St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZZ COIL/.035 STANDARD/5-3

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569075
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/.035 STANDARD/5-5

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569076
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/.035 STANDARD/5-5

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569076
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/.035 STANDARD/5-8

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569077
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/.035 STANDARD/5-8

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569077
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/.038 STANDARD/15-15

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569078
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/.038 STANDARD/15-15

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569078
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/.038 STANDARD/2-3

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569079
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/.038 STANDARD/2-3

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569079
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/.038 STANDARD/4-3

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569080
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/.038 STANDARD/4-3

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569080
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/.038 STANDARD/5-5

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569081
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/.038 STANDARD/5-5

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569081
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/.038 STANDARD/5-8

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569082
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/.038 STANDARD/5-8

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569082
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/.038 STANDARD/8-10

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569083
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/.038 STANDARD/8-10

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569083
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/.038 STANDARD/8-12

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569084
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/.038 STANDARD/8-12

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569084
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/.038 STANDARD/8-15

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569085
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/.038 STANDARD/8-15

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569085
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/.052 STANDARD/10-15

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569101
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/.052 STANDARD/10-15

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569101
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/.052 STANDARD/15-15

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569284
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/.052 STANDARD/15-15

Facility

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569284
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.

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