St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZZ NITINOL BILIARY STENT

Facility

$5,103.00

Service Code	HCPCS C1876
Hospital Charge Code	41569273
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$5,358.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,806.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$3,061.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,551.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,934.22
Rate for Payer: EmblemHealth Commercial	$2,551.50
Rate for Payer: Fidelis Medicare Advantage	$5,358.15
Rate for Payer: Group Health Inc Commercial	$2,551.50
Rate for Payer: Group Health Inc Medicare	$1,786.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,551.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,551.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,316.95

ZZ NM ADENOSINE 30MG

Facility

$551.20

Hospital Charge Code	41568759
Hospital Revenue Code	250
Min. Negotiated Rate	$192.92
Max. Negotiated Rate	$440.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.60
Rate for Payer: Aetna Government	$275.60
Rate for Payer: Brighton Health Commercial	$413.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$440.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$374.82
Rate for Payer: Group Health Inc Commercial	$275.60
Rate for Payer: Group Health Inc Medicare	$192.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.60
Rate for Payer: Hamaspik Choice Inc Medicare	$275.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$358.28

ZZ NM CCK VIAL

Facility

$184.80

Service Code	HCPCS J2805
Hospital Charge Code	41568598
Hospital Revenue Code	636
Min. Negotiated Rate	$64.68
Max. Negotiated Rate	$137.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$101.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$121.08
Rate for Payer: Aetna Government	$121.08
Rate for Payer: Brighton Health Commercial	$110.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$92.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$106.26
Rate for Payer: Group Health Inc Commercial	$92.40
Rate for Payer: Group Health Inc Medicare	$64.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.40
Rate for Payer: Hamaspik Choice Inc Medicare	$92.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$137.53
Rate for Payer: SOMOS Essential	$137.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$120.12

ZZ NM CCK VIAL

Facility

$184.80

Service Code	HCPCS J2805
Hospital Charge Code	41568598
Hospital Revenue Code	636
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$92.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.40
Rate for Payer: Hamaspik Choice Inc Medicare	$92.40

ZZ NM DIPYRIDAMOLE, PER 10MG

Facility

$271.88

Service Code	HCPCS J1245
Hospital Charge Code	41569588
Hospital Revenue Code	636
Min. Negotiated Rate	$135.94
Max. Negotiated Rate	$135.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$135.94
Rate for Payer: Hamaspik Choice Inc Medicare	$135.94

ZZ NM DIPYRIDAMOLE, PER 10MG

Facility

$271.88

Service Code	HCPCS J1245
Hospital Charge Code	41569588
Hospital Revenue Code	636
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$176.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$149.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.65
Rate for Payer: Aetna Government	$3.65
Rate for Payer: Brighton Health Commercial	$163.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$135.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$156.33
Rate for Payer: Group Health Inc Commercial	$135.94
Rate for Payer: Group Health Inc Medicare	$95.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$135.94
Rate for Payer: Hamaspik Choice Inc Medicare	$135.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.96
Rate for Payer: SOMOS Essential	$3.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$176.72

ZZ NM FUROSEMIDE/LASIX

Facility

$0.26

Service Code	HCPCS J1940
Hospital Charge Code	41568605
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.64
Rate for Payer: SOMOS Essential	$0.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

ZZ NM FUROSEMIDE/LASIX

Facility

$0.26

Service Code	HCPCS J1940
Hospital Charge Code	41568605
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13

ZZ NM GA-67, PER MCI

Facility

$25.28

Service Code	HCPCS A9556
Hospital Charge Code	41569585
Hospital Revenue Code	343
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$99.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$99.50
Rate for Payer: Aetna Government	$99.50
Rate for Payer: Brighton Health Commercial	$18.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.19
Rate for Payer: Group Health Inc Commercial	$12.64
Rate for Payer: Group Health Inc Medicare	$8.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.64
Rate for Payer: Hamaspik Choice Inc Medicare	$12.64

ZZ NM I-123 CAPSULE

Facility

$68.48

Service Code	HCPCS A9509
Hospital Charge Code	41568593
Hospital Revenue Code	343
Min. Negotiated Rate	$23.97
Max. Negotiated Rate	$1,497.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,497.44
Rate for Payer: Aetna Government	$1,497.44
Rate for Payer: Brighton Health Commercial	$51.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$54.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.57
Rate for Payer: Group Health Inc Commercial	$34.24
Rate for Payer: Group Health Inc Medicare	$23.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.24
Rate for Payer: Hamaspik Choice Inc Medicare	$34.24

