St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

XR X-RAY EXAM OF SKULL

Facility

$327.00

Service Code	HCPCS 70250 TC
Hospital Charge Code	41102188
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR XRAY EXAM OF TEETH

Facility

$705.83

Service Code	HCPCS 70310 TC
Hospital Charge Code	41109907
Hospital Revenue Code	320
Rate for Payer: Cash Price	$283.37

XR XRAY EXAM OF TEETH

Facility

$705.83

Service Code	HCPCS 70310 TC
Hospital Charge Code	41109907
Hospital Revenue Code	320
Min. Negotiated Rate	$51.62
Max. Negotiated Rate	$388.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$388.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$283.37
Rate for Payer: Aetna Government	$283.37
Rate for Payer: Affinity Essential Plan 1&2	$198.36
Rate for Payer: Affinity Essential Plan 3&4	$198.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$198.36
Rate for Payer: Brighton Health Commercial	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$283.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$61.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.62
Rate for Payer: Elderplan Medicare Advantage	$283.37
Rate for Payer: EmblemHealth Commercial	$198.36
Rate for Payer: Fidelis CHP/HARP/Medicaid	$240.86
Rate for Payer: Fidelis Essential Plan Aliesa	$240.86
Rate for Payer: Fidelis Essential Plan QHP	$252.20
Rate for Payer: Fidelis Medicare Advantage	$283.37
Rate for Payer: Fidelis Qualified Health Plan	$252.20
Rate for Payer: Group Health Inc Commercial	$255.03
Rate for Payer: Group Health Inc Medicare	$255.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.92
Rate for Payer: Hamaspik Choice Inc Medicare	$283.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$255.03
Rate for Payer: Healthfirst Medicare Advantage	$283.37
Rate for Payer: Healthfirst QHP	$283.37
Rate for Payer: Humana Medicare	$289.04
Rate for Payer: Senior Whole Health Medicare Advantage	$283.37
Rate for Payer: United Healthcare Medicare Advantage	$283.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$283.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$226.70
Rate for Payer: Wellcare Medicare	$269.20

XR X-RAY IAC'S(INTERNAL AUD CANAL

Facility

$1,458.58

Service Code	HCPCS 70134 TC
Hospital Charge Code	41102868
Hospital Revenue Code	320
Rate for Payer: Cash Price	$637.97

XR X-RAY IAC'S(INTERNAL AUD CANAL

Facility

$1,458.58

Service Code	HCPCS 70134 TC
Hospital Charge Code	41102868
Hospital Revenue Code	320
Min. Negotiated Rate	$128.48
Max. Negotiated Rate	$802.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$802.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$637.97
Rate for Payer: Aetna Government	$637.97
Rate for Payer: Affinity Essential Plan 1&2	$446.58
Rate for Payer: Affinity Essential Plan 3&4	$446.58
Rate for Payer: Affinity Medicaid/CHP/HARP	$446.58
Rate for Payer: Brighton Health Commercial	$637.97
Rate for Payer: Cash Price	$637.97
Rate for Payer: Cash Price	$637.97
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$637.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$151.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$128.48
Rate for Payer: Elderplan Medicare Advantage	$637.97
Rate for Payer: EmblemHealth Commercial	$446.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$542.27
Rate for Payer: Fidelis Essential Plan Aliesa	$542.27
Rate for Payer: Fidelis Essential Plan QHP	$567.79
Rate for Payer: Fidelis Medicare Advantage	$637.97
Rate for Payer: Fidelis Qualified Health Plan	$567.79
Rate for Payer: Group Health Inc Commercial	$574.17
Rate for Payer: Group Health Inc Medicare	$574.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.29
Rate for Payer: Hamaspik Choice Inc Medicare	$637.97
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$574.17
Rate for Payer: Healthfirst Medicare Advantage	$637.97
Rate for Payer: Healthfirst QHP	$637.97
Rate for Payer: Humana Medicare	$650.73
Rate for Payer: Senior Whole Health Medicare Advantage	$637.97
Rate for Payer: United Healthcare Medicare Advantage	$637.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$637.97
Rate for Payer: Wellcare CHP/FHP/Medicaid	$510.38
Rate for Payer: Wellcare Medicare	$606.07

XSMALL STAPLE 7.5X1.2MMX1.2MM

Facility

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	40200805
Hospital Revenue Code	278
Min. Negotiated Rate	$275.00
Max. Negotiated Rate	$275.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$275.00

