St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BALLOON MLDING ALLINONE (MOB37)

Facility

$509.00

Hospital Charge Code	64906464
Hospital Revenue Code	279
Min. Negotiated Rate	$178.15
Max. Negotiated Rate	$407.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$279.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$254.50
Rate for Payer: Aetna Government	$254.50
Rate for Payer: Brighton Health Commercial	$381.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$407.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$346.12
Rate for Payer: Group Health Inc Commercial	$254.50
Rate for Payer: Group Health Inc Medicare	$178.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$254.50
Rate for Payer: Hamaspik Choice Inc Medicare	$254.50

BALLOON, PRESSURE REG 61-70CM

Facility

$6,340.00

Hospital Charge Code	64906063
Hospital Revenue Code	270
Min. Negotiated Rate	$2,219.00
Max. Negotiated Rate	$5,072.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,487.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,170.00
Rate for Payer: Aetna Government	$3,170.00
Rate for Payer: Brighton Health Commercial	$4,755.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,072.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,311.20
Rate for Payer: Group Health Inc Commercial	$3,170.00
Rate for Payer: Group Health Inc Medicare	$2,219.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,170.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,170.00

BALLOONS LOW PROFILE PTA 6X8CM

Facility

$425.00

Hospital Charge Code	64905120
Hospital Revenue Code	270
Min. Negotiated Rate	$148.75
Max. Negotiated Rate	$340.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$233.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$212.50
Rate for Payer: Aetna Government	$212.50
Rate for Payer: Brighton Health Commercial	$318.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$340.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$289.00
Rate for Payer: Group Health Inc Commercial	$212.50
Rate for Payer: Group Health Inc Medicare	$148.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$212.50
Rate for Payer: Hamaspik Choice Inc Medicare	$212.50

BAMLANIVIMAB 700 MG/20ML IV SOLN [175456]

Facility

$0.00

Service Code	NDC 00002791001
Hospital Charge Code	00002791001
Hospital Revenue Code	278
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.00
Rate for Payer: Aetna Government	$0.00
Rate for Payer: Brighton Health Commercial	$0.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.00
Rate for Payer: EmblemHealth Commercial	$0.00
Rate for Payer: Fidelis Medicare Advantage	$0.00
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.00

BAMLANIVIMAB 700 MG/20ML IV SOLN [175456]

Facility

$0.00

Service Code	NDC 00002791001
Hospital Charge Code	00002791001
Hospital Revenue Code	278
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00

BAMLANIVIMAB-XXXX INFUSION

Facility

$0.01

Service Code	HCPCS Q0245
Hospital Charge Code	41640202
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

BAMLANIVIMAB-XXXX INFUSION

Facility

$0.01

Service Code	HCPCS Q0245
Hospital Charge Code	41650202
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: Brighton Health Commercial	$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: United Healthcare Commercial	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

BAMLANIVIMAB-XXXX INFUSION

Facility

$309.60

Service Code	HCPCS M0239
Hospital Charge Code	30300257
Hospital Revenue Code	260
Min. Negotiated Rate	$76.00
Max. Negotiated Rate	$247.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$170.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$154.80
Rate for Payer: Aetna Government	$154.80
Rate for Payer: Brighton Health Commercial	$232.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$247.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$210.53
Rate for Payer: Group Health Inc Commercial	$154.80
Rate for Payer: Group Health Inc Medicare	$108.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$154.80
Rate for Payer: Hamaspik Choice Inc Medicare	$154.80
Rate for Payer: United Healthcare Commercial	$76.00

BAMLANIVIMAB-XXXX INFUSION

Facility

$0.01

Service Code	HCPCS Q0245
Hospital Charge Code	41640202
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: Brighton Health Commercial	$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: United Healthcare Commercial	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

BAMLANIVIMAB-XXXX INFUSION

Facility

$0.01

Service Code	HCPCS Q0245
Hospital Charge Code	41650202
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

