St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZZ INTRO SET 10.0/30CM G08686

Facility

$136.62

Service Code	HCPCS C1894
Hospital Charge Code	41569944
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$143.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$75.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Brighton Health Commercial	$81.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$68.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$78.56
Rate for Payer: EmblemHealth Commercial	$68.31
Rate for Payer: Fidelis Medicare Advantage	$143.45
Rate for Payer: Group Health Inc Commercial	$68.31
Rate for Payer: Group Health Inc Medicare	$47.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.31
Rate for Payer: Hamaspik Choice Inc Medicare	$68.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$88.80

ZZ INTRO SET 10.0/40CM G32233

Facility

$156.28

Service Code	HCPCS C1894
Hospital Charge Code	41569940
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$164.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Brighton Health Commercial	$93.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$89.86
Rate for Payer: EmblemHealth Commercial	$78.14
Rate for Payer: Fidelis Medicare Advantage	$164.09
Rate for Payer: Group Health Inc Commercial	$78.14
Rate for Payer: Group Health Inc Medicare	$54.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.14
Rate for Payer: Hamaspik Choice Inc Medicare	$78.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$101.58

ZZ INTRO SET 10.0/40CM G32233

Facility

$156.28

Service Code	HCPCS C1894
Hospital Charge Code	41569940
Hospital Revenue Code	278
Min. Negotiated Rate	$78.14
Max. Negotiated Rate	$78.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.14
Rate for Payer: Hamaspik Choice Inc Medicare	$78.14

ZZ INTRO SET 10.0/60CM G10836

Facility

$157.80

Service Code	HCPCS C1894
Hospital Charge Code	41569945
Hospital Revenue Code	278
Min. Negotiated Rate	$78.90
Max. Negotiated Rate	$78.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.90
Rate for Payer: Hamaspik Choice Inc Medicare	$78.90

ZZ INTRO SET 10.0/60CM G10836

Facility

$157.80

Service Code	HCPCS C1894
Hospital Charge Code	41569945
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$165.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Brighton Health Commercial	$94.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$90.74
Rate for Payer: EmblemHealth Commercial	$78.90
Rate for Payer: Fidelis Medicare Advantage	$165.69
Rate for Payer: Group Health Inc Commercial	$78.90
Rate for Payer: Group Health Inc Medicare	$55.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.90
Rate for Payer: Hamaspik Choice Inc Medicare	$78.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$102.57

ZZ INTRO SET 11.0/70CM G11240

Facility

$140.30

Hospital Charge Code	41569946
Hospital Revenue Code	279
Min. Negotiated Rate	$49.10
Max. Negotiated Rate	$112.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$77.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.15
Rate for Payer: Aetna Government	$70.15
Rate for Payer: Brighton Health Commercial	$105.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$112.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.40
Rate for Payer: Group Health Inc Commercial	$70.15
Rate for Payer: Group Health Inc Medicare	$49.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.15
Rate for Payer: Hamaspik Choice Inc Medicare	$70.15

ZZ INTRO SET 12.0/30CM G08956

Facility

$140.30

Hospital Charge Code	41569947
Hospital Revenue Code	279
Min. Negotiated Rate	$49.10
Max. Negotiated Rate	$112.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$77.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.15
Rate for Payer: Aetna Government	$70.15
Rate for Payer: Brighton Health Commercial	$105.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$112.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.40
Rate for Payer: Group Health Inc Commercial	$70.15
Rate for Payer: Group Health Inc Medicare	$49.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.15
Rate for Payer: Hamaspik Choice Inc Medicare	$70.15

ZZ INTRO SET 14.0/30CM G08957

Facility

$140.30

Hospital Charge Code	41569948
Hospital Revenue Code	279
Min. Negotiated Rate	$49.10
Max. Negotiated Rate	$112.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$77.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.15
Rate for Payer: Aetna Government	$70.15
Rate for Payer: Brighton Health Commercial	$105.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$112.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.40
Rate for Payer: Group Health Inc Commercial	$70.15
Rate for Payer: Group Health Inc Medicare	$49.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.15
Rate for Payer: Hamaspik Choice Inc Medicare	$70.15

ZZ INTRO SET 6.0/48CM G10346

Facility

$111.78

Hospital Charge Code	41569941
Hospital Revenue Code	279
Min. Negotiated Rate	$39.12
Max. Negotiated Rate	$89.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$55.89
Rate for Payer: Aetna Government	$55.89
Rate for Payer: Brighton Health Commercial	$83.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$89.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.01
Rate for Payer: Group Health Inc Commercial	$55.89
Rate for Payer: Group Health Inc Medicare	$39.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.89
Rate for Payer: Hamaspik Choice Inc Medicare	$55.89

