St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

Maternity Normal Delivery

Facility

$5,045.00

Service Code	MSDRG 792
Min. Negotiated Rate	$5,045.00
Max. Negotiated Rate	$5,045.00
Rate for Payer: EmblemHealth Commercial	$5,045.00

Maternity Normal Delivery

Facility

$5,045.00

Service Code	MSDRG 794
Min. Negotiated Rate	$5,045.00
Max. Negotiated Rate	$5,045.00
Rate for Payer: EmblemHealth Commercial	$5,045.00

Maternity Normal Delivery

Facility

$5,045.00

Service Code	MSDRG 791
Min. Negotiated Rate	$5,045.00
Max. Negotiated Rate	$5,045.00
Rate for Payer: EmblemHealth Commercial	$5,045.00

Maternity Normal Delivery

Facility

$5,045.00

Service Code	MSDRG 793
Min. Negotiated Rate	$5,045.00
Max. Negotiated Rate	$5,045.00
Rate for Payer: EmblemHealth Commercial	$5,045.00

Maternity Normal Delivery

Facility

$5,045.00

Service Code	MSDRG 790
Min. Negotiated Rate	$5,045.00
Max. Negotiated Rate	$5,045.00
Rate for Payer: EmblemHealth Commercial	$5,045.00

MAT/FETAL, 1ST TRI, 1 FETUS

Facility

$339.45

Service Code	HCPCS 76801 TC
Hospital Charge Code	30301262
Hospital Revenue Code	402
Min. Negotiated Rate	$77.02
Max. Negotiated Rate	$192.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.14
Rate for Payer: Aetna Government	$127.14
Rate for Payer: Affinity Essential Plan 1&2	$89.00
Rate for Payer: Affinity Essential Plan 3&4	$89.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$89.00
Rate for Payer: Brighton Health Commercial	$127.14
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cash Price	$127.14
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$192.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.05
Rate for Payer: Elderplan Medicare Advantage	$127.14
Rate for Payer: EmblemHealth Commercial	$89.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$108.07
Rate for Payer: Fidelis Essential Plan Aliesa	$108.07
Rate for Payer: Fidelis Essential Plan QHP	$113.15
Rate for Payer: Fidelis Medicare Advantage	$127.14
Rate for Payer: Fidelis Qualified Health Plan	$113.15
Rate for Payer: Group Health Inc Commercial	$114.43
Rate for Payer: Group Health Inc Medicare	$114.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$127.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$114.43
Rate for Payer: Healthfirst Medicare Advantage	$127.14
Rate for Payer: Healthfirst QHP	$127.14
Rate for Payer: Humana Medicare	$129.68
Rate for Payer: Senior Whole Health Medicare Advantage	$127.14
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: United Healthcare Medicare Advantage	$127.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$127.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$101.71
Rate for Payer: Wellcare Medicare	$120.78

MAT/FETAL, 1ST TRI, 1 FETUS

Facility

$339.45

Service Code	HCPCS 76801 TC
Hospital Charge Code	30301262
Hospital Revenue Code	402
Rate for Payer: Cash Price	$127.14

MAT/FETAL, 1ST TRI, ADD FETUS

Facility

$169.73

Service Code	HCPCS 76802 TC
Hospital Charge Code	30301263
Hospital Revenue Code	402
Min. Negotiated Rate	$17.57
Max. Negotiated Rate	$127.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.57
Rate for Payer: Aetna Government	$17.57
Rate for Payer: Brighton Health Commercial	$127.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$124.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.41
Rate for Payer: Group Health Inc Commercial	$84.86
Rate for Payer: Group Health Inc Medicare	$59.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$84.86
Rate for Payer: Hamaspik Choice Inc Medicare	$84.86
Rate for Payer: United Healthcare Commercial	$49.80

MAT.FETAL, TRI 2-3, ADD FETUS

Facility

$169.73

Service Code	HCPCS 76810 TC
Hospital Charge Code	30301264
Hospital Revenue Code	402
Min. Negotiated Rate	$34.03
Max. Negotiated Rate	$192.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$34.03
Rate for Payer: Aetna Government	$34.03
Rate for Payer: Brighton Health Commercial	$127.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$192.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.05
Rate for Payer: Group Health Inc Commercial	$84.86
Rate for Payer: Group Health Inc Medicare	$59.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$84.86
Rate for Payer: Hamaspik Choice Inc Medicare	$84.86
Rate for Payer: United Healthcare Commercial	$77.02

