St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZZ BALLOON SYMMETRY 2X2.5X135

Facility

$965.32

Service Code	HCPCS C1725
Hospital Charge Code	41569682
Hospital Revenue Code	278
Min. Negotiated Rate	$482.66
Max. Negotiated Rate	$482.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$482.66
Rate for Payer: Hamaspik Choice Inc Medicare	$482.66

ZZ BALLOON SYMMETRY 2X2X135

Facility

$965.32

Service Code	HCPCS C1725
Hospital Charge Code	41569681
Hospital Revenue Code	278
Min. Negotiated Rate	$482.66
Max. Negotiated Rate	$482.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$482.66
Rate for Payer: Hamaspik Choice Inc Medicare	$482.66

ZZ BALLOON SYMMETRY 2X2X135

Facility

$965.32

Service Code	HCPCS C1725
Hospital Charge Code	41569681
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

ZZ BALLOON/SYMMETRY/3-2-90

Facility

$784.59

Service Code	HCPCS C1725
Hospital Charge Code	41569092
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/3-2-90

Facility

$784.59

Service Code	HCPCS C1725
Hospital Charge Code	41569092
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/35-2-90

Facility

$784.59

Service Code	HCPCS C1725
Hospital Charge Code	41569093
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/35-2-90

Facility

$784.59

Service Code	HCPCS C1725
Hospital Charge Code	41569093
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/4-2-135

Facility

$827.12

Service Code	HCPCS C1725
Hospital Charge Code	41569102
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$868.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$454.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$496.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$413.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$475.59
Rate for Payer: EmblemHealth Commercial	$413.56
Rate for Payer: Fidelis Medicare Advantage	$868.48
Rate for Payer: Group Health Inc Commercial	$413.56
Rate for Payer: Group Health Inc Medicare	$289.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$413.56
Rate for Payer: Hamaspik Choice Inc Medicare	$413.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$537.63

ZZ BALLOON/SYMMETRY/4-2-135

Facility

$827.12

Service Code	HCPCS C1725
Hospital Charge Code	41569102
Hospital Revenue Code	278
Min. Negotiated Rate	$413.56
Max. Negotiated Rate	$413.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$413.56
Rate for Payer: Hamaspik Choice Inc Medicare	$413.56

ZZ BALLOON SYMMETRY 4.5X2X135

Facility

$965.32

Hospital Charge Code	41569683
Hospital Revenue Code	270
Min. Negotiated Rate	$337.86
Max. Negotiated Rate	$772.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$530.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$482.66
Rate for Payer: Aetna Government	$482.66
Rate for Payer: Brighton Health Commercial	$723.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$772.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$656.42
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

ZZ BALLOON/SYMMETRY/6-2-90

Facility

$784.59

Service Code	HCPCS C1725
Hospital Charge Code	41569087
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/6-2-90

Facility

$784.59

Service Code	HCPCS C1725
Hospital Charge Code	41569087
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/6-4-90

Facility

$784.59

Service Code	HCPCS C1725
Hospital Charge Code	41569088
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/6-4-90

Facility

$784.59

Service Code	HCPCS C1725
Hospital Charge Code	41569088
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/SS/2.5-2-135

Facility

$827.12

Service Code	HCPCS C1725
Hospital Charge Code	41569098
Hospital Revenue Code	278
Min. Negotiated Rate	$413.56
Max. Negotiated Rate	$413.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$413.56
Rate for Payer: Hamaspik Choice Inc Medicare	$413.56

ZZ BALLOON/SYMMETRY/SS/2.5-2-135

Facility

$827.12

Service Code	HCPCS C1725
Hospital Charge Code	41569098
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$868.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$454.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$496.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$413.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$475.59
Rate for Payer: EmblemHealth Commercial	$413.56
Rate for Payer: Fidelis Medicare Advantage	$868.48
Rate for Payer: Group Health Inc Commercial	$413.56
Rate for Payer: Group Health Inc Medicare	$289.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$413.56
Rate for Payer: Hamaspik Choice Inc Medicare	$413.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$537.63

