St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MOD CS DIFF PHYS 5 YRS +

Facility

$135.05

Service Code	HCPCS 99156
Hospital Charge Code	30103327
Hospital Revenue Code	379
Min. Negotiated Rate	$47.27
Max. Negotiated Rate	$108.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.47
Rate for Payer: Aetna Government	$65.47
Rate for Payer: Brighton Health Commercial	$101.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$108.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$91.83
Rate for Payer: Group Health Inc Commercial	$67.52
Rate for Payer: Group Health Inc Medicare	$47.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.52
Rate for Payer: Hamaspik Choice Inc Medicare	$67.52

MODERNA COVID19 VAC ADMIN 1ST DSE

Facility

$102.55

Service Code	HCPCS 0094A
Hospital Charge Code	30300255
Hospital Revenue Code	771
Min. Negotiated Rate	$44.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.28
Rate for Payer: Aetna Government	$51.28
Rate for Payer: Brighton Health Commercial	$76.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$82.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.73
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.28
Rate for Payer: Hamaspik Choice Inc Medicare	$51.28
Rate for Payer: United Healthcare Commercial	$44.00

MODERNA COVID19 VAC ADMIN 2ND DSE

Facility

$102.55

Service Code	HCPCS 0094A
Hospital Charge Code	30300256
Hospital Revenue Code	771
Min. Negotiated Rate	$44.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.28
Rate for Payer: Aetna Government	$51.28
Rate for Payer: Brighton Health Commercial	$76.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$82.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.73
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.28
Rate for Payer: Hamaspik Choice Inc Medicare	$51.28
Rate for Payer: United Healthcare Commercial	$44.00

MOD HALF PIN 4X200 40 CONT T

Facility

$350.00

Hospital Charge Code	64904336
Hospital Revenue Code	270
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$280.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.00
Rate for Payer: Aetna Government	$175.00
Rate for Payer: Brighton Health Commercial	$262.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$280.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$238.00
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

MODIFIED MAGIC MOUTHWASH (NO LIDOCAINE) - COMPOUNDED [400499]

Facility

$0.19

Service Code	NDC 09999408453
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.13
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

MODIF. OR TRAIN. OF VOICE PROSTHE

Facility

$228.65

Service Code	HCPCS 92507
Hospital Charge Code	41905006
Hospital Revenue Code	440
Min. Negotiated Rate	$52.82
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$125.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$52.82
Rate for Payer: Aetna Government	$52.82
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.95
Rate for Payer: Group Health Inc Commercial	$114.32
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.32
Rate for Payer: Hamaspik Choice Inc Medicare	$114.32
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: Wellcare Medicare	$55.00

MOD. OF RMOVBL PROSTH. FOLL. SURG

Facility

$602.00

Service Code	HCPCS D5875
Hospital Charge Code	42303316
Hospital Revenue Code	361
Min. Negotiated Rate	$179.96
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$331.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$179.96
Rate for Payer: Aetna Government	$179.96
Rate for Payer: Brighton Health Commercial	$451.50
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	$301.00
Rate for Payer: Group Health Inc Medicare	$210.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$301.00
Rate for Payer: Hamaspik Choice Inc Medicare	$301.00

MOD TRANSFIX 250MM

Facility

$478.80

Hospital Charge Code	40200784
Hospital Revenue Code	270
Min. Negotiated Rate	$167.58
Max. Negotiated Rate	$383.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$263.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$239.40
Rate for Payer: Aetna Government	$239.40
Rate for Payer: Brighton Health Commercial	$359.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$383.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$325.58
Rate for Payer: Group Health Inc Commercial	$239.40
Rate for Payer: Group Health Inc Medicare	$167.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$239.40
Rate for Payer: Hamaspik Choice Inc Medicare	$239.40

MODULAR HAND SYSTEM PLATE

Facility

$433.80

Service Code	HCPCS C1713
Hospital Charge Code	40209566
Hospital Revenue Code	278
Min. Negotiated Rate	$216.90
Max. Negotiated Rate	$216.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$216.90
Rate for Payer: Hamaspik Choice Inc Medicare	$216.90

