payer: Group Health Inc Commercial	$7.00
Rate for Payer: Group Health Inc Medicare	$4.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00

LOOPS BLUE MAXI#01-1-012

Facility

$13.50

Hospital Charge Code	40200495
Hospital Revenue Code	270
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$10.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.75
Rate for Payer: Aetna Government	$6.75
Rate for Payer: Brighton Health Commercial	$10.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.18
Rate for Payer: Group Health Inc Commercial	$6.75
Rate for Payer: Group Health Inc Medicare	$4.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.75
Rate for Payer: Hamaspik Choice Inc Medicare	$6.75

LOOPS RED MINI#01-1-001

Facility

$12.26

Hospital Charge Code	40200496
Hospital Revenue Code	270
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$9.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.13
Rate for Payer: Aetna Government	$6.13
Rate for Payer: Brighton Health Commercial	$9.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.34
Rate for Payer: Group Health Inc Commercial	$6.13
Rate for Payer: Group Health Inc Medicare	$4.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.13
Rate for Payer: Hamaspik Choice Inc Medicare	$6.13

LOOP STENT URETERAL 5FRX20CM

Facility

$358.00

Service Code	HCPCS C2617
Hospital Charge Code	40209677
Hospital Revenue Code	278
Min. Negotiated Rate	$179.00
Max. Negotiated Rate	$179.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00
Rate for Payer: Hamaspik Choice Inc Medicare	$179.00

LOOP STENT URETERAL 5FRX20CM

Facility

$358.00

Service Code	HCPCS C2617
Hospital Charge Code	40209677
Hospital Revenue Code	278
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$375.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$196.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.14
Rate for Payer: Aetna Government	$10.14
Rate for Payer: Brighton Health Commercial	$214.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$179.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$205.85
Rate for Payer: EmblemHealth Commercial	$179.00
Rate for Payer: Fidelis Medicare Advantage	$375.90
Rate for Payer: Group Health Inc Commercial	$179.00
Rate for Payer: Group Health Inc Medicare	$125.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00
Rate for Payer: Hamaspik Choice Inc Medicare	$179.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$232.70

LOOP STENT URETERAL 5FRX24CM

Facility

$358.00

Service Code	HCPCS C2617
Hospital Charge Code	40209678
Hospital Revenue Code	278
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$375.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$196.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.14
Rate for Payer: Aetna Government	$10.14
Rate for Payer: Brighton Health Commercial	$214.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$179.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$205.85
Rate for Payer: EmblemHealth Commercial	$179.00
Rate for Payer: Fidelis Medicare Advantage	$375.90
Rate for Payer: Group Health Inc Commercial	$179.00
Rate for Payer: Group Health Inc Medicare	$125.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00
Rate for Payer: Hamaspik Choice Inc Medicare	$179.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$232.70

LOOP STENT URETERAL 5FRX24CM

Facility

$358.00

Service Code	HCPCS C2617
Hospital Charge Code	40209678
Hospital Revenue Code	278
Min. Negotiated Rate	$179.00
Max. Negotiated Rate	$179.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00
Rate for Payer: Hamaspik Choice Inc Medicare	$179.00

LOOP STENT URETERAL 6FRX22CM

Facility

$370.00

Service Code	HCPCS C2617
Hospital Charge Code	40209679
Hospital Revenue Code	278
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$388.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$203.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.14
Rate for Payer: Aetna Government	$10.14
Rate for Payer: Brighton Health Commercial	$222.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$185.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$212.75
Rate for Payer: EmblemHealth Commercial	$185.00
Rate for Payer: Fidelis Medicare Advantage	$388.50
Rate for Payer: Group Health Inc Commercial	$185.00
Rate for Payer: Group Health Inc Medicare	$129.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.00
Rate for Payer: Hamaspik Choice Inc Medicare	$185.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$240.50

LOOP STENT URETERAL 6FRX22CM

Facility

$370.00

Service Code	HCPCS C2617
Hospital Charge Code	40209679
Hospital Revenue Code	278
Min. Negotiated Rate	$185.00
Max. Negotiated Rate	$185.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.00
Rate for Payer: Hamaspik Choice Inc Medicare	$185.00

LOOPS VESSEL 1.3MM RED MINI ST

Facility

$14.04

Hospital Charge Code	64902705
Hospital Revenue Code	270
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$11.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.02
Rate for Payer: Aetna Government	$7.02
Rate for Payer: Brighton Health Commercial	$10.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.55
Rate for Payer: Group Health Inc Commercial	$7.02
Rate for Payer: Group Health Inc Medicare	$4.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.02
Rate for Payer: Hamaspik Choice Inc Medicare	$7.02

LOPERAMIDE 0.2 MG/ML LIQUID

Facility

$4.00

Hospital Charge Code	41641235
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

Know your out-of-pocket cost for care.

All Charges