St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZZ BALLOON/UT/DIAMOND/8-4-120

Facility

$574.09

Service Code	HCPCS C1725
Hospital Charge Code	41569444
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/8-4-120

Facility

$574.09

Service Code	HCPCS C1725
Hospital Charge Code	41569444
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/8-4-75

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569445
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/8-4-75

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569445
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/9-2-75

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569446
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/9-2-75

Facility

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569446
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/9-4-120

Facility

$574.09

Service Code	HCPCS C1725
Hospital Charge Code	41569447
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/9-4-120

Facility

$574.09

Service Code	HCPCS C1725
Hospital Charge Code	41569447
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/XXL/12-4-120

Facility

$657.02

Service Code	HCPCS C1725
Hospital Charge Code	41569448
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$689.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$361.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$394.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$328.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$377.79
Rate for Payer: EmblemHealth Commercial	$328.51
Rate for Payer: Fidelis Medicare Advantage	$689.87
Rate for Payer: Group Health Inc Commercial	$328.51
Rate for Payer: Group Health Inc Medicare	$229.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.51
Rate for Payer: Hamaspik Choice Inc Medicare	$328.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$427.06

ZZ BALLOON/XXL/12-4-120

Facility

$657.02

Service Code	HCPCS C1725
Hospital Charge Code	41569448
Hospital Revenue Code	278
Min. Negotiated Rate	$328.51
Max. Negotiated Rate	$328.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.51
Rate for Payer: Hamaspik Choice Inc Medicare	$328.51

ZZ BALLOON/XXL/12-4-75

Facility

$657.02

Service Code	HCPCS C1725
Hospital Charge Code	41569450
Hospital Revenue Code	278
Min. Negotiated Rate	$328.51
Max. Negotiated Rate	$328.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.51
Rate for Payer: Hamaspik Choice Inc Medicare	$328.51

ZZ BALLOON/XXL/12-4-75

Facility

$657.02

Service Code	HCPCS C1725
Hospital Charge Code	41569450
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$689.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$361.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$394.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$328.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$377.79
Rate for Payer: EmblemHealth Commercial	$328.51
Rate for Payer: Fidelis Medicare Advantage	$689.87
Rate for Payer: Group Health Inc Commercial	$328.51
Rate for Payer: Group Health Inc Medicare	$229.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.51
Rate for Payer: Hamaspik Choice Inc Medicare	$328.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$427.06

ZZ BALLOON/XXL/14-4-75

Facility

$657.02

Service Code	HCPCS C1725
Hospital Charge Code	41569449
Hospital Revenue Code	278
Min. Negotiated Rate	$328.51
Max. Negotiated Rate	$328.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.51
Rate for Payer: Hamaspik Choice Inc Medicare	$328.51

ZZ BALLOON/XXL/14-4-75

Facility

$657.02

Service Code	HCPCS C1725
Hospital Charge Code	41569449
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$689.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$361.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$394.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$328.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$377.79
Rate for Payer: EmblemHealth Commercial	$328.51
Rate for Payer: Fidelis Medicare Advantage	$689.87
Rate for Payer: Group Health Inc Commercial	$328.51
Rate for Payer: Group Health Inc Medicare	$229.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.51
Rate for Payer: Hamaspik Choice Inc Medicare	$328.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$427.06

ZZ BALLOON/XXL/16-4-75

Facility

$722.93

Service Code	HCPCS C1725
Hospital Charge Code	41569451
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$759.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$397.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$433.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$361.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$415.68
Rate for Payer: EmblemHealth Commercial	$361.46
Rate for Payer: Fidelis Medicare Advantage	$759.08
Rate for Payer: Group Health Inc Commercial	$361.46
Rate for Payer: Group Health Inc Medicare	$253.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$361.46
Rate for Payer: Hamaspik Choice Inc Medicare	$361.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$469.90

ZZ BALLOON/XXL/16-4-75

Facility

$722.93

Service Code	HCPCS C1725
Hospital Charge Code	41569451
Hospital Revenue Code	278
Min. Negotiated Rate	$361.46
Max. Negotiated Rate	$361.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$361.46
Rate for Payer: Hamaspik Choice Inc Medicare	$361.46

