St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

NUT

Facility

$30.00

Service Code	HCPCS C1713
Hospital Charge Code	64904711
Hospital Revenue Code	278
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$18.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.25
Rate for Payer: EmblemHealth Commercial	$15.00
Rate for Payer: Fidelis Medicare Advantage	$31.50
Rate for Payer: Group Health Inc Commercial	$15.00
Rate for Payer: Group Health Inc Medicare	$10.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00
Rate for Payer: Hamaspik Choice Inc Medicare	$15.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.50

NUT

Facility

$30.00

Service Code	HCPCS C1713
Hospital Charge Code	64904711
Hospital Revenue Code	278
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00
Rate for Payer: Hamaspik Choice Inc Medicare	$15.00

NUT 10MM S&N

Facility

$14.10

Service Code	HCPCS C1713
Hospital Charge Code	64901283
Hospital Revenue Code	278
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$8.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.11
Rate for Payer: EmblemHealth Commercial	$7.05
Rate for Payer: Fidelis Medicare Advantage	$14.80
Rate for Payer: Group Health Inc Commercial	$7.05
Rate for Payer: Group Health Inc Medicare	$4.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.05
Rate for Payer: Hamaspik Choice Inc Medicare	$7.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.16

NUT 10MM S&N

Facility

$14.10

Service Code	HCPCS C1713
Hospital Charge Code	64901283
Hospital Revenue Code	278
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$7.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.05
Rate for Payer: Hamaspik Choice Inc Medicare	$7.05

NUT CONNECTING

Facility

$36.95

Service Code	HCPCS C1713
Hospital Charge Code	64907400
Hospital Revenue Code	278
Min. Negotiated Rate	$18.48
Max. Negotiated Rate	$18.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.48
Rate for Payer: Hamaspik Choice Inc Medicare	$18.48

NUT CONNECTING

Facility

$36.95

Service Code	HCPCS C1713
Hospital Charge Code	64907400
Hospital Revenue Code	278
Min. Negotiated Rate	$12.93
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$22.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.25
Rate for Payer: EmblemHealth Commercial	$18.48
Rate for Payer: Fidelis Medicare Advantage	$38.80
Rate for Payer: Group Health Inc Commercial	$18.48
Rate for Payer: Group Health Inc Medicare	$12.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.48
Rate for Payer: Hamaspik Choice Inc Medicare	$18.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$24.02

NUT FLOW METER ADAPTER GR

Facility

$4.24

Hospital Charge Code	64901804
Hospital Revenue Code	270
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$3.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.12
Rate for Payer: Aetna Government	$2.12
Rate for Payer: Brighton Health Commercial	$3.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.88
Rate for Payer: Group Health Inc Commercial	$2.12
Rate for Payer: Group Health Inc Medicare	$1.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2.12

NUT FOR RING / ROD

Facility

$60.00

Service Code	HCPCS C1713
Hospital Charge Code	64902963
Hospital Revenue Code	278
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$36.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.50
Rate for Payer: EmblemHealth Commercial	$30.00
Rate for Payer: Fidelis Medicare Advantage	$63.00
Rate for Payer: Group Health Inc Commercial	$30.00
Rate for Payer: Group Health Inc Medicare	$21.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.00
Rate for Payer: Hamaspik Choice Inc Medicare	$30.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.00

NUT FOR RING / ROD

Facility

$60.00

Service Code	HCPCS C1713
Hospital Charge Code	64902963
Hospital Revenue Code	278
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.00
Rate for Payer: Hamaspik Choice Inc Medicare	$30.00

NUTRITIONAL COUNSELING - CONTROL

Facility

$81.51

Service Code	HCPCS D1310
Hospital Charge Code	42300270
Hospital Revenue Code	361
Min. Negotiated Rate	$12.78
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.78
Rate for Payer: Aetna Government	$12.78
Rate for Payer: Brighton Health Commercial	$61.13
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	$40.76
Rate for Payer: Group Health Inc Medicare	$28.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.76
Rate for Payer: Hamaspik Choice Inc Medicare	$40.76

NUTRITIONAL COUNSELING, DIET

Facility

$20.00

Service Code	HCPCS S9470
Hospital Charge Code	30305710
Hospital Revenue Code	942
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.00
Rate for Payer: Aetna Government	$25.00
Rate for Payer: Brighton Health Commercial	$15.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.60
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	$10.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10.00
Rate for Payer: United Healthcare Commercial	$10.00