ZZ INTRO SET 8.0/63CM G08133

Facility

$111.78

Hospital Charge Code	41569942
Hospital Revenue Code	279
Min. Negotiated Rate	$39.12
Max. Negotiated Rate	$89.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$55.89
Rate for Payer: Aetna Government	$55.89
Rate for Payer: Brighton Health Commercial	$83.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$89.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.01
Rate for Payer: Group Health Inc Commercial	$55.89
Rate for Payer: Group Health Inc Medicare	$39.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.89
Rate for Payer: Hamaspik Choice Inc Medicare	$55.89

ZZ INTRO SET 9.0/75CM G09190

Facility

$111.78

Hospital Charge Code	41569943
Hospital Revenue Code	279
Min. Negotiated Rate	$39.12
Max. Negotiated Rate	$89.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$55.89
Rate for Payer: Aetna Government	$55.89
Rate for Payer: Brighton Health Commercial	$83.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$89.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.01
Rate for Payer: Group Health Inc Commercial	$55.89
Rate for Payer: Group Health Inc Medicare	$39.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.89
Rate for Payer: Hamaspik Choice Inc Medicare	$55.89

ZZ INTRO SET RAABE 8.0/55CM

Facility

$119.60

Hospital Charge Code	41569937
Hospital Revenue Code	279
Min. Negotiated Rate	$41.86
Max. Negotiated Rate	$95.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$65.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.80
Rate for Payer: Aetna Government	$59.80
Rate for Payer: Brighton Health Commercial	$89.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$95.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.33
Rate for Payer: Group Health Inc Commercial	$59.80
Rate for Payer: Group Health Inc Medicare	$41.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.80
Rate for Payer: Hamaspik Choice Inc Medicare	$59.80

ZZ INTRO SET RAABE 8.0/70CM

Facility

$119.60

Hospital Charge Code	41569938
Hospital Revenue Code	279
Min. Negotiated Rate	$41.86
Max. Negotiated Rate	$95.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$65.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.80
Rate for Payer: Aetna Government	$59.80
Rate for Payer: Brighton Health Commercial	$89.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$95.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.33
Rate for Payer: Group Health Inc Commercial	$59.80
Rate for Payer: Group Health Inc Medicare	$41.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.80
Rate for Payer: Hamaspik Choice Inc Medicare	$59.80

ZZ INTRO SET SHUTTLE 6.5/125CM

Facility

$165.60

Hospital Charge Code	41569939
Hospital Revenue Code	279
Min. Negotiated Rate	$57.96
Max. Negotiated Rate	$132.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$82.80
Rate for Payer: Aetna Government	$82.80
Rate for Payer: Brighton Health Commercial	$124.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$132.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$112.61
Rate for Payer: Group Health Inc Commercial	$82.80
Rate for Payer: Group Health Inc Medicare	$57.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.80
Rate for Payer: Hamaspik Choice Inc Medicare	$82.80

ZZ INTRO SHEATH 8 10 38

Facility

$107.37

Hospital Charge Code	41567056
Hospital Revenue Code	270
Min. Negotiated Rate	$37.58
Max. Negotiated Rate	$85.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$53.68
Rate for Payer: Aetna Government	$53.68
Rate for Payer: Brighton Health Commercial	$80.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$85.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$73.01
Rate for Payer: Group Health Inc Commercial	$53.68
Rate for Payer: Group Health Inc Medicare	$37.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.68
Rate for Payer: Hamaspik Choice Inc Medicare	$53.68

ZZ INTRO SHEATH 9 10 38

Facility

$107.37

Hospital Charge Code	41567057
Hospital Revenue Code	270
Min. Negotiated Rate	$37.58
Max. Negotiated Rate	$85.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$53.68
Rate for Payer: Aetna Government	$53.68
Rate for Payer: Brighton Health Commercial	$80.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$85.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$73.01
Rate for Payer: Group Health Inc Commercial	$53.68
Rate for Payer: Group Health Inc Medicare	$37.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.68
Rate for Payer: Hamaspik Choice Inc Medicare	$53.68

ZZ INTRSHT RENAL MP6FO38/45

Facility

$354.38

Hospital Charge Code	41569782
Hospital Revenue Code	270
Min. Negotiated Rate	$124.03
Max. Negotiated Rate	$283.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$194.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$177.19
Rate for Payer: Aetna Government	$177.19
Rate for Payer: Brighton Health Commercial	$265.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$283.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$240.98
Rate for Payer: Group Health Inc Commercial	$177.19
Rate for Payer: Group Health Inc Medicare	$124.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.19
Rate for Payer: Hamaspik Choice Inc Medicare	$177.19

