St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

STENT URETERAL 5FRX22CM

Facility

$350.00

Service Code	HCPCS C2617
Hospital Charge Code	40209683
Hospital Revenue Code	278
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

STENT URETERAL 5FRX24CM

Facility

$350.00

Service Code	HCPCS C2617
Hospital Charge Code	40209391
Hospital Revenue Code	278
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$367.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.14
Rate for Payer: Aetna Government	$10.14
Rate for Payer: Brighton Health Commercial	$210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$175.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.25
Rate for Payer: EmblemHealth Commercial	$175.00
Rate for Payer: Fidelis Medicare Advantage	$367.50
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$227.50

STENT URETERAL 5FRX24CM

Facility

$350.00

Service Code	HCPCS C2617
Hospital Charge Code	40209391
Hospital Revenue Code	278
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

STENT URETERAL 5FRX24CM

Facility

$350.00

Service Code	HCPCS C2617
Hospital Charge Code	40209684
Hospital Revenue Code	278
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$367.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.14
Rate for Payer: Aetna Government	$10.14
Rate for Payer: Brighton Health Commercial	$210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$175.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.25
Rate for Payer: EmblemHealth Commercial	$175.00
Rate for Payer: Fidelis Medicare Advantage	$367.50
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$227.50

STENT URETERAL 5FRX24CM

Facility

$350.00

Service Code	HCPCS C2617
Hospital Charge Code	40209684
Hospital Revenue Code	278
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

STENT URETERAL 5 FRX26CM

Facility

$350.00

Service Code	HCPCS C2617
Hospital Charge Code	40209609
Hospital Revenue Code	278
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

STENT URETERAL 5 FRX26CM

Facility

$350.00

Service Code	HCPCS C2617
Hospital Charge Code	40209609
Hospital Revenue Code	278
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$367.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.14
Rate for Payer: Aetna Government	$10.14
Rate for Payer: Brighton Health Commercial	$210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$175.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.25
Rate for Payer: EmblemHealth Commercial	$175.00
Rate for Payer: Fidelis Medicare Advantage	$367.50
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$227.50

STENT URETERAL 5FRX26CM

Facility

$350.00

Service Code	HCPCS C2617
Hospital Charge Code	40209685
Hospital Revenue Code	278
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$367.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.14
Rate for Payer: Aetna Government	$10.14
Rate for Payer: Brighton Health Commercial	$210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$175.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.25
Rate for Payer: EmblemHealth Commercial	$175.00
Rate for Payer: Fidelis Medicare Advantage	$367.50
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$227.50

STENT URETERAL 5FRX26CM

Facility

$350.00

Service Code	HCPCS C2617
Hospital Charge Code	40209685
Hospital Revenue Code	278
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

STENT URETERAL 5FRX28CM

Facility

$350.00

Service Code	HCPCS C2617
Hospital Charge Code	40209686
Hospital Revenue Code	278
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$367.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.14
Rate for Payer: Aetna Government	$10.14
Rate for Payer: Brighton Health Commercial	$210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$175.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.25
Rate for Payer: EmblemHealth Commercial	$175.00
Rate for Payer: Fidelis Medicare Advantage	$367.50
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$227.50

STENT URETERAL 5FRX28CM

Facility

$350.00

Service Code	HCPCS C2617
Hospital Charge Code	40209686
Hospital Revenue Code	278
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

STENT URETERAL 5FRX30CM

Facility

$350.00

Service Code	HCPCS C2617
Hospital Charge Code	40209687
Hospital Revenue Code	278
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$367.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.14
Rate for Payer: Aetna Government	$10.14
Rate for Payer: Brighton Health Commercial	$210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$175.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.25
Rate for Payer: EmblemHealth Commercial	$175.00
Rate for Payer: Fidelis Medicare Advantage	$367.50
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$227.50

STENT URETERAL 5FRX30CM

Facility

$350.00

Service Code	HCPCS C2617
Hospital Charge Code	40209687
Hospital Revenue Code	278
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

STENT URETERAL 6FRX20CM

Facility

$350.00

Service Code	HCPCS C2617
Hospital Charge Code	40209688
Hospital Revenue Code	278
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$367.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.14
Rate for Payer: Aetna Government	$10.14
Rate for Payer: Brighton Health Commercial	$210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$175.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.25
Rate for Payer: EmblemHealth Commercial	$175.00
Rate for Payer: Fidelis Medicare Advantage	$367.50
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$227.50

