St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SP REPOSITION GI FEED TBE

Facility

$711.45

Service Code	HCPCS 43761 TC
Hospital Charge Code	41542710
Hospital Revenue Code	361
Min. Negotiated Rate	$249.01
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$391.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$355.72
Rate for Payer: Aetna Government	$355.72
Rate for Payer: Brighton Health Commercial	$533.59
Rate for Payer: Cash Price	$285.81
Rate for Payer: Cash Price	$285.81
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	$355.72
Rate for Payer: Group Health Inc Medicare	$249.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$355.72
Rate for Payer: Hamaspik Choice Inc Medicare	$355.72

SP RETROGRADE BRACHIAL ARTERY

Facility

$1,475.15

Service Code	HCPCS 36140 TC
Hospital Charge Code	41542008
Hospital Revenue Code	361
Min. Negotiated Rate	$516.30
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$811.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$737.58
Rate for Payer: Aetna Government	$737.58
Rate for Payer: Brighton Health Commercial	$1,106.36
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	$737.58
Rate for Payer: Group Health Inc Medicare	$516.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$737.58
Rate for Payer: Hamaspik Choice Inc Medicare	$737.58

SP REV IMPL INTRAVENOUS INF PUMP

Facility

$1,909.65

Service Code	HCPCS 36575 TC
Hospital Charge Code	41547713
Hospital Revenue Code	361
Rate for Payer: Cash Price	$726.47

SP REV IMPL INTRAVENOUS INF PUMP

Facility

$1,909.65

Service Code	HCPCS 36575 TC
Hospital Charge Code	41547713
Hospital Revenue Code	361
Min. Negotiated Rate	$668.38
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,050.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$954.82
Rate for Payer: Aetna Government	$954.82
Rate for Payer: Brighton Health Commercial	$1,432.24
Rate for Payer: Cash Price	$726.47
Rate for Payer: Cash Price	$726.47
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	$954.82
Rate for Payer: Group Health Inc Medicare	$668.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.82
Rate for Payer: Hamaspik Choice Inc Medicare	$954.82

SP REV IMPL VEN ACC PT W/WO SUB

Facility

$1,909.65

Service Code	HCPCS 36575 TC
Hospital Charge Code	41547603
Hospital Revenue Code	361
Rate for Payer: Cash Price	$726.47

SP REV IMPL VEN ACC PT W/WO SUB

Facility

$1,909.65

Service Code	HCPCS 36575 TC
Hospital Charge Code	41547603
Hospital Revenue Code	361
Min. Negotiated Rate	$668.38
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,050.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$954.82
Rate for Payer: Aetna Government	$954.82
Rate for Payer: Brighton Health Commercial	$1,432.24
Rate for Payer: Cash Price	$726.47
Rate for Payer: Cash Price	$726.47
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	$954.82
Rate for Payer: Group Health Inc Medicare	$668.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.82
Rate for Payer: Hamaspik Choice Inc Medicare	$954.82

SP RFA BONE

Facility

$17,690.84

Service Code	HCPCS 20982 TC
Hospital Charge Code	41548037
Hospital Revenue Code	361
Rate for Payer: Cash Price	$15,219.83

SP RFA BONE

Facility

$17,690.84

Service Code	HCPCS 20982 TC
Hospital Charge Code	41548037
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$13,268.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9,729.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8,845.42
Rate for Payer: Aetna Government	$8,845.42
Rate for Payer: Brighton Health Commercial	$13,268.13
Rate for Payer: Cash Price	$15,219.83
Rate for Payer: Cash Price	$15,219.83
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	$8,845.42
Rate for Payer: Group Health Inc Medicare	$6,191.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,845.42
Rate for Payer: Hamaspik Choice Inc Medicare	$8,845.42

