St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX

Professional

Both

$205.42

Service Code	HCPCS 94690
Min. Negotiated Rate	$154.06
Max. Negotiated Rate	$154.06
Rate for Payer: Cash Price	$57.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$154.06
Rate for Payer: SOMOS Essential	$154.06

PR O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX

Professional

Both

$189.60

Service Code	HCPCS 94690 TC
Min. Negotiated Rate	$142.20
Max. Negotiated Rate	$142.20
Rate for Payer: Cash Price	$53.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$142.20
Rate for Payer: SOMOS Essential	$142.20

PR O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX

Professional

Both

$15.82

Service Code	HCPCS 94690 26
Min. Negotiated Rate	$11.86
Max. Negotiated Rate	$11.86
Rate for Payer: Cash Price	$4.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$11.86
Rate for Payer: SOMOS Essential	$11.86

PR O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC

Professional

Both

$37.84

Service Code	HCPCS 94681 26
Min. Negotiated Rate	$28.38
Max. Negotiated Rate	$28.38
Rate for Payer: Cash Price	$10.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28.38
Rate for Payer: SOMOS Essential	$28.38

PR O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC

Professional

Both

$201.46

Service Code	HCPCS 94681
Min. Negotiated Rate	$151.10
Max. Negotiated Rate	$151.10
Rate for Payer: Cash Price	$56.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$151.10
Rate for Payer: SOMOS Essential	$151.10

PR O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC

Professional

Both

$163.59

Service Code	HCPCS 94681 TC
Min. Negotiated Rate	$122.69
Max. Negotiated Rate	$122.69
Rate for Payer: Cash Price	$46.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$122.69
Rate for Payer: SOMOS Essential	$122.69

PR O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP

Professional

Both

$175.11

Service Code	HCPCS 94680 TC
Min. Negotiated Rate	$131.33
Max. Negotiated Rate	$131.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$131.33
Rate for Payer: SOMOS Essential	$131.33

PR O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP

Professional

Both

$50.96

Service Code	HCPCS 94680 26
Min. Negotiated Rate	$38.22
Max. Negotiated Rate	$38.22
Rate for Payer: Cash Price	$13.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38.22
Rate for Payer: SOMOS Essential	$38.22

PR O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP

Professional

Both

$226.07

Service Code	HCPCS 94680
Min. Negotiated Rate	$169.55
Max. Negotiated Rate	$169.55
Rate for Payer: Cash Price	$63.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$169.55
Rate for Payer: SOMOS Essential	$169.55

PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM

Professional

Both

$12,239.68

Service Code	HCPCS 59510
Min. Negotiated Rate	$9,179.76
Max. Negotiated Rate	$9,179.76
Rate for Payer: Cash Price	$3,298.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9,179.76
Rate for Payer: SOMOS Essential	$9,179.76

PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM

Professional

Both

$10,931.24

Service Code	HCPCS 59400
Min. Negotiated Rate	$8,198.43
Max. Negotiated Rate	$8,198.43
Rate for Payer: Cash Price	$2,942.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,198.43
Rate for Payer: SOMOS Essential	$8,198.43

PROBE 90 DEG RF 2

Facility

$312.50

Hospital Charge Code	64904984
Hospital Revenue Code	270
Min. Negotiated Rate	$109.38
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$171.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$156.25
Rate for Payer: Aetna Government	$156.25
Rate for Payer: Brighton Health Commercial	$234.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$212.50
Rate for Payer: Group Health Inc Commercial	$156.25
Rate for Payer: Group Health Inc Medicare	$109.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.25
Rate for Payer: Hamaspik Choice Inc Medicare	$156.25

