St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZZ COIL/.018 HILAL/3-4

Facility

$127.87

Service Code	HCPCS C1884
Hospital Charge Code	41569050
Hospital Revenue Code	278
Min. Negotiated Rate	$63.94
Max. Negotiated Rate	$63.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.94
Rate for Payer: Hamaspik Choice Inc Medicare	$63.94

ZZ COIL/.018 HILAL/4-6

Facility

$127.87

Service Code	HCPCS C1884
Hospital Charge Code	41569051
Hospital Revenue Code	278
Min. Negotiated Rate	$63.94
Max. Negotiated Rate	$63.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.94
Rate for Payer: Hamaspik Choice Inc Medicare	$63.94

ZZ COIL/.018 HILAL/4-6

Facility

$127.87

Service Code	HCPCS C1884
Hospital Charge Code	41569051
Hospital Revenue Code	278
Min. Negotiated Rate	$44.75
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$76.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$63.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$73.53
Rate for Payer: EmblemHealth Commercial	$63.94
Rate for Payer: Fidelis Medicare Advantage	$134.26
Rate for Payer: Group Health Inc Commercial	$63.94
Rate for Payer: Group Health Inc Medicare	$44.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.94
Rate for Payer: Hamaspik Choice Inc Medicare	$63.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$83.12

ZZ COIL/018 HILAL/4-7

Facility

$127.87

Service Code	HCPCS C1884
Hospital Charge Code	41569052
Hospital Revenue Code	278
Min. Negotiated Rate	$63.94
Max. Negotiated Rate	$63.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.94
Rate for Payer: Hamaspik Choice Inc Medicare	$63.94

ZZ COIL/018 HILAL/4-7

Facility

$127.87

Service Code	HCPCS C1884
Hospital Charge Code	41569052
Hospital Revenue Code	278
Min. Negotiated Rate	$44.75
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$76.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$63.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$73.53
Rate for Payer: EmblemHealth Commercial	$63.94
Rate for Payer: Fidelis Medicare Advantage	$134.26
Rate for Payer: Group Health Inc Commercial	$63.94
Rate for Payer: Group Health Inc Medicare	$44.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.94
Rate for Payer: Hamaspik Choice Inc Medicare	$63.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$83.12

ZZ COIL/.018 HILAL/6-10

Facility

$127.87

Service Code	HCPCS C1884
Hospital Charge Code	41569053
Hospital Revenue Code	278
Min. Negotiated Rate	$44.75
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$76.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$63.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$73.53
Rate for Payer: EmblemHealth Commercial	$63.94
Rate for Payer: Fidelis Medicare Advantage	$134.26
Rate for Payer: Group Health Inc Commercial	$63.94
Rate for Payer: Group Health Inc Medicare	$44.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.94
Rate for Payer: Hamaspik Choice Inc Medicare	$63.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$83.12

ZZ COIL/.018 HILAL/6-10

Facility

$127.87

Service Code	HCPCS C1884
Hospital Charge Code	41569053
Hospital Revenue Code	278
Min. Negotiated Rate	$63.94
Max. Negotiated Rate	$63.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.94
Rate for Payer: Hamaspik Choice Inc Medicare	$63.94

ZZ COIL/.018 HILAL/6-5

Facility

$127.87

Service Code	HCPCS C1884
Hospital Charge Code	41569054
Hospital Revenue Code	278
Min. Negotiated Rate	$63.94
Max. Negotiated Rate	$63.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.94
Rate for Payer: Hamaspik Choice Inc Medicare	$63.94

ZZ COIL/.018 HILAL/6-5

Facility

$127.87

Service Code	HCPCS C1884
Hospital Charge Code	41569054
Hospital Revenue Code	278
Min. Negotiated Rate	$44.75
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$76.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$63.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$73.53
Rate for Payer: EmblemHealth Commercial	$63.94
Rate for Payer: Fidelis Medicare Advantage	$134.26
Rate for Payer: Group Health Inc Commercial	$63.94
Rate for Payer: Group Health Inc Medicare	$44.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.94
Rate for Payer: Hamaspik Choice Inc Medicare	$63.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$83.12

ZZ COIL/.018 HILAL/6-7

Facility

$142.46

Service Code	HCPCS C1884
Hospital Charge Code	41569055
Hospital Revenue Code	278
Min. Negotiated Rate	$71.23
Max. Negotiated Rate	$71.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.23
Rate for Payer: Hamaspik Choice Inc Medicare	$71.23

ZZ COIL/.018 HILAL/6-7

Facility

$142.46

Service Code	HCPCS C1884
Hospital Charge Code	41569055
Hospital Revenue Code	278
Min. Negotiated Rate	$49.86
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$85.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$71.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.91
Rate for Payer: EmblemHealth Commercial	$71.23
Rate for Payer: Fidelis Medicare Advantage	$149.58
Rate for Payer: Group Health Inc Commercial	$71.23
Rate for Payer: Group Health Inc Medicare	$49.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.23
Rate for Payer: Hamaspik Choice Inc Medicare	$71.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$92.60

ZZ COIL/.018 TORNADO/3-2

Facility

$156.74

Service Code	HCPCS C1884
Hospital Charge Code	41569056
Hospital Revenue Code	278
Min. Negotiated Rate	$78.37
Max. Negotiated Rate	$78.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.37
Rate for Payer: Hamaspik Choice Inc Medicare	$78.37