NUTRITION CLASS

Facility

$20.00

Service Code	HCPCS S9452
Hospital Charge Code	30305709
Hospital Revenue Code	942
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.21
Rate for Payer: Aetna Government	$24.21
Rate for Payer: Brighton Health Commercial	$15.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.60
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	$10.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10.00
Rate for Payer: United Healthcare Commercial	$10.00

NUVASIVE RELINE ROD

Facility

$1,364.50

Service Code	HCPCS C1713
Hospital Charge Code	40205606
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,432.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$750.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$818.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$682.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$784.59
Rate for Payer: EmblemHealth Commercial	$682.25
Rate for Payer: Fidelis Medicare Advantage	$1,432.72
Rate for Payer: Group Health Inc Commercial	$682.25
Rate for Payer: Group Health Inc Medicare	$477.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$682.25
Rate for Payer: Hamaspik Choice Inc Medicare	$682.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$886.92

NUVASIVE RELINE ROD

Facility

$1,364.50

Service Code	HCPCS C1713
Hospital Charge Code	40205606
Hospital Revenue Code	278
Min. Negotiated Rate	$682.25
Max. Negotiated Rate	$682.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$682.25
Rate for Payer: Hamaspik Choice Inc Medicare	$682.25

NV I-PAS III DIAMOND T

Facility

$1,100.00

Hospital Charge Code	64905790
Hospital Revenue Code	270
Min. Negotiated Rate	$385.00
Max. Negotiated Rate	$880.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$605.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$550.00
Rate for Payer: Aetna Government	$550.00
Rate for Payer: Brighton Health Commercial	$825.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$880.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$748.00
Rate for Payer: Group Health Inc Commercial	$550.00
Rate for Payer: Group Health Inc Medicare	$385.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$550.00

NVM5 NEEDLE MODULE

Facility

$3,591.50

Hospital Charge Code	64905778
Hospital Revenue Code	270
Min. Negotiated Rate	$1,257.02
Max. Negotiated Rate	$2,873.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,975.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,795.75
Rate for Payer: Aetna Government	$1,795.75
Rate for Payer: Brighton Health Commercial	$2,693.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,873.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,442.22
Rate for Payer: Group Health Inc Commercial	$1,795.75
Rate for Payer: Group Health Inc Medicare	$1,257.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,795.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,795.75

NVM5 XLIF DIL

Facility

$2,631.75

Hospital Charge Code	64905776
Hospital Revenue Code	270
Min. Negotiated Rate	$921.11
Max. Negotiated Rate	$2,105.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,447.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,315.88
Rate for Payer: Aetna Government	$1,315.88
Rate for Payer: Brighton Health Commercial	$1,973.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,105.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,789.59
Rate for Payer: Group Health Inc Commercial	$1,315.88
Rate for Payer: Group Health Inc Medicare	$921.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,315.88
Rate for Payer: Hamaspik Choice Inc Medicare	$1,315.88

NYBC SPEC. AG TYPE FEE

Facility

$858.38

Service Code	HCPCS 86902
Hospital Charge Code	40701193
Hospital Revenue Code	300
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$643.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$472.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$415.67
Rate for Payer: Aetna Government	$415.67
Rate for Payer: Affinity Essential Plan 1&2	$290.97
Rate for Payer: Affinity Essential Plan 3&4	$290.97
Rate for Payer: Affinity Medicaid/CHP/HARP	$290.97
Rate for Payer: Brighton Health Commercial	$643.78
Rate for Payer: Cash Price	$415.67
Rate for Payer: Cash Price	$415.67
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$415.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.15
Rate for Payer: Elderplan Medicare Advantage	$415.67
Rate for Payer: EmblemHealth Commercial	$415.67
Rate for Payer: Fidelis Essential Plan Aliesa	$353.32
Rate for Payer: Fidelis Essential Plan QHP	$369.95
Rate for Payer: Fidelis Medicare Advantage	$415.67
Rate for Payer: Fidelis Qualified Health Plan	$369.95
Rate for Payer: Group Health Inc Commercial	$415.67
Rate for Payer: Group Health Inc Medicare	$415.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$429.19
Rate for Payer: Hamaspik Choice Inc Medicare	$415.67
Rate for Payer: Healthfirst Medicare Advantage	$415.67
Rate for Payer: Healthfirst QHP	$415.67
Rate for Payer: Humana Medicare	$423.98
Rate for Payer: Senior Whole Health Medicare Advantage	$415.67
Rate for Payer: United Healthcare Commercial	$4.84
Rate for Payer: United Healthcare Medicare Advantage	$415.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$415.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$332.54
Rate for Payer: Wellcare Medicare	$374.10

