St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TECHNETIUM TC 99M EXAMETAZIME IV KIT

Facility

$2.00

Service Code	NDC 1715602505
Hospital Charge Code	1715602505
Hospital Revenue Code	258
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00

TECHNETIUM TC 99M EXAMETAZIME IV KIT

Facility

$10.00

Service Code	NDC 1715602205
Hospital Charge Code	1715602205
Hospital Revenue Code	258
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$5.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00

TECHNETIUM TC 99M EXAMETAZIME IV KIT

Facility

$10.00

Service Code	NDC 1715602205
Hospital Charge Code	1715602205
Hospital Revenue Code	258
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$8.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.00
Rate for Payer: Aetna Government	$5.00
Rate for Payer: Brighton Health Commercial	$7.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.80
Rate for Payer: EmblemHealth Commercial	$5.00
Rate for Payer: Group Health Inc Commercial	$5.00
Rate for Payer: Group Health Inc Medicare	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.50

TECHNETIUM TC 99M MEBROFENIN

Facility

$49.52

Service Code	NDC 9999408442
Hospital Charge Code	9999408442
Hospital Revenue Code	250
Min. Negotiated Rate	$24.76
Max. Negotiated Rate	$24.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.76

TECHNETIUM TC 99M MEBROFENIN

Facility

$49.52

Service Code	NDC 9999408442
Hospital Charge Code	9999408442
Hospital Revenue Code	250
Min. Negotiated Rate	$17.33
Max. Negotiated Rate	$39.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.76
Rate for Payer: Aetna Government	$24.76
Rate for Payer: Brighton Health Commercial	$37.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.67
Rate for Payer: EmblemHealth Commercial	$24.76
Rate for Payer: Group Health Inc Commercial	$24.76
Rate for Payer: Group Health Inc Medicare	$17.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.76
Rate for Payer: Hamaspik Choice Inc Medicare	$24.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$32.19

TECHNETIUM TC 99M MEBROFENIN IV KIT

Facility

$113.46

Service Code	HCPCS A9537
Hospital Charge Code	4556704551
Hospital Revenue Code	258
Min. Negotiated Rate	$39.71
Max. Negotiated Rate	$90.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$45.80
Rate for Payer: Aetna Government	$45.80
Rate for Payer: Brighton Health Commercial	$85.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.15
Rate for Payer: EmblemHealth Commercial	$56.73
Rate for Payer: Group Health Inc Commercial	$56.73
Rate for Payer: Group Health Inc Medicare	$39.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.73
Rate for Payer: Hamaspik Choice Inc Medicare	$56.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$73.75

TECHNETIUM TC 99M MEBROFENIN IV KIT

Facility

$113.46

Service Code	HCPCS A9537
Hospital Charge Code	4556704551
Hospital Revenue Code	258
Min. Negotiated Rate	$56.73
Max. Negotiated Rate	$56.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.73

TECHNETIUM TC 99M MEDRONATE IV KIT

Facility

$98.22

Service Code	HCPCS A9503
Hospital Charge Code	4556700402
Hospital Revenue Code	258
Min. Negotiated Rate	$10.76
Max. Negotiated Rate	$78.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$54.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.76
Rate for Payer: Aetna Government	$10.76
Rate for Payer: Brighton Health Commercial	$73.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$66.79
Rate for Payer: EmblemHealth Commercial	$49.11
Rate for Payer: Group Health Inc Commercial	$49.11
Rate for Payer: Group Health Inc Medicare	$34.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.11
Rate for Payer: Hamaspik Choice Inc Medicare	$49.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$63.84

TECHNETIUM TC 99M MEDRONATE IV KIT

Facility

$98.22

Service Code	HCPCS A9503
Hospital Charge Code	4556700401
Hospital Revenue Code	258
Min. Negotiated Rate	$10.76
Max. Negotiated Rate	$78.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$54.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.76
Rate for Payer: Aetna Government	$10.76
Rate for Payer: Brighton Health Commercial	$73.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$66.79
Rate for Payer: EmblemHealth Commercial	$49.11
Rate for Payer: Group Health Inc Commercial	$49.11
Rate for Payer: Group Health Inc Medicare	$34.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.11
Rate for Payer: Hamaspik Choice Inc Medicare	$49.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$63.84

