St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BEARING PSN R TB C-D FM 6-9

Facility

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	64906659
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,570.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,870.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,040.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,700.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,955.00
Rate for Payer: EmblemHealth Commercial	$1,700.00
Rate for Payer: Fidelis Medicare Advantage	$3,570.00
Rate for Payer: Group Health Inc Commercial	$1,700.00
Rate for Payer: Group Health Inc Medicare	$1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,210.00

BEARING SHOULDER VIV-E 36MM

Facility

$4,620.00

Service Code	HCPCS C1776
Hospital Charge Code	64906971
Hospital Revenue Code	278
Min. Negotiated Rate	$2,310.00
Max. Negotiated Rate	$2,310.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,310.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,310.00

BEARING SHOULDER VIV-E 36MM

Facility

$4,620.00

Service Code	HCPCS C1776
Hospital Charge Code	64906971
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,851.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,541.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,772.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,310.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,656.50
Rate for Payer: EmblemHealth Commercial	$2,310.00
Rate for Payer: Fidelis Medicare Advantage	$4,851.00
Rate for Payer: Group Health Inc Commercial	$2,310.00
Rate for Payer: Group Health Inc Medicare	$1,617.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,310.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,310.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,003.00

BEARING TIB

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64907256
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$10,500.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,500.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$6,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,750.00
Rate for Payer: EmblemHealth Commercial	$5,000.00
Rate for Payer: Fidelis Medicare Advantage	$10,500.00
Rate for Payer: Group Health Inc Commercial	$5,000.00
Rate for Payer: Group Health Inc Medicare	$3,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,500.00

BEARING TIB

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64907256
Hospital Revenue Code	278
Min. Negotiated Rate	$5,000.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,000.00

BEARING VIVACIT E 3MM REV

Facility

$4,620.00

Service Code	HCPCS C1776
Hospital Charge Code	64907003
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,851.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,541.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,772.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,310.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,656.50
Rate for Payer: EmblemHealth Commercial	$2,310.00
Rate for Payer: Fidelis Medicare Advantage	$4,851.00
Rate for Payer: Group Health Inc Commercial	$2,310.00
Rate for Payer: Group Health Inc Medicare	$1,617.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,310.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,310.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,003.00

BEARING VIVACIT E 3MM REV

Facility

$4,620.00

Service Code	HCPCS C1776
Hospital Charge Code	64907003
Hospital Revenue Code	278
Min. Negotiated Rate	$2,310.00
Max. Negotiated Rate	$2,310.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,310.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,310.00

BEBTELOVIMAB (COVID-19 MAB) INJ

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41640333
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

BEBTELOVIMAB (COVID-19 MAB) INJ

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41650333
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

BEBTELOVIMAB (COVID-19 MAB) INJ

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41640333
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

BEBTELOVIMAB (COVID-19 MAB) INJ

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41650333
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

BECLOMETHASONE DIPROP HFA 40 MCG/ACT IN AERB [150704]

Facility

$24.19

Service Code	NDC 59310030240
Hospital Charge Code	59310030240
Hospital Revenue Code	250
Min. Negotiated Rate	$8.47
Max. Negotiated Rate	$19.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.10
Rate for Payer: Aetna Government	$12.10
Rate for Payer: Brighton Health Commercial	$18.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.45
Rate for Payer: Group Health Inc Commercial	$12.10
Rate for Payer: Group Health Inc Medicare	$8.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.10
Rate for Payer: Hamaspik Choice Inc Medicare	$12.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.72

BECLOMETHASONE DIPROPIONATE 80 MCG/ACT NA AERS [114285]

Facility

$34.46

Service Code	NDC 59310041012
Hospital Charge Code	59310041012
Hospital Revenue Code	250
Min. Negotiated Rate	$12.06
Max. Negotiated Rate	$27.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.23
Rate for Payer: Aetna Government	$17.23
Rate for Payer: Brighton Health Commercial	$25.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.43
Rate for Payer: Group Health Inc Commercial	$17.23
Rate for Payer: Group Health Inc Medicare	$12.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.23
Rate for Payer: Hamaspik Choice Inc Medicare	$17.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.40