ZZ NM I-131 CAPSULE/1-6MCI

Facility

$241.38

Service Code	HCPCS A9517
Hospital Charge Code	41568594
Hospital Revenue Code	344
Min. Negotiated Rate	$17.07
Max. Negotiated Rate	$193.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.34
Rate for Payer: Aetna Government	$21.34
Rate for Payer: Brighton Health Commercial	$21.34
Rate for Payer: Cash Price	$21.34
Rate for Payer: Cash Price	$21.34
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$193.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$164.14
Rate for Payer: Elderplan Medicare Advantage	$21.34
Rate for Payer: EmblemHealth Commercial	$21.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18.14
Rate for Payer: Fidelis Essential Plan Aliesa	$18.14
Rate for Payer: Fidelis Essential Plan QHP	$18.99
Rate for Payer: Fidelis Medicare Advantage	$21.34
Rate for Payer: Fidelis Qualified Health Plan	$18.99
Rate for Payer: Group Health Inc Commercial	$21.34
Rate for Payer: Group Health Inc Medicare	$21.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.69
Rate for Payer: Hamaspik Choice Inc Medicare	$21.34
Rate for Payer: Healthfirst Medicare Advantage	$18.14
Rate for Payer: Healthfirst QHP	$21.34
Rate for Payer: Senior Whole Health Medicare Advantage	$21.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.07
Rate for Payer: Wellcare Medicare	$20.27

ZZ NM I-131 CAPSULE/1-6MCI

Facility

$241.38

Service Code	HCPCS A9517
Hospital Charge Code	41568594
Hospital Revenue Code	344
Rate for Payer: Cash Price	$21.34

ZZ NM I-131 CAPSULE ADD'L MCI

Facility

$132.00

Service Code	HCPCS A9517
Hospital Charge Code	41568595
Hospital Revenue Code	344
Min. Negotiated Rate	$17.07
Max. Negotiated Rate	$105.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$72.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.34
Rate for Payer: Aetna Government	$21.34
Rate for Payer: Brighton Health Commercial	$21.34
Rate for Payer: Cash Price	$21.34
Rate for Payer: Cash Price	$21.34
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$105.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$89.76
Rate for Payer: Elderplan Medicare Advantage	$21.34
Rate for Payer: EmblemHealth Commercial	$21.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18.14
Rate for Payer: Fidelis Essential Plan Aliesa	$18.14
Rate for Payer: Fidelis Essential Plan QHP	$18.99
Rate for Payer: Fidelis Medicare Advantage	$21.34
Rate for Payer: Fidelis Qualified Health Plan	$18.99
Rate for Payer: Group Health Inc Commercial	$21.34
Rate for Payer: Group Health Inc Medicare	$21.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.00
Rate for Payer: Hamaspik Choice Inc Medicare	$21.34
Rate for Payer: Healthfirst Medicare Advantage	$18.14
Rate for Payer: Healthfirst QHP	$21.34
Rate for Payer: Senior Whole Health Medicare Advantage	$21.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.07
Rate for Payer: Wellcare Medicare	$20.27

ZZ NM I-131 CAPSULE ADD'L MCI

Facility

$132.00

Service Code	HCPCS A9517
Hospital Charge Code	41568595
Hospital Revenue Code	344
Rate for Payer: Cash Price	$21.34

ZZ NM INDIUM IN-111 AUTO WBC

Facility

$1,472.50

Service Code	HCPCS A9570
Hospital Charge Code	41567751
Hospital Revenue Code	343
Min. Negotiated Rate	$515.38
Max. Negotiated Rate	$2,961.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$809.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,961.14
Rate for Payer: Aetna Government	$2,961.14
Rate for Payer: Brighton Health Commercial	$1,104.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,178.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,001.30
Rate for Payer: Group Health Inc Commercial	$736.25
Rate for Payer: Group Health Inc Medicare	$515.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$736.25
Rate for Payer: Hamaspik Choice Inc Medicare	$736.25

ZZ NM INDIUM IN-111 PENTETREOTIDE

Facility

$1,472.50

Service Code	HCPCS A9570
Hospital Charge Code	41567752
Hospital Revenue Code	343
Min. Negotiated Rate	$515.38
Max. Negotiated Rate	$2,961.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$809.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,961.14
Rate for Payer: Aetna Government	$2,961.14
Rate for Payer: Brighton Health Commercial	$1,104.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,178.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,001.30
Rate for Payer: Group Health Inc Commercial	$736.25
Rate for Payer: Group Health Inc Medicare	$515.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$736.25
Rate for Payer: Hamaspik Choice Inc Medicare	$736.25

