St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SP MECH REMOVAL INSTRALUMINAL

Facility

$4,940.28

Service Code	HCPCS 36596 TC
Hospital Charge Code	41561836
Hospital Revenue Code	361
Min. Negotiated Rate	$1,729.10
Max. Negotiated Rate	$3,705.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,717.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,470.14
Rate for Payer: Aetna Government	$2,470.14
Rate for Payer: Brighton Health Commercial	$3,705.21
Rate for Payer: Cash Price	$1,852.05
Rate for Payer: Cash Price	$1,852.05
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	$2,470.14
Rate for Payer: Group Health Inc Medicare	$1,729.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.14
Rate for Payer: Hamaspik Choice Inc Medicare	$2,470.14

SP MECH REMOVAL INSTRALUMINAL

Facility

$4,940.28

Service Code	HCPCS 36596 TC
Hospital Charge Code	41561836
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,852.05

SP MR GUIDED 1ST LOCAL

Facility

$1,847.58

Service Code	HCPCS 19287 TC
Hospital Charge Code	41104027
Hospital Revenue Code	361
Rate for Payer: Cash Price	$813.63

SP MR GUIDED 1ST LOCAL

Facility

$1,847.58

Service Code	HCPCS 19287 TC
Hospital Charge Code	41104027
Hospital Revenue Code	361
Min. Negotiated Rate	$646.65
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,016.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$923.79
Rate for Payer: Aetna Government	$923.79
Rate for Payer: Brighton Health Commercial	$1,385.68
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
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	$923.79
Rate for Payer: Group Health Inc Medicare	$646.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.79
Rate for Payer: Hamaspik Choice Inc Medicare	$923.79

SP MR GUIDED BREAST ADD

Facility

$30,948.00

Service Code	HCPCS 19086 TC
Hospital Charge Code	41004045
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: 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 MR GUIDED BREAST ADD

Facility

$1,042.00

Service Code	HCPCS 19086
Hospital Charge Code	41104055
Hospital Revenue Code	610
Min. Negotiated Rate	$78.64
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$78.64
Rate for Payer: Aetna Government	$78.64
Rate for Payer: Brighton Health Commercial	$781.50
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	$521.00
Rate for Payer: Group Health Inc Medicare	$364.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$521.00
Rate for Payer: Hamaspik Choice Inc Medicare	$521.00

SP MR GUIDED EACH ADD

Facility

$146.00

Service Code	HCPCS 19288 TC
Hospital Charge Code	41104029
Hospital Revenue Code	361
Min. Negotiated Rate	$51.10
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$73.00
Rate for Payer: Aetna Government	$73.00
Rate for Payer: Brighton Health Commercial	$109.50
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	$73.00
Rate for Payer: Group Health Inc Medicare	$51.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.00
Rate for Payer: Hamaspik Choice Inc Medicare	$73.00

SP MRI GUIDANCE NEEDLE PLACEMENT

Facility

$2,176.65

Service Code	HCPCS 77021 TC
Hospital Charge Code	41568805
Hospital Revenue Code	610
Min. Negotiated Rate	$761.83
Max. Negotiated Rate	$1,741.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,197.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,088.32
Rate for Payer: Aetna Government	$1,088.32
Rate for Payer: Brighton Health Commercial	$1,632.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,741.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,480.12
Rate for Payer: Group Health Inc Commercial	$1,088.32
Rate for Payer: Group Health Inc Medicare	$761.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,088.32
Rate for Payer: Hamaspik Choice Inc Medicare	$1,088.32

SP MRI GUIDED BREAST BX

Facility

$4,157.25

Service Code	HCPCS 19085
Hospital Charge Code	41104023
Hospital Revenue Code	610
Min. Negotiated Rate	$1,312.42
Max. Negotiated Rate	$3,117.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,874.89
Rate for Payer: Aetna Government	$1,874.89
Rate for Payer: Brighton Health Commercial	$3,117.94
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,874.89
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	$1,874.89
Rate for Payer: EmblemHealth Commercial	$1,312.42
Rate for Payer: Fidelis Essential Plan Aliesa	$1,593.66
Rate for Payer: Fidelis Essential Plan QHP	$1,668.65
Rate for Payer: Fidelis Medicare Advantage	$1,874.89
Rate for Payer: Fidelis Qualified Health Plan	$1,668.65
Rate for Payer: Group Health Inc Commercial	$1,687.40
Rate for Payer: Group Health Inc Medicare	$1,687.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,874.89
Rate for Payer: Healthfirst Medicare Advantage	$1,593.66
Rate for Payer: Healthfirst QHP	$1,874.89
Rate for Payer: Senior Whole Health Medicare Advantage	$1,874.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,874.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,499.91
Rate for Payer: Wellcare Medicare	$1,781.15