BANANA PEEL SHTH 11 15

Facility

$146.72

Hospital Charge Code	41567059
Hospital Revenue Code	270
Min. Negotiated Rate	$51.35
Max. Negotiated Rate	$117.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$73.36
Rate for Payer: Aetna Government	$73.36
Rate for Payer: Brighton Health Commercial	$110.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$117.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$99.77
Rate for Payer: Group Health Inc Commercial	$73.36
Rate for Payer: Group Health Inc Medicare	$51.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.36
Rate for Payer: Hamaspik Choice Inc Medicare	$73.36

BANDAGE 3 PLY

Facility

$12.05

Hospital Charge Code	40200603
Hospital Revenue Code	270
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$9.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.02
Rate for Payer: Aetna Government	$6.02
Rate for Payer: Brighton Health Commercial	$9.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.19
Rate for Payer: Group Health Inc Commercial	$6.02
Rate for Payer: Group Health Inc Medicare	$4.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.02
Rate for Payer: Hamaspik Choice Inc Medicare	$6.02

BANDAGE ELASTIC 6 HONECOM BEIGE

Facility

$113.00

Hospital Charge Code	64906242
Hospital Revenue Code	270
Min. Negotiated Rate	$39.55
Max. Negotiated Rate	$90.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.50
Rate for Payer: Aetna Government	$56.50
Rate for Payer: Brighton Health Commercial	$84.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.84
Rate for Payer: Group Health Inc Commercial	$56.50
Rate for Payer: Group Health Inc Medicare	$39.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.50
Rate for Payer: Hamaspik Choice Inc Medicare	$56.50

BANDAGE ESMARK 4X9

Facility

$5.22

Hospital Charge Code	40201029
Hospital Revenue Code	270
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$4.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.61
Rate for Payer: Aetna Government	$2.61
Rate for Payer: Brighton Health Commercial	$3.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.55
Rate for Payer: Group Health Inc Commercial	$2.61
Rate for Payer: Group Health Inc Medicare	$1.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.61
Rate for Payer: Hamaspik Choice Inc Medicare	$2.61

BANDAGE ESMARK 6X9

Facility

$7.30

Hospital Charge Code	40201030
Hospital Revenue Code	270
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$5.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.65
Rate for Payer: Aetna Government	$3.65
Rate for Payer: Brighton Health Commercial	$5.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.96
Rate for Payer: Group Health Inc Commercial	$3.65
Rate for Payer: Group Health Inc Medicare	$2.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.65
Rate for Payer: Hamaspik Choice Inc Medicare	$3.65

BANDAGE ESMARK STERILE 4X12

Facility

$13.50

Hospital Charge Code	40201031
Hospital Revenue Code	270
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$10.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.75
Rate for Payer: Aetna Government	$6.75
Rate for Payer: Brighton Health Commercial	$10.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.18
Rate for Payer: Group Health Inc Commercial	$6.75
Rate for Payer: Group Health Inc Medicare	$4.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.75
Rate for Payer: Hamaspik Choice Inc Medicare	$6.75

BANDAGE FIBERGLSS ORTHOGLSS 3X15'

Facility

$129.50

Hospital Charge Code	64902398
Hospital Revenue Code	270
Min. Negotiated Rate	$45.32
Max. Negotiated Rate	$103.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.75
Rate for Payer: Aetna Government	$64.75
Rate for Payer: Brighton Health Commercial	$97.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$103.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$88.06
Rate for Payer: Group Health Inc Commercial	$64.75
Rate for Payer: Group Health Inc Medicare	$45.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.75
Rate for Payer: Hamaspik Choice Inc Medicare	$64.75

BANDAID STERILE 3/4 X 3

Facility

$0.08

Hospital Charge Code	64901240
Hospital Revenue Code	270
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04

BANDAID STERILE 3/4X3

Facility

$0.50

Hospital Charge Code	40209451
Hospital Revenue Code	270
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.34
Rate for Payer: Group Health Inc Commercial	$0.25
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25

BANDAID TAZ BUGS BANDAIDS

Facility

$0.08

Hospital Charge Code	64902433
Hospital Revenue Code	270
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04

