St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PRECEPT SCREW, 6.5X50 POLY

Facility

$4,200.00

Service Code	HCPCS C1713
Hospital Charge Code	64905184
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,410.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,310.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,520.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,415.00
Rate for Payer: EmblemHealth Commercial	$2,100.00
Rate for Payer: Fidelis Medicare Advantage	$4,410.00
Rate for Payer: Group Health Inc Commercial	$2,100.00
Rate for Payer: Group Health Inc Medicare	$1,470.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,730.00

PRECEPT TI ROD 100MM PRE

Facility

$1,437.50

Service Code	HCPCS C1713
Hospital Charge Code	64903555
Hospital Revenue Code	278
Min. Negotiated Rate	$718.75
Max. Negotiated Rate	$718.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$718.75
Rate for Payer: Hamaspik Choice Inc Medicare	$718.75

PRECEPT TI ROD 100MM PRE

Facility

$1,437.50

Service Code	HCPCS C1713
Hospital Charge Code	64903555
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,509.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$790.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$862.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$718.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$826.56
Rate for Payer: EmblemHealth Commercial	$718.75
Rate for Payer: Fidelis Medicare Advantage	$1,509.38
Rate for Payer: Group Health Inc Commercial	$718.75
Rate for Payer: Group Health Inc Medicare	$503.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$718.75
Rate for Payer: Hamaspik Choice Inc Medicare	$718.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$934.38

PRECEPT TI ROD 110MM PRE

Facility

$1,437.50

Service Code	HCPCS C1713
Hospital Charge Code	64903557
Hospital Revenue Code	278
Min. Negotiated Rate	$718.75
Max. Negotiated Rate	$718.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$718.75
Rate for Payer: Hamaspik Choice Inc Medicare	$718.75

PRECEPT TI ROD 110MM PRE

Facility

$1,437.50

Service Code	HCPCS C1713
Hospital Charge Code	64903557
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,509.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$790.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$862.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$718.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$826.56
Rate for Payer: EmblemHealth Commercial	$718.75
Rate for Payer: Fidelis Medicare Advantage	$1,509.38
Rate for Payer: Group Health Inc Commercial	$718.75
Rate for Payer: Group Health Inc Medicare	$503.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$718.75
Rate for Payer: Hamaspik Choice Inc Medicare	$718.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$934.38

PRECEPT TI ROD, 45MM PRE BNT

Facility

$1,416.25

Service Code	HCPCS C1713
Hospital Charge Code	64905186
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,487.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$778.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$849.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$708.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$814.34
Rate for Payer: EmblemHealth Commercial	$708.12
Rate for Payer: Fidelis Medicare Advantage	$1,487.06
Rate for Payer: Group Health Inc Commercial	$708.12
Rate for Payer: Group Health Inc Medicare	$495.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$708.12
Rate for Payer: Hamaspik Choice Inc Medicare	$708.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$920.56

PRECEPT TI ROD, 45MM PRE BNT

Facility

$1,416.25

Service Code	HCPCS C1713
Hospital Charge Code	64905186
Hospital Revenue Code	278
Min. Negotiated Rate	$708.12
Max. Negotiated Rate	$708.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$708.12
Rate for Payer: Hamaspik Choice Inc Medicare	$708.12

PR ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY

Professional

Both

$32.66

Service Code	HCPCS 93010
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$24.50
Rate for Payer: Cash Price	$8.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24.50
Rate for Payer: SOMOS Essential	$24.50

PR ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R

Professional

Both

$28.60

Service Code	HCPCS 93005
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$21.45
Rate for Payer: Cash Price	$7.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21.45
Rate for Payer: SOMOS Essential	$21.45

PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R

Professional

Both

$61.25

Service Code	HCPCS 93000
Min. Negotiated Rate	$45.94
Max. Negotiated Rate	$45.94
Rate for Payer: Cash Price	$16.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$45.94
Rate for Payer: SOMOS Essential	$45.94

PRE-CHEMORX HYDRATION

Facility

$556.50

Service Code	HCPCS 96360
Hospital Charge Code	40509866
Hospital Revenue Code	260
Rate for Payer: Cash Price	$247.87