TECHNETIUM TC 99M MEDRONATE IV KIT

Facility

$98.22

Service Code	HCPCS A9503
Hospital Charge Code	4556700401
Hospital Revenue Code	258
Min. Negotiated Rate	$49.11
Max. Negotiated Rate	$49.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.11

TECHNETIUM TC 99M MEDRONATE IV KIT

Facility

$98.22

Service Code	HCPCS A9503
Hospital Charge Code	4556700402
Hospital Revenue Code	258
Min. Negotiated Rate	$49.11
Max. Negotiated Rate	$49.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.11

TECHNETIUM TC 99M PYROPHOS IV KIT

Facility

$76.86

Service Code	HCPCS A9558
Hospital Charge Code	4556700601
Hospital Revenue Code	258
Min. Negotiated Rate	$38.43
Max. Negotiated Rate	$38.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.43

TECHNETIUM TC 99M PYROPHOS IV KIT

Facility

$76.86

Service Code	HCPCS A9558
Hospital Charge Code	4556700601
Hospital Revenue Code	258
Min. Negotiated Rate	$26.90
Max. Negotiated Rate	$173.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$173.64
Rate for Payer: Aetna Government	$173.64
Rate for Payer: Brighton Health Commercial	$57.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$61.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$52.26
Rate for Payer: EmblemHealth Commercial	$38.43
Rate for Payer: Group Health Inc Commercial	$38.43
Rate for Payer: Group Health Inc Medicare	$26.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.43
Rate for Payer: Hamaspik Choice Inc Medicare	$38.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$49.96

TECHNETIUM TC 99M PYROPHOSPHATE

Facility

$44.10

Service Code	HCPCS A9538
Hospital Charge Code	9999408446
Hospital Revenue Code	250
Min. Negotiated Rate	$15.44
Max. Negotiated Rate	$41.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.40
Rate for Payer: Aetna Government	$41.40
Rate for Payer: Brighton Health Commercial	$33.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.99
Rate for Payer: EmblemHealth Commercial	$22.05
Rate for Payer: Group Health Inc Commercial	$22.05
Rate for Payer: Group Health Inc Medicare	$15.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.05
Rate for Payer: Hamaspik Choice Inc Medicare	$22.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.66

TECHNETIUM TC 99M PYROPHOSPHATE

Facility

$44.10

Service Code	HCPCS A9538
Hospital Charge Code	9999408446
Hospital Revenue Code	250
Min. Negotiated Rate	$22.05
Max. Negotiated Rate	$22.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.05

TECHNETIUM TC 99M SESTAMIBI - CARDIOLITE

Facility

$45.79

Service Code	HCPCS A9500
Hospital Charge Code	9999408436
Hospital Revenue Code	250
Min. Negotiated Rate	$22.89
Max. Negotiated Rate	$22.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.89

TECHNETIUM TC 99M SESTAMIBI - CARDIOLITE

Facility

$45.79

Service Code	HCPCS A9500
Hospital Charge Code	9999408436
Hospital Revenue Code	250
Min. Negotiated Rate	$16.03
Max. Negotiated Rate	$88.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$88.39
Rate for Payer: Aetna Government	$88.39
Rate for Payer: Brighton Health Commercial	$34.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.14
Rate for Payer: EmblemHealth Commercial	$22.89
Rate for Payer: Group Health Inc Commercial	$22.89
Rate for Payer: Group Health Inc Medicare	$16.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.89
Rate for Payer: Hamaspik Choice Inc Medicare	$22.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.76

