St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$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/ULTRATHIN DIAM/6-2

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569105
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/ULTRATHIN DIAM/6-2

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569105
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/UT/DIAMOND/10-2-75

Facility

$574.09

Service Code	HCPCS C1725
Hospital Charge Code	41569106
Hospital Revenue Code	278
Min. Negotiated Rate	$287.04
Max. Negotiated Rate	$287.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$287.04
Rate for Payer: Hamaspik Choice Inc Medicare	$287.04

ZZ BALLOON/UT/DIAMOND/10-2-75

Facility

$574.09

Service Code	HCPCS C1725
Hospital Charge Code	41569106
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$602.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$315.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$344.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$287.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$330.10
Rate for Payer: EmblemHealth Commercial	$287.04
Rate for Payer: Fidelis Medicare Advantage	$602.79
Rate for Payer: Group Health Inc Commercial	$287.04
Rate for Payer: Group Health Inc Medicare	$200.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$287.04
Rate for Payer: Hamaspik Choice Inc Medicare	$287.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$373.16

ZZ BALLOON/UT/DIAMOND/10-4-120

Facility

$574.09

Service Code	HCPCS C1725
Hospital Charge Code	41569108
Hospital Revenue Code	278
Min. Negotiated Rate	$287.04
Max. Negotiated Rate	$287.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$287.04
Rate for Payer: Hamaspik Choice Inc Medicare	$287.04

ZZ BALLOON/UT/DIAMOND/10-4-120

Facility

$574.09

Service Code	HCPCS C1725
Hospital Charge Code	41569108
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$602.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$315.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$344.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$287.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$330.10
Rate for Payer: EmblemHealth Commercial	$287.04
Rate for Payer: Fidelis Medicare Advantage	$602.79
Rate for Payer: Group Health Inc Commercial	$287.04
Rate for Payer: Group Health Inc Medicare	$200.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$287.04
Rate for Payer: Hamaspik Choice Inc Medicare	$287.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$373.16

ZZ BALLOON/UT/DIAMOND/10-4-75

Facility

$574.09

Service Code	HCPCS C1725
Hospital Charge Code	41569109
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$602.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$315.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$344.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$287.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$330.10
Rate for Payer: EmblemHealth Commercial	$287.04
Rate for Payer: Fidelis Medicare Advantage	$602.79
Rate for Payer: Group Health Inc Commercial	$287.04
Rate for Payer: Group Health Inc Medicare	$200.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$287.04
Rate for Payer: Hamaspik Choice Inc Medicare	$287.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$373.16

ZZ BALLOON/UT/DIAMOND/10-4-75

Facility

$574.09

Service Code	HCPCS C1725
Hospital Charge Code	41569109
Hospital Revenue Code	278
Min. Negotiated Rate	$287.04
Max. Negotiated Rate	$287.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$287.04
Rate for Payer: Hamaspik Choice Inc Medicare	$287.04

ZZ BALLOON/UT/DIAMOND/4-2-120

Facility

$574.09

Hospital Charge Code	41569110
Hospital Revenue Code	270
Min. Negotiated Rate	$200.93
Max. Negotiated Rate	$459.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$315.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$287.04
Rate for Payer: Aetna Government	$287.04
Rate for Payer: Brighton Health Commercial	$430.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$459.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$390.38
Rate for Payer: Group Health Inc Commercial	$287.04
Rate for Payer: Group Health Inc Medicare	$200.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$287.04
Rate for Payer: Hamaspik Choice Inc Medicare	$287.04

ZZ BALLOON/UT/DIAMOND/4-4-75

Facility

$574.09

Service Code	HCPCS C1725
Hospital Charge Code	41569111
Hospital Revenue Code	278
Min. Negotiated Rate	$287.04
Max. Negotiated Rate	$287.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$287.04
Rate for Payer: Hamaspik Choice Inc Medicare	$287.04

ZZ BALLOON/UT/DIAMOND/4-4-75

Facility

$574.09

Service Code	HCPCS C1725
Hospital Charge Code	41569111
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$602.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$315.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$344.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$287.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$330.10
Rate for Payer: EmblemHealth Commercial	$287.04
Rate for Payer: Fidelis Medicare Advantage	$602.79
Rate for Payer: Group Health Inc Commercial	$287.04
Rate for Payer: Group Health Inc Medicare	$200.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$287.04
Rate for Payer: Hamaspik Choice Inc Medicare	$287.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$373.16

ZZ BALLOON/UT/DIAMOND 4X2X75

Facility

$578.34

Service Code	HCPCS C1725
Hospital Charge Code	41569685
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/UT/DIAMOND 4X2X75

Facility

$578.34

Service Code	HCPCS C1725
Hospital Charge Code	41569685
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/UT/DIAMOND/5-2-120

Facility

$574.09

Hospital Charge Code	41569112
Hospital Revenue Code	270
Min. Negotiated Rate	$200.93
Max. Negotiated Rate	$459.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$315.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$287.04
Rate for Payer: Aetna Government	$287.04
Rate for Payer: Brighton Health Commercial	$430.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$459.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$390.38
Rate for Payer: Group Health Inc Commercial	$287.04
Rate for Payer: Group Health Inc Medicare	$200.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$287.04
Rate for Payer: Hamaspik Choice Inc Medicare	$287.04

ZZ BALLOON/UT/DIAMOND/5-2-75

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569113
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/UT/DIAMOND/5-2-75

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569113
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/UT/DIAMOND/5-4-120

Facility

$574.09

Service Code	HCPCS C1725
Hospital Charge Code	41569114
Hospital Revenue Code	278
Min. Negotiated Rate	$287.04
Max. Negotiated Rate	$287.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$287.04
Rate for Payer: Hamaspik Choice Inc Medicare	$287.04

ZZ BALLOON/UT/DIAMOND/5-4-120

Facility

$574.09

Service Code	HCPCS C1725
Hospital Charge Code	41569114
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$602.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$315.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$344.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$287.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$330.10
Rate for Payer: EmblemHealth Commercial	$287.04
Rate for Payer: Fidelis Medicare Advantage	$602.79
Rate for Payer: Group Health Inc Commercial	$287.04
Rate for Payer: Group Health Inc Medicare	$200.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$287.04
Rate for Payer: Hamaspik Choice Inc Medicare	$287.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$373.16

ZZ BALLOON/UT/DIAMOND/5-4-75

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569115
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/UT/DIAMOND/5-4-75

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569115
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/UT/DIAMOND 5X2X40

Facility

$578.34

Service Code	HCPCS C1725
Hospital Charge Code	41569686
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/UT/DIAMOND 5X2X40

Facility

$578.34

Service Code	HCPCS C1725
Hospital Charge Code	41569686
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/UT/DIAMOND/6-2-120

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569116
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/UT/DIAMOND/6-2-120

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569116
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

Know your out-of-pocket cost for care.

All Charges