St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZZ BALLOON MARSHAL 6-4 5.2T 90

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569019
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$569.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$298.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$325.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$311.76
Rate for Payer: EmblemHealth Commercial	$271.10
Rate for Payer: Fidelis Medicare Advantage	$569.31
Rate for Payer: Group Health Inc Commercial	$271.10
Rate for Payer: Group Health Inc Medicare	$189.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$271.10
Rate for Payer: Hamaspik Choice Inc Medicare	$271.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$352.43

ZZ BALLOON MARSHAL 7-4 5.8T 90

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569020
Hospital Revenue Code	278
Min. Negotiated Rate	$271.10
Max. Negotiated Rate	$271.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$271.10
Rate for Payer: Hamaspik Choice Inc Medicare	$271.10

ZZ BALLOON MARSHAL 7-4 5.8T 90

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569020
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$569.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$298.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$325.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$311.76
Rate for Payer: EmblemHealth Commercial	$271.10
Rate for Payer: Fidelis Medicare Advantage	$569.31
Rate for Payer: Group Health Inc Commercial	$271.10
Rate for Payer: Group Health Inc Medicare	$189.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$271.10
Rate for Payer: Hamaspik Choice Inc Medicare	$271.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$352.43

ZZ BALLOON MARSHAL 8-2 5.8T 90

Facility

$542.20

Hospital Charge Code	41569021
Hospital Revenue Code	270
Min. Negotiated Rate	$189.77
Max. Negotiated Rate	$433.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$298.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$271.10
Rate for Payer: Aetna Government	$271.10
Rate for Payer: Brighton Health Commercial	$406.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$433.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$368.70
Rate for Payer: Group Health Inc Commercial	$271.10
Rate for Payer: Group Health Inc Medicare	$189.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$271.10
Rate for Payer: Hamaspik Choice Inc Medicare	$271.10

ZZ BALLOON MARSHAL 9-4 5.8T 90

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569022
Hospital Revenue Code	278
Min. Negotiated Rate	$271.10
Max. Negotiated Rate	$271.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$271.10
Rate for Payer: Hamaspik Choice Inc Medicare	$271.10

ZZ BALLOON MARSHAL 9-4 5.8T 90

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569022
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$569.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$298.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$325.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$311.76
Rate for Payer: EmblemHealth Commercial	$271.10
Rate for Payer: Fidelis Medicare Advantage	$569.31
Rate for Payer: Group Health Inc Commercial	$271.10
Rate for Payer: Group Health Inc Medicare	$189.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$271.10
Rate for Payer: Hamaspik Choice Inc Medicare	$271.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$352.43

ZZ BALLOON MARSHALL 7X6

Facility

$578.34

Service Code	HCPCS C1725
Hospital Charge Code	41569626
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$607.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$318.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$347.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$289.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$332.55
Rate for Payer: EmblemHealth Commercial	$289.17
Rate for Payer: Fidelis Medicare Advantage	$607.26
Rate for Payer: Group Health Inc Commercial	$289.17
Rate for Payer: Group Health Inc Medicare	$202.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$289.17
Rate for Payer: Hamaspik Choice Inc Medicare	$289.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$375.92

ZZ BALLOON MARSHALL 7X6

Facility

$578.34

Service Code	HCPCS C1725
Hospital Charge Code	41569626
Hospital Revenue Code	278
Min. Negotiated Rate	$289.17
Max. Negotiated Rate	$289.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$289.17
Rate for Payer: Hamaspik Choice Inc Medicare	$289.17

ZZ BALLOON/OCCLUSION/LARGE 20MM

Facility

$361.46

Service Code	HCPCS C1725
Hospital Charge Code	41569143
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$379.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$198.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$216.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$180.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$207.84
Rate for Payer: EmblemHealth Commercial	$180.73
Rate for Payer: Fidelis Medicare Advantage	$379.53
Rate for Payer: Group Health Inc Commercial	$180.73
Rate for Payer: Group Health Inc Medicare	$126.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$180.73
Rate for Payer: Hamaspik Choice Inc Medicare	$180.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$234.95

ZZ BALLOON/OCCLUSION/LARGE 20MM

Facility

$361.46

Service Code	HCPCS C1725
Hospital Charge Code	41569143
Hospital Revenue Code	278
Min. Negotiated Rate	$180.73
Max. Negotiated Rate	$180.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$180.73
Rate for Payer: Hamaspik Choice Inc Medicare	$180.73

ZZ BALLOON/OCCLUSION/MEDIUM 13MM

Facility

$382.73

Service Code	HCPCS C1725
Hospital Charge Code	41569144
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$401.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$210.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$229.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$191.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$220.07
Rate for Payer: EmblemHealth Commercial	$191.36
Rate for Payer: Fidelis Medicare Advantage	$401.87
Rate for Payer: Group Health Inc Commercial	$191.36
Rate for Payer: Group Health Inc Medicare	$133.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.36
Rate for Payer: Hamaspik Choice Inc Medicare	$191.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$248.77

ZZ BALLOON/OCCLUSION/MEDIUM 13MM

Facility

$382.73

Service Code	HCPCS C1725
Hospital Charge Code	41569144
Hospital Revenue Code	278
Min. Negotiated Rate	$191.36
Max. Negotiated Rate	$191.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.36
Rate for Payer: Hamaspik Choice Inc Medicare	$191.36

ZZ BALLOON/OCCLUSION/SMALL 8.5MM

Facility

$372.10

Service Code	HCPCS C1725
Hospital Charge Code	41569086
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$390.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$204.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$223.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$186.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$213.96
Rate for Payer: EmblemHealth Commercial	$186.05
Rate for Payer: Fidelis Medicare Advantage	$390.70
Rate for Payer: Group Health Inc Commercial	$186.05
Rate for Payer: Group Health Inc Medicare	$130.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$186.05
Rate for Payer: Hamaspik Choice Inc Medicare	$186.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$241.86