XSMALL STAPLE 7.5X1.2MMX1.2MM

Facility

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	40200805
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$577.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$302.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$330.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$275.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$316.25
Rate for Payer: EmblemHealth Commercial	$275.00
Rate for Payer: Fidelis Medicare Advantage	$577.50
Rate for Payer: Group Health Inc Commercial	$275.00
Rate for Payer: Group Health Inc Medicare	$192.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$275.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$357.50

X-STOP IPD IMPLANT TI/14MM

Facility

$9,250.00

Hospital Charge Code	40209958
Hospital Revenue Code	272
Min. Negotiated Rate	$3,237.50
Max. Negotiated Rate	$7,400.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,087.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,625.00
Rate for Payer: Aetna Government	$4,625.00
Rate for Payer: Brighton Health Commercial	$6,937.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,290.00
Rate for Payer: Group Health Inc Commercial	$4,625.00
Rate for Payer: Group Health Inc Medicare	$3,237.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,625.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,625.00

XYLOCAINE

Facility

$9.57

Hospital Charge Code	40207280
Hospital Revenue Code	270
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$7.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.78
Rate for Payer: Aetna Government	$4.78
Rate for Payer: Brighton Health Commercial	$7.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.51
Rate for Payer: Group Health Inc Commercial	$4.78
Rate for Payer: Group Health Inc Medicare	$3.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.78
Rate for Payer: Hamaspik Choice Inc Medicare	$4.78

YANKAUER,BULB TIP,1-PIECE (K86)

Facility

$0.02

Hospital Charge Code	64902556
Hospital Revenue Code	270
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

YASARGIL TI STD CLIP

Facility

$833.42

Hospital Charge Code	64906545
Hospital Revenue Code	279
Min. Negotiated Rate	$291.70
Max. Negotiated Rate	$666.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$458.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$416.71
Rate for Payer: Aetna Government	$416.71
Rate for Payer: Brighton Health Commercial	$625.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$666.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$566.73
Rate for Payer: Group Health Inc Commercial	$416.71
Rate for Payer: Group Health Inc Medicare	$291.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$416.71
Rate for Payer: Hamaspik Choice Inc Medicare	$416.71

YASARGIL TYPE TMP CLIP SLGHT CRV

Facility

$1,022.50

Hospital Charge Code	64905646
Hospital Revenue Code	270
Min. Negotiated Rate	$357.88
Max. Negotiated Rate	$818.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$562.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$511.25
Rate for Payer: Aetna Government	$511.25
Rate for Payer: Brighton Health Commercial	$766.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$818.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$695.30
Rate for Payer: Group Health Inc Commercial	$511.25
Rate for Payer: Group Health Inc Medicare	$357.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$511.25
Rate for Payer: Hamaspik Choice Inc Medicare	$511.25

Y CABLE CONNECTS TO CMP BC10PMO

Facility

$1,242.00

Hospital Charge Code	40205297
Hospital Revenue Code	292
Min. Negotiated Rate	$434.70
Max. Negotiated Rate	$993.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$683.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$621.00
Rate for Payer: Aetna Government	$621.00
Rate for Payer: Brighton Health Commercial	$931.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$993.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$844.56
Rate for Payer: Group Health Inc Commercial	$621.00
Rate for Payer: Group Health Inc Medicare	$434.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$621.00
Rate for Payer: Hamaspik Choice Inc Medicare	$621.00

YELLOW FEVER VACCINE

Facility

$427.68

Service Code	HCPCS 90717
Hospital Charge Code	41640378
Hospital Revenue Code	636
Min. Negotiated Rate	$143.47
Max. Negotiated Rate	$277.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$235.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$143.47
Rate for Payer: Aetna Government	$143.47
Rate for Payer: Brighton Health Commercial	$256.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$213.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$245.92
Rate for Payer: Group Health Inc Commercial	$213.84
Rate for Payer: Group Health Inc Medicare	$149.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.84
Rate for Payer: Hamaspik Choice Inc Medicare	$213.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$277.99

YELLOW FEVER VACCINE

Facility

$146.00

Service Code	HCPCS 90717
Hospital Charge Code	41645955
Hospital Revenue Code	636
Min. Negotiated Rate	$73.00
Max. Negotiated Rate	$73.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.00
Rate for Payer: Hamaspik Choice Inc Medicare	$73.00

