St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PACK CYSTO

Facility

$83.33

Hospital Charge Code	64901443
Hospital Revenue Code	270
Min. Negotiated Rate	$29.17
Max. Negotiated Rate	$66.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.66
Rate for Payer: Aetna Government	$41.66
Rate for Payer: Brighton Health Commercial	$62.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$66.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$56.66
Rate for Payer: Group Health Inc Commercial	$41.66
Rate for Payer: Group Health Inc Medicare	$29.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.66
Rate for Payer: Hamaspik Choice Inc Medicare	$41.66

PACKED RED CELLS (250CC)

Facility

$550.00

Service Code	HCPCS P9021
Hospital Charge Code	40701021
Hospital Revenue Code	390
Rate for Payer: Cash Price	$165.68

PACKED RED CELLS (250CC)

Facility

$550.00

Service Code	HCPCS P9021
Hospital Charge Code	40701021
Hospital Revenue Code	390
Min. Negotiated Rate	$115.98
Max. Negotiated Rate	$440.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$302.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$165.68
Rate for Payer: Aetna Government	$165.68
Rate for Payer: Affinity Essential Plan 1&2	$115.98
Rate for Payer: Affinity Essential Plan 3&4	$115.98
Rate for Payer: Affinity Medicaid/CHP/HARP	$115.98
Rate for Payer: Brighton Health Commercial	$412.50
Rate for Payer: Cash Price	$165.68
Rate for Payer: Cash Price	$165.68
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$165.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$440.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$374.00
Rate for Payer: Elderplan Medicare Advantage	$165.68
Rate for Payer: EmblemHealth Commercial	$165.68
Rate for Payer: Fidelis Essential Plan Aliesa	$140.83
Rate for Payer: Fidelis Essential Plan QHP	$147.46
Rate for Payer: Fidelis Medicare Advantage	$165.68
Rate for Payer: Fidelis Qualified Health Plan	$147.46
Rate for Payer: Group Health Inc Commercial	$165.68
Rate for Payer: Group Health Inc Medicare	$165.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$165.68
Rate for Payer: Healthfirst Medicare Advantage	$140.83
Rate for Payer: Healthfirst QHP	$165.68
Rate for Payer: Humana Medicare	$168.99
Rate for Payer: Senior Whole Health Medicare Advantage	$165.68
Rate for Payer: United Healthcare Commercial	$275.00
Rate for Payer: United Healthcare Medicare Advantage	$165.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$165.68
Rate for Payer: Wellcare CHP/FHP/Medicaid	$132.54
Rate for Payer: Wellcare Medicare	$157.40

PACK EXTREMITY

Facility

$100.44

Hospital Charge Code	64901362
Hospital Revenue Code	270
Min. Negotiated Rate	$35.15
Max. Negotiated Rate	$80.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.22
Rate for Payer: Aetna Government	$50.22
Rate for Payer: Brighton Health Commercial	$75.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.30
Rate for Payer: Group Health Inc Commercial	$50.22
Rate for Payer: Group Health Inc Medicare	$35.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.22
Rate for Payer: Hamaspik Choice Inc Medicare	$50.22

PACK FOAM VITOSS 2.5CC

Facility

$2,960.10

Hospital Charge Code	64904960
Hospital Revenue Code	270
Min. Negotiated Rate	$1,036.04
Max. Negotiated Rate	$2,368.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,628.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,480.05
Rate for Payer: Aetna Government	$1,480.05
Rate for Payer: Brighton Health Commercial	$2,220.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,368.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,012.87
Rate for Payer: Group Health Inc Commercial	$1,480.05
Rate for Payer: Group Health Inc Medicare	$1,036.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,480.05
Rate for Payer: Hamaspik Choice Inc Medicare	$1,480.05

PACK FULL MOUTH REHAB

Facility

$64.49

Hospital Charge Code	64901354
Hospital Revenue Code	270
Min. Negotiated Rate	$22.57
Max. Negotiated Rate	$51.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.24
Rate for Payer: Aetna Government	$32.24
Rate for Payer: Brighton Health Commercial	$48.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$51.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.85
Rate for Payer: Group Health Inc Commercial	$32.24
Rate for Payer: Group Health Inc Medicare	$22.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.24
Rate for Payer: Hamaspik Choice Inc Medicare	$32.24

PACK GRAFT DELIVERY GDP-10

Facility

$1,500.00

Hospital Charge Code	64905425
Hospital Revenue Code	279
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$825.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$750.00
Rate for Payer: Aetna Government	$750.00
Rate for Payer: Brighton Health Commercial	$1,125.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,020.00
Rate for Payer: Group Health Inc Commercial	$750.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$750.00