SP RFA KIDNEY

Facility

$14,640.10

Service Code	HCPCS 50592 TC
Hospital Charge Code	41548036
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$10,980.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8,052.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7,320.05
Rate for Payer: Aetna Government	$7,320.05
Rate for Payer: Brighton Health Commercial	$10,980.08
Rate for Payer: Cash Price	$6,672.53
Rate for Payer: Cash Price	$6,672.53
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	$7,320.05
Rate for Payer: Group Health Inc Medicare	$5,124.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,320.05
Rate for Payer: Hamaspik Choice Inc Medicare	$7,320.05

SP RFA KIDNEY

Facility

$14,640.10

Service Code	HCPCS 50592 TC
Hospital Charge Code	41548036
Hospital Revenue Code	361
Rate for Payer: Cash Price	$6,672.53

SP RFA LUNG

Facility

$14,640.10

Service Code	HCPCS 32998 TC
Hospital Charge Code	41549955
Hospital Revenue Code	361
Rate for Payer: Cash Price	$6,672.53

SP RFA LUNG

Facility

$14,640.10

Service Code	HCPCS 32998 TC
Hospital Charge Code	41549955
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$10,980.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8,052.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7,320.05
Rate for Payer: Aetna Government	$7,320.05
Rate for Payer: Brighton Health Commercial	$10,980.08
Rate for Payer: Cash Price	$6,672.53
Rate for Payer: Cash Price	$6,672.53
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	$7,320.05
Rate for Payer: Group Health Inc Medicare	$5,124.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,320.05
Rate for Payer: Hamaspik Choice Inc Medicare	$7,320.05

SPRING QUATTRO SECURE S LEAD

Facility

$10,678.00

Service Code	HCPCS C1777
Hospital Charge Code	66574666
Hospital Revenue Code	275
Min. Negotiated Rate	$988.18
Max. Negotiated Rate	$11,211.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,872.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$988.18
Rate for Payer: Aetna Government	$988.18
Rate for Payer: Brighton Health Commercial	$6,406.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,339.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,139.85
Rate for Payer: EmblemHealth Commercial	$5,339.00
Rate for Payer: Fidelis Medicare Advantage	$11,211.90
Rate for Payer: Group Health Inc Commercial	$5,339.00
Rate for Payer: Group Health Inc Medicare	$3,737.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,339.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,339.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,940.70

SPRING WIRE GUIDE

Facility

$26.02

Service Code	HCPCS C1769
Hospital Charge Code	64905219
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$27.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$15.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.96
Rate for Payer: EmblemHealth Commercial	$13.01
Rate for Payer: Fidelis Medicare Advantage	$27.32
Rate for Payer: Group Health Inc Commercial	$13.01
Rate for Payer: Group Health Inc Medicare	$9.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.01
Rate for Payer: Hamaspik Choice Inc Medicare	$13.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.91

SPRING WIRE GUIDE

Facility

$26.02

Service Code	HCPCS C1769
Hospital Charge Code	64905219
Hospital Revenue Code	278
Min. Negotiated Rate	$13.01
Max. Negotiated Rate	$13.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.01
Rate for Payer: Hamaspik Choice Inc Medicare	$13.01

SPRING WIRE GUIDE .018 X 25CM

Facility

$30.00

Service Code	HCPCS C1769
Hospital Charge Code	64905217
Hospital Revenue Code	278
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00
Rate for Payer: Hamaspik Choice Inc Medicare	$15.00

SPRING WIRE GUIDE .018 X 25CM

Facility

$30.00

Service Code	HCPCS C1769
Hospital Charge Code	64905217
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$31.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$18.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.25
Rate for Payer: EmblemHealth Commercial	$15.00
Rate for Payer: Fidelis Medicare Advantage	$31.50
Rate for Payer: Group Health Inc Commercial	$15.00
Rate for Payer: Group Health Inc Medicare	$10.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00
Rate for Payer: Hamaspik Choice Inc Medicare	$15.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.50