BECLOMETHASONE INHALER 40 MCG/INHALATION

Facility

$193.00

Hospital Charge Code	41654328
Hospital Revenue Code	250
Min. Negotiated Rate	$67.55
Max. Negotiated Rate	$154.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$106.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$96.50
Rate for Payer: Aetna Government	$96.50
Rate for Payer: Brighton Health Commercial	$144.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$154.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$131.24
Rate for Payer: Group Health Inc Commercial	$96.50
Rate for Payer: Group Health Inc Medicare	$67.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.50
Rate for Payer: Hamaspik Choice Inc Medicare	$96.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$125.45

BECLOMETHASONE INHALER 40 MCG/INHALATION

Facility

$193.00

Hospital Charge Code	41644328
Hospital Revenue Code	250
Min. Negotiated Rate	$67.55
Max. Negotiated Rate	$154.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$106.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$96.50
Rate for Payer: Aetna Government	$96.50
Rate for Payer: Brighton Health Commercial	$144.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$154.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$131.24
Rate for Payer: Group Health Inc Commercial	$96.50
Rate for Payer: Group Health Inc Medicare	$67.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.50
Rate for Payer: Hamaspik Choice Inc Medicare	$96.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$125.45

BED EFICA

Facility

$349.85

Hospital Charge Code	64902954
Hospital Revenue Code	270
Min. Negotiated Rate	$122.45
Max. Negotiated Rate	$279.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$174.92
Rate for Payer: Aetna Government	$174.92
Rate for Payer: Brighton Health Commercial	$262.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$279.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$237.90
Rate for Payer: Group Health Inc Commercial	$174.92
Rate for Payer: Group Health Inc Medicare	$122.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$174.92
Rate for Payer: Hamaspik Choice Inc Medicare	$174.92

BED ELEXIS

Facility

$345.00

Hospital Charge Code	64902966
Hospital Revenue Code	270
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$276.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$189.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$172.50
Rate for Payer: Aetna Government	$172.50
Rate for Payer: Brighton Health Commercial	$258.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$276.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.60
Rate for Payer: Group Health Inc Commercial	$172.50
Rate for Payer: Group Health Inc Medicare	$120.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.50
Rate for Payer: Hamaspik Choice Inc Medicare	$172.50

BED FLEXICAIR W/SCALE

Facility

$186.20

Hospital Charge Code	64902952
Hospital Revenue Code	270
Min. Negotiated Rate	$65.17
Max. Negotiated Rate	$148.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$102.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$93.10
Rate for Payer: Aetna Government	$93.10
Rate for Payer: Brighton Health Commercial	$139.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$148.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$126.62
Rate for Payer: Group Health Inc Commercial	$93.10
Rate for Payer: Group Health Inc Medicare	$65.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$93.10
Rate for Payer: Hamaspik Choice Inc Medicare	$93.10

BEDPAN 2QT STACKABLE TEAL H113-13

Facility

$1.49

Hospital Charge Code	40209461
Hospital Revenue Code	270
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$1.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Brighton Health Commercial	$1.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.01
Rate for Payer: Group Health Inc Commercial	$0.75
Rate for Payer: Group Health Inc Medicare	$0.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75
Rate for Payer: Hamaspik Choice Inc Medicare	$0.75

BEDPAN FRACTURE GOLD

Facility

$1.70

Hospital Charge Code	64901856
Hospital Revenue Code	270
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.85
Rate for Payer: Aetna Government	$0.85
Rate for Payer: Brighton Health Commercial	$1.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.16
Rate for Payer: Group Health Inc Commercial	$0.85
Rate for Payer: Group Health Inc Medicare	$0.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.85
Rate for Payer: Hamaspik Choice Inc Medicare	$0.85

