St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TECHNETIUM TC 99M MEBROFENIN IV KIT [103948]

Facility

$113.46

Service Code	HCPCS A9537
Hospital Charge Code	45567045501
Hospital Revenue Code	278
Min. Negotiated Rate	$39.71
Max. Negotiated Rate	$119.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$45.80
Rate for Payer: Aetna Government	$45.80
Rate for Payer: Brighton Health Commercial	$68.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.24
Rate for Payer: EmblemHealth Commercial	$56.73
Rate for Payer: Fidelis Medicare Advantage	$119.13
Rate for Payer: Group Health Inc Commercial	$56.73
Rate for Payer: Group Health Inc Medicare	$39.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.73
Rate for Payer: Hamaspik Choice Inc Medicare	$56.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$73.75

TECHNETIUM TC-99M MEDRONATE

Facility

$43.00

Service Code	HCPCS A9503
Hospital Charge Code	41656489
Hospital Revenue Code	343
Min. Negotiated Rate	$10.76
Max. Negotiated Rate	$34.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.76
Rate for Payer: Aetna Government	$10.76
Rate for Payer: Brighton Health Commercial	$32.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.24
Rate for Payer: Group Health Inc Commercial	$21.50
Rate for Payer: Group Health Inc Medicare	$15.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.50
Rate for Payer: Hamaspik Choice Inc Medicare	$21.50

TECHNETIUM TC 99M MEDRONATE IV KIT [98466]

Facility

$98.22

Service Code	HCPCS A9503
Hospital Charge Code	45567004002
Hospital Revenue Code	278
Min. Negotiated Rate	$49.11
Max. Negotiated Rate	$49.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.11
Rate for Payer: Hamaspik Choice Inc Medicare	$49.11

TECHNETIUM TC 99M MEDRONATE IV KIT [98466]

Facility

$98.22

Service Code	HCPCS A9503
Hospital Charge Code	45567004001
Hospital Revenue Code	278
Min. Negotiated Rate	$49.11
Max. Negotiated Rate	$49.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.11
Rate for Payer: Hamaspik Choice Inc Medicare	$49.11

TECHNETIUM TC 99M MEDRONATE IV KIT [98466]

Facility

$98.22

Service Code	HCPCS A9503
Hospital Charge Code	45567004002
Hospital Revenue Code	278
Min. Negotiated Rate	$10.76
Max. Negotiated Rate	$103.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$54.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.76
Rate for Payer: Aetna Government	$10.76
Rate for Payer: Brighton Health Commercial	$58.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$49.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$56.48
Rate for Payer: EmblemHealth Commercial	$49.11
Rate for Payer: Fidelis Medicare Advantage	$103.13
Rate for Payer: Group Health Inc Commercial	$49.11
Rate for Payer: Group Health Inc Medicare	$34.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.11
Rate for Payer: Hamaspik Choice Inc Medicare	$49.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$63.84

TECHNETIUM TC 99M MEDRONATE IV KIT [98466]

Facility

$98.22

Service Code	HCPCS A9503
Hospital Charge Code	45567004001
Hospital Revenue Code	278
Min. Negotiated Rate	$10.76
Max. Negotiated Rate	$103.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$54.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.76
Rate for Payer: Aetna Government	$10.76
Rate for Payer: Brighton Health Commercial	$58.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$49.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$56.48
Rate for Payer: EmblemHealth Commercial	$49.11
Rate for Payer: Fidelis Medicare Advantage	$103.13
Rate for Payer: Group Health Inc Commercial	$49.11
Rate for Payer: Group Health Inc Medicare	$34.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.11
Rate for Payer: Hamaspik Choice Inc Medicare	$49.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$63.84

TECHNETIUM TC-99M PERTECHNET 10MC

Facility

$3.97

Service Code	HCPCS A9512
Hospital Charge Code	41646569
Hospital Revenue Code	343
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$3.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.32
Rate for Payer: Aetna Government	$1.32
Rate for Payer: Brighton Health Commercial	$2.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.70
Rate for Payer: Group Health Inc Commercial	$1.98
Rate for Payer: Group Health Inc Medicare	$1.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.98
Rate for Payer: Hamaspik Choice Inc Medicare	$1.98

TECHNETIUM TC-99M PERTECHNET 30MC

Facility

$1.32

Service Code	HCPCS A9512
Hospital Charge Code	41656570
Hospital Revenue Code	343
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$1.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.32
Rate for Payer: Aetna Government	$1.32
Rate for Payer: Brighton Health Commercial	$0.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.90
Rate for Payer: Group Health Inc Commercial	$0.66
Rate for Payer: Group Health Inc Medicare	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.66
Rate for Payer: Hamaspik Choice Inc Medicare	$0.66

TECHNETIUM TC 99M PYROPHOS IV KIT [134584]