SPRINT QUATTRO SECURE LEAD

Facility

$6,700.00

Service Code	HCPCS C1777
Hospital Charge Code	66571494
Hospital Revenue Code	278
Min. Negotiated Rate	$988.18
Max. Negotiated Rate	$7,035.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,685.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$988.18
Rate for Payer: Aetna Government	$988.18
Rate for Payer: Brighton Health Commercial	$4,020.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,852.50
Rate for Payer: EmblemHealth Commercial	$3,350.00
Rate for Payer: Fidelis Medicare Advantage	$7,035.00
Rate for Payer: Group Health Inc Commercial	$3,350.00
Rate for Payer: Group Health Inc Medicare	$2,345.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,350.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,355.00

SPRINT QUATTRO SECURE LEAD

Facility

$6,700.00

Service Code	HCPCS C1777
Hospital Charge Code	66571494
Hospital Revenue Code	278
Min. Negotiated Rate	$3,350.00
Max. Negotiated Rate	$3,350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,350.00

SP RT. HEART/PUL. TRUNK ONLY

Facility

$2,450.50

Service Code	HCPCS 36013 TC
Hospital Charge Code	41547444
Hospital Revenue Code	361
Min. Negotiated Rate	$857.68
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,347.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,225.25
Rate for Payer: Aetna Government	$1,225.25
Rate for Payer: Brighton Health Commercial	$1,837.88
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	$1,225.25
Rate for Payer: Group Health Inc Medicare	$857.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,225.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,225.25

SP SACROILIAC JOINT ARTHOGRAM

Facility

$1,027.56

Service Code	HCPCS 27096 TC
Hospital Charge Code	41561912
Hospital Revenue Code	361
Min. Negotiated Rate	$359.65
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$565.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$513.78
Rate for Payer: Aetna Government	$513.78
Rate for Payer: Brighton Health Commercial	$770.67
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	$513.78
Rate for Payer: Group Health Inc Medicare	$359.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$513.78
Rate for Payer: Hamaspik Choice Inc Medicare	$513.78

SP SELECTIVE VAS CATHE- CORO ARTE

Facility

$8,631.78

Service Code	HCPCS 93454 TC
Hospital Charge Code	41547707
Hospital Revenue Code	480
Rate for Payer: Cash Price	$3,768.27

SP SELECTIVE VAS CATHE- CORO ARTE

Facility

$8,631.78

Service Code	HCPCS 93454 TC
Hospital Charge Code	41547707
Hospital Revenue Code	480
Min. Negotiated Rate	$3,021.12
Max. Negotiated Rate	$6,905.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,747.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,315.89
Rate for Payer: Aetna Government	$4,315.89
Rate for Payer: Brighton Health Commercial	$6,473.84
Rate for Payer: Cash Price	$3,768.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,905.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,869.61
Rate for Payer: Group Health Inc Commercial	$4,315.89
Rate for Payer: Group Health Inc Medicare	$3,021.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,315.89
Rate for Payer: Hamaspik Choice Inc Medicare	$4,315.89

SP SHOULDER ARTHOGRAM

Facility

$439.65

Service Code	HCPCS 23350 TC
Hospital Charge Code	41547468
Hospital Revenue Code	361
Min. Negotiated Rate	$153.88
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$241.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$219.82
Rate for Payer: Aetna Government	$219.82
Rate for Payer: Brighton Health Commercial	$329.74
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	$219.82
Rate for Payer: Group Health Inc Medicare	$153.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$219.82
Rate for Payer: Hamaspik Choice Inc Medicare	$219.82

SP SIALOGRAM

Facility

$419.13

Service Code	HCPCS 42550 TC
Hospital Charge Code	41542818
Hospital Revenue Code	361
Min. Negotiated Rate	$146.70
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$230.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$209.56
Rate for Payer: Aetna Government	$209.56
Rate for Payer: Brighton Health Commercial	$314.35
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	$209.56
Rate for Payer: Group Health Inc Medicare	$146.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.56
Rate for Payer: Hamaspik Choice Inc Medicare	$209.56

Know your out-of-pocket cost for care.

All Charges