SP MRI GUIDED BREAST BX

Facility

$4,157.25

Service Code	HCPCS 19085
Hospital Charge Code	41104023
Hospital Revenue Code	610
Rate for Payer: Cash Price	$1,874.89

SP MUSCLE PERCUTANEOUS

Facility

$4,157.25

Service Code	HCPCS 20206 TC
Hospital Charge Code	41542801
Hospital Revenue Code	361
Min. Negotiated Rate	$1,455.04
Max. Negotiated Rate	$3,117.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,286.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,078.62
Rate for Payer: Aetna Government	$2,078.62
Rate for Payer: Brighton Health Commercial	$3,117.94
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$1,874.89
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	$2,078.62
Rate for Payer: Group Health Inc Medicare	$1,455.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.62
Rate for Payer: Hamaspik Choice Inc Medicare	$2,078.62

SP MUSCLE PERCUTANEOUS

Facility

$4,157.25

Service Code	HCPCS 20206 TC
Hospital Charge Code	41542801
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,874.89

SP NASAL/OROGASTRIC W/STENT

Facility

$1,101.23

Service Code	HCPCS 43752 TC
Hospital Charge Code	41549812
Hospital Revenue Code	450
Rate for Payer: Cash Price	$460.76

SP NASAL/OROGASTRIC W/STENT

Facility

$1,101.23

Service Code	HCPCS 43752
Hospital Charge Code	30104154
Hospital Revenue Code	450
Rate for Payer: Cash Price	$460.76

SP NASAL/OROGASTRIC W/STENT

Facility

$1,101.23

Service Code	HCPCS 43752
Hospital Charge Code	30104154
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$460.76
Rate for Payer: Aetna Government	$460.76
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$460.76
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$460.76
Rate for Payer: Cash Price	$460.76
Rate for Payer: Cash Price	$460.76
Rate for Payer: Cash Price	$460.76
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$460.76
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	$460.76
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$391.65
Rate for Payer: Fidelis Essential Plan QHP	$410.08
Rate for Payer: Fidelis Medicare Advantage	$460.76
Rate for Payer: Fidelis Qualified Health Plan	$410.08
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$550.62
Rate for Payer: Hamaspik Choice Inc Medicare	$460.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$460.76
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$460.76
Rate for Payer: Senior Whole Health Medicare Advantage	$460.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$460.76
Rate for Payer: Wellcare CHP/FHP/Medicaid	$368.61
Rate for Payer: Wellcare Medicare	$437.72

SP NASAL/OROGASTRIC W/STENT

Facility

$1,101.23

Service Code	HCPCS 43752 TC
Hospital Charge Code	41549812
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$550.62
Rate for Payer: Aetna Government	$550.62
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cash Price	$460.76
Rate for Payer: Cash Price	$460.76
Rate for Payer: Cash Price	$460.76
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	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$550.62
Rate for Payer: Hamaspik Choice Inc Medicare	$550.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00

SP NEPHROSTOGRAM

Facility

$1,685.60

Service Code	HCPCS 50431 TC
Hospital Charge Code	41542724
Hospital Revenue Code	361
Min. Negotiated Rate	$589.96
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$927.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$842.80
Rate for Payer: Aetna Government	$842.80
Rate for Payer: Brighton Health Commercial	$1,264.20
Rate for Payer: Cash Price	$789.96
Rate for Payer: Cash Price	$789.96
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	$842.80
Rate for Payer: Group Health Inc Medicare	$589.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$842.80
Rate for Payer: Hamaspik Choice Inc Medicare	$842.80

SP NEPHROSTOGRAM

Facility

$1,685.60

Service Code	HCPCS 50431 TC
Hospital Charge Code	41542724
Hospital Revenue Code	361
Rate for Payer: Cash Price	$789.96

SP NEPHROSTOMY TUBE CHANGE

Facility

$5,365.58

Service Code	HCPCS 50435 TC
Hospital Charge Code	41542734
Hospital Revenue Code	361
Rate for Payer: Cash Price	$2,355.42