PACK GYN LAPAROSCOPY

Facility

$108.93

Hospital Charge Code	64901360
Hospital Revenue Code	270
Min. Negotiated Rate	$38.13
Max. Negotiated Rate	$87.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.46
Rate for Payer: Aetna Government	$54.46
Rate for Payer: Brighton Health Commercial	$81.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.07
Rate for Payer: Group Health Inc Commercial	$54.46
Rate for Payer: Group Health Inc Medicare	$38.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.46
Rate for Payer: Hamaspik Choice Inc Medicare	$54.46

PACK HEAD & NECK

Facility

$86.40

Hospital Charge Code	64901428
Hospital Revenue Code	270
Min. Negotiated Rate	$30.24
Max. Negotiated Rate	$69.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.20
Rate for Payer: Aetna Government	$43.20
Rate for Payer: Brighton Health Commercial	$64.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$69.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.75
Rate for Payer: Group Health Inc Commercial	$43.20
Rate for Payer: Group Health Inc Medicare	$30.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.20
Rate for Payer: Hamaspik Choice Inc Medicare	$43.20

PACK,HOT,INST,NON-INSUL

Facility

$0.90

Hospital Charge Code	64902018
Hospital Revenue Code	270
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.61
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45

PACKING NASAL 4.5CM ANT RAPID RH

Facility

$89.00

Hospital Charge Code	64904109
Hospital Revenue Code	270
Min. Negotiated Rate	$31.15
Max. Negotiated Rate	$71.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.50
Rate for Payer: Aetna Government	$44.50
Rate for Payer: Brighton Health Commercial	$66.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$71.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$60.52
Rate for Payer: Group Health Inc Commercial	$44.50
Rate for Payer: Group Health Inc Medicare	$31.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.50
Rate for Payer: Hamaspik Choice Inc Medicare	$44.50

PACKING NASAL 5.5CM ANT RAPID RH

Facility

$89.00

Hospital Charge Code	64904111
Hospital Revenue Code	270
Min. Negotiated Rate	$31.15
Max. Negotiated Rate	$71.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.50
Rate for Payer: Aetna Government	$44.50
Rate for Payer: Brighton Health Commercial	$66.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$71.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$60.52
Rate for Payer: Group Health Inc Commercial	$44.50
Rate for Payer: Group Health Inc Medicare	$31.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.50
Rate for Payer: Hamaspik Choice Inc Medicare	$44.50

PACKING NASAL 7.5CM ANT/PST RAP

Facility

$87.25

Hospital Charge Code	64904113
Hospital Revenue Code	270
Min. Negotiated Rate	$30.54
Max. Negotiated Rate	$69.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.62
Rate for Payer: Aetna Government	$43.62
Rate for Payer: Brighton Health Commercial	$65.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$69.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.33
Rate for Payer: Group Health Inc Commercial	$43.62
Rate for Payer: Group Health Inc Medicare	$30.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.62
Rate for Payer: Hamaspik Choice Inc Medicare	$43.62

PACKING VAGINAK 2X72

Facility

$2.27

Hospital Charge Code	40200611
Hospital Revenue Code	270
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.14
Rate for Payer: Aetna Government	$1.14
Rate for Payer: Brighton Health Commercial	$1.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.54
Rate for Payer: Group Health Inc Commercial	$1.14
Rate for Payer: Group Health Inc Medicare	$0.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.14
Rate for Payer: Hamaspik Choice Inc Medicare	$1.14

PACKING VAGINAL 2X72

Facility

$5.33

Hospital Charge Code	64904027
Hospital Revenue Code	270
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$4.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.66
Rate for Payer: Aetna Government	$2.66
Rate for Payer: Brighton Health Commercial	$4.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.62
Rate for Payer: Group Health Inc Commercial	$2.66
Rate for Payer: Group Health Inc Medicare	$1.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.66
Rate for Payer: Hamaspik Choice Inc Medicare	$2.66

PACK LAP

Facility

$36.68

Hospital Charge Code	64901308
Hospital Revenue Code	270
Min. Negotiated Rate	$12.84
Max. Negotiated Rate	$29.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.34
Rate for Payer: Aetna Government	$18.34
Rate for Payer: Brighton Health Commercial	$27.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.94
Rate for Payer: Group Health Inc Commercial	$18.34
Rate for Payer: Group Health Inc Medicare	$12.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.34
Rate for Payer: Hamaspik Choice Inc Medicare	$18.34