TECHNETIUM TC 99M SESTAMIBI IV KIT

Facility

$385.38

Service Code	HCPCS A9500
Hospital Charge Code	6585750020
Hospital Revenue Code	258
Min. Negotiated Rate	$88.39
Max. Negotiated Rate	$308.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$211.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$88.39
Rate for Payer: Aetna Government	$88.39
Rate for Payer: Brighton Health Commercial	$289.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$308.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$262.06
Rate for Payer: EmblemHealth Commercial	$192.69
Rate for Payer: Group Health Inc Commercial	$192.69
Rate for Payer: Group Health Inc Medicare	$134.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$192.69
Rate for Payer: Hamaspik Choice Inc Medicare	$192.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$250.50

TECHNETIUM TC 99M SESTAMIBI IV KIT

Facility

$385.38

Service Code	HCPCS A9500
Hospital Charge Code	6585750020
Hospital Revenue Code	258
Min. Negotiated Rate	$192.69
Max. Negotiated Rate	$192.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$192.69

TECHNETIUM TC 99M SESTAMIBI IV KIT

Facility

$133.74

Service Code	HCPCS A9500
Hospital Charge Code	1199400120
Hospital Revenue Code	258
Min. Negotiated Rate	$66.87
Max. Negotiated Rate	$66.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.87

TECHNETIUM TC 99M SESTAMIBI IV KIT

Facility

$133.74

Service Code	HCPCS A9500
Hospital Charge Code	1199400120
Hospital Revenue Code	258
Min. Negotiated Rate	$46.81
Max. Negotiated Rate	$106.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$73.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$88.39
Rate for Payer: Aetna Government	$88.39
Rate for Payer: Brighton Health Commercial	$100.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$106.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$90.94
Rate for Payer: EmblemHealth Commercial	$66.87
Rate for Payer: Group Health Inc Commercial	$66.87
Rate for Payer: Group Health Inc Medicare	$46.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.87
Rate for Payer: Hamaspik Choice Inc Medicare	$66.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$86.93

TECHNETIUM TC 99M SULFUR COLLOID

Facility

$130.50

Service Code	HCPCS A9541
Hospital Charge Code	9999408440
Hospital Revenue Code	250
Min. Negotiated Rate	$45.67
Max. Negotiated Rate	$221.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$221.38
Rate for Payer: Aetna Government	$221.38
Rate for Payer: Brighton Health Commercial	$97.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$104.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$88.74
Rate for Payer: EmblemHealth Commercial	$65.25
Rate for Payer: Group Health Inc Commercial	$65.25
Rate for Payer: Group Health Inc Medicare	$45.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.25
Rate for Payer: Hamaspik Choice Inc Medicare	$65.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$84.83

TECHNETIUM TC 99M SULFUR COLLOID

Facility

$130.50

Service Code	HCPCS A9541
Hospital Charge Code	9999408440
Hospital Revenue Code	250
Min. Negotiated Rate	$65.25
Max. Negotiated Rate	$65.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.25

TECHNETIUM TC99M SULFUR COLLOID FILTERED

Facility

$254.16

Service Code	HCPCS A9541
Hospital Charge Code	9999701422
Hospital Revenue Code	250
Min. Negotiated Rate	$127.08
Max. Negotiated Rate	$127.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$127.08

TECHNETIUM TC99M SULFUR COLLOID FILTERED

Facility

$254.16

Service Code	HCPCS A9541
Hospital Charge Code	9999701422
Hospital Revenue Code	250
Min. Negotiated Rate	$88.96
Max. Negotiated Rate	$221.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$139.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$221.38
Rate for Payer: Aetna Government	$221.38
Rate for Payer: Brighton Health Commercial	$190.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$203.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$172.83
Rate for Payer: EmblemHealth Commercial	$127.08
Rate for Payer: Group Health Inc Commercial	$127.08
Rate for Payer: Group Health Inc Medicare	$88.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$127.08
Rate for Payer: Hamaspik Choice Inc Medicare	$127.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$165.20

Know your out-of-pocket cost for care.

All Charges