PROBE ABLAT SER 90-S CRUISE

Facility

$4,731.25

Hospital Charge Code	64907499
Hospital Revenue Code	279
Min. Negotiated Rate	$1,655.94
Max. Negotiated Rate	$3,785.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,602.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,365.62
Rate for Payer: Aetna Government	$2,365.62
Rate for Payer: Brighton Health Commercial	$3,548.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,785.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,217.25
Rate for Payer: Group Health Inc Commercial	$2,365.62
Rate for Payer: Group Health Inc Medicare	$1,655.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,365.62
Rate for Payer: Hamaspik Choice Inc Medicare	$2,365.62

PROBE ANTERIOR VITRECTOMY

Facility

$700.00

Hospital Charge Code	40201133
Hospital Revenue Code	270
Min. Negotiated Rate	$245.00
Max. Negotiated Rate	$560.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$385.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$350.00
Rate for Payer: Aetna Government	$350.00
Rate for Payer: Brighton Health Commercial	$525.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$560.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$476.00
Rate for Payer: Group Health Inc Commercial	$350.00
Rate for Payer: Group Health Inc Medicare	$245.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00

PROBE ANTERIOR VITRECTOMY

Facility

$413.33

Hospital Charge Code	64903046
Hospital Revenue Code	270
Min. Negotiated Rate	$144.67
Max. Negotiated Rate	$330.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$227.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$206.66
Rate for Payer: Aetna Government	$206.66
Rate for Payer: Brighton Health Commercial	$310.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$330.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$281.06
Rate for Payer: Group Health Inc Commercial	$206.66
Rate for Payer: Group Health Inc Medicare	$144.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$206.66
Rate for Payer: Hamaspik Choice Inc Medicare	$206.66

PROBE DISP 23GA INFINITI ULT

Facility

$562.50

Hospital Charge Code	64904953
Hospital Revenue Code	270
Min. Negotiated Rate	$196.88
Max. Negotiated Rate	$450.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$309.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$281.25
Rate for Payer: Aetna Government	$281.25
Rate for Payer: Brighton Health Commercial	$421.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$450.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$382.50
Rate for Payer: Group Health Inc Commercial	$281.25
Rate for Payer: Group Health Inc Medicare	$196.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.25
Rate for Payer: Hamaspik Choice Inc Medicare	$281.25

PROBE FIAPC W/FIL 2.3MMX220CM

Facility

$534.88

Hospital Charge Code	64904754
Hospital Revenue Code	270
Min. Negotiated Rate	$187.21
Max. Negotiated Rate	$427.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$294.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$267.44
Rate for Payer: Aetna Government	$267.44
Rate for Payer: Brighton Health Commercial	$401.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$427.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$363.72
Rate for Payer: Group Health Inc Commercial	$267.44
Rate for Payer: Group Health Inc Medicare	$187.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$267.44
Rate for Payer: Hamaspik Choice Inc Medicare	$267.44

PROBE GOLD 10FR

Facility

$2,444.00

Hospital Charge Code	40200816
Hospital Revenue Code	270
Min. Negotiated Rate	$855.40
Max. Negotiated Rate	$1,955.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,344.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,222.00
Rate for Payer: Aetna Government	$1,222.00
Rate for Payer: Brighton Health Commercial	$1,833.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,955.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,661.92
Rate for Payer: Group Health Inc Commercial	$1,222.00
Rate for Payer: Group Health Inc Medicare	$855.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,222.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,222.00

PROBE INCREMENTING A

Facility

$485.00

Hospital Charge Code	64905128
Hospital Revenue Code	270
Min. Negotiated Rate	$169.75
Max. Negotiated Rate	$388.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$266.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$242.50
Rate for Payer: Aetna Government	$242.50
Rate for Payer: Brighton Health Commercial	$363.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$388.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$329.80
Rate for Payer: Group Health Inc Commercial	$242.50
Rate for Payer: Group Health Inc Medicare	$169.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$242.50
Rate for Payer: Hamaspik Choice Inc Medicare	$242.50

