St. Barnabas Hospital

All Charges

Charge

Type

Price

BREAST SIZER 76951

Facility OP

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201638
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$402.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

BREAST SIZER 76952

Facility IP

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201639
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

BREAST SIZER 76952

Facility OP

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201639
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$402.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

BREAST SIZER 76953

Facility OP

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40207451
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$402.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

BREAST SIZER 76953

Facility IP

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40207451
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

BREAST SIZER 76954

Facility IP

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40207452
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

BREAST SIZER 76954

Facility OP

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40207452
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$402.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

BREAST SIZER 76955

Facility IP

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201546
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

BREAST SIZER 76955

Facility OP

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201546
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$402.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

BREAST SIZER 76980

Facility OP

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201548
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$402.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

BREAST SIZER 76980

Facility IP

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201548
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

BREAST SIZER 76991

Facility IP

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201636
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

BREAST SIZER 76991

Facility OP

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201636
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$402.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

BREAST SIZER 76992

Facility OP

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201637
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$402.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

BREAST SIZER 76992

Facility IP

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201637
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

BREAST SIZER 76993

Facility IP

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201547
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

BREAST SIZER 76993

Facility OP

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201547
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$402.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

BREAST SIZER 77464

Facility IP

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201549
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

BREAST SIZER 77464

Facility OP

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201549
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$402.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

BRENTUXIMAB VEDOTIN 50MG/10ML PF

Facility OP

$383.10

Service Code	HCPCS J9042
Hospital Charge Code	41658891
Hospital Revenue Code	636
Min. Negotiated Rate	$184.49
Max. Negotiated Rate	$249.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$210.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$230.61
Rate for Payer: Aetna Government	$230.61
Rate for Payer: Cash Price	$230.61
Rate for Payer: Cash Price	$230.61
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$230.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$191.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$220.28
Rate for Payer: Elderplan Medicare Advantage	$230.61
Rate for Payer: EmblemHealth Commercial	$230.61
Rate for Payer: Fidelis CHP/HARP/Medicaid	$230.61
Rate for Payer: Fidelis Essential Plan Aliesa	$230.61
Rate for Payer: Fidelis Essential Plan QHP	$242.14
Rate for Payer: Fidelis Medicare Advantage	$230.61
Rate for Payer: Fidelis Qualified Health Plan	$242.14
Rate for Payer: Group Health Inc Commercial	$230.61
Rate for Payer: Group Health Inc Medicare	$230.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.55
Rate for Payer: Hamaspik Choice Inc Medicare	$191.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$221.96
Rate for Payer: Healthfirst Medicare Advantage	$196.02
Rate for Payer: Healthfirst QHP	$230.61
Rate for Payer: Senior Whole Health Medicare Advantage	$230.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$244.59
Rate for Payer: SOMOS Essential	$244.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$249.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$184.49
Rate for Payer: Wellcare Medicare	$219.08

BRENTUXIMAB VEDOTIN 50MG/10ML PF

Facility IP

$383.10

Service Code	HCPCS J9042
Hospital Charge Code	41658891
Hospital Revenue Code	636
Min. Negotiated Rate	$191.55
Max. Negotiated Rate	$191.55
Rate for Payer: Cash Price	$230.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.55
Rate for Payer: Hamaspik Choice Inc Medicare	$191.55

BRENTUXIMAB VEDOTIN 50MG/10ML PF

Facility IP

$383.10

Service Code	HCPCS J9042
Hospital Charge Code	41648891
Hospital Revenue Code	636
Min. Negotiated Rate	$191.55
Max. Negotiated Rate	$191.55
Rate for Payer: Cash Price	$230.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.55
Rate for Payer: Hamaspik Choice Inc Medicare	$191.55

BRENTUXIMAB VEDOTIN 50MG/10ML PF

Facility OP

$383.10

Service Code	HCPCS J9042
Hospital Charge Code	41648891
Hospital Revenue Code	636
Min. Negotiated Rate	$184.49
Max. Negotiated Rate	$249.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$210.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$230.61
Rate for Payer: Aetna Government	$230.61
Rate for Payer: Cash Price	$230.61
Rate for Payer: Cash Price	$230.61
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$230.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$191.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$220.28
Rate for Payer: Elderplan Medicare Advantage	$230.61
Rate for Payer: EmblemHealth Commercial	$230.61
Rate for Payer: Fidelis CHP/HARP/Medicaid	$230.61
Rate for Payer: Fidelis Essential Plan Aliesa	$230.61
Rate for Payer: Fidelis Essential Plan QHP	$242.14
Rate for Payer: Fidelis Medicare Advantage	$230.61
Rate for Payer: Fidelis Qualified Health Plan	$242.14
Rate for Payer: Group Health Inc Commercial	$230.61
Rate for Payer: Group Health Inc Medicare	$230.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.55
Rate for Payer: Hamaspik Choice Inc Medicare	$191.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$221.96
Rate for Payer: Healthfirst Medicare Advantage	$196.02
Rate for Payer: Healthfirst QHP	$230.61
Rate for Payer: Senior Whole Health Medicare Advantage	$230.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$244.59
Rate for Payer: SOMOS Essential	$244.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$249.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$184.49
Rate for Payer: Wellcare Medicare	$219.08

BRIDGE REPAIR, BY REPORT

Facility OP

$496.00

Service Code	HCPCS D6980
Hospital Charge Code	42301625
Hospital Revenue Code	361
Min. Negotiated Rate	$122.12
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$272.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$122.12
Rate for Payer: Aetna Government	$122.12
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	$248.00
Rate for Payer: Group Health Inc Medicare	$173.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$248.00
Rate for Payer: Hamaspik Choice Inc Medicare	$248.00

BRIEF CHECK IN BY MD/QHP

Facility OP

$37.83

Service Code	HCPCS G2012
Hospital Charge Code	30300132
Hospital Revenue Code	988
Min. Negotiated Rate	$7.89
Max. Negotiated Rate	$30.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.89
Rate for Payer: Aetna Government	$7.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$13.16
Rate for Payer: Group Health Inc Commercial	$18.92
Rate for Payer: Group Health Inc Medicare	$13.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.92
Rate for Payer: Hamaspik Choice Inc Medicare	$18.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$14.62

Price Transparency.

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