St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

NCB STR NRW PLT,12H,L 174MM STRL

Facility

$1,275.56

Service Code	HCPCS C1713
Hospital Charge Code	40007031
Hospital Revenue Code	278
Min. Negotiated Rate	$637.78
Max. Negotiated Rate	$637.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$637.78
Rate for Payer: Hamaspik Choice Inc Medicare	$637.78

NCB STR NRW PLT,12H,L 174MM STRL

Facility

$1,275.56

Service Code	HCPCS C1713
Hospital Charge Code	40007031
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,339.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$701.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$765.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$637.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$733.45
Rate for Payer: EmblemHealth Commercial	$637.78
Rate for Payer: Fidelis Medicare Advantage	$1,339.34
Rate for Payer: Group Health Inc Commercial	$637.78
Rate for Payer: Group Health Inc Medicare	$446.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$637.78
Rate for Payer: Hamaspik Choice Inc Medicare	$637.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$829.11

NCB STR NRW PLT 14H L202MM NONSTR

Facility

$1,238.48

Service Code	HCPCS C1713
Hospital Charge Code	40007286
Hospital Revenue Code	278
Min. Negotiated Rate	$619.24
Max. Negotiated Rate	$619.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$619.24
Rate for Payer: Hamaspik Choice Inc Medicare	$619.24

NCB STR NRW PLT 14H L202MM NONSTR

Facility

$1,238.48

Service Code	HCPCS C1713
Hospital Charge Code	40007286
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,300.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$681.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$743.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$619.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$712.13
Rate for Payer: EmblemHealth Commercial	$619.24
Rate for Payer: Fidelis Medicare Advantage	$1,300.40
Rate for Payer: Group Health Inc Commercial	$619.24
Rate for Payer: Group Health Inc Medicare	$433.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$619.24
Rate for Payer: Hamaspik Choice Inc Medicare	$619.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$805.01

NCB STR NRW PLT,14H,L 202MM STRL

Facility

$1,275.56

Service Code	HCPCS C1713
Hospital Charge Code	40007032
Hospital Revenue Code	278
Min. Negotiated Rate	$637.78
Max. Negotiated Rate	$637.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$637.78
Rate for Payer: Hamaspik Choice Inc Medicare	$637.78

NCB STR NRW PLT,14H,L 202MM STRL

Facility

$1,275.56

Service Code	HCPCS C1713
Hospital Charge Code	40007032
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,339.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$701.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$765.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$637.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$733.45
Rate for Payer: EmblemHealth Commercial	$637.78
Rate for Payer: Fidelis Medicare Advantage	$1,339.34
Rate for Payer: Group Health Inc Commercial	$637.78
Rate for Payer: Group Health Inc Medicare	$446.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$637.78
Rate for Payer: Hamaspik Choice Inc Medicare	$637.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$829.11

NCB STR NRW PLT, 16H, L 230MM

Facility

$1,290.40

Service Code	HCPCS C1713
Hospital Charge Code	40007033
Hospital Revenue Code	278
Min. Negotiated Rate	$645.20
Max. Negotiated Rate	$645.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$645.20
Rate for Payer: Hamaspik Choice Inc Medicare	$645.20

NCB STR NRW PLT, 16H, L 230MM

Facility

$1,290.40

Service Code	HCPCS C1713
Hospital Charge Code	40007033
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,354.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$709.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$774.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$645.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$741.98
Rate for Payer: EmblemHealth Commercial	$645.20
Rate for Payer: Fidelis Medicare Advantage	$1,354.92
Rate for Payer: Group Health Inc Commercial	$645.20
Rate for Payer: Group Health Inc Medicare	$451.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$645.20
Rate for Payer: Hamaspik Choice Inc Medicare	$645.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$838.76

NCB STR NRW PLT 16H L230MM NONSTR

Facility

$1,260.72

Service Code	HCPCS C1713
Hospital Charge Code	40007287
Hospital Revenue Code	278
Min. Negotiated Rate	$630.36
Max. Negotiated Rate	$630.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$630.36
Rate for Payer: Hamaspik Choice Inc Medicare	$630.36

