St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

RESOLUTE ONYX 2.25X22

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521611
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

RESOLUTE ONYX 2.25X26

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521612
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

RESOLUTE ONYX 2.25X26

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521612
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: EmblemHealth Commercial	$1,500.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

RESOLUTE ONYX 2.25X30

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521613
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

RESOLUTE ONYX 2.25X30

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521613
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: EmblemHealth Commercial	$1,500.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

RESOLUTE ONYX 2.25X34

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521614
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: EmblemHealth Commercial	$1,500.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

RESOLUTE ONYX 2.25X34

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521614
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

RESOLUTE ONYX 2.25X38

Facility

$2,100.00

Service Code	HCPCS C1874
Hospital Charge Code	66521615
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,050.00

RESOLUTE ONYX 2.25X38

Facility

$2,100.00

Service Code	HCPCS C1874
Hospital Charge Code	66521615
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$2,205.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,155.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$1,260.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,050.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,207.50
Rate for Payer: EmblemHealth Commercial	$1,050.00
Rate for Payer: Fidelis Medicare Advantage	$2,205.00
Rate for Payer: Group Health Inc Commercial	$1,050.00
Rate for Payer: Group Health Inc Medicare	$735.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,050.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,365.00

RESOLUTE ONYX 2.50X08

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521616
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: EmblemHealth Commercial	$1,500.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

RESOLUTE ONYX 2.50X08

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521616
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

RESOLUTE ONYX 2.50X12

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521617
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

RESOLUTE ONYX 2.50X12

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521617
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: EmblemHealth Commercial	$1,500.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

RESOLUTE ONYX 2.50X15

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521618
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: EmblemHealth Commercial	$1,500.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

RESOLUTE ONYX 2.50X15

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521618
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

RESOLUTE ONYX 2.50X18

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521619
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: EmblemHealth Commercial	$1,500.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

RESOLUTE ONYX 2.50X18

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521646
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: EmblemHealth Commercial	$1,500.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

RESOLUTE ONYX 2.50X18

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521619
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

RESOLUTE ONYX 2.50X18

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521646
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

RESOLUTE ONYX 2.50X22

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521620
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

RESOLUTE ONYX 2.50X22

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521620
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: EmblemHealth Commercial	$1,500.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

RESOLUTE ONYX 2.50X22

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521647
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: EmblemHealth Commercial	$1,500.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

RESOLUTE ONYX 2.50X22

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521647
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

RESOLUTE ONYX 2.50X26

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521621
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

RESOLUTE ONYX 2.50X26

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521621
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: EmblemHealth Commercial	$1,500.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

Know your out-of-pocket cost for care.

All Charges