St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SP INTRA ARTERIAL CHEMO,INFUSION

Facility

$556.18

Service Code	HCPCS 96422 TC
Hospital Charge Code	41561852
Hospital Revenue Code	335
Rate for Payer: Cash Price	$391.64

SP INTRACRAN ANGIOPLSTY W/STENT

Facility

$9,552.85

Service Code	HCPCS 61635 TC
Hospital Charge Code	41543349
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$7,164.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,254.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,776.42
Rate for Payer: Aetna Government	$4,776.42
Rate for Payer: Brighton Health Commercial	$7,164.64
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: Group Health Inc Commercial	$4,776.42
Rate for Payer: Group Health Inc Medicare	$3,343.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,776.42
Rate for Payer: Hamaspik Choice Inc Medicare	$4,776.42

SP INTRACRANIAL ANGIOPLASTY

Facility

$9,062.15

Service Code	HCPCS 61630 TC
Hospital Charge Code	41543348
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$6,796.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,984.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,531.08
Rate for Payer: Aetna Government	$4,531.08
Rate for Payer: Brighton Health Commercial	$6,796.61
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: Group Health Inc Commercial	$4,531.08
Rate for Payer: Group Health Inc Medicare	$3,171.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,531.08
Rate for Payer: Hamaspik Choice Inc Medicare	$4,531.08

SP INTR INTRAVAS STNT 1ST

Facility

$30,948.00

Service Code	HCPCS 37236 TC
Hospital Charge Code	41104045
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$23,211.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17,021.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15,474.00
Rate for Payer: Aetna Government	$15,474.00
Rate for Payer: Brighton Health Commercial	$23,211.00
Rate for Payer: Cash Price	$12,721.98
Rate for Payer: Cash Price	$12,721.98
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: Group Health Inc Commercial	$15,474.00
Rate for Payer: Group Health Inc Medicare	$10,831.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,474.00
Rate for Payer: Hamaspik Choice Inc Medicare	$15,474.00

SP INTR INTRAVAS STNT 1ST

Facility

$30,948.00

Service Code	HCPCS 37236 TC
Hospital Charge Code	41104045
Hospital Revenue Code	361
Rate for Payer: Cash Price	$12,721.98

SP INTR INTRAVAS STNT ADD

Facility

$15,474.00

Service Code	HCPCS 37237 TC
Hospital Charge Code	41104047
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$11,605.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8,510.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7,737.00
Rate for Payer: Aetna Government	$7,737.00
Rate for Payer: Brighton Health Commercial	$11,605.50
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: Group Health Inc Commercial	$7,737.00
Rate for Payer: Group Health Inc Medicare	$5,415.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,737.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7,737.00

SP INVUS NONCORONARY ADD VESSEL

Facility

$1,520.83

Service Code	HCPCS 37253 TC
Hospital Charge Code	41561848
Hospital Revenue Code	361
Min. Negotiated Rate	$532.29
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$836.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$760.42
Rate for Payer: Aetna Government	$760.42
Rate for Payer: Brighton Health Commercial	$1,140.62
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: Group Health Inc Commercial	$760.42
Rate for Payer: Group Health Inc Medicare	$532.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$760.42
Rate for Payer: Hamaspik Choice Inc Medicare	$760.42

SPIRATION VALVE SYSTEM

Facility

$6,625.00

Hospital Charge Code	64906858
Hospital Revenue Code	270
Min. Negotiated Rate	$2,318.75
Max. Negotiated Rate	$5,300.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,643.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,312.50
Rate for Payer: Aetna Government	$3,312.50
Rate for Payer: Brighton Health Commercial	$4,968.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,505.00
Rate for Payer: Group Health Inc Commercial	$3,312.50
Rate for Payer: Group Health Inc Medicare	$2,318.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,312.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,312.50

SPIRIVA INHALER QD

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306315
Hospital Revenue Code	410
Min. Negotiated Rate	$132.45
Max. Negotiated Rate	$417.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$246.65
Rate for Payer: Aetna Government	$246.65
Rate for Payer: Brighton Health Commercial	$417.88
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$246.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.45
Rate for Payer: Elderplan Medicare Advantage	$246.65
Rate for Payer: EmblemHealth Commercial	$246.65
Rate for Payer: Fidelis Essential Plan Aliesa	$209.65
Rate for Payer: Fidelis Essential Plan QHP	$219.52
Rate for Payer: Fidelis Medicare Advantage	$246.65
Rate for Payer: Fidelis Qualified Health Plan	$219.52
Rate for Payer: Group Health Inc Commercial	$246.65
Rate for Payer: Group Health Inc Medicare	$246.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.59
Rate for Payer: Hamaspik Choice Inc Medicare	$246.65
Rate for Payer: Healthfirst Medicare Advantage	$209.65
Rate for Payer: Healthfirst QHP	$246.65
Rate for Payer: Senior Whole Health Medicare Advantage	$246.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$246.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$197.32
Rate for Payer: Wellcare Medicare	$234.32