MAT INSTRUMENT TRAY

Facility

$165.70

Hospital Charge Code	64903835
Hospital Revenue Code	270
Min. Negotiated Rate	$58.00
Max. Negotiated Rate	$132.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$82.85
Rate for Payer: Aetna Government	$82.85
Rate for Payer: Brighton Health Commercial	$124.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$132.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$112.68
Rate for Payer: Group Health Inc Commercial	$82.85
Rate for Payer: Group Health Inc Medicare	$58.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.85
Rate for Payer: Hamaspik Choice Inc Medicare	$82.85

MA TRANS/PORTABLE MAMMO

Facility

$70.88

Service Code	HCPCS R0075
Hospital Charge Code	41107720
Hospital Revenue Code	969
Min. Negotiated Rate	$20.10
Max. Negotiated Rate	$56.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.10
Rate for Payer: Aetna Government	$20.10
Rate for Payer: Brighton Health Commercial	$53.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.20
Rate for Payer: Group Health Inc Commercial	$35.44
Rate for Payer: Group Health Inc Medicare	$24.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.44
Rate for Payer: Hamaspik Choice Inc Medicare	$35.44

MATRIX 6HOLE MALL PLATE 3X3 1.0MM

Facility

$360.00

Service Code	HCPCS C1713
Hospital Charge Code	40209880
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$180.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$180.00
Rate for Payer: Hamaspik Choice Inc Medicare	$180.00

MATRIX 6HOLE MALL PLATE 3X3 1.0MM

Facility

$360.00

Service Code	HCPCS C1713
Hospital Charge Code	40209880
Hospital Revenue Code	278
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$378.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$198.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$216.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$180.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$207.00
Rate for Payer: EmblemHealth Commercial	$180.00
Rate for Payer: Fidelis Medicare Advantage	$378.00
Rate for Payer: Group Health Inc Commercial	$180.00
Rate for Payer: Group Health Inc Medicare	$126.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$180.00
Rate for Payer: Hamaspik Choice Inc Medicare	$180.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$234.00

MATRIX COLL SURGIMEND 20X30CM

Facility

$20,400.00

Service Code	HCPCS C1762
Hospital Charge Code	40205092
Hospital Revenue Code	278
Min. Negotiated Rate	$10,200.00
Max. Negotiated Rate	$10,200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10,200.00

MATRIX COLL SURGIMEND 20X30CM

Facility

$20,400.00

Service Code	HCPCS C1762
Hospital Charge Code	40205092
Hospital Revenue Code	278
Min. Negotiated Rate	$1,879.82
Max. Negotiated Rate	$21,420.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11,220.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,879.82
Rate for Payer: Aetna Government	$1,879.82
Rate for Payer: Brighton Health Commercial	$12,240.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$11,730.00
Rate for Payer: EmblemHealth Commercial	$10,200.00
Rate for Payer: Fidelis Medicare Advantage	$21,420.00
Rate for Payer: Group Health Inc Commercial	$10,200.00
Rate for Payer: Group Health Inc Medicare	$7,140.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10,200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13,260.00

MAX ASPIRATION TUBING

Facility

$900.00

Hospital Charge Code	41103923
Hospital Revenue Code	272
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$720.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$495.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$450.00
Rate for Payer: Aetna Government	$450.00
Rate for Payer: Brighton Health Commercial	$675.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$720.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$612.00
Rate for Payer: Group Health Inc Commercial	$450.00
Rate for Payer: Group Health Inc Medicare	$315.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$450.00

MAX CANITER TUBE/FILTER NON-STERI

Facility

$900.00

Hospital Charge Code	41103924
Hospital Revenue Code	270
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$720.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$495.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$450.00
Rate for Payer: Aetna Government	$450.00
Rate for Payer: Brighton Health Commercial	$675.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$720.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$612.00
Rate for Payer: Group Health Inc Commercial	$450.00
Rate for Payer: Group Health Inc Medicare	$315.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$450.00