STENT URETERAL 6FRX20CM

Facility

$350.00

Service Code	HCPCS C2617
Hospital Charge Code	40209688
Hospital Revenue Code	278
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

STENT URETERAL 6FRX22CM

Facility

$585.00

Service Code	HCPCS C2617
Hospital Charge Code	40209689
Hospital Revenue Code	278
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$614.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$321.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.14
Rate for Payer: Aetna Government	$10.14
Rate for Payer: Brighton Health Commercial	$351.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$292.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$336.38
Rate for Payer: EmblemHealth Commercial	$292.50
Rate for Payer: Fidelis Medicare Advantage	$614.25
Rate for Payer: Group Health Inc Commercial	$292.50
Rate for Payer: Group Health Inc Medicare	$204.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$292.50
Rate for Payer: Hamaspik Choice Inc Medicare	$292.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$380.25

STENT URETERAL 6FRX22CM

Facility

$585.00

Service Code	HCPCS C2617
Hospital Charge Code	40209689
Hospital Revenue Code	278
Min. Negotiated Rate	$292.50
Max. Negotiated Rate	$292.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$292.50
Rate for Payer: Hamaspik Choice Inc Medicare	$292.50

STENT URETERAL 6FRX24CM

Facility

$350.00

Service Code	HCPCS C2617
Hospital Charge Code	40209672
Hospital Revenue Code	278
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$367.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.14
Rate for Payer: Aetna Government	$10.14
Rate for Payer: Brighton Health Commercial	$210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$175.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.25
Rate for Payer: EmblemHealth Commercial	$175.00
Rate for Payer: Fidelis Medicare Advantage	$367.50
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$227.50

STENT URETERAL 6FRX24CM

Facility

$350.00

Service Code	HCPCS C2617
Hospital Charge Code	40209672
Hospital Revenue Code	278
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

STENT URETERAL 6FRX28CM

Facility

$350.00

Service Code	HCPCS C2617
Hospital Charge Code	40209690
Hospital Revenue Code	278
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

STENT URETERAL 6FRX28CM

Facility

$350.00

Service Code	HCPCS C2617
Hospital Charge Code	40209690
Hospital Revenue Code	278
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$367.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.14
Rate for Payer: Aetna Government	$10.14
Rate for Payer: Brighton Health Commercial	$210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$175.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.25
Rate for Payer: EmblemHealth Commercial	$175.00
Rate for Payer: Fidelis Medicare Advantage	$367.50
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$227.50

STENT URETERAL 7FRX20CM

Facility

$338.00

Service Code	HCPCS C2617
Hospital Charge Code	40209691
Hospital Revenue Code	278
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$354.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$185.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.14
Rate for Payer: Aetna Government	$10.14
Rate for Payer: Brighton Health Commercial	$202.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$169.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$194.35
Rate for Payer: EmblemHealth Commercial	$169.00
Rate for Payer: Fidelis Medicare Advantage	$354.90
Rate for Payer: Group Health Inc Commercial	$169.00
Rate for Payer: Group Health Inc Medicare	$118.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.00
Rate for Payer: Hamaspik Choice Inc Medicare	$169.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$219.70

STENT URETERAL 7FRX20CM

Facility

$338.00

Service Code	HCPCS C2617
Hospital Charge Code	40209691
Hospital Revenue Code	278
Min. Negotiated Rate	$169.00
Max. Negotiated Rate	$169.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.00
Rate for Payer: Hamaspik Choice Inc Medicare	$169.00

STENT URETERAL 7FRX22CM

Facility

$390.00

Service Code	HCPCS C2617
Hospital Charge Code	40209692
Hospital Revenue Code	278
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$195.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$195.00
Rate for Payer: Hamaspik Choice Inc Medicare	$195.00

STENT URETERAL 7FRX22CM

Facility

$390.00

Service Code	HCPCS C2617
Hospital Charge Code	40209692
Hospital Revenue Code	278
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$409.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$214.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.14
Rate for Payer: Aetna Government	$10.14
Rate for Payer: Brighton Health Commercial	$234.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$195.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$224.25
Rate for Payer: EmblemHealth Commercial	$195.00
Rate for Payer: Fidelis Medicare Advantage	$409.50
Rate for Payer: Group Health Inc Commercial	$195.00
Rate for Payer: Group Health Inc Medicare	$136.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$195.00
Rate for Payer: Hamaspik Choice Inc Medicare	$195.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$253.50

Know your out-of-pocket cost for care.

All Charges