PACK MAJOR LAP

Facility

$134.87

Hospital Charge Code	64901358
Hospital Revenue Code	270
Min. Negotiated Rate	$47.20
Max. Negotiated Rate	$107.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$67.44
Rate for Payer: Aetna Government	$67.44
Rate for Payer: Brighton Health Commercial	$101.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$107.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$91.71
Rate for Payer: Group Health Inc Commercial	$67.44
Rate for Payer: Group Health Inc Medicare	$47.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.44
Rate for Payer: Hamaspik Choice Inc Medicare	$67.44

PACK MINOR/LAPAROSCOPY

Facility

$108.83

Hospital Charge Code	64901503
Hospital Revenue Code	270
Min. Negotiated Rate	$38.09
Max. Negotiated Rate	$87.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.42
Rate for Payer: Aetna Government	$54.42
Rate for Payer: Brighton Health Commercial	$81.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.00
Rate for Payer: Group Health Inc Commercial	$54.42
Rate for Payer: Group Health Inc Medicare	$38.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.42
Rate for Payer: Hamaspik Choice Inc Medicare	$54.42

PACK OB

Facility

$20.30

Hospital Charge Code	64901732
Hospital Revenue Code	270
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$16.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.15
Rate for Payer: Aetna Government	$10.15
Rate for Payer: Brighton Health Commercial	$15.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.80
Rate for Payer: Group Health Inc Commercial	$10.15
Rate for Payer: Group Health Inc Medicare	$7.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.15
Rate for Payer: Hamaspik Choice Inc Medicare	$10.15

PACK PERI/GYN

Facility

$28.60

Hospital Charge Code	64901352
Hospital Revenue Code	270
Min. Negotiated Rate	$10.01
Max. Negotiated Rate	$22.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.30
Rate for Payer: Aetna Government	$14.30
Rate for Payer: Brighton Health Commercial	$21.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.45
Rate for Payer: Group Health Inc Commercial	$14.30
Rate for Payer: Group Health Inc Medicare	$10.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.30
Rate for Payer: Hamaspik Choice Inc Medicare	$14.30

PACK PRINTING COLOR UPC-510

Facility

$406.00

Hospital Charge Code	40200600
Hospital Revenue Code	270
Min. Negotiated Rate	$142.10
Max. Negotiated Rate	$324.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$223.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$203.00
Rate for Payer: Aetna Government	$203.00
Rate for Payer: Brighton Health Commercial	$304.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$324.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$276.08
Rate for Payer: Group Health Inc Commercial	$203.00
Rate for Payer: Group Health Inc Medicare	$142.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.00
Rate for Payer: Hamaspik Choice Inc Medicare	$203.00

PACK PROCEDURE BMAC 120

Facility

$6,500.00

Hospital Charge Code	64905424
Hospital Revenue Code	279
Min. Negotiated Rate	$2,275.00
Max. Negotiated Rate	$5,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,575.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,250.00
Rate for Payer: Aetna Government	$3,250.00
Rate for Payer: Brighton Health Commercial	$4,875.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,420.00
Rate for Payer: Group Health Inc Commercial	$3,250.00
Rate for Payer: Group Health Inc Medicare	$2,275.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,250.00

PACK SHROUD

Facility

$3.38

Hospital Charge Code	40200601
Hospital Revenue Code	270
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$2.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.69
Rate for Payer: Aetna Government	$1.69
Rate for Payer: Brighton Health Commercial	$2.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.30
Rate for Payer: Group Health Inc Commercial	$1.69
Rate for Payer: Group Health Inc Medicare	$1.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.69
Rate for Payer: Hamaspik Choice Inc Medicare	$1.69

PACK STEAM TEST PROCESS CHALLENGE

Facility

$7.98

Hospital Charge Code	64904767
Hospital Revenue Code	270
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$6.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.99
Rate for Payer: Aetna Government	$3.99
Rate for Payer: Brighton Health Commercial	$5.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.43
Rate for Payer: Group Health Inc Commercial	$3.99
Rate for Payer: Group Health Inc Medicare	$2.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.99
Rate for Payer: Hamaspik Choice Inc Medicare	$3.99

PACK SUBSTITUTE BONE GRA FOAM

Facility

$11,550.00

Hospital Charge Code	64906034
Hospital Revenue Code	270
Min. Negotiated Rate	$4,042.50
Max. Negotiated Rate	$9,240.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,352.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,775.00
Rate for Payer: Aetna Government	$5,775.00
Rate for Payer: Brighton Health Commercial	$8,662.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9,240.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,854.00
Rate for Payer: Group Health Inc Commercial	$5,775.00
Rate for Payer: Group Health Inc Medicare	$4,042.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,775.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,775.00

Know your out-of-pocket cost for care.

All Charges