NYBC SPEC. AG TYPE FEE

Facility

$858.38

Service Code	HCPCS 86902
Hospital Charge Code	40701193
Hospital Revenue Code	300
Rate for Payer: Cash Price	$415.67

NY BLOOD CENTER COMP CELL SAVER

Facility

$2,120.00

Hospital Charge Code	40205091
Hospital Revenue Code	270
Min. Negotiated Rate	$742.00
Max. Negotiated Rate	$1,696.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,166.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,060.00
Rate for Payer: Aetna Government	$1,060.00
Rate for Payer: Brighton Health Commercial	$1,590.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,696.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,441.60
Rate for Payer: Group Health Inc Commercial	$1,060.00
Rate for Payer: Group Health Inc Medicare	$742.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,060.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,060.00

NY BLOOD CTR COMPLETE CELL SAVER

Facility

$1,550.00

Hospital Charge Code	40009362
Hospital Revenue Code	272
Min. Negotiated Rate	$542.50
Max. Negotiated Rate	$1,240.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$852.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$775.00
Rate for Payer: Aetna Government	$775.00
Rate for Payer: Brighton Health Commercial	$1,162.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,240.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,054.00
Rate for Payer: Group Health Inc Commercial	$775.00
Rate for Payer: Group Health Inc Medicare	$542.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$775.00
Rate for Payer: Hamaspik Choice Inc Medicare	$775.00

NY COMP. CELL SAVER ADD.HR.

Facility

$180.00

Hospital Charge Code	40206003
Hospital Revenue Code	270
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$144.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$99.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$90.00
Rate for Payer: Aetna Government	$90.00
Rate for Payer: Brighton Health Commercial	$135.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$144.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$122.40
Rate for Payer: Group Health Inc Commercial	$90.00
Rate for Payer: Group Health Inc Medicare	$63.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.00
Rate for Payer: Hamaspik Choice Inc Medicare	$90.00

NYSTAGMUS TEST

Facility

$330.23

Service Code	HCPCS 92541 TC
Hospital Charge Code	30305003
Hospital Revenue Code	471
Rate for Payer: Cash Price	$147.72

NYSTAGMUS TEST

Facility

$330.23

Service Code	HCPCS 92541 TC
Hospital Charge Code	30305003
Hospital Revenue Code	471
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$264.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$181.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$147.72
Rate for Payer: Aetna Government	$147.72
Rate for Payer: Affinity Essential Plan 1&2	$103.40
Rate for Payer: Affinity Essential Plan 3&4	$103.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$103.40
Rate for Payer: Brighton Health Commercial	$247.67
Rate for Payer: Cash Price	$147.72
Rate for Payer: Cash Price	$147.72
Rate for Payer: Cash Price	$147.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$147.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$264.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$224.56
Rate for Payer: Elderplan Medicare Advantage	$147.72
Rate for Payer: EmblemHealth Commercial	$147.72
Rate for Payer: Fidelis Essential Plan Aliesa	$125.56
Rate for Payer: Fidelis Essential Plan QHP	$131.47
Rate for Payer: Fidelis Medicare Advantage	$147.72
Rate for Payer: Fidelis Qualified Health Plan	$131.47
Rate for Payer: Group Health Inc Commercial	$147.72
Rate for Payer: Group Health Inc Medicare	$147.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.12
Rate for Payer: Hamaspik Choice Inc Medicare	$147.72
Rate for Payer: Healthfirst Medicare Advantage	$125.56
Rate for Payer: Healthfirst QHP	$147.72
Rate for Payer: Humana Medicare	$150.67
Rate for Payer: Senior Whole Health Medicare Advantage	$147.72
Rate for Payer: United Healthcare Commercial	$158.00
Rate for Payer: United Healthcare Medicare Advantage	$147.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$147.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$118.18
Rate for Payer: Wellcare Medicare	$140.33

NYSTATIN 100000 UNIT/GM EX CREA [5749]

Facility

$0.88

Service Code	NDC 45802005911
Hospital Charge Code	45802005911
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.44
Rate for Payer: Aetna Government	$0.44
Rate for Payer: Brighton Health Commercial	$0.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.60
Rate for Payer: Group Health Inc Commercial	$0.44
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.44
Rate for Payer: Hamaspik Choice Inc Medicare	$0.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.57

Know your out-of-pocket cost for care.

All Charges