St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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
Rate for Payer: Cash Price	$1,054.06

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

Facility

$1,229.75

Service Code	HCPCS 64484
Hospital Charge Code	41101548
Hospital Revenue Code	361
Min. Negotiated Rate	$59.08
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.08
Rate for Payer: Aetna Government	$59.08
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 INTERLAMINAR CRV/THRC

Facility

$2,533.95

Service Code	HCPCS 62325
Hospital Charge Code	41101517
Hospital Revenue Code	361
Min. Negotiated Rate	$780.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,054.06
Rate for Payer: Aetna Government	$1,054.06
Rate for Payer: Brighton Health Commercial	$1,900.46
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	$1,266.98
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 INTERLAMINAR CRV/THRC

Facility

$2,533.95

Service Code	HCPCS 62325
Hospital Charge Code	41101517
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,054.06

SP NJX INTERLAMINAR LMBR/SAC

Facility

$1,893.13

Service Code	HCPCS 62322
Hospital Charge Code	41563239
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	$1,419.85
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	$946.56
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 INTERLAMINAR LMBR/SAC

Facility

$1,893.13

Service Code	HCPCS 62322
Hospital Charge Code	41563239
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,054.06

SP NJX INTERLAMINAR LMB/SAC

Facility

$2,533.95

Service Code	HCPCS 62327
Hospital Charge Code	41101539
Hospital Revenue Code	361
Min. Negotiated Rate	$780.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,054.06
Rate for Payer: Aetna Government	$1,054.06
Rate for Payer: Brighton Health Commercial	$1,900.46
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	$1,266.98
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 INTERLAMINAR LMB/SAC

Facility

$2,533.95

Service Code	HCPCS 62327
Hospital Charge Code	41101539
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,054.06

SP NJX INTRLAMINR LMBR/SAC W/GUID

Facility

$1,893.13

Service Code	HCPCS 62323
Hospital Charge Code	41563240
Hospital Revenue Code	361
Min. Negotiated Rate	$639.78
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$799.72
Rate for Payer: Aetna Government	$799.72
Rate for Payer: Brighton Health Commercial	$1,419.85
Rate for Payer: Cash Price	$799.72
Rate for Payer: Cash Price	$799.72
Rate for Payer: Cash Price	$799.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$799.72
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	$799.72
Rate for Payer: EmblemHealth Commercial	$799.72
Rate for Payer: Fidelis Essential Plan Aliesa	$679.76
Rate for Payer: Fidelis Essential Plan QHP	$711.75
Rate for Payer: Fidelis Medicare Advantage	$799.72
Rate for Payer: Fidelis Qualified Health Plan	$711.75
Rate for Payer: Group Health Inc Commercial	$799.72
Rate for Payer: Group Health Inc Medicare	$799.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$946.56
Rate for Payer: Hamaspik Choice Inc Medicare	$799.72
Rate for Payer: Healthfirst Medicare Advantage	$679.76
Rate for Payer: Healthfirst QHP	$799.72
Rate for Payer: Senior Whole Health Medicare Advantage	$799.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$799.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$639.78
Rate for Payer: Wellcare Medicare	$759.73

SP NJX INTRLAMINR LMBR/SAC W/GUID

Facility

$1,893.13

Service Code	HCPCS 62323
Hospital Charge Code	41563240
Hospital Revenue Code	361
Rate for Payer: Cash Price	$799.72

SP NJX NONCMPND SCLRSNT 1 VEIN

Facility

$4,914.88

Service Code	HCPCS 36465 TC
Hospital Charge Code	41563233
Hospital Revenue Code	361
Min. Negotiated Rate	$1,720.21
Max. Negotiated Rate	$3,686.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,703.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,457.44
Rate for Payer: Aetna Government	$2,457.44
Rate for Payer: Brighton Health Commercial	$3,686.16
Rate for Payer: Cash Price	$2,108.87
Rate for Payer: Cash Price	$2,108.87
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	$2,457.44
Rate for Payer: Group Health Inc Medicare	$1,720.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,457.44
Rate for Payer: Hamaspik Choice Inc Medicare	$2,457.44

SP NJX NONCMPND SCLRSNT 1 VEIN

Facility

$4,914.88

Service Code	HCPCS 36465 TC
Hospital Charge Code	41563233
Hospital Revenue Code	361
Rate for Payer: Cash Price	$2,108.87

SP NJX NONCMPND SCLRSNT MLT VN

Facility

$4,914.88

Service Code	HCPCS 36466 TC
Hospital Charge Code	41563234
Hospital Revenue Code	361
Min. Negotiated Rate	$1,720.21
Max. Negotiated Rate	$3,686.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,703.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,457.44
Rate for Payer: Aetna Government	$2,457.44
Rate for Payer: Brighton Health Commercial	$3,686.16
Rate for Payer: Cash Price	$2,108.87
Rate for Payer: Cash Price	$2,108.87
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	$2,457.44
Rate for Payer: Group Health Inc Medicare	$1,720.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,457.44
Rate for Payer: Hamaspik Choice Inc Medicare	$2,457.44

