St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SPIRONOLACTONE 25 MG TAB

Facility

$1.00

Hospital Charge Code	41640236
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 TAB

Facility

$1.00

Hospital Charge Code	41650236
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 5 MG/ML PO SUSP - COMPOUNDED [701384]

Facility

$1.00

Service Code	NDC 09999701384
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

SP IVC FILTER RETREVIAL

Facility

$8,393.53

Service Code	HCPCS 37193
Hospital Charge Code	41542900
Hospital Revenue Code	361
Min. Negotiated Rate	$2,134.00
Max. Negotiated Rate	$6,295.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,686.08
Rate for Payer: Aetna Government	$3,686.08
Rate for Payer: Brighton Health Commercial	$6,295.15
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,686.08
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	$3,686.08
Rate for Payer: EmblemHealth Commercial	$3,686.08
Rate for Payer: Fidelis Essential Plan Aliesa	$3,133.17
Rate for Payer: Fidelis Essential Plan QHP	$3,280.61
Rate for Payer: Fidelis Medicare Advantage	$3,686.08
Rate for Payer: Fidelis Qualified Health Plan	$3,280.61
Rate for Payer: Group Health Inc Commercial	$3,686.08
Rate for Payer: Group Health Inc Medicare	$3,686.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.76
Rate for Payer: Hamaspik Choice Inc Medicare	$3,686.08
Rate for Payer: Healthfirst Medicare Advantage	$3,133.17
Rate for Payer: Healthfirst QHP	$3,686.08
Rate for Payer: Senior Whole Health Medicare Advantage	$3,686.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,686.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,948.86
Rate for Payer: Wellcare Medicare	$3,501.78

SP IVC FILTER RETREVIAL

Facility

$8,393.53

Service Code	HCPCS 37193
Hospital Charge Code	41542900
Hospital Revenue Code	361
Rate for Payer: Cash Price	$3,686.08

SP IVUS NONCORONARY 1ST

Facility

$2,536.83

Service Code	HCPCS 37252 TC
Hospital Charge Code	41561847
Hospital Revenue Code	361
Min. Negotiated Rate	$887.89
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,395.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,268.42
Rate for Payer: Aetna Government	$1,268.42
Rate for Payer: Brighton Health Commercial	$1,902.62
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	$1,268.42
Rate for Payer: Group Health Inc Medicare	$887.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,268.42
Rate for Payer: Hamaspik Choice Inc Medicare	$1,268.42

SP KNEE ARTHROGRAM

Facility

$464.83

Service Code	HCPCS 27369 TC
Hospital Charge Code	41547467
Hospital Revenue Code	361
Min. Negotiated Rate	$162.69
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$255.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$232.42
Rate for Payer: Aetna Government	$232.42
Rate for Payer: Brighton Health Commercial	$348.62
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	$232.42
Rate for Payer: Group Health Inc Medicare	$162.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$232.42
Rate for Payer: Hamaspik Choice Inc Medicare	$232.42

SP KYPHOPLASTY ADD'L

Facility

$13,964.12

Service Code	HCPCS 22515 TC
Hospital Charge Code	41543161
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$10,473.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7,680.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,982.06
Rate for Payer: Aetna Government	$6,982.06
Rate for Payer: Brighton Health Commercial	$10,473.09
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	$6,982.06
Rate for Payer: Group Health Inc Medicare	$4,887.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,982.06
Rate for Payer: Hamaspik Choice Inc Medicare	$6,982.06

SP KYPHOPLASTY LUMBAR

Facility

$18,618.83

Service Code	HCPCS 22514 TC
Hospital Charge Code	41543160
Hospital Revenue Code	361
Rate for Payer: Cash Price	$8,273.12

SP KYPHOPLASTY LUMBAR

Facility

$18,618.83

Service Code	HCPCS 22514 TC
Hospital Charge Code	41543160
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$13,964.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10,240.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9,309.42
Rate for Payer: Aetna Government	$9,309.42
Rate for Payer: Brighton Health Commercial	$13,964.12
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Cash Price	$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: Group Health Inc Commercial	$9,309.42
Rate for Payer: Group Health Inc Medicare	$6,516.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,309.42
Rate for Payer: Hamaspik Choice Inc Medicare	$9,309.42

