St. Barnabas Hospital

All Charges

Charge

Type

Price

TECHNETIUM TC-99M EXAMETAZIME

Facility OP

$3,364.25

Service Code	HCPCS A9521
Hospital Charge Code	41656487
Hospital Revenue Code	343
Min. Negotiated Rate	$1,177.49
Max. Negotiated Rate	$2,691.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,850.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,265.82
Rate for Payer: Aetna Government	$1,265.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,691.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,287.69
Rate for Payer: Group Health Inc Commercial	$1,682.12
Rate for Payer: Group Health Inc Medicare	$1,177.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,682.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,682.12

TECHNETIUM TC-99M MEBROFENIN

Facility OP

$129.00

Service Code	HCPCS A9537
Hospital Charge Code	41656563
Hospital Revenue Code	343
Min. Negotiated Rate	$45.15
Max. Negotiated Rate	$103.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$45.80
Rate for Payer: Aetna Government	$45.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$103.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$87.72
Rate for Payer: Group Health Inc Commercial	$64.50
Rate for Payer: Group Health Inc Medicare	$45.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.50
Rate for Payer: Hamaspik Choice Inc Medicare	$64.50

TECHNETIUM TC-99M MEBROFENIN

Facility OP

$129.00

Service Code	HCPCS A9537
Hospital Charge Code	41646563
Hospital Revenue Code	343
Min. Negotiated Rate	$45.15
Max. Negotiated Rate	$103.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$45.80
Rate for Payer: Aetna Government	$45.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$103.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$87.72
Rate for Payer: Group Health Inc Commercial	$64.50
Rate for Payer: Group Health Inc Medicare	$45.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.50
Rate for Payer: Hamaspik Choice Inc Medicare	$64.50

TECHNETIUM TC-99M MEDRONATE

Facility OP

$43.00

Service Code	HCPCS A9503
Hospital Charge Code	41656489
Hospital Revenue Code	343
Min. Negotiated Rate	$10.76
Max. Negotiated Rate	$34.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.76
Rate for Payer: Aetna Government	$10.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.24
Rate for Payer: Group Health Inc Commercial	$21.50
Rate for Payer: Group Health Inc Medicare	$15.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.50
Rate for Payer: Hamaspik Choice Inc Medicare	$21.50

TECHNETIUM TC-99M PERTECHNET 10MC

Facility OP

$3.97

Service Code	HCPCS A9512
Hospital Charge Code	41646569
Hospital Revenue Code	343
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$3.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.32
Rate for Payer: Aetna Government	$1.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.70
Rate for Payer: Group Health Inc Commercial	$1.98
Rate for Payer: Group Health Inc Medicare	$1.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.98
Rate for Payer: Hamaspik Choice Inc Medicare	$1.98

TECHNETIUM TC-99M PERTECHNET 30MC

Facility OP

$1.32

Service Code	HCPCS A9512
Hospital Charge Code	41656570
Hospital Revenue Code	343
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$1.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.32
Rate for Payer: Aetna Government	$1.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.90
Rate for Payer: Group Health Inc Commercial	$0.66
Rate for Payer: Group Health Inc Medicare	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.66
Rate for Payer: Hamaspik Choice Inc Medicare	$0.66

TECHNETIUM TC-99M PYROPHOSPHATE

Facility OP

$3.61

Service Code	HCPCS A9538
Hospital Charge Code	41656571
Hospital Revenue Code	343
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$41.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.40
Rate for Payer: Aetna Government	$41.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.45
Rate for Payer: Group Health Inc Commercial	$1.80
Rate for Payer: Group Health Inc Medicare	$1.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.80
Rate for Payer: Hamaspik Choice Inc Medicare	$1.80

TECHNETIUM TC-99M PYROPHOSPHATE

Facility OP

$3.61

Service Code	HCPCS A9538
Hospital Charge Code	41646571
Hospital Revenue Code	343
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$41.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.40
Rate for Payer: Aetna Government	$41.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.45
Rate for Payer: Group Health Inc Commercial	$1.80
Rate for Payer: Group Health Inc Medicare	$1.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.80
Rate for Payer: Hamaspik Choice Inc Medicare	$1.80

TECHNETIUM TC-99M SESTAMIBI

Facility OP

$86.87

Service Code	HCPCS A9500
Hospital Charge Code	41646559
Hospital Revenue Code	343
Min. Negotiated Rate	$30.40
Max. Negotiated Rate	$88.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$88.39
Rate for Payer: Aetna Government	$88.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$69.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.07
Rate for Payer: Group Health Inc Commercial	$43.44
Rate for Payer: Group Health Inc Medicare	$30.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.44
Rate for Payer: Hamaspik Choice Inc Medicare	$43.44

TECHNETIUM TC-99M SESTAMIBI 10MCI

Facility OP

$86.87

Service Code	HCPCS A9500
Hospital Charge Code	41656559
Hospital Revenue Code	343
Min. Negotiated Rate	$30.40
Max. Negotiated Rate	$88.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$88.39
Rate for Payer: Aetna Government	$88.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$69.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.07
Rate for Payer: Group Health Inc Commercial	$43.44
Rate for Payer: Group Health Inc Medicare	$30.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.44
Rate for Payer: Hamaspik Choice Inc Medicare	$43.44

TECHNETIUM TC-99M SULFUR COLLOID

Facility OP

$141.87

Service Code	HCPCS A9541
Hospital Charge Code	41646562
Hospital Revenue Code	343
Min. Negotiated Rate	$49.65
Max. Negotiated Rate	$221.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$221.38
Rate for Payer: Aetna Government	$221.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$113.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$96.47
Rate for Payer: Group Health Inc Commercial	$70.94
Rate for Payer: Group Health Inc Medicare	$49.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.94
Rate for Payer: Hamaspik Choice Inc Medicare	$70.94