NCB STR NRW PLT 16H L230MM NONSTR

Facility

$1,260.72

Service Code	HCPCS C1713
Hospital Charge Code	40007287
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,323.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$693.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$756.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$630.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$724.91
Rate for Payer: EmblemHealth Commercial	$630.36
Rate for Payer: Fidelis Medicare Advantage	$1,323.76
Rate for Payer: Group Health Inc Commercial	$630.36
Rate for Payer: Group Health Inc Medicare	$441.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$630.36
Rate for Payer: Hamaspik Choice Inc Medicare	$630.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$819.47

NCB STR NRW PLT, 18H L 258MM

Facility

$1,290.40

Service Code	HCPCS C1713
Hospital Charge Code	40007034
Hospital Revenue Code	278
Min. Negotiated Rate	$645.20
Max. Negotiated Rate	$645.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$645.20
Rate for Payer: Hamaspik Choice Inc Medicare	$645.20

NCB STR NRW PLT, 18H L 258MM

Facility

$1,290.40

Service Code	HCPCS C1713
Hospital Charge Code	40007034
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,354.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$709.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$774.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$645.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$741.98
Rate for Payer: EmblemHealth Commercial	$645.20
Rate for Payer: Fidelis Medicare Advantage	$1,354.92
Rate for Payer: Group Health Inc Commercial	$645.20
Rate for Payer: Group Health Inc Medicare	$451.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$645.20
Rate for Payer: Hamaspik Choice Inc Medicare	$645.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$838.76

NCB STR NRW PLT 18H L258MM NONSTR

Facility

$1,260.72

Service Code	HCPCS C1713
Hospital Charge Code	40007288
Hospital Revenue Code	278
Min. Negotiated Rate	$630.36
Max. Negotiated Rate	$630.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$630.36
Rate for Payer: Hamaspik Choice Inc Medicare	$630.36

NCB STR NRW PLT 18H L258MM NONSTR

Facility

$1,260.72

Service Code	HCPCS C1713
Hospital Charge Code	40007288
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,323.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$693.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$756.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$630.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$724.91
Rate for Payer: EmblemHealth Commercial	$630.36
Rate for Payer: Fidelis Medicare Advantage	$1,323.76
Rate for Payer: Group Health Inc Commercial	$630.36
Rate for Payer: Group Health Inc Medicare	$441.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$630.36
Rate for Payer: Hamaspik Choice Inc Medicare	$630.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$819.47

NCB STR NRW PLT 8H L118MM NONSTER

Facility

$1,238.48

Service Code	HCPCS C1713
Hospital Charge Code	40007283
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,300.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$681.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$743.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$619.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$712.13
Rate for Payer: EmblemHealth Commercial	$619.24
Rate for Payer: Fidelis Medicare Advantage	$1,300.40
Rate for Payer: Group Health Inc Commercial	$619.24
Rate for Payer: Group Health Inc Medicare	$433.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$619.24
Rate for Payer: Hamaspik Choice Inc Medicare	$619.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$805.01

NCB STR NRW PLT 8H L118MM NONSTER

Facility

$1,238.48

Service Code	HCPCS C1713
Hospital Charge Code	40007283
Hospital Revenue Code	278
Min. Negotiated Rate	$619.24
Max. Negotiated Rate	$619.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$619.24
Rate for Payer: Hamaspik Choice Inc Medicare	$619.24

NCB STR NRW PLT,8H,L 118MM STRL

Facility

$1,275.56

Service Code	HCPCS C1713
Hospital Charge Code	40007029
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,339.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$701.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$765.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$637.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$733.45
Rate for Payer: EmblemHealth Commercial	$637.78
Rate for Payer: Fidelis Medicare Advantage	$1,339.34
Rate for Payer: Group Health Inc Commercial	$637.78
Rate for Payer: Group Health Inc Medicare	$446.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$637.78
Rate for Payer: Hamaspik Choice Inc Medicare	$637.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$829.11