ZZ BALLOON/XXL/18-4-75

Facility

$722.93

Service Code	HCPCS C1725
Hospital Charge Code	41569452
Hospital Revenue Code	278
Min. Negotiated Rate	$361.46
Max. Negotiated Rate	$361.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$361.46
Rate for Payer: Hamaspik Choice Inc Medicare	$361.46

ZZ BALLOON/XXL/18-4-75

Facility

$722.93

Service Code	HCPCS C1725
Hospital Charge Code	41569452
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$759.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$397.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$433.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$361.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$415.68
Rate for Payer: EmblemHealth Commercial	$361.46
Rate for Payer: Fidelis Medicare Advantage	$759.08
Rate for Payer: Group Health Inc Commercial	$361.46
Rate for Payer: Group Health Inc Medicare	$253.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$361.46
Rate for Payer: Hamaspik Choice Inc Medicare	$361.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$469.90

ZZ BANANA PEEL SHTH 12 15

Facility

$146.72

Service Code	HCPCS C1725
Hospital Charge Code	41567060
Hospital Revenue Code	278
Min. Negotiated Rate	$73.36
Max. Negotiated Rate	$73.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.36
Rate for Payer: Hamaspik Choice Inc Medicare	$73.36

ZZ BANANA PEEL SHTH 12 15

Facility

$146.72

Service Code	HCPCS C1725
Hospital Charge Code	41567060
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$154.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$88.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$73.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$84.36
Rate for Payer: EmblemHealth Commercial	$73.36
Rate for Payer: Fidelis Medicare Advantage	$154.06
Rate for Payer: Group Health Inc Commercial	$73.36
Rate for Payer: Group Health Inc Medicare	$51.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.36
Rate for Payer: Hamaspik Choice Inc Medicare	$73.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$95.37

ZZ BANANA PEEL SHTH 14 15

Facility

$146.72

Service Code	HCPCS C1725
Hospital Charge Code	41567061
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$154.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$88.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$73.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$84.36
Rate for Payer: EmblemHealth Commercial	$73.36
Rate for Payer: Fidelis Medicare Advantage	$154.06
Rate for Payer: Group Health Inc Commercial	$73.36
Rate for Payer: Group Health Inc Medicare	$51.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.36
Rate for Payer: Hamaspik Choice Inc Medicare	$73.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$95.37

ZZ BANANA PEEL SHTH 14 15

Facility

$146.72

Service Code	HCPCS C1725
Hospital Charge Code	41567061
Hospital Revenue Code	278
Min. Negotiated Rate	$73.36
Max. Negotiated Rate	$73.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.36
Rate for Payer: Hamaspik Choice Inc Medicare	$73.36

ZZ BANANA PEEL SHTH 9 15

Facility

$146.72

Service Code	HCPCS C1725
Hospital Charge Code	41567058
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$154.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$88.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$73.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$84.36
Rate for Payer: EmblemHealth Commercial	$73.36
Rate for Payer: Fidelis Medicare Advantage	$154.06
Rate for Payer: Group Health Inc Commercial	$73.36
Rate for Payer: Group Health Inc Medicare	$51.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.36
Rate for Payer: Hamaspik Choice Inc Medicare	$73.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$95.37

ZZ BANANA PEEL SHTH 9 15

Facility

$146.72

Service Code	HCPCS C1725
Hospital Charge Code	41567058
Hospital Revenue Code	278
Min. Negotiated Rate	$73.36
Max. Negotiated Rate	$73.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.36
Rate for Payer: Hamaspik Choice Inc Medicare	$73.36

ZZ BARD BIOPSY INSTRUMENT KIT

Facility

$210.00

Hospital Charge Code	41562920
Hospital Revenue Code	272
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$168.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$115.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$105.00
Rate for Payer: Aetna Government	$105.00
Rate for Payer: Brighton Health Commercial	$157.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$168.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$142.80
Rate for Payer: Group Health Inc Commercial	$105.00
Rate for Payer: Group Health Inc Medicare	$73.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.00
Rate for Payer: Hamaspik Choice Inc Medicare	$105.00

Know your out-of-pocket cost for care.

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