ZZ BALLOON/SYMMETRY/SS/3-2-135

Facility

$827.12

Service Code	HCPCS C1725
Hospital Charge Code	41569099
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$868.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$454.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$496.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$413.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$475.59
Rate for Payer: EmblemHealth Commercial	$413.56
Rate for Payer: Fidelis Medicare Advantage	$868.48
Rate for Payer: Group Health Inc Commercial	$413.56
Rate for Payer: Group Health Inc Medicare	$289.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$413.56
Rate for Payer: Hamaspik Choice Inc Medicare	$413.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$537.63

ZZ BALLOON/SYMMETRY/SS/3-2-135

Facility

$827.12

Service Code	HCPCS C1725
Hospital Charge Code	41569099
Hospital Revenue Code	278
Min. Negotiated Rate	$413.56
Max. Negotiated Rate	$413.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$413.56
Rate for Payer: Hamaspik Choice Inc Medicare	$413.56

ZZ BALLOON/SYMMETRY/SS/3.5-2-135

Facility

$827.12

Service Code	HCPCS C1725
Hospital Charge Code	41569100
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$868.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$454.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$496.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$413.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$475.59
Rate for Payer: EmblemHealth Commercial	$413.56
Rate for Payer: Fidelis Medicare Advantage	$868.48
Rate for Payer: Group Health Inc Commercial	$413.56
Rate for Payer: Group Health Inc Medicare	$289.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$413.56
Rate for Payer: Hamaspik Choice Inc Medicare	$413.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$537.63

ZZ BALLOON/SYMMETRY/SS/3.5-2-135

Facility

$827.12

Service Code	HCPCS C1725
Hospital Charge Code	41569100
Hospital Revenue Code	278
Min. Negotiated Rate	$413.56
Max. Negotiated Rate	$413.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$413.56
Rate for Payer: Hamaspik Choice Inc Medicare	$413.56

ZZ BALLOON/SYMMETRY/SS/5-2-135

Facility

$827.12

Service Code	HCPCS C1725
Hospital Charge Code	41569103
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$868.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$454.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$496.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$413.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$475.59
Rate for Payer: EmblemHealth Commercial	$413.56
Rate for Payer: Fidelis Medicare Advantage	$868.48
Rate for Payer: Group Health Inc Commercial	$413.56
Rate for Payer: Group Health Inc Medicare	$289.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$413.56
Rate for Payer: Hamaspik Choice Inc Medicare	$413.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$537.63

ZZ BALLOON/SYMMETRY/SS/5-2-135

Facility

$827.12

Service Code	HCPCS C1725
Hospital Charge Code	41569103
Hospital Revenue Code	278
Min. Negotiated Rate	$413.56
Max. Negotiated Rate	$413.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$413.56
Rate for Payer: Hamaspik Choice Inc Medicare	$413.56

ZZ BALLOON/SYMMETRY/SS/5-4-135

Facility

$827.12

Service Code	HCPCS C1725
Hospital Charge Code	41569104
Hospital Revenue Code	278
Min. Negotiated Rate	$413.56
Max. Negotiated Rate	$413.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$413.56
Rate for Payer: Hamaspik Choice Inc Medicare	$413.56

ZZ BALLOON/SYMMETRY/SS/5-4-135

Facility

$827.12

Service Code	HCPCS C1725
Hospital Charge Code	41569104
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$868.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$454.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$496.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$413.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$475.59
Rate for Payer: EmblemHealth Commercial	$413.56
Rate for Payer: Fidelis Medicare Advantage	$868.48
Rate for Payer: Group Health Inc Commercial	$413.56
Rate for Payer: Group Health Inc Medicare	$289.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$413.56
Rate for Payer: Hamaspik Choice Inc Medicare	$413.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$537.63

ZZ BALLOON/SYMMETRY/S-S/6-4-135

Facility

$827.12

Service Code	HCPCS C1725
Hospital Charge Code	41569089
Hospital Revenue Code	278
Min. Negotiated Rate	$413.56
Max. Negotiated Rate	$413.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$413.56
Rate for Payer: Hamaspik Choice Inc Medicare	$413.56

Know your out-of-pocket cost for care.

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