PRE-CHEMORX HYDRATION

Facility

$556.50

Service Code	HCPCS 96360
Hospital Charge Code	40509866
Hospital Revenue Code	260
Min. Negotiated Rate	$76.00
Max. Negotiated Rate	$445.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$247.87
Rate for Payer: Aetna Government	$247.87
Rate for Payer: Affinity Essential Plan 1&2	$173.51
Rate for Payer: Affinity Essential Plan 3&4	$173.51
Rate for Payer: Affinity Medicaid/CHP/HARP	$173.51
Rate for Payer: Brighton Health Commercial	$417.38
Rate for Payer: Cash Price	$247.87
Rate for Payer: Cash Price	$247.87
Rate for Payer: Cash Price	$247.87
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$247.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$445.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$378.42
Rate for Payer: Elderplan Medicare Advantage	$247.87
Rate for Payer: EmblemHealth Commercial	$247.87
Rate for Payer: Fidelis Essential Plan Aliesa	$210.69
Rate for Payer: Fidelis Essential Plan QHP	$220.60
Rate for Payer: Fidelis Medicare Advantage	$247.87
Rate for Payer: Fidelis Qualified Health Plan	$220.60
Rate for Payer: Group Health Inc Commercial	$247.87
Rate for Payer: Group Health Inc Medicare	$247.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.25
Rate for Payer: Hamaspik Choice Inc Medicare	$247.87
Rate for Payer: Healthfirst Medicare Advantage	$210.69
Rate for Payer: Healthfirst QHP	$247.87
Rate for Payer: Humana Medicare	$252.83
Rate for Payer: Senior Whole Health Medicare Advantage	$247.87
Rate for Payer: United Healthcare Commercial	$76.00
Rate for Payer: United Healthcare Medicare Advantage	$247.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$247.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$198.30
Rate for Payer: Wellcare Medicare	$235.48

PR ECHO GUIDANCE RADIOTHERAPY

Professional

Both

$767.97

Service Code	HCPCS G6001
Min. Negotiated Rate	$575.98
Max. Negotiated Rate	$575.98
Rate for Payer: Cash Price	$210.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$575.98
Rate for Payer: SOMOS Essential	$575.98

PR ECHO GUIDANCE RADIOTHERAPY

Professional

Both

$640.99

Service Code	HCPCS G6001 TC
Min. Negotiated Rate	$480.74
Max. Negotiated Rate	$480.74
Rate for Payer: Cash Price	$175.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$480.74
Rate for Payer: SOMOS Essential	$480.74

PR ECHO GUIDANCE RADIOTHERAPY

Professional

Both

$126.98

Service Code	HCPCS G6001 26
Min. Negotiated Rate	$95.24
Max. Negotiated Rate	$95.24
Rate for Payer: Cash Price	$34.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$95.24
Rate for Payer: SOMOS Essential	$95.24

PR ECHO R-T 2D W/PROBE PLACEMENT ONLY

Professional

Both

$45.22

Service Code	HCPCS 93313
Min. Negotiated Rate	$33.92
Max. Negotiated Rate	$33.92
Rate for Payer: Cash Price	$12.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33.92
Rate for Payer: SOMOS Essential	$33.92

PR ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN

Professional

Both

$898.49

Service Code	HCPCS 93355
Min. Negotiated Rate	$673.87
Max. Negotiated Rate	$673.87
Rate for Payer: Cash Price	$245.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$673.87
Rate for Payer: SOMOS Essential	$673.87

PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R

Professional

Both

$495.08

Service Code	HCPCS 93315 26
Min. Negotiated Rate	$371.31
Max. Negotiated Rate	$371.31
Rate for Payer: Cash Price	$135.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$371.31
Rate for Payer: SOMOS Essential	$371.31

PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R

Professional

Both

$1,222.83

Service Code	HCPCS 93315
Min. Negotiated Rate	$917.12
Max. Negotiated Rate	$917.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$917.12
Rate for Payer: SOMOS Essential	$917.12

PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R

Professional

Both

$727.76

Service Code	HCPCS 93315 TC
Min. Negotiated Rate	$545.82
Max. Negotiated Rate	$545.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$545.82
Rate for Payer: SOMOS Essential	$545.82

PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY

Professional

Both

$101.92

Service Code	HCPCS 93316
Min. Negotiated Rate	$76.44
Max. Negotiated Rate	$76.44
Rate for Payer: Cash Price	$28.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$76.44
Rate for Payer: SOMOS Essential	$76.44

PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT

Professional

Both

$1,077.58

Service Code	HCPCS 93317
Min. Negotiated Rate	$808.18
Max. Negotiated Rate	$808.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$808.18
Rate for Payer: SOMOS Essential	$808.18

PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT

Professional

Both

$349.83

Service Code	HCPCS 93317 26
Min. Negotiated Rate	$262.37
Max. Negotiated Rate	$262.37
Rate for Payer: Cash Price	$95.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$262.37
Rate for Payer: SOMOS Essential	$262.37

PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT

Professional

Both

$727.76

Service Code	HCPCS 93317 TC
Min. Negotiated Rate	$545.82
Max. Negotiated Rate	$545.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$545.82
Rate for Payer: SOMOS Essential	$545.82

PR ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ

Professional

Both

$815.15

Service Code	HCPCS 93318
Min. Negotiated Rate	$611.36
Max. Negotiated Rate	$611.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$611.36
Rate for Payer: SOMOS Essential	$611.36

Know your out-of-pocket cost for care.

All Charges