Facility

$76.86

Service Code	HCPCS A9558
Hospital Charge Code	45567006001
Hospital Revenue Code	278
Min. Negotiated Rate	$26.90
Max. Negotiated Rate	$173.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$173.64
Rate for Payer: Aetna Government	$173.64
Rate for Payer: Brighton Health Commercial	$46.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.19
Rate for Payer: EmblemHealth Commercial	$38.43
Rate for Payer: Fidelis Medicare Advantage	$80.70
Rate for Payer: Group Health Inc Commercial	$38.43
Rate for Payer: Group Health Inc Medicare	$26.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.43
Rate for Payer: Hamaspik Choice Inc Medicare	$38.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$49.96

TECHNETIUM TC 99M PYROPHOS IV KIT [134584]

Facility

$76.86

Service Code	HCPCS A9558
Hospital Charge Code	45567006001
Hospital Revenue Code	278
Min. Negotiated Rate	$38.43
Max. Negotiated Rate	$38.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.43
Rate for Payer: Hamaspik Choice Inc Medicare	$38.43

TECHNETIUM TC-99M PYROPHOSPHATE

Facility

$3.61

Service Code	HCPCS A9538
Hospital Charge Code	41646571
Hospital Revenue Code	343
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$41.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.40
Rate for Payer: Aetna Government	$41.40
Rate for Payer: Brighton Health Commercial	$2.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.45
Rate for Payer: Group Health Inc Commercial	$1.80
Rate for Payer: Group Health Inc Medicare	$1.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.80
Rate for Payer: Hamaspik Choice Inc Medicare	$1.80

TECHNETIUM TC-99M PYROPHOSPHATE

Facility

$3.61

Service Code	HCPCS A9538
Hospital Charge Code	41656571
Hospital Revenue Code	343
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$41.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.40
Rate for Payer: Aetna Government	$41.40
Rate for Payer: Brighton Health Commercial	$2.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.45
Rate for Payer: Group Health Inc Commercial	$1.80
Rate for Payer: Group Health Inc Medicare	$1.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.80
Rate for Payer: Hamaspik Choice Inc Medicare	$1.80

TECHNETIUM TC 99M PYROPHOSPHATE [40840067]

Facility

$44.10

Service Code	HCPCS A9538
Hospital Revenue Code	250
Min. Negotiated Rate	$15.44
Max. Negotiated Rate	$41.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.40
Rate for Payer: Aetna Government	$41.40
Rate for Payer: Brighton Health Commercial	$33.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.99
Rate for Payer: Group Health Inc Commercial	$22.05
Rate for Payer: Group Health Inc Medicare	$15.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.05
Rate for Payer: Hamaspik Choice Inc Medicare	$22.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.66

TECHNETIUM TC-99M SESTAMIBI

Facility

$86.87

Service Code	HCPCS A9500
Hospital Charge Code	41646559
Hospital Revenue Code	343
Min. Negotiated Rate	$30.40
Max. Negotiated Rate	$88.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$88.39
Rate for Payer: Aetna Government	$88.39
Rate for Payer: Brighton Health Commercial	$65.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$69.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.07
Rate for Payer: Group Health Inc Commercial	$43.44
Rate for Payer: Group Health Inc Medicare	$30.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.44
Rate for Payer: Hamaspik Choice Inc Medicare	$43.44

TECHNETIUM TC-99M SESTAMIBI 10MCI

Facility

$86.87

Service Code	HCPCS A9500
Hospital Charge Code	41656559
Hospital Revenue Code	343
Min. Negotiated Rate	$30.40
Max. Negotiated Rate	$88.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$88.39
Rate for Payer: Aetna Government	$88.39
Rate for Payer: Brighton Health Commercial	$65.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$69.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.07
Rate for Payer: Group Health Inc Commercial	$43.44
Rate for Payer: Group Health Inc Medicare	$30.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.44
Rate for Payer: Hamaspik Choice Inc Medicare	$43.44

TECHNETIUM TC 99M SESTAMIBI - CARDIOLITE [40840057]

Facility

$45.79

Service Code	HCPCS A9500
Hospital Revenue Code	250
Min. Negotiated Rate	$16.03
Max. Negotiated Rate	$88.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$88.39
Rate for Payer: Aetna Government	$88.39
Rate for Payer: Brighton Health Commercial	$34.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.14
Rate for Payer: Group Health Inc Commercial	$22.90
Rate for Payer: Group Health Inc Medicare	$16.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.90
Rate for Payer: Hamaspik Choice Inc Medicare	$22.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.76

TECHNETIUM TC 99M SESTAMIBI IV KIT [134046]

Facility

$133.74

Service Code	NDC 11994000120
Hospital Charge Code	11994000120
Hospital Revenue Code	278
Min. Negotiated Rate	$66.87
Max. Negotiated Rate	$66.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.87
Rate for Payer: Hamaspik Choice Inc Medicare	$66.87

TECHNETIUM TC 99M SESTAMIBI IV KIT [134046]