SP KYPHOPLASTY THORACIC

Facility

$18,618.83

Service Code	HCPCS 22513 TC
Hospital Charge Code	41543162
Hospital Revenue Code	361
Rate for Payer: Cash Price	$8,273.12

SP KYPHOPLASTY THORACIC

Facility

$18,618.83

Service Code	HCPCS 22513 TC
Hospital Charge Code	41543162
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$13,964.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10,240.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9,309.42
Rate for Payer: Aetna Government	$9,309.42
Rate for Payer: Brighton Health Commercial	$13,964.12
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Cash Price	$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: Group Health Inc Commercial	$9,309.42
Rate for Payer: Group Health Inc Medicare	$6,516.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,309.42
Rate for Payer: Hamaspik Choice Inc Medicare	$9,309.42

SP LATERAL VE ARTERIAL

Facility

$705.83

Service Code	HCPCS 93930 TC
Hospital Charge Code	41201168
Hospital Revenue Code	920
Rate for Payer: Cash Price	$283.37

SP LATERAL VE ARTERIAL

Facility

$705.83

Service Code	HCPCS 93930 TC
Hospital Charge Code	41201168
Hospital Revenue Code	920
Min. Negotiated Rate	$247.04
Max. Negotiated Rate	$564.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$388.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$352.92
Rate for Payer: Aetna Government	$352.92
Rate for Payer: Brighton Health Commercial	$529.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.96
Rate for Payer: Group Health Inc Commercial	$352.92
Rate for Payer: Group Health Inc Medicare	$247.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.92
Rate for Payer: Hamaspik Choice Inc Medicare	$352.92

SPLENECTOMY

Facility

$2,783.55

Service Code	HCPCS 38100
Hospital Charge Code	40011100
Hospital Revenue Code	360
Min. Negotiated Rate	$974.24
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,530.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,217.08
Rate for Payer: Aetna Government	$1,217.08
Rate for Payer: Brighton Health Commercial	$2,087.66
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: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$1,391.78
Rate for Payer: Group Health Inc Medicare	$974.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,391.78
Rate for Payer: Hamaspik Choice Inc Medicare	$1,391.78

SPLENIC PROCEDURES WITH CC

Facility

$48,658.86

Service Code	MSDRG 800
Min. Negotiated Rate	$21,576.91
Max. Negotiated Rate	$48,658.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41,546.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$46,401.96
Rate for Payer: Aetna Government	$46,401.96
Rate for Payer: Brighton Health Commercial	$40,856.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$47,330.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48,658.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$40,155.38
Rate for Payer: Elderplan Medicare Advantage	$44,081.86
Rate for Payer: EmblemHealth Commercial	$24,161.80
Rate for Payer: Fidelis Medicare Advantage	$46,401.96
Rate for Payer: Group Health Inc Commercial	$46,401.96
Rate for Payer: Group Health Inc Medicare	$46,401.96
Rate for Payer: Hamaspik Choice Inc Medicare	$46,401.96
Rate for Payer: Healthfirst Medicare Advantage	$21,576.91
Rate for Payer: Senior Whole Health Medicare Advantage	$46,401.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46,401.96
Rate for Payer: Wellcare Medicare	$44,081.86

SPLENIC PROCEDURES WITH MCC

Facility

$85,560.99

Service Code	MSDRG 799
Min. Negotiated Rate	$35,356.36
Max. Negotiated Rate	$85,560.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$73,055.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$76,035.19
Rate for Payer: Aetna Government	$76,035.19
Rate for Payer: Brighton Health Commercial	$71,841.70
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$77,555.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$85,560.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$70,608.60
Rate for Payer: Elderplan Medicare Advantage	$72,233.43
Rate for Payer: EmblemHealth Commercial	$42,485.70
Rate for Payer: Fidelis Medicare Advantage	$76,035.19
Rate for Payer: Group Health Inc Commercial	$76,035.19
Rate for Payer: Group Health Inc Medicare	$76,035.19
Rate for Payer: Hamaspik Choice Inc Medicare	$76,035.19
Rate for Payer: Healthfirst Medicare Advantage	$35,356.36
Rate for Payer: Senior Whole Health Medicare Advantage	$76,035.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$76,035.19
Rate for Payer: Wellcare Medicare	$72,233.43