MODULAR HAND SYSTEM PLATE

Facility

$433.80

Service Code	HCPCS C1713
Hospital Charge Code	40209566
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$455.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$238.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$260.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$216.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$249.44
Rate for Payer: EmblemHealth Commercial	$216.90
Rate for Payer: Fidelis Medicare Advantage	$455.49
Rate for Payer: Group Health Inc Commercial	$216.90
Rate for Payer: Group Health Inc Medicare	$151.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$216.90
Rate for Payer: Hamaspik Choice Inc Medicare	$216.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$281.97

MODULAR HEAD COMPONENT 32MMX3MM

Facility

$702.00

Service Code	HCPCS C1776
Hospital Charge Code	40202203
Hospital Revenue Code	278
Min. Negotiated Rate	$351.00
Max. Negotiated Rate	$351.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$351.00
Rate for Payer: Hamaspik Choice Inc Medicare	$351.00

MODULAR HEAD COMPONENT 32MMX3MM

Facility

$702.00

Service Code	HCPCS C1776
Hospital Charge Code	40202203
Hospital Revenue Code	278
Min. Negotiated Rate	$245.70
Max. Negotiated Rate	$737.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$386.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$421.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$351.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$403.65
Rate for Payer: EmblemHealth Commercial	$351.00
Rate for Payer: Fidelis Medicare Advantage	$737.10
Rate for Payer: Group Health Inc Commercial	$351.00
Rate for Payer: Group Health Inc Medicare	$245.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$351.00
Rate for Payer: Hamaspik Choice Inc Medicare	$351.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$456.30

MODULAR NECK

Facility

$1,442.00

Service Code	HCPCS C1776
Hospital Charge Code	40203101
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,514.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$793.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$865.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$721.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$829.15
Rate for Payer: EmblemHealth Commercial	$721.00
Rate for Payer: Fidelis Medicare Advantage	$1,514.10
Rate for Payer: Group Health Inc Commercial	$721.00
Rate for Payer: Group Health Inc Medicare	$504.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$721.00
Rate for Payer: Hamaspik Choice Inc Medicare	$721.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$937.30

MODULAR NECK

Facility

$1,442.00

Service Code	HCPCS C1776
Hospital Charge Code	40203101
Hospital Revenue Code	278
Min. Negotiated Rate	$721.00
Max. Negotiated Rate	$721.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$721.00
Rate for Payer: Hamaspik Choice Inc Medicare	$721.00

MODULE INTRAOSSEOUS BLUE

Facility

$112.50

Hospital Charge Code	64903059
Hospital Revenue Code	270
Min. Negotiated Rate	$39.38
Max. Negotiated Rate	$90.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.25
Rate for Payer: Aetna Government	$56.25
Rate for Payer: Brighton Health Commercial	$84.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.50
Rate for Payer: Group Health Inc Commercial	$56.25
Rate for Payer: Group Health Inc Medicare	$39.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.25
Rate for Payer: Hamaspik Choice Inc Medicare	$56.25

MODULE INTRAOSSEOUS GREEN

Facility

$112.50

Hospital Charge Code	64903077
Hospital Revenue Code	270
Min. Negotiated Rate	$39.38
Max. Negotiated Rate	$90.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.25
Rate for Payer: Aetna Government	$56.25
Rate for Payer: Brighton Health Commercial	$84.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.50
Rate for Payer: Group Health Inc Commercial	$56.25
Rate for Payer: Group Health Inc Medicare	$39.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.25
Rate for Payer: Hamaspik Choice Inc Medicare	$56.25

MODULE INTRAOSSEOUS ORANGE

Facility

$112.50

Hospital Charge Code	64903075
Hospital Revenue Code	270
Min. Negotiated Rate	$39.38
Max. Negotiated Rate	$90.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.25
Rate for Payer: Aetna Government	$56.25
Rate for Payer: Brighton Health Commercial	$84.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.50
Rate for Payer: Group Health Inc Commercial	$56.25
Rate for Payer: Group Health Inc Medicare	$39.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.25
Rate for Payer: Hamaspik Choice Inc Medicare	$56.25