ZZ COIL/.018 TORNADO/3-2

Facility

$156.74

Service Code	HCPCS C1884
Hospital Charge Code	41569056
Hospital Revenue Code	278
Min. Negotiated Rate	$54.86
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$94.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$90.13
Rate for Payer: EmblemHealth Commercial	$78.37
Rate for Payer: Fidelis Medicare Advantage	$164.58
Rate for Payer: Group Health Inc Commercial	$78.37
Rate for Payer: Group Health Inc Medicare	$54.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.37
Rate for Payer: Hamaspik Choice Inc Medicare	$78.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$101.88

ZZ COIL/.018 TORNADO/4-2

Facility

$156.74

Service Code	HCPCS C1884
Hospital Charge Code	41569057
Hospital Revenue Code	278
Min. Negotiated Rate	$54.86
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$94.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$90.13
Rate for Payer: EmblemHealth Commercial	$78.37
Rate for Payer: Fidelis Medicare Advantage	$164.58
Rate for Payer: Group Health Inc Commercial	$78.37
Rate for Payer: Group Health Inc Medicare	$54.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.37
Rate for Payer: Hamaspik Choice Inc Medicare	$78.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$101.88

ZZ COIL/.018 TORNADO/4-2

Facility

$156.74

Service Code	HCPCS C1884
Hospital Charge Code	41569057
Hospital Revenue Code	278
Min. Negotiated Rate	$78.37
Max. Negotiated Rate	$78.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.37
Rate for Payer: Hamaspik Choice Inc Medicare	$78.37

ZZ COIL/.018 TORNADO/5-2

Facility

$156.74

Service Code	HCPCS C1884
Hospital Charge Code	41569059
Hospital Revenue Code	278
Min. Negotiated Rate	$54.86
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$94.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$90.13
Rate for Payer: EmblemHealth Commercial	$78.37
Rate for Payer: Fidelis Medicare Advantage	$164.58
Rate for Payer: Group Health Inc Commercial	$78.37
Rate for Payer: Group Health Inc Medicare	$54.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.37
Rate for Payer: Hamaspik Choice Inc Medicare	$78.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$101.88

ZZ COIL/.018 TORNADO/5-2

Facility

$156.74

Service Code	HCPCS C1884
Hospital Charge Code	41569059
Hospital Revenue Code	278
Min. Negotiated Rate	$78.37
Max. Negotiated Rate	$78.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.37
Rate for Payer: Hamaspik Choice Inc Medicare	$78.37

ZZ COIL/.018 TORNADO/6-2

Facility

$156.74

Service Code	HCPCS C1884
Hospital Charge Code	41569058
Hospital Revenue Code	278
Min. Negotiated Rate	$54.86
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$94.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$90.13
Rate for Payer: EmblemHealth Commercial	$78.37
Rate for Payer: Fidelis Medicare Advantage	$164.58
Rate for Payer: Group Health Inc Commercial	$78.37
Rate for Payer: Group Health Inc Medicare	$54.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.37
Rate for Payer: Hamaspik Choice Inc Medicare	$78.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$101.88

ZZ COIL/.018 TORNADO/6-2

Facility

$156.74

Service Code	HCPCS C1884
Hospital Charge Code	41569058
Hospital Revenue Code	278
Min. Negotiated Rate	$78.37
Max. Negotiated Rate	$78.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.37
Rate for Payer: Hamaspik Choice Inc Medicare	$78.37

ZZ COIL/.025 STANDARD/1.2-2

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569060
Hospital Revenue Code	278
Min. Negotiated Rate	$32.49
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$55.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.37
Rate for Payer: EmblemHealth Commercial	$46.41
Rate for Payer: Fidelis Medicare Advantage	$97.46
Rate for Payer: Group Health Inc Commercial	$46.41
Rate for Payer: Group Health Inc Medicare	$32.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$60.33

ZZ COIL/.025 STANDARD/1.2-2

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569060
Hospital Revenue Code	278
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$46.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41

ZZ COIL/.025 STANDARD/2-3

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569061
Hospital Revenue Code	278
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$46.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41

ZZ COIL/.025 STANDARD/2-3

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569061
Hospital Revenue Code	278
Min. Negotiated Rate	$32.49
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$55.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.37
Rate for Payer: EmblemHealth Commercial	$46.41
Rate for Payer: Fidelis Medicare Advantage	$97.46
Rate for Payer: Group Health Inc Commercial	$46.41
Rate for Payer: Group Health Inc Medicare	$32.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$60.33

ZZ COIL/.025 STANDARD/2.5-2

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569062
Hospital Revenue Code	278
Min. Negotiated Rate	$32.49
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$55.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.37
Rate for Payer: EmblemHealth Commercial	$46.41
Rate for Payer: Fidelis Medicare Advantage	$97.46
Rate for Payer: Group Health Inc Commercial	$46.41
Rate for Payer: Group Health Inc Medicare	$32.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$60.33

ZZ COIL/.025 STANDARD/2.5-2

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569062
Hospital Revenue Code	278
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$46.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41

Know your out-of-pocket cost for care.

All Charges