St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZZ BALLOON/UT/DIAMOND 6X2X75

Facility

$578.34

Service Code	HCPCS C1725
Hospital Charge Code	41569687
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 6X2X75

Facility

$578.34

Service Code	HCPCS C1725
Hospital Charge Code	41569687
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 6X4

Facility

$578.34

Service Code	HCPCS C1725
Hospital Charge Code	41569627
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 6X4

Facility

$578.34

Service Code	HCPCS C1725
Hospital Charge Code	41569627
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 6X4X120

Facility

$578.34

Service Code	HCPCS C1725
Hospital Charge Code	41569690
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 6X4X120

Facility

$578.34

Service Code	HCPCS C1725
Hospital Charge Code	41569690
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 6X4X40

Facility

$578.34

Hospital Charge Code	41569688
Hospital Revenue Code	270
Min. Negotiated Rate	$202.42
Max. Negotiated Rate	$462.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$318.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$289.17
Rate for Payer: Aetna Government	$289.17
Rate for Payer: Brighton Health Commercial	$433.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$462.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$393.27
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

ZZ BALLOON/UT/DIAMOND 6X4X75

Facility

$578.34

Service Code	HCPCS C1725
Hospital Charge Code	41569689
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 6X4X75

Facility

$578.34

Service Code	HCPCS C1725
Hospital Charge Code	41569689
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/7-2-75

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569436
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/7-2-75

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569436
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/7-4-120

Facility

$574.09

Service Code	HCPCS C1725
Hospital Charge Code	41569437
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/7-4-120

Facility

$574.09

Service Code	HCPCS C1725
Hospital Charge Code	41569437
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/7-4-75

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569438
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/7-4-75

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569438
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/8-2-120

Facility

$574.09

Service Code	HCPCS C1725
Hospital Charge Code	41569439
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/8-2-120

Facility

$574.09

Service Code	HCPCS C1725
Hospital Charge Code	41569439
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/8-2-75

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569440
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/8-2-75

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569440
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/8-3-120

Facility

$574.09

Service Code	HCPCS C1725
Hospital Charge Code	41569441
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/8-3-120

Facility

$574.09

Service Code	HCPCS C1725
Hospital Charge Code	41569441
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/8-3-40

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569442
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/8-3-40

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569442
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/8-3-75

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569443
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/8-3-75

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569443
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

Know your out-of-pocket cost for care.

All Charges