St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

NCB_4.0 DP THD SCR L=22MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007101
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB 4.0 DP THD SCR L=24MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006920
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB 4.0 DP THD SCR L=24MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006920
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB 4.0 DP THD SCR L=24MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006921
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB 4.0 DP THD SCR L=24MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006921
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB_4.0 DP THD SCR L=24MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007102
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB_4.0 DP THD SCR L=24MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007102
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB 4.0 DP THD SCR L=26MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006922
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB 4.0 DP THD SCR L=26MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006922
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB_4.0 DP THD SCR L=26MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007103
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB_4.0 DP THD SCR L=26MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007103
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB 4.0 DP THD SCR L=28MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006923
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB 4.0 DP THD SCR L=28MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006923
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB_4.0 DP THD SCR L=28MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007104
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB_4.0 DP THD SCR L=28MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007104
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB 4.0 DP THD SCR L=30MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006924
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB 4.0 DP THD SCR L=30MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006924
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB_4.0 DP THD SCR L=30MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007105
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB_4.0 DP THD SCR L=30MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007105
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB 4.0 DP THD SCR L=32MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006925
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB 4.0 DP THD SCR L=32MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006925
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB_4.0 DP THD SCR L=32MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007106
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB_4.0 DP THD SCR L=32MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007106
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB 4.0 DP THD SCR L=34MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006926
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB 4.0 DP THD SCR L=34MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006926
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

Know your out-of-pocket cost for care.

All Charges