MAX CAST PLUS

Facility

$12.05

Hospital Charge Code	40200070
Hospital Revenue Code	270
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$9.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.02
Rate for Payer: Aetna Government	$6.02
Rate for Payer: Brighton Health Commercial	$9.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.19
Rate for Payer: Group Health Inc Commercial	$6.02
Rate for Payer: Group Health Inc Medicare	$4.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.02
Rate for Payer: Hamaspik Choice Inc Medicare	$6.02

MAXCESS 4 KIT

Facility

$5,229.63

Hospital Charge Code	64905774
Hospital Revenue Code	270
Min. Negotiated Rate	$1,830.37
Max. Negotiated Rate	$4,183.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,876.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,614.82
Rate for Payer: Aetna Government	$2,614.82
Rate for Payer: Brighton Health Commercial	$3,922.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,183.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,556.15
Rate for Payer: Group Health Inc Commercial	$2,614.82
Rate for Payer: Group Health Inc Medicare	$1,830.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,614.82
Rate for Payer: Hamaspik Choice Inc Medicare	$2,614.82

MAXFIRE MARXMAN CURVED

Facility

$824.00

Service Code	HCPCS C1776
Hospital Charge Code	40208123
Hospital Revenue Code	278
Min. Negotiated Rate	$288.40
Max. Negotiated Rate	$865.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$453.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$494.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$412.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$473.80
Rate for Payer: EmblemHealth Commercial	$412.00
Rate for Payer: Fidelis Medicare Advantage	$865.20
Rate for Payer: Group Health Inc Commercial	$412.00
Rate for Payer: Group Health Inc Medicare	$288.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$412.00
Rate for Payer: Hamaspik Choice Inc Medicare	$412.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$535.60

MAXFIRE MARXMAN CURVED

Facility

$824.00

Service Code	HCPCS C1776
Hospital Charge Code	40208123
Hospital Revenue Code	278
Min. Negotiated Rate	$412.00
Max. Negotiated Rate	$412.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$412.00
Rate for Payer: Hamaspik Choice Inc Medicare	$412.00

MAXFIRE MARXMAN STRAIGHT

Facility

$824.00

Service Code	HCPCS C1776
Hospital Charge Code	40208122
Hospital Revenue Code	278
Min. Negotiated Rate	$288.40
Max. Negotiated Rate	$865.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$453.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$494.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$412.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$473.80
Rate for Payer: EmblemHealth Commercial	$412.00
Rate for Payer: Fidelis Medicare Advantage	$865.20
Rate for Payer: Group Health Inc Commercial	$412.00
Rate for Payer: Group Health Inc Medicare	$288.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$412.00
Rate for Payer: Hamaspik Choice Inc Medicare	$412.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$535.60

MAXFIRE MARXMAN STRAIGHT

Facility

$824.00

Service Code	HCPCS C1776
Hospital Charge Code	40208122
Hospital Revenue Code	278
Min. Negotiated Rate	$412.00
Max. Negotiated Rate	$412.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$412.00
Rate for Payer: Hamaspik Choice Inc Medicare	$412.00

MAXILLA FRACTURE-CLOSED REDUCTION

Facility

$1,450.00

Service Code	HCPCS D7720
Hospital Charge Code	42301905
Hospital Revenue Code	361
Min. Negotiated Rate	$507.50
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$797.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$992.43
Rate for Payer: Aetna Government	$992.43
Rate for Payer: Brighton Health Commercial	$1,087.50
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	$725.00
Rate for Payer: Group Health Inc Medicare	$507.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$725.00
Rate for Payer: Hamaspik Choice Inc Medicare	$725.00

MAXILLA FRACTURE-OPEN REDUCTION,

Facility

$7,088.00

Service Code	HCPCS D7710
Hospital Charge Code	42301900
Hospital Revenue Code	361
Min. Negotiated Rate	$1,414.03
Max. Negotiated Rate	$5,316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,898.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,414.03
Rate for Payer: Aetna Government	$1,414.03
Rate for Payer: Brighton Health Commercial	$5,316.00
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	$3,544.00
Rate for Payer: Group Health Inc Medicare	$2,480.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,544.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,544.00

Know your out-of-pocket cost for care.

All Charges