ZZ BALLOON/OCCLUSION/SMALL 8.5MM

Facility

$372.10

Service Code	HCPCS C1725
Hospital Charge Code	41569086
Hospital Revenue Code	278
Min. Negotiated Rate	$186.05
Max. Negotiated Rate	$186.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$186.05
Rate for Payer: Hamaspik Choice Inc Medicare	$186.05

ZZ BALLOON/SYMMETRY/14-2-90

Facility

$784.59

Service Code	HCPCS C1725
Hospital Charge Code	41569094
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$823.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$431.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$470.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$392.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$451.14
Rate for Payer: EmblemHealth Commercial	$392.30
Rate for Payer: Fidelis Medicare Advantage	$823.82
Rate for Payer: Group Health Inc Commercial	$392.30
Rate for Payer: Group Health Inc Medicare	$274.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$392.30
Rate for Payer: Hamaspik Choice Inc Medicare	$392.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$509.98

ZZ BALLOON/SYMMETRY/14-2-90

Facility

$784.59

Service Code	HCPCS C1725
Hospital Charge Code	41569094
Hospital Revenue Code	278
Min. Negotiated Rate	$392.30
Max. Negotiated Rate	$392.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$392.30
Rate for Payer: Hamaspik Choice Inc Medicare	$392.30

ZZ BALLOON/SYMMETRY/15-2-90

Facility

$784.59

Service Code	HCPCS C1725
Hospital Charge Code	41569095
Hospital Revenue Code	278
Min. Negotiated Rate	$392.30
Max. Negotiated Rate	$392.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$392.30
Rate for Payer: Hamaspik Choice Inc Medicare	$392.30

ZZ BALLOON/SYMMETRY/15-2-90

Facility

$784.59

Service Code	HCPCS C1725
Hospital Charge Code	41569095
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$823.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$431.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$470.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$392.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$451.14
Rate for Payer: EmblemHealth Commercial	$392.30
Rate for Payer: Fidelis Medicare Advantage	$823.82
Rate for Payer: Group Health Inc Commercial	$392.30
Rate for Payer: Group Health Inc Medicare	$274.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$392.30
Rate for Payer: Hamaspik Choice Inc Medicare	$392.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$509.98

ZZ BALLOON/SYMMETRY/15-4-90

Facility

$784.59

Service Code	HCPCS C1725
Hospital Charge Code	41569096
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$823.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$431.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$470.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$392.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$451.14
Rate for Payer: EmblemHealth Commercial	$392.30
Rate for Payer: Fidelis Medicare Advantage	$823.82
Rate for Payer: Group Health Inc Commercial	$392.30
Rate for Payer: Group Health Inc Medicare	$274.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$392.30
Rate for Payer: Hamaspik Choice Inc Medicare	$392.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$509.98

ZZ BALLOON/SYMMETRY/15-4-90

Facility

$784.59

Service Code	HCPCS C1725
Hospital Charge Code	41569096
Hospital Revenue Code	278
Min. Negotiated Rate	$392.30
Max. Negotiated Rate	$392.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$392.30
Rate for Payer: Hamaspik Choice Inc Medicare	$392.30

ZZ BALLOON/SYMMETRY/2-2-90

Facility

$784.59

Service Code	HCPCS C1725
Hospital Charge Code	41569090
Hospital Revenue Code	278
Min. Negotiated Rate	$392.30
Max. Negotiated Rate	$392.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$392.30
Rate for Payer: Hamaspik Choice Inc Medicare	$392.30

ZZ BALLOON/SYMMETRY/2-2-90

Facility

$784.59

Service Code	HCPCS C1725
Hospital Charge Code	41569090
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$823.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$431.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$470.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$392.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$451.14
Rate for Payer: EmblemHealth Commercial	$392.30
Rate for Payer: Fidelis Medicare Advantage	$823.82
Rate for Payer: Group Health Inc Commercial	$392.30
Rate for Payer: Group Health Inc Medicare	$274.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$392.30
Rate for Payer: Hamaspik Choice Inc Medicare	$392.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$509.98

ZZ BALLOON/SYMMETRY/2.5-2-90

Facility

$784.59

Service Code	HCPCS C1725
Hospital Charge Code	41569091
Hospital Revenue Code	278
Min. Negotiated Rate	$392.30
Max. Negotiated Rate	$392.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$392.30
Rate for Payer: Hamaspik Choice Inc Medicare	$392.30

ZZ BALLOON/SYMMETRY/2.5-2-90

Facility

$784.59

Service Code	HCPCS C1725
Hospital Charge Code	41569091
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$823.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$431.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$470.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$392.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$451.14
Rate for Payer: EmblemHealth Commercial	$392.30
Rate for Payer: Fidelis Medicare Advantage	$823.82
Rate for Payer: Group Health Inc Commercial	$392.30
Rate for Payer: Group Health Inc Medicare	$274.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$392.30
Rate for Payer: Hamaspik Choice Inc Medicare	$392.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$509.98

ZZ BALLOON SYMMETRY 2X2.5X135

Facility

$965.32

Service Code	HCPCS C1725
Hospital Charge Code	41569682
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$1,013.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$530.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$579.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$482.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$555.06
Rate for Payer: EmblemHealth Commercial	$482.66
Rate for Payer: Fidelis Medicare Advantage	$1,013.59
Rate for Payer: Group Health Inc Commercial	$482.66
Rate for Payer: Group Health Inc Medicare	$337.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$482.66
Rate for Payer: Hamaspik Choice Inc Medicare	$482.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$627.46

Know your out-of-pocket cost for care.

All Charges