SPIRIVA INHALER QD

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306315
Hospital Revenue Code	410
Rate for Payer: Cash Price	$246.65

SPIROMETRY

Facility

$419.03

Service Code	HCPCS 94010 TC
Hospital Charge Code	30305698
Hospital Revenue Code	460
Min. Negotiated Rate	$146.66
Max. Negotiated Rate	$335.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$230.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$209.52
Rate for Payer: Aetna Government	$209.52
Rate for Payer: Brighton Health Commercial	$314.27
Rate for Payer: Cash Price	$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: Group Health Inc Commercial	$209.52
Rate for Payer: Group Health Inc Medicare	$146.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.52
Rate for Payer: Hamaspik Choice Inc Medicare	$209.52

SPIROMETRY

Facility

$419.03

Service Code	HCPCS 94010 TC
Hospital Charge Code	30305698
Hospital Revenue Code	460
Rate for Payer: Cash Price	$180.64

SPIROMETRY

Facility

$419.03

Service Code	HCPCS 94010 TC
Hospital Charge Code	40402704
Hospital Revenue Code	460
Rate for Payer: Cash Price	$180.64

SPIROMETRY

Facility

$419.03

Service Code	HCPCS 94010 TC
Hospital Charge Code	40402704
Hospital Revenue Code	460
Min. Negotiated Rate	$146.66
Max. Negotiated Rate	$335.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$230.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$209.52
Rate for Payer: Aetna Government	$209.52
Rate for Payer: Brighton Health Commercial	$314.27
Rate for Payer: Cash Price	$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: Group Health Inc Commercial	$209.52
Rate for Payer: Group Health Inc Medicare	$146.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.52
Rate for Payer: Hamaspik Choice Inc Medicare	$209.52

SPIRONOLACTONE 100 MG PO TABS [11425]

Facility

$0.88

Service Code	NDC 60687048701
Hospital Charge Code	60687048701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.44
Rate for Payer: Aetna Government	$0.44
Rate for Payer: Brighton Health Commercial	$0.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.60
Rate for Payer: Group Health Inc Commercial	$0.44
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.44
Rate for Payer: Hamaspik Choice Inc Medicare	$0.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.57

SPIRONOLACTONE 100 MG PO TABS [11425]

Facility

$0.88

Service Code	NDC 60687048711
Hospital Charge Code	60687048711
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.44
Rate for Payer: Aetna Government	$0.44
Rate for Payer: Brighton Health Commercial	$0.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.60
Rate for Payer: Group Health Inc Commercial	$0.44
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.44
Rate for Payer: Hamaspik Choice Inc Medicare	$0.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.57

SPIRONOLACTONE 100 MG PO TABS [11425]

Facility

$1.42

Service Code	NDC 53489032901
Hospital Charge Code	53489032901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.71
Rate for Payer: Aetna Government	$0.71
Rate for Payer: Brighton Health Commercial	$1.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.96
Rate for Payer: Group Health Inc Commercial	$0.71
Rate for Payer: Group Health Inc Medicare	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.71
Rate for Payer: Hamaspik Choice Inc Medicare	$0.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.92

SPIRONOLACTONE 100 MG TAB

Facility

$2.00

Hospital Charge Code	41650653
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

SPIRONOLACTONE 100 MG TAB

Facility

$2.00

Hospital Charge Code	41640653
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

SPIRONOLACTONE 1 MG/ML SUSP

Facility

$1.00

Hospital Charge Code	41641814
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

SPIRONOLACTONE 1 MG/ML SUSP

Facility

$1.00

Hospital Charge Code	41651814
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

SPIRONOLACTONE 25 MG PO TABS [7437]

Facility

$0.19

Service Code	NDC 00904692761
Hospital Charge Code	00904692761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.13
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

SPIRONOLACTONE 25 MG PO TABS [7437]

Facility

$0.43

Service Code	NDC 63739054410
Hospital Charge Code	63739054410
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.21
Rate for Payer: Aetna Government	$0.21
Rate for Payer: Brighton Health Commercial	$0.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.29
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.28

SPIRONOLACTONE 25 MG PO TABS [7437]

Facility

$0.45

Service Code	NDC 16729022516
Hospital Charge Code	16729022516
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.22
Rate for Payer: Aetna Government	$0.22
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.30
Rate for Payer: Group Health Inc Commercial	$0.22
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.29

SPIRONOLACTONE 25 MG PO TABS [7437]

Facility

$0.23

Service Code	NDC 60687046511
Hospital Charge Code	60687046511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.16
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.15

Know your out-of-pocket cost for care.

All Charges