PROBE INJ GOLD CATH 10FX25GX210CM

Facility

$650.00

Hospital Charge Code	64904304
Hospital Revenue Code	279
Min. Negotiated Rate	$227.50
Max. Negotiated Rate	$520.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$357.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$325.00
Rate for Payer: Aetna Government	$325.00
Rate for Payer: Brighton Health Commercial	$487.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$520.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$442.00
Rate for Payer: Group Health Inc Commercial	$325.00
Rate for Payer: Group Health Inc Medicare	$227.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$325.00

PROBE MICRO, DOPPLER

Facility

$1,617.00

Hospital Charge Code	64906329
Hospital Revenue Code	270
Min. Negotiated Rate	$565.95
Max. Negotiated Rate	$1,293.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$889.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$808.50
Rate for Payer: Aetna Government	$808.50
Rate for Payer: Brighton Health Commercial	$1,212.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,293.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,099.56
Rate for Payer: Group Health Inc Commercial	$808.50
Rate for Payer: Group Health Inc Medicare	$565.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$808.50
Rate for Payer: Hamaspik Choice Inc Medicare	$808.50

PROBE MONO ELECTRO L-TIP 33CM

Facility

$433.43

Hospital Charge Code	64904838
Hospital Revenue Code	270
Min. Negotiated Rate	$151.70
Max. Negotiated Rate	$346.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$238.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$216.72
Rate for Payer: Aetna Government	$216.72
Rate for Payer: Brighton Health Commercial	$325.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$346.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$294.73
Rate for Payer: Group Health Inc Commercial	$216.72
Rate for Payer: Group Health Inc Medicare	$151.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$216.72
Rate for Payer: Hamaspik Choice Inc Medicare	$216.72

PROBE MONO ELECTRO SPATULA TP

Facility

$435.28

Hospital Charge Code	64904840
Hospital Revenue Code	270
Min. Negotiated Rate	$152.35
Max. Negotiated Rate	$348.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$239.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$217.64
Rate for Payer: Aetna Government	$217.64
Rate for Payer: Brighton Health Commercial	$326.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$348.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$295.99
Rate for Payer: Group Health Inc Commercial	$217.64
Rate for Payer: Group Health Inc Medicare	$152.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$217.64
Rate for Payer: Hamaspik Choice Inc Medicare	$217.64

PROBE NASOLACRIMAL DUCT

Facility

$5,861.23

Service Code	HCPCS 68811
Hospital Charge Code	30301203
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,930.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,702.32
Rate for Payer: Aetna Government	$2,702.32
Rate for Payer: Affinity Essential Plan 1&2	$1,891.62
Rate for Payer: Affinity Essential Plan 3&4	$1,891.62
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,891.62
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$2,702.32
Rate for Payer: Cash Price	$2,702.32
Rate for Payer: Cash Price	$2,702.32
Rate for Payer: Cash Price	$2,702.32
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,702.32
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: Elderplan Medicare Advantage	$2,702.32
Rate for Payer: Fidelis Essential Plan Aliesa	$2,296.97
Rate for Payer: Fidelis Essential Plan QHP	$2,405.06
Rate for Payer: Fidelis Medicare Advantage	$2,702.32
Rate for Payer: Fidelis Qualified Health Plan	$2,405.06
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	$2,930.62
Rate for Payer: Hamaspik Choice Inc Medicare	$2,702.32
Rate for Payer: Healthfirst Medicare Advantage	$2,296.97
Rate for Payer: Healthfirst QHP	$2,702.32
Rate for Payer: Humana Medicare	$2,756.37
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$2,702.32
Rate for Payer: Senior Whole Health Medicare Advantage	$2,702.32
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$2,702.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,702.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,161.86
Rate for Payer: Wellcare Medicare	$2,567.20

PROBE NASOLACRIMAL DUCT

Facility

$5,861.23

Service Code	HCPCS 68811
Hospital Charge Code	30301203
Hospital Revenue Code	510
Rate for Payer: Cash Price	$2,702.32

Know your out-of-pocket cost for care.

All Charges