St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZZ EMBOLIZA COIL 52 15 15

Facility

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567343
Hospital Revenue Code	278
Min. Negotiated Rate	$23.44
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$36.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$40.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$38.51
Rate for Payer: EmblemHealth Commercial	$33.49
Rate for Payer: Fidelis Medicare Advantage	$70.33
Rate for Payer: Group Health Inc Commercial	$33.49
Rate for Payer: Group Health Inc Medicare	$23.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.49
Rate for Payer: Hamaspik Choice Inc Medicare	$33.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$43.54

ZZ EMBOLIZA COIL 52 15 15

Facility

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567343
Hospital Revenue Code	278
Min. Negotiated Rate	$33.49
Max. Negotiated Rate	$33.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.49
Rate for Payer: Hamaspik Choice Inc Medicare	$33.49

ZZ EMBOLIZATION PORT/100-200

Facility

$180.88

Service Code	HCPCS C1884
Hospital Charge Code	41569496
Hospital Revenue Code	278
Min. Negotiated Rate	$63.31
Max. Negotiated Rate	$189.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$99.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$108.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$104.01
Rate for Payer: EmblemHealth Commercial	$90.44
Rate for Payer: Fidelis Medicare Advantage	$189.92
Rate for Payer: Group Health Inc Commercial	$90.44
Rate for Payer: Group Health Inc Medicare	$63.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.44
Rate for Payer: Hamaspik Choice Inc Medicare	$90.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$117.57

ZZ EMBOLIZATION PORT/100-200

Facility

$180.88

Service Code	HCPCS C1884
Hospital Charge Code	41569496
Hospital Revenue Code	278
Min. Negotiated Rate	$90.44
Max. Negotiated Rate	$90.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.44
Rate for Payer: Hamaspik Choice Inc Medicare	$90.44

ZZ EMBOLIZATION PORT/200-300

Facility

$180.88

Service Code	HCPCS C1884
Hospital Charge Code	41569494
Hospital Revenue Code	278
Min. Negotiated Rate	$63.31
Max. Negotiated Rate	$189.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$99.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$108.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$104.01
Rate for Payer: EmblemHealth Commercial	$90.44
Rate for Payer: Fidelis Medicare Advantage	$189.92
Rate for Payer: Group Health Inc Commercial	$90.44
Rate for Payer: Group Health Inc Medicare	$63.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.44
Rate for Payer: Hamaspik Choice Inc Medicare	$90.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$117.57

ZZ EMBOLIZATION PORT/200-300

Facility

$180.88

Service Code	HCPCS C1884
Hospital Charge Code	41569494
Hospital Revenue Code	278
Min. Negotiated Rate	$90.44
Max. Negotiated Rate	$90.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.44
Rate for Payer: Hamaspik Choice Inc Medicare	$90.44

ZZ EMBOLIZATION PORT/300-500

Facility

$180.88

Service Code	HCPCS C1884
Hospital Charge Code	41569495
Hospital Revenue Code	278
Min. Negotiated Rate	$90.44
Max. Negotiated Rate	$90.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.44
Rate for Payer: Hamaspik Choice Inc Medicare	$90.44

ZZ EMBOLIZATION PORT/300-500

Facility

$180.88

Service Code	HCPCS C1884
Hospital Charge Code	41569495
Hospital Revenue Code	278
Min. Negotiated Rate	$63.31
Max. Negotiated Rate	$189.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$99.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$108.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$104.01
Rate for Payer: EmblemHealth Commercial	$90.44
Rate for Payer: Fidelis Medicare Advantage	$189.92
Rate for Payer: Group Health Inc Commercial	$90.44
Rate for Payer: Group Health Inc Medicare	$63.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.44
Rate for Payer: Hamaspik Choice Inc Medicare	$90.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$117.57

ZZ EMBOLIZATION PORT/500-700

Facility

$180.88

Service Code	HCPCS C1884
Hospital Charge Code	41569492
Hospital Revenue Code	278
Min. Negotiated Rate	$90.44
Max. Negotiated Rate	$90.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.44
Rate for Payer: Hamaspik Choice Inc Medicare	$90.44

ZZ EMBOLIZATION PORT/500-700

Facility

$180.88

Service Code	HCPCS C1884
Hospital Charge Code	41569492
Hospital Revenue Code	278
Min. Negotiated Rate	$63.31
Max. Negotiated Rate	$189.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$99.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$108.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$104.01
Rate for Payer: EmblemHealth Commercial	$90.44
Rate for Payer: Fidelis Medicare Advantage	$189.92
Rate for Payer: Group Health Inc Commercial	$90.44
Rate for Payer: Group Health Inc Medicare	$63.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.44
Rate for Payer: Hamaspik Choice Inc Medicare	$90.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$117.57

ZZ EMBOLIZATION PORT/700-1000

Facility

$180.88

Service Code	HCPCS C1884
Hospital Charge Code	41569493
Hospital Revenue Code	278
Min. Negotiated Rate	$90.44
Max. Negotiated Rate	$90.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.44
Rate for Payer: Hamaspik Choice Inc Medicare	$90.44

ZZ EMBOLIZATION PORT/700-1000

Facility

$180.88

Service Code	HCPCS C1884
Hospital Charge Code	41569493
Hospital Revenue Code	278
Min. Negotiated Rate	$63.31
Max. Negotiated Rate	$189.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$99.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$108.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$104.01
Rate for Payer: EmblemHealth Commercial	$90.44
Rate for Payer: Fidelis Medicare Advantage	$189.92
Rate for Payer: Group Health Inc Commercial	$90.44
Rate for Payer: Group Health Inc Medicare	$63.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.44
Rate for Payer: Hamaspik Choice Inc Medicare	$90.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$117.57