YELLOW FEVER VACCINE

Facility

$146.00

Service Code	HCPCS 90717
Hospital Charge Code	41655955
Hospital Revenue Code	636
Min. Negotiated Rate	$51.10
Max. Negotiated Rate	$143.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$143.47
Rate for Payer: Aetna Government	$143.47
Rate for Payer: Brighton Health Commercial	$87.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$73.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$83.95
Rate for Payer: Group Health Inc Commercial	$73.00
Rate for Payer: Group Health Inc Medicare	$51.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.00
Rate for Payer: Hamaspik Choice Inc Medicare	$73.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$94.90

YELLOW FEVER VACCINE

Facility

$146.00

Service Code	HCPCS 90717
Hospital Charge Code	41655955
Hospital Revenue Code	636
Min. Negotiated Rate	$73.00
Max. Negotiated Rate	$73.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.00
Rate for Payer: Hamaspik Choice Inc Medicare	$73.00

YELLOW FEVER VACCINE

Facility

$427.68

Service Code	HCPCS 90717
Hospital Charge Code	41650378
Hospital Revenue Code	636
Min. Negotiated Rate	$143.47
Max. Negotiated Rate	$277.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$235.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$143.47
Rate for Payer: Aetna Government	$143.47
Rate for Payer: Brighton Health Commercial	$256.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$213.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$245.92
Rate for Payer: Group Health Inc Commercial	$213.84
Rate for Payer: Group Health Inc Medicare	$149.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.84
Rate for Payer: Hamaspik Choice Inc Medicare	$213.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$277.99

YELLOW FEVER VACCINE

Facility

$427.68

Service Code	HCPCS 90717
Hospital Charge Code	41650378
Hospital Revenue Code	636
Min. Negotiated Rate	$213.84
Max. Negotiated Rate	$213.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.84
Rate for Payer: Hamaspik Choice Inc Medicare	$213.84

YELLOW FEVER VACCINE

Facility

$146.00

Service Code	HCPCS 90717
Hospital Charge Code	41645955
Hospital Revenue Code	636
Min. Negotiated Rate	$51.10
Max. Negotiated Rate	$143.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$143.47
Rate for Payer: Aetna Government	$143.47
Rate for Payer: Brighton Health Commercial	$87.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$73.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$83.95
Rate for Payer: Group Health Inc Commercial	$73.00
Rate for Payer: Group Health Inc Medicare	$51.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.00
Rate for Payer: Hamaspik Choice Inc Medicare	$73.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$94.90

YELLOW FEVER VACCINE

Facility

$427.68

Service Code	HCPCS 90717
Hospital Charge Code	41640378
Hospital Revenue Code	636
Min. Negotiated Rate	$213.84
Max. Negotiated Rate	$213.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.84
Rate for Payer: Hamaspik Choice Inc Medicare	$213.84

YELLOW FEVER VACCINE SC INJ [8822]

Facility

$708.92

Service Code	NDC 49281091501
Hospital Charge Code	49281091501
Hospital Revenue Code	250
Min. Negotiated Rate	$248.12
Max. Negotiated Rate	$567.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$389.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$354.46
Rate for Payer: Aetna Government	$354.46
Rate for Payer: Brighton Health Commercial	$531.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$567.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$482.07
Rate for Payer: Group Health Inc Commercial	$354.46
Rate for Payer: Group Health Inc Medicare	$248.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$354.46
Rate for Payer: Hamaspik Choice Inc Medicare	$354.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$460.80

YELLOW STRUT

Facility

$4,562.50

Hospital Charge Code	64902961
Hospital Revenue Code	279
Min. Negotiated Rate	$1,596.88
Max. Negotiated Rate	$3,650.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,509.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,281.25
Rate for Payer: Aetna Government	$2,281.25
Rate for Payer: Brighton Health Commercial	$3,421.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,650.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,102.50
Rate for Payer: Group Health Inc Commercial	$2,281.25
Rate for Payer: Group Health Inc Medicare	$1,596.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,281.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,281.25

YOUNGSWICK 1MM GUIDE

Facility

$250.00

Hospital Charge Code	64903964
Hospital Revenue Code	270
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$125.00
Rate for Payer: Aetna Government	$125.00
Rate for Payer: Brighton Health Commercial	$187.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.00
Rate for Payer: Group Health Inc Commercial	$125.00
Rate for Payer: Group Health Inc Medicare	$87.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$125.00

Y-PLATE

Facility

$1,987.50

Service Code	HCPCS C1713
Hospital Charge Code	64907244
Hospital Revenue Code	278
Min. Negotiated Rate	$993.75
Max. Negotiated Rate	$993.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$993.75
Rate for Payer: Hamaspik Choice Inc Medicare	$993.75

Know your out-of-pocket cost for care.

All Charges