NCB STR NRW PLT,8H,L 118MM STRL

Facility

$1,275.56

Service Code	HCPCS C1713
Hospital Charge Code	40007029
Hospital Revenue Code	278
Min. Negotiated Rate	$637.78
Max. Negotiated Rate	$637.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$637.78
Rate for Payer: Hamaspik Choice Inc Medicare	$637.78

NCB STR NRW PLT PROV, 14/

Facility

$252.16

Service Code	HCPCS C1713
Hospital Charge Code	40006815
Hospital Revenue Code	278
Min. Negotiated Rate	$126.08
Max. Negotiated Rate	$126.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.08
Rate for Payer: Hamaspik Choice Inc Medicare	$126.08

NCB STR NRW PLT PROV, 14/

Facility

$252.16

Service Code	HCPCS C1713
Hospital Charge Code	40006815
Hospital Revenue Code	278
Min. Negotiated Rate	$88.26
Max. Negotiated Rate	$264.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$138.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$151.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$126.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.99
Rate for Payer: EmblemHealth Commercial	$126.08
Rate for Payer: Fidelis Medicare Advantage	$264.77
Rate for Payer: Group Health Inc Commercial	$126.08
Rate for Payer: Group Health Inc Medicare	$88.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.08
Rate for Payer: Hamaspik Choice Inc Medicare	$126.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$163.90

NCB STR NRW PLT PROV, 8/1

Facility

$252.16

Service Code	HCPCS C1713
Hospital Charge Code	40006814
Hospital Revenue Code	278
Min. Negotiated Rate	$88.26
Max. Negotiated Rate	$264.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$138.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$151.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$126.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.99
Rate for Payer: EmblemHealth Commercial	$126.08
Rate for Payer: Fidelis Medicare Advantage	$264.77
Rate for Payer: Group Health Inc Commercial	$126.08
Rate for Payer: Group Health Inc Medicare	$88.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.08
Rate for Payer: Hamaspik Choice Inc Medicare	$126.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$163.90

NCB STR NRW PLT PROV, 8/1

Facility

$252.16

Service Code	HCPCS C1713
Hospital Charge Code	40006814
Hospital Revenue Code	278
Min. Negotiated Rate	$126.08
Max. Negotiated Rate	$126.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.08
Rate for Payer: Hamaspik Choice Inc Medicare	$126.08

NCB TAP 4.0MM,L=250MM W QU COUPL

Facility

$355.98

Hospital Charge Code	40006778
Hospital Revenue Code	272
Min. Negotiated Rate	$124.59
Max. Negotiated Rate	$284.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$195.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$177.99
Rate for Payer: Aetna Government	$177.99
Rate for Payer: Brighton Health Commercial	$266.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$284.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$242.07
Rate for Payer: Group Health Inc Commercial	$177.99
Rate for Payer: Group Health Inc Medicare	$124.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.99
Rate for Payer: Hamaspik Choice Inc Medicare	$177.99

NCB TAP 5.0MM,L=250MM W QU COUPL

Facility

$370.80

Hospital Charge Code	40006779
Hospital Revenue Code	272
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$296.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$203.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$185.40
Rate for Payer: Aetna Government	$185.40
Rate for Payer: Brighton Health Commercial	$278.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$296.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$252.14
Rate for Payer: Group Health Inc Commercial	$185.40
Rate for Payer: Group Health Inc Medicare	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.40
Rate for Payer: Hamaspik Choice Inc Medicare	$185.40

NCB TAP 5.0MM X 145MM

Facility

$370.80

Service Code	HCPCS C1713
Hospital Charge Code	40006714
Hospital Revenue Code	278
Min. Negotiated Rate	$185.40
Max. Negotiated Rate	$185.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.40
Rate for Payer: Hamaspik Choice Inc Medicare	$185.40

Know your out-of-pocket cost for care.

All Charges