ZZ EMBOLIZ COIL 52 10 15

Facility

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567143
Hospital Revenue Code	278
Min. Negotiated Rate	$23.44
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$36.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$40.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$38.51
Rate for Payer: EmblemHealth Commercial	$33.49
Rate for Payer: Fidelis Medicare Advantage	$70.33
Rate for Payer: Group Health Inc Commercial	$33.49
Rate for Payer: Group Health Inc Medicare	$23.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.49
Rate for Payer: Hamaspik Choice Inc Medicare	$33.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$43.54

ZZ EMBOLIZ COIL 52 10 15

Facility

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567143
Hospital Revenue Code	278
Min. Negotiated Rate	$33.49
Max. Negotiated Rate	$33.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.49
Rate for Payer: Hamaspik Choice Inc Medicare	$33.49

ZZ EMBOSPHERE 300-500

Facility

$2,500.00

Service Code	HCPCS C1884
Hospital Charge Code	41563139
Hospital Revenue Code	278
Min. Negotiated Rate	$180.07
Max. Negotiated Rate	$2,625.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,375.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$1,500.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,437.50
Rate for Payer: EmblemHealth Commercial	$1,250.00
Rate for Payer: Fidelis Medicare Advantage	$2,625.00
Rate for Payer: Group Health Inc Commercial	$1,250.00
Rate for Payer: Group Health Inc Medicare	$875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,625.00

ZZ EMBOSPHERE 300-500

Facility

$2,500.00

Service Code	HCPCS C1884
Hospital Charge Code	41563139
Hospital Revenue Code	278
Min. Negotiated Rate	$1,250.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,250.00

ZZ EMBOSPHERE 500-700

Facility

$2,905.88

Service Code	HCPCS C1884
Hospital Charge Code	41569765
Hospital Revenue Code	278
Min. Negotiated Rate	$180.07
Max. Negotiated Rate	$3,051.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,598.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$1,743.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,452.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,670.88
Rate for Payer: EmblemHealth Commercial	$1,452.94
Rate for Payer: Fidelis Medicare Advantage	$3,051.17
Rate for Payer: Group Health Inc Commercial	$1,452.94
Rate for Payer: Group Health Inc Medicare	$1,017.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,452.94
Rate for Payer: Hamaspik Choice Inc Medicare	$1,452.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,888.82

ZZ EMBOSPHERE 500-700

Facility

$2,905.88

Service Code	HCPCS C1884
Hospital Charge Code	41569765
Hospital Revenue Code	278
Min. Negotiated Rate	$1,452.94
Max. Negotiated Rate	$1,452.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,452.94
Rate for Payer: Hamaspik Choice Inc Medicare	$1,452.94

ZZ EMBOSPHERE 700-900

Facility

$1,488.38

Service Code	HCPCS C1884
Hospital Charge Code	41569766
Hospital Revenue Code	278
Min. Negotiated Rate	$180.07
Max. Negotiated Rate	$1,562.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$818.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$893.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$744.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$855.82
Rate for Payer: EmblemHealth Commercial	$744.19
Rate for Payer: Fidelis Medicare Advantage	$1,562.80
Rate for Payer: Group Health Inc Commercial	$744.19
Rate for Payer: Group Health Inc Medicare	$520.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$744.19
Rate for Payer: Hamaspik Choice Inc Medicare	$744.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$967.45

ZZ EMBOSPHERE 700-900

Facility

$1,488.38

Service Code	HCPCS C1884
Hospital Charge Code	41569766
Hospital Revenue Code	278
Min. Negotiated Rate	$744.19
Max. Negotiated Rate	$744.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$744.19
Rate for Payer: Hamaspik Choice Inc Medicare	$744.19

ZZ EMBOSPHERE 900-1200

Facility

$106.00

Service Code	HCPCS C1884
Hospital Charge Code	41561915
Hospital Revenue Code	278
Min. Negotiated Rate	$53.00
Max. Negotiated Rate	$53.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.00
Rate for Payer: Hamaspik Choice Inc Medicare	$53.00

ZZ EMBOSPHERE 900-1200

Facility

$106.00

Service Code	HCPCS C1884
Hospital Charge Code	41561915
Hospital Revenue Code	278
Min. Negotiated Rate	$37.10
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$63.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$53.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$60.95
Rate for Payer: EmblemHealth Commercial	$53.00
Rate for Payer: Fidelis Medicare Advantage	$111.30
Rate for Payer: Group Health Inc Commercial	$53.00
Rate for Payer: Group Health Inc Medicare	$37.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.00
Rate for Payer: Hamaspik Choice Inc Medicare	$53.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$68.90

ZZ EMBOZENE 2ML 500UM

Facility

$350.00

Hospital Charge Code	41561351
Hospital Revenue Code	272
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$280.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.00
Rate for Payer: Aetna Government	$175.00
Rate for Payer: Brighton Health Commercial	$262.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$280.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$238.00
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

ZZ EMBOZENE 2ML 700UM

Facility

$350.00

Hospital Charge Code	41561352
Hospital Revenue Code	272
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$280.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.00
Rate for Payer: Aetna Government	$175.00
Rate for Payer: Brighton Health Commercial	$262.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$280.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$238.00
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

ZZ EMBOZENE 2ML 900UM

Facility

$350.00

Hospital Charge Code	41561353
Hospital Revenue Code	272
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$280.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.00
Rate for Payer: Aetna Government	$175.00
Rate for Payer: Brighton Health Commercial	$262.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$280.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$238.00
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

Know your out-of-pocket cost for care.

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