SPLENIC PROCEDURES WITHOUT CC/MCC

Facility

$32,789.22

Service Code	MSDRG 801
Min. Negotiated Rate	$14,948.02
Max. Negotiated Rate	$32,789.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26,389.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32,146.29
Rate for Payer: Aetna Government	$32,146.29
Rate for Payer: Brighton Health Commercial	$25,950.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$32,789.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30,906.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$25,505.23
Rate for Payer: Elderplan Medicare Advantage	$30,538.98
Rate for Payer: EmblemHealth Commercial	$15,346.70
Rate for Payer: Fidelis Medicare Advantage	$32,146.29
Rate for Payer: Group Health Inc Commercial	$32,146.29
Rate for Payer: Group Health Inc Medicare	$32,146.29
Rate for Payer: Hamaspik Choice Inc Medicare	$32,146.29
Rate for Payer: Healthfirst Medicare Advantage	$14,948.02
Rate for Payer: Senior Whole Health Medicare Advantage	$32,146.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$32,146.29
Rate for Payer: Wellcare Medicare	$30,538.98

SPLENORRAPHY

Facility

$2,586.65

Service Code	HCPCS 38115
Hospital Charge Code	40019520
Hospital Revenue Code	360
Min. Negotiated Rate	$905.33
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,422.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,330.09
Rate for Payer: Aetna Government	$1,330.09
Rate for Payer: Brighton Health Commercial	$1,939.99
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: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$1,293.32
Rate for Payer: Group Health Inc Medicare	$905.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,293.32
Rate for Payer: Hamaspik Choice Inc Medicare	$1,293.32

SP LIMITED LE ARTERIAL

Facility

$339.45

Service Code	HCPCS 93926 TC
Hospital Charge Code	41201167
Hospital Revenue Code	920
Rate for Payer: Cash Price	$127.14

SP LIMITED LE ARTERIAL

Facility

$339.45

Service Code	HCPCS 93926 TC
Hospital Charge Code	41201167
Hospital Revenue Code	920
Min. Negotiated Rate	$118.81
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.72
Rate for Payer: Aetna Government	$169.72
Rate for Payer: Brighton Health Commercial	$254.59
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Group Health Inc Commercial	$169.72
Rate for Payer: Group Health Inc Medicare	$118.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72

SP LIMITED LE VENOUS

Facility

$339.45

Service Code	HCPCS 93971 TC
Hospital Charge Code	41201171
Hospital Revenue Code	920
Rate for Payer: Cash Price	$127.14

SP LIMITED LE VENOUS

Facility

$339.45

Service Code	HCPCS 93971 TC
Hospital Charge Code	41201171
Hospital Revenue Code	920
Min. Negotiated Rate	$118.81
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.72
Rate for Payer: Aetna Government	$169.72
Rate for Payer: Brighton Health Commercial	$254.59
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Group Health Inc Commercial	$169.72
Rate for Payer: Group Health Inc Medicare	$118.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72

SP LIMITED PENILE

Facility

$339.45

Service Code	HCPCS 93981 TC
Hospital Charge Code	41201177
Hospital Revenue Code	920
Min. Negotiated Rate	$118.81
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.72
Rate for Payer: Aetna Government	$169.72
Rate for Payer: Brighton Health Commercial	$254.59
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Group Health Inc Commercial	$169.72
Rate for Payer: Group Health Inc Medicare	$118.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72

SP LIMITED PENILE

Facility

$339.45

Service Code	HCPCS 93981 TC
Hospital Charge Code	41201177
Hospital Revenue Code	920
Rate for Payer: Cash Price	$127.14

Know your out-of-pocket cost for care.

All Charges