MODULE INTRAOSSEOUS YELLOW

Facility

$112.50

Hospital Charge Code	64903108
Hospital Revenue Code	270
Min. Negotiated Rate	$39.38
Max. Negotiated Rate	$90.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.25
Rate for Payer: Aetna Government	$56.25
Rate for Payer: Brighton Health Commercial	$84.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.50
Rate for Payer: Group Health Inc Commercial	$56.25
Rate for Payer: Group Health Inc Medicare	$39.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.25
Rate for Payer: Hamaspik Choice Inc Medicare	$56.25

MODULE INTRAOSSEUS PUR

Facility

$112.50

Hospital Charge Code	64903087
Hospital Revenue Code	270
Min. Negotiated Rate	$39.38
Max. Negotiated Rate	$90.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.25
Rate for Payer: Aetna Government	$56.25
Rate for Payer: Brighton Health Commercial	$84.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.50
Rate for Payer: Group Health Inc Commercial	$56.25
Rate for Payer: Group Health Inc Medicare	$39.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.25
Rate for Payer: Hamaspik Choice Inc Medicare	$56.25

MODULE INTRAOSSEUS RED

Facility

$112.50

Hospital Charge Code	64903067
Hospital Revenue Code	270
Min. Negotiated Rate	$39.38
Max. Negotiated Rate	$90.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.25
Rate for Payer: Aetna Government	$56.25
Rate for Payer: Brighton Health Commercial	$84.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.50
Rate for Payer: Group Health Inc Commercial	$56.25
Rate for Payer: Group Health Inc Medicare	$39.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.25
Rate for Payer: Hamaspik Choice Inc Medicare	$56.25

MODULE INTRAOSSEUS RED

Facility

$168.00

Hospital Charge Code	40202251
Hospital Revenue Code	270
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$134.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$92.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$84.00
Rate for Payer: Aetna Government	$84.00
Rate for Payer: Brighton Health Commercial	$126.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$134.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$114.24
Rate for Payer: Group Health Inc Commercial	$84.00
Rate for Payer: Group Health Inc Medicare	$58.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$84.00
Rate for Payer: Hamaspik Choice Inc Medicare	$84.00

MODULE INTUBATION BLUE

Facility

$187.50

Hospital Charge Code	64903873
Hospital Revenue Code	270
Min. Negotiated Rate	$65.62
Max. Negotiated Rate	$150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$103.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$93.75
Rate for Payer: Aetna Government	$93.75
Rate for Payer: Brighton Health Commercial	$140.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$127.50
Rate for Payer: Group Health Inc Commercial	$93.75
Rate for Payer: Group Health Inc Medicare	$65.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$93.75
Rate for Payer: Hamaspik Choice Inc Medicare	$93.75

MODULE INTUBATION GREEN

Facility

$187.50

Hospital Charge Code	64903879
Hospital Revenue Code	270
Min. Negotiated Rate	$65.62
Max. Negotiated Rate	$150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$103.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$93.75
Rate for Payer: Aetna Government	$93.75
Rate for Payer: Brighton Health Commercial	$140.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$127.50
Rate for Payer: Group Health Inc Commercial	$93.75
Rate for Payer: Group Health Inc Medicare	$65.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$93.75
Rate for Payer: Hamaspik Choice Inc Medicare	$93.75

MODULE INTUBATION PUR

Facility

$75.00

Hospital Charge Code	64903085
Hospital Revenue Code	270
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$60.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.50
Rate for Payer: Aetna Government	$37.50
Rate for Payer: Brighton Health Commercial	$56.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.00
Rate for Payer: Group Health Inc Commercial	$37.50
Rate for Payer: Group Health Inc Medicare	$26.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.50
Rate for Payer: Hamaspik Choice Inc Medicare	$37.50

MODULE INTUBATION RED A

Facility

$75.00

Hospital Charge Code	64903063
Hospital Revenue Code	270
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$60.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.50
Rate for Payer: Aetna Government	$37.50
Rate for Payer: Brighton Health Commercial	$56.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.00
Rate for Payer: Group Health Inc Commercial	$37.50
Rate for Payer: Group Health Inc Medicare	$26.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.50
Rate for Payer: Hamaspik Choice Inc Medicare	$37.50

Know your out-of-pocket cost for care.

All Charges