SP NEPHROSTOMY TUBE CHANGE

Facility

$5,365.58

Service Code	HCPCS 50435 TC
Hospital Charge Code	41542734
Hospital Revenue Code	361
Min. Negotiated Rate	$1,877.95
Max. Negotiated Rate	$4,024.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,951.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,682.79
Rate for Payer: Aetna Government	$2,682.79
Rate for Payer: Brighton Health Commercial	$4,024.18
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Cash Price	$2,355.42
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	$2,682.79
Rate for Payer: Group Health Inc Medicare	$1,877.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,682.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2,682.79

SPNGE GAUZE4X416 PLY CTTON STERI

Facility

$1.24

Hospital Charge Code	40200627
Hospital Revenue Code	270
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.62
Rate for Payer: Aetna Government	$0.62
Rate for Payer: Brighton Health Commercial	$0.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.84
Rate for Payer: Group Health Inc Commercial	$0.62
Rate for Payer: Group Health Inc Medicare	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.62
Rate for Payer: Hamaspik Choice Inc Medicare	$0.62

SP NJX AA&/STRD TFRM EPI C/T 1

Facility

$2,459.50

Service Code	HCPCS 64479
Hospital Charge Code	41101545
Hospital Revenue Code	361
Min. Negotiated Rate	$843.25
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,054.06
Rate for Payer: Aetna Government	$1,054.06
Rate for Payer: Brighton Health Commercial	$1,844.62
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,054.06
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	$1,054.06
Rate for Payer: EmblemHealth Commercial	$1,054.06
Rate for Payer: Fidelis Essential Plan Aliesa	$895.95
Rate for Payer: Fidelis Essential Plan QHP	$938.11
Rate for Payer: Fidelis Medicare Advantage	$1,054.06
Rate for Payer: Fidelis Qualified Health Plan	$938.11
Rate for Payer: Group Health Inc Commercial	$1,054.06
Rate for Payer: Group Health Inc Medicare	$1,054.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,229.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,054.06
Rate for Payer: Healthfirst Medicare Advantage	$895.95
Rate for Payer: Healthfirst QHP	$1,054.06
Rate for Payer: Senior Whole Health Medicare Advantage	$1,054.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,054.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$843.25
Rate for Payer: Wellcare Medicare	$1,001.36

SP NJX AA&/STRD TFRM EPI C/T 1

Facility

$2,459.50

Service Code	HCPCS 64479
Hospital Charge Code	41101545
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,054.06

SP NJX AA&/STRD TFRM EPI C/T EA

Facility

$1,229.75

Service Code	HCPCS 64480
Hospital Charge Code	41101546
Hospital Revenue Code	361
Min. Negotiated Rate	$72.01
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$72.01
Rate for Payer: Aetna Government	$72.01
Rate for Payer: Brighton Health Commercial	$922.31
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	$614.88
Rate for Payer: Group Health Inc Medicare	$430.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$614.88
Rate for Payer: Hamaspik Choice Inc Medicare	$614.88

SP NJX AA&/STRD TFRM EPI L/S 1

Facility

$2,459.50

Service Code	HCPCS 64483
Hospital Charge Code	41101547
Hospital Revenue Code	361
Min. Negotiated Rate	$843.25
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,054.06
Rate for Payer: Aetna Government	$1,054.06
Rate for Payer: Brighton Health Commercial	$1,844.62
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,054.06
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	$1,054.06
Rate for Payer: EmblemHealth Commercial	$1,054.06
Rate for Payer: Fidelis Essential Plan Aliesa	$895.95
Rate for Payer: Fidelis Essential Plan QHP	$938.11
Rate for Payer: Fidelis Medicare Advantage	$1,054.06
Rate for Payer: Fidelis Qualified Health Plan	$938.11
Rate for Payer: Group Health Inc Commercial	$1,054.06
Rate for Payer: Group Health Inc Medicare	$1,054.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,229.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,054.06
Rate for Payer: Healthfirst Medicare Advantage	$895.95
Rate for Payer: Healthfirst QHP	$1,054.06
Rate for Payer: Senior Whole Health Medicare Advantage	$1,054.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,054.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$843.25
Rate for Payer: Wellcare Medicare	$1,001.36

Know your out-of-pocket cost for care.

All Charges