ZZ INTRSHT RENAL MP7FO38/45

Facility

$354.38

Hospital Charge Code	41569784
Hospital Revenue Code	270
Min. Negotiated Rate	$124.03
Max. Negotiated Rate	$283.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$194.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$177.19
Rate for Payer: Aetna Government	$177.19
Rate for Payer: Brighton Health Commercial	$265.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$283.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$240.98
Rate for Payer: Group Health Inc Commercial	$177.19
Rate for Payer: Group Health Inc Medicare	$124.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.19
Rate for Payer: Hamaspik Choice Inc Medicare	$177.19

ZZ INTRSHT RENAL ST6FO38/45

Facility

$354.38

Hospital Charge Code	41569781
Hospital Revenue Code	270
Min. Negotiated Rate	$124.03
Max. Negotiated Rate	$283.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$194.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$177.19
Rate for Payer: Aetna Government	$177.19
Rate for Payer: Brighton Health Commercial	$265.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$283.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$240.98
Rate for Payer: Group Health Inc Commercial	$177.19
Rate for Payer: Group Health Inc Medicare	$124.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.19
Rate for Payer: Hamaspik Choice Inc Medicare	$177.19

ZZ INTRSHT RENAL ST7FO38/45

Facility

$354.38

Hospital Charge Code	41569783
Hospital Revenue Code	270
Min. Negotiated Rate	$124.03
Max. Negotiated Rate	$283.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$194.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$177.19
Rate for Payer: Aetna Government	$177.19
Rate for Payer: Brighton Health Commercial	$265.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$283.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$240.98
Rate for Payer: Group Health Inc Commercial	$177.19
Rate for Payer: Group Health Inc Medicare	$124.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.19
Rate for Payer: Hamaspik Choice Inc Medicare	$177.19

ZZ INTR TTUBE PALMAZ STENT

Facility

$65.21

Service Code	HCPCS C1876
Hospital Charge Code	41567195
Hospital Revenue Code	278
Min. Negotiated Rate	$22.82
Max. Negotiated Rate	$398.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$39.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.50
Rate for Payer: EmblemHealth Commercial	$32.60
Rate for Payer: Fidelis Medicare Advantage	$68.47
Rate for Payer: Group Health Inc Commercial	$32.60
Rate for Payer: Group Health Inc Medicare	$22.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.60
Rate for Payer: Hamaspik Choice Inc Medicare	$32.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.39

ZZ INTR TTUBE PALMAZ STENT

Facility

$65.21

Service Code	HCPCS C1876
Hospital Charge Code	41567195
Hospital Revenue Code	278
Min. Negotiated Rate	$32.60
Max. Negotiated Rate	$32.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.60
Rate for Payer: Hamaspik Choice Inc Medicare	$32.60

ZZ INT SH W/O NDL 5.5 38

Facility

$51.39

Hospital Charge Code	41567033
Hospital Revenue Code	270
Min. Negotiated Rate	$17.99
Max. Negotiated Rate	$41.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.70
Rate for Payer: Aetna Government	$25.70
Rate for Payer: Brighton Health Commercial	$38.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.95
Rate for Payer: Group Health Inc Commercial	$25.70
Rate for Payer: Group Health Inc Medicare	$17.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.70
Rate for Payer: Hamaspik Choice Inc Medicare	$25.70

ZZ INT SH W/O NDL 6.5 38

Facility

$51.39

Hospital Charge Code	41567034
Hospital Revenue Code	270
Min. Negotiated Rate	$17.99
Max. Negotiated Rate	$41.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.70
Rate for Payer: Aetna Government	$25.70
Rate for Payer: Brighton Health Commercial	$38.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.95
Rate for Payer: Group Health Inc Commercial	$25.70
Rate for Payer: Group Health Inc Medicare	$17.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.70
Rate for Payer: Hamaspik Choice Inc Medicare	$25.70

ZZ INT SH W/O NDL 6.5 38

Facility

$51.39

Hospital Charge Code	41567035
Hospital Revenue Code	270
Min. Negotiated Rate	$17.99
Max. Negotiated Rate	$41.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.70
Rate for Payer: Aetna Government	$25.70
Rate for Payer: Brighton Health Commercial	$38.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.95
Rate for Payer: Group Health Inc Commercial	$25.70
Rate for Payer: Group Health Inc Medicare	$17.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.70
Rate for Payer: Hamaspik Choice Inc Medicare	$25.70

Know your out-of-pocket cost for care.

All Charges