BED PULMONEX

Facility

$162.50

Hospital Charge Code	64902956
Hospital Revenue Code	270
Min. Negotiated Rate	$56.88
Max. Negotiated Rate	$130.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$81.25
Rate for Payer: Aetna Government	$81.25
Rate for Payer: Brighton Health Commercial	$121.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$130.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$110.50
Rate for Payer: Group Health Inc Commercial	$81.25
Rate for Payer: Group Health Inc Medicare	$56.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.25
Rate for Payer: Hamaspik Choice Inc Medicare	$81.25

BEDSIDE SPIROMETRY

Facility

$419.03

Service Code	HCPCS 94150 TC
Hospital Charge Code	40307150
Hospital Revenue Code	460
Rate for Payer: Cash Price	$180.64

BEDSIDE SPIROMETRY

Facility

$419.03

Service Code	HCPCS 94150 TC
Hospital Charge Code	40307150
Hospital Revenue Code	460
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$335.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$230.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.64
Rate for Payer: Aetna Government	$180.64
Rate for Payer: Affinity Essential Plan 1&2	$126.45
Rate for Payer: Affinity Essential Plan 3&4	$126.45
Rate for Payer: Affinity Medicaid/CHP/HARP	$126.45
Rate for Payer: Brighton Health Commercial	$314.27
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cash Price	$180.64
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$180.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$335.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$284.94
Rate for Payer: Elderplan Medicare Advantage	$180.64
Rate for Payer: EmblemHealth Commercial	$180.64
Rate for Payer: Fidelis Essential Plan Aliesa	$153.54
Rate for Payer: Fidelis Essential Plan QHP	$160.77
Rate for Payer: Fidelis Medicare Advantage	$180.64
Rate for Payer: Fidelis Qualified Health Plan	$160.77
Rate for Payer: Group Health Inc Commercial	$180.64
Rate for Payer: Group Health Inc Medicare	$180.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.52
Rate for Payer: Hamaspik Choice Inc Medicare	$180.64
Rate for Payer: Healthfirst Medicare Advantage	$153.54
Rate for Payer: Healthfirst QHP	$180.64
Rate for Payer: Humana Medicare	$184.25
Rate for Payer: Senior Whole Health Medicare Advantage	$180.64
Rate for Payer: United Healthcare Commercial	$209.52
Rate for Payer: United Healthcare Medicare Advantage	$180.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$180.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$144.51
Rate for Payer: Wellcare Medicare	$171.61

BED ZONE AIR WITH SCALE

Facility

$2.50

Hospital Charge Code	64902958
Hospital Revenue Code	270
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$2.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.25
Rate for Payer: Aetna Government	$1.25
Rate for Payer: Brighton Health Commercial	$1.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.70
Rate for Payer: Group Health Inc Commercial	$1.25
Rate for Payer: Group Health Inc Medicare	$0.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1.25

BEHAVIORAL AND DEVELOPMENTAL DISORDERS

Facility

$33,443.97

Service Code	MSDRG 886
Min. Negotiated Rate	$905.00
Max. Negotiated Rate	$33,443.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,859.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30,648.62
Rate for Payer: Aetna Government	$30,648.62
Rate for Payer: Brighton Health Commercial	$24,384.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$31,261.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29,041.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$23,966.11
Rate for Payer: Elderplan Medicare Advantage	$29,116.19
Rate for Payer: EmblemHealth Commercial	$905.00
Rate for Payer: Fidelis Medicare Advantage	$30,648.62
Rate for Payer: Group Health Inc Commercial	$30,648.62
Rate for Payer: Group Health Inc Medicare	$30,648.62
Rate for Payer: Hamaspik Choice Inc Medicare	$30,648.62
Rate for Payer: Healthfirst Medicare Advantage	$14,251.61
Rate for Payer: Senior Whole Health Medicare Advantage	$30,648.62
Rate for Payer: United Healthcare Commercial	$33,443.97
Rate for Payer: United Healthcare Medicare Advantage	$30,648.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30,648.62
Rate for Payer: Wellcare Medicare	$29,116.19

Know your out-of-pocket cost for care.

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