TECHNETIUM TC-99M SULFUR COLLOID

Facility OP

$141.87

Service Code	HCPCS A9541
Hospital Charge Code	41656562
Hospital Revenue Code	343
Min. Negotiated Rate	$49.65
Max. Negotiated Rate	$221.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$221.38
Rate for Payer: Aetna Government	$221.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$113.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$96.47
Rate for Payer: Group Health Inc Commercial	$70.94
Rate for Payer: Group Health Inc Medicare	$49.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.94
Rate for Payer: Hamaspik Choice Inc Medicare	$70.94

TECHNETIUM TC-99 PERTECHNET 10MCI

Facility OP

$3.97

Service Code	HCPCS A9512
Hospital Charge Code	41656569
Hospital Revenue Code	343
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$3.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.32
Rate for Payer: Aetna Government	$1.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.70
Rate for Payer: Group Health Inc Commercial	$1.98
Rate for Payer: Group Health Inc Medicare	$1.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.98
Rate for Payer: Hamaspik Choice Inc Medicare	$1.98

TECHNETIUM TC-99 PERTECHNET 30MCI

Facility OP

$1.32

Service Code	HCPCS A9512
Hospital Charge Code	41646570
Hospital Revenue Code	343
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$1.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.32
Rate for Payer: Aetna Government	$1.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.90
Rate for Payer: Group Health Inc Commercial	$0.66
Rate for Payer: Group Health Inc Medicare	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.66
Rate for Payer: Hamaspik Choice Inc Medicare	$0.66

TECH TC-99M FILTERED SULFER COLL

Facility OP

$275.00

Service Code	HCPCS A9541
Hospital Charge Code	41646592
Hospital Revenue Code	343
Min. Negotiated Rate	$96.25
Max. Negotiated Rate	$221.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$151.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$221.38
Rate for Payer: Aetna Government	$221.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$220.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$187.00
Rate for Payer: Group Health Inc Commercial	$137.50
Rate for Payer: Group Health Inc Medicare	$96.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.50
Rate for Payer: Hamaspik Choice Inc Medicare	$137.50

TECH TC-99M FILTERED SULFUR COLL

Facility OP

$275.00

Service Code	HCPCS A9541
Hospital Charge Code	41656592
Hospital Revenue Code	343
Min. Negotiated Rate	$96.25
Max. Negotiated Rate	$221.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$151.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$221.38
Rate for Payer: Aetna Government	$221.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$220.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$187.00
Rate for Payer: Group Health Inc Commercial	$137.50
Rate for Payer: Group Health Inc Medicare	$96.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.50
Rate for Payer: Hamaspik Choice Inc Medicare	$137.50

TECNIS ITEC PRELOADED 1PC MONO PC

Facility OP

$260.00

Service Code	HCPCS C1780
Hospital Charge Code	64906496
Hospital Revenue Code	276
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$273.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$143.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.26
Rate for Payer: Aetna Government	$2.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$208.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$176.80
Rate for Payer: Fidelis Medicare Advantage	$273.00
Rate for Payer: Group Health Inc Commercial	$130.00
Rate for Payer: Group Health Inc Medicare	$91.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.00
Rate for Payer: Hamaspik Choice Inc Medicare	$130.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$169.00

TECOVIRIMAT CAPUSLES

Facility OP

$0.01

Hospital Charge Code	41650379
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TECOVIRIMAT CAPUSLES

Facility OP

$0.01

Hospital Charge Code	41640379
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TECOVIRIMAT INJ

Facility IP

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41650380
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

TECOVIRIMAT INJ

Facility OP

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41640380
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TECOVIRIMAT INJ

Facility OP

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41650380
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TECOVIRIMAT INJ

Facility IP

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41640380
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

Ted Stockings

Facility OP

$16.65

Hospital Charge Code	40206000
Hospital Revenue Code	270
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$13.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.32
Rate for Payer: Aetna Government	$8.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.32
Rate for Payer: Group Health Inc Commercial	$8.32
Rate for Payer: Group Health Inc Medicare	$5.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.32
Rate for Payer: Hamaspik Choice Inc Medicare	$8.32

TEETH EXT.

Facility OP

$616.78

Service Code	HCPCS 41899
Hospital Charge Code	40011315
Hospital Revenue Code	360
Min. Negotiated Rate	$225.98
Max. Negotiated Rate	$142,987.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,880.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$282.47
Rate for Payer: Aetna Government	$282.47
Rate for Payer: Amida Care Medicaid	$1,429.87
Rate for Payer: Cash Price	$282.47
Rate for Payer: Cash Price	$282.47
Rate for Payer: Cash Price	$282.47
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$282.47
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	$282.47
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$142,987.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,429.87
Rate for Payer: Fidelis Essential Plan QHP	$1,429.87
Rate for Payer: Fidelis Medicare Advantage	$282.47
Rate for Payer: Fidelis Qualified Health Plan	$1,501.36
Rate for Payer: Group Health Inc Commercial	$282.47
Rate for Payer: Group Health Inc Medicare	$282.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,429.87
Rate for Payer: Hamaspik Choice Inc Medicare	$282.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,429.87
Rate for Payer: Healthfirst Essential Plan	$3,217.21
Rate for Payer: Healthfirst Medicare Advantage	$240.10
Rate for Payer: Healthfirst QHP	$1,429.87
Rate for Payer: Senior Whole Health Medicare Advantage	$282.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,429.87
Rate for Payer: SOMOS Essential	$3,217.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$282.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$225.98
Rate for Payer: Wellcare Medicare	$268.35

Price Transparency.

All Charges