SP NJX NONCMPND SCLRSNT MLT VN

Facility

$4,914.88

Service Code	HCPCS 36466 TC
Hospital Charge Code	41563234
Hospital Revenue Code	361
Rate for Payer: Cash Price	$2,108.87

SP NJX SCLRSNT 1 INCMPTNT VEIN

Facility

$967.73

Service Code	HCPCS 36470 TC
Hospital Charge Code	41563231
Hospital Revenue Code	361
Min. Negotiated Rate	$338.71
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$532.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$483.86
Rate for Payer: Aetna Government	$483.86
Rate for Payer: Brighton Health Commercial	$725.80
Rate for Payer: Cash Price	$461.12
Rate for Payer: Cash Price	$461.12
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	$483.86
Rate for Payer: Group Health Inc Medicare	$338.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$483.86
Rate for Payer: Hamaspik Choice Inc Medicare	$483.86

SP NJX SCLRSNT 1 INCMPTNT VEIN

Facility

$967.73

Service Code	HCPCS 36470 TC
Hospital Charge Code	41563231
Hospital Revenue Code	361
Rate for Payer: Cash Price	$461.12

SP NJX SCLRSNT MLT INCMPTNT VN

Facility

$967.73

Service Code	HCPCS 36471 TC
Hospital Charge Code	41563232
Hospital Revenue Code	361
Min. Negotiated Rate	$338.71
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$532.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$483.86
Rate for Payer: Aetna Government	$483.86
Rate for Payer: Brighton Health Commercial	$725.80
Rate for Payer: Cash Price	$461.12
Rate for Payer: Cash Price	$461.12
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	$483.86
Rate for Payer: Group Health Inc Medicare	$338.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$483.86
Rate for Payer: Hamaspik Choice Inc Medicare	$483.86

SP NJX SCLRSNT MLT INCMPTNT VN

Facility

$967.73

Service Code	HCPCS 36471 TC
Hospital Charge Code	41563232
Hospital Revenue Code	361
Rate for Payer: Cash Price	$461.12

SP NJX SCLRSNT SPIDER VEINS

Facility

$529.23

Service Code	HCPCS 36468 TC
Hospital Charge Code	41563230
Hospital Revenue Code	361
Rate for Payer: Cash Price	$461.12

SP NJX SCLRSNT SPIDER VEINS

Facility

$529.23

Service Code	HCPCS 36468 TC
Hospital Charge Code	41563230
Hospital Revenue Code	361
Min. Negotiated Rate	$185.23
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$291.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$264.62
Rate for Payer: Aetna Government	$264.62
Rate for Payer: Brighton Health Commercial	$396.92
Rate for Payer: Cash Price	$461.12
Rate for Payer: Cash Price	$461.12
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	$264.62
Rate for Payer: Group Health Inc Medicare	$185.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.62
Rate for Payer: Hamaspik Choice Inc Medicare	$264.62

SP NON-RF LIVER ABLATION

Facility

$1,847.58

Service Code	HCPCS 47399 TC
Hospital Charge Code	41561825
Hospital Revenue Code	361
Rate for Payer: Cash Price	$813.63

SP NON-RF LIVER ABLATION

Facility

$1,847.58

Service Code	HCPCS 47399 TC
Hospital Charge Code	41561825
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 NON SELECTIVE SPLENOPORTOGRAPH

Facility

$379.68

Service Code	HCPCS 38200 TC
Hospital Charge Code	41547708
Hospital Revenue Code	361
Min. Negotiated Rate	$132.89
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$208.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$189.84
Rate for Payer: Aetna Government	$189.84
Rate for Payer: Brighton Health Commercial	$284.76
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: Group Health Inc Commercial	$189.84
Rate for Payer: Group Health Inc Medicare	$132.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$189.84
Rate for Payer: Hamaspik Choice Inc Medicare	$189.84

SPONGE, CMPR 8X8X10MM

Facility

$2,252.03

Service Code	HCPCS C1713
Hospital Charge Code	64905397
Hospital Revenue Code	278
Min. Negotiated Rate	$1,126.02
Max. Negotiated Rate	$1,126.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,126.02
Rate for Payer: Hamaspik Choice Inc Medicare	$1,126.02

SPONGE, CMPR 8X8X10MM

Facility

$2,252.03

Service Code	HCPCS C1713
Hospital Charge Code	64905397
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,364.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,238.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,351.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,126.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,294.92
Rate for Payer: EmblemHealth Commercial	$1,126.02
Rate for Payer: Fidelis Medicare Advantage	$2,364.63
Rate for Payer: Group Health Inc Commercial	$1,126.02
Rate for Payer: Group Health Inc Medicare	$788.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,126.02
Rate for Payer: Hamaspik Choice Inc Medicare	$1,126.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,463.82

Know your out-of-pocket cost for care.

All Charges