BANDING OF HEMORRHOIDS

Facility

$2,313.60

Service Code	HCPCS 46221
Hospital Charge Code	40019706
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,056.92

BANDING OF HEMORRHOIDS

Facility

$2,313.60

Service Code	HCPCS 46221
Hospital Charge Code	40019706
Hospital Revenue Code	360
Min. Negotiated Rate	$739.84
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,056.92
Rate for Payer: Aetna Government	$1,056.92
Rate for Payer: Affinity Essential Plan 1&2	$739.84
Rate for Payer: Affinity Essential Plan 3&4	$739.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$739.84
Rate for Payer: Brighton Health Commercial	$1,735.20
Rate for Payer: Cash Price	$1,056.92
Rate for Payer: Cash Price	$1,056.92
Rate for Payer: Cash Price	$1,056.92
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,056.92
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	$1,056.92
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$898.38
Rate for Payer: Fidelis Essential Plan QHP	$940.66
Rate for Payer: Fidelis Medicare Advantage	$1,056.92
Rate for Payer: Fidelis Qualified Health Plan	$940.66
Rate for Payer: Group Health Inc Commercial	$1,056.92
Rate for Payer: Group Health Inc Medicare	$1,056.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,156.80
Rate for Payer: Hamaspik Choice Inc Medicare	$1,056.92
Rate for Payer: Healthfirst Medicare Advantage	$898.38
Rate for Payer: Healthfirst QHP	$1,056.92
Rate for Payer: Humana Medicare	$1,078.06
Rate for Payer: Senior Whole Health Medicare Advantage	$1,056.92
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$1,056.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,056.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$845.54
Rate for Payer: Wellcare Medicare	$1,004.07

BANISH

Facility

$14.53

Hospital Charge Code	40200671
Hospital Revenue Code	270
Min. Negotiated Rate	$5.09
Max. Negotiated Rate	$11.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.26
Rate for Payer: Aetna Government	$7.26
Rate for Payer: Brighton Health Commercial	$10.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.88
Rate for Payer: Group Health Inc Commercial	$7.26
Rate for Payer: Group Health Inc Medicare	$5.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.26
Rate for Payer: Hamaspik Choice Inc Medicare	$7.26

BANKART PROCEDURE

Facility

$18,117.83

Service Code	HCPCS 23455
Hospital Charge Code	40014303
Hospital Revenue Code	360
Rate for Payer: Cash Price	$8,273.12

BANKART PROCEDURE

Facility

$18,117.83

Service Code	HCPCS 23455
Hospital Charge Code	40014303
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$13,588.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,065.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8,273.12
Rate for Payer: Aetna Government	$8,273.12
Rate for Payer: Affinity Essential Plan 1&2	$5,791.18
Rate for Payer: Affinity Essential Plan 3&4	$5,791.18
Rate for Payer: Affinity Medicaid/CHP/HARP	$5,791.18
Rate for Payer: Brighton Health Commercial	$13,588.37
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8,273.12
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	$8,273.12
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$7,032.15
Rate for Payer: Fidelis Essential Plan QHP	$7,363.08
Rate for Payer: Fidelis Medicare Advantage	$8,273.12
Rate for Payer: Fidelis Qualified Health Plan	$7,363.08
Rate for Payer: Group Health Inc Commercial	$8,273.12
Rate for Payer: Group Health Inc Medicare	$8,273.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,058.92
Rate for Payer: Hamaspik Choice Inc Medicare	$8,273.12
Rate for Payer: Healthfirst Medicare Advantage	$7,032.15
Rate for Payer: Healthfirst QHP	$8,273.12
Rate for Payer: Humana Medicare	$8,438.58
Rate for Payer: Senior Whole Health Medicare Advantage	$8,273.12
Rate for Payer: United Healthcare Commercial	$2,546.00
Rate for Payer: United Healthcare Medicare Advantage	$8,273.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,273.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6,618.50
Rate for Payer: Wellcare Medicare	$7,859.46

Know your out-of-pocket cost for care.

All Charges