Facility

$133.74

Service Code	NDC 11994000120
Hospital Charge Code	11994000120
Hospital Revenue Code	278
Min. Negotiated Rate	$46.81
Max. Negotiated Rate	$140.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$73.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$66.87
Rate for Payer: Aetna Government	$66.87
Rate for Payer: Brighton Health Commercial	$80.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$66.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.90
Rate for Payer: EmblemHealth Commercial	$66.87
Rate for Payer: Fidelis Medicare Advantage	$140.42
Rate for Payer: Group Health Inc Commercial	$66.87
Rate for Payer: Group Health Inc Medicare	$46.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.87
Rate for Payer: Hamaspik Choice Inc Medicare	$66.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$86.93

TECHNETIUM TC 99M SESTAMIBI IV KIT [134046]

Facility

$385.38

Service Code	NDC 65857050020
Hospital Charge Code	65857050020
Hospital Revenue Code	278
Min. Negotiated Rate	$192.69
Max. Negotiated Rate	$192.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$192.69
Rate for Payer: Hamaspik Choice Inc Medicare	$192.69

TECHNETIUM TC 99M SESTAMIBI IV KIT [134046]

Facility

$385.38

Service Code	NDC 65857050020
Hospital Charge Code	65857050020
Hospital Revenue Code	278
Min. Negotiated Rate	$134.88
Max. Negotiated Rate	$404.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$211.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$192.69
Rate for Payer: Aetna Government	$192.69
Rate for Payer: Brighton Health Commercial	$231.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$192.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$221.59
Rate for Payer: EmblemHealth Commercial	$192.69
Rate for Payer: Fidelis Medicare Advantage	$404.65
Rate for Payer: Group Health Inc Commercial	$192.69
Rate for Payer: Group Health Inc Medicare	$134.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$192.69
Rate for Payer: Hamaspik Choice Inc Medicare	$192.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$250.50

TECHNETIUM TC-99M SULFUR COLLOID

Facility

$141.87

Service Code	HCPCS A9541
Hospital Charge Code	41646562
Hospital Revenue Code	343
Min. Negotiated Rate	$49.65
Max. Negotiated Rate	$221.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$221.38
Rate for Payer: Aetna Government	$221.38
Rate for Payer: Brighton Health Commercial	$106.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$113.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$96.47
Rate for Payer: Group Health Inc Commercial	$70.94
Rate for Payer: Group Health Inc Medicare	$49.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.94
Rate for Payer: Hamaspik Choice Inc Medicare	$70.94

TECHNETIUM TC-99M SULFUR COLLOID

Facility

$141.87

Service Code	HCPCS A9541
Hospital Charge Code	41656562
Hospital Revenue Code	343
Min. Negotiated Rate	$49.65
Max. Negotiated Rate	$221.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$221.38
Rate for Payer: Aetna Government	$221.38
Rate for Payer: Brighton Health Commercial	$106.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$113.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$96.47
Rate for Payer: Group Health Inc Commercial	$70.94
Rate for Payer: Group Health Inc Medicare	$49.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.94
Rate for Payer: Hamaspik Choice Inc Medicare	$70.94

TECHNETIUM TC 99M SULFUR COLLOID [40840061]

Facility

$130.50

Service Code	HCPCS A9541
Hospital Revenue Code	250
Min. Negotiated Rate	$45.68
Max. Negotiated Rate	$221.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$221.38
Rate for Payer: Aetna Government	$221.38
Rate for Payer: Brighton Health Commercial	$97.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$104.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$88.74
Rate for Payer: Group Health Inc Commercial	$65.25
Rate for Payer: Group Health Inc Medicare	$45.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.25
Rate for Payer: Hamaspik Choice Inc Medicare	$65.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$84.82

TECHNETIUM TC99M SULFUR COLLOID FILTERED [701422]

Facility

$254.16

Service Code	HCPCS A9541
Hospital Charge Code	09999701422
Hospital Revenue Code	250
Min. Negotiated Rate	$88.96
Max. Negotiated Rate	$221.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$139.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$221.38
Rate for Payer: Aetna Government	$221.38
Rate for Payer: Brighton Health Commercial	$190.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$203.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$172.83
Rate for Payer: Group Health Inc Commercial	$127.08
Rate for Payer: Group Health Inc Medicare	$88.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$127.08
Rate for Payer: Hamaspik Choice Inc Medicare	$127.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$165.20

TECHNETIUM TC-99 PERTECHNET 10MCI

Facility

$3.97

Service Code	HCPCS A9512
Hospital Charge Code	41656569
Hospital Revenue Code	343
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$3.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.32
Rate for Payer: Aetna Government	$1.32
Rate for Payer: Brighton Health Commercial	$2.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.70
Rate for Payer: Group Health Inc Commercial	$1.98
Rate for Payer: Group Health Inc Medicare	$1.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.98
Rate for Payer: Hamaspik Choice Inc Medicare	$1.98

Know your out-of-pocket cost for care.

All Charges