ZZ NM LEXISCAN (REGADENOSON) INJ

Facility

$534.30

Service Code	HCPCS J2785
Hospital Charge Code	41505953
Hospital Revenue Code	636
Min. Negotiated Rate	$7.47
Max. Negotiated Rate	$347.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$293.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.70
Rate for Payer: Aetna Government	$59.70
Rate for Payer: Brighton Health Commercial	$320.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$267.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$307.22
Rate for Payer: Group Health Inc Commercial	$267.15
Rate for Payer: Group Health Inc Medicare	$187.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$267.15
Rate for Payer: Hamaspik Choice Inc Medicare	$267.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7.47
Rate for Payer: SOMOS Essential	$7.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$347.30

ZZ NM LEXISCAN (REGADENOSON) INJ

Facility

$534.30

Service Code	HCPCS J2785
Hospital Charge Code	41505953
Hospital Revenue Code	636
Min. Negotiated Rate	$267.15
Max. Negotiated Rate	$267.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$267.15
Rate for Payer: Hamaspik Choice Inc Medicare	$267.15

ZZ NM-MDP-TC04

Facility

$31.18

Service Code	HCPCS A9503
Hospital Charge Code	41568582
Hospital Revenue Code	343
Min. Negotiated Rate	$10.76
Max. Negotiated Rate	$24.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.76
Rate for Payer: Aetna Government	$10.76
Rate for Payer: Brighton Health Commercial	$23.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.20
Rate for Payer: Group Health Inc Commercial	$15.59
Rate for Payer: Group Health Inc Medicare	$10.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.59
Rate for Payer: Hamaspik Choice Inc Medicare	$15.59

ZZ NM MEBROFENIN VIAL

Facility

$82.34

Service Code	HCPCS A9537
Hospital Charge Code	41568603
Hospital Revenue Code	343
Min. Negotiated Rate	$28.82
Max. Negotiated Rate	$65.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$45.80
Rate for Payer: Aetna Government	$45.80
Rate for Payer: Brighton Health Commercial	$61.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.99
Rate for Payer: Group Health Inc Commercial	$41.17
Rate for Payer: Group Health Inc Medicare	$28.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.17
Rate for Payer: Hamaspik Choice Inc Medicare	$41.17

ZZ NM PYP

Facility

$55.80

Service Code	HCPCS A9538
Hospital Charge Code	41568599
Hospital Revenue Code	343
Min. Negotiated Rate	$19.53
Max. Negotiated Rate	$44.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.40
Rate for Payer: Aetna Government	$41.40
Rate for Payer: Brighton Health Commercial	$41.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$44.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.94
Rate for Payer: Group Health Inc Commercial	$27.90
Rate for Payer: Group Health Inc Medicare	$19.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.90
Rate for Payer: Hamaspik Choice Inc Medicare	$27.90

ZZ NM-RBC-TC04

Facility

$175.00

Service Code	HCPCS A9560
Hospital Charge Code	41568583
Hospital Revenue Code	343
Min. Negotiated Rate	$61.25
Max. Negotiated Rate	$140.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$96.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$77.34
Rate for Payer: Aetna Government	$77.34
Rate for Payer: Brighton Health Commercial	$131.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$140.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$119.00
Rate for Payer: Group Health Inc Commercial	$87.50
Rate for Payer: Group Health Inc Medicare	$61.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.50
Rate for Payer: Hamaspik Choice Inc Medicare	$87.50

ZZ NM SULFUX COLLOID/FILTERED

Facility

$95.14

Service Code	HCPCS A9541
Hospital Charge Code	41568588
Hospital Revenue Code	343
Min. Negotiated Rate	$33.30
Max. Negotiated Rate	$221.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$221.38
Rate for Payer: Aetna Government	$221.38
Rate for Payer: Brighton Health Commercial	$71.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$76.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$64.70
Rate for Payer: Group Health Inc Commercial	$47.57
Rate for Payer: Group Health Inc Medicare	$33.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.57
Rate for Payer: Hamaspik Choice Inc Medicare	$47.57

ZZ NM SULFUX COLLOID/NON-FILTERED

Facility

$31.16

Service Code	HCPCS A9541
Hospital Charge Code	41568589
Hospital Revenue Code	343
Min. Negotiated Rate	$10.91
Max. Negotiated Rate	$221.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$221.38
Rate for Payer: Aetna Government	$221.38
Rate for Payer: Brighton Health Commercial	$23.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.19
Rate for Payer: Group Health Inc Commercial	$15.58
Rate for Payer: Group Health Inc Medicare	$10.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.58
Rate for Payer: Hamaspik Choice Inc Medicare	$15.58

ZZ NM TC-04(TC-99N)

Facility

$175.00

Service Code	HCPCS A9560
Hospital Charge Code	41568608
Hospital Revenue Code	343
Min. Negotiated Rate	$61.25
Max. Negotiated Rate	$140.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$96.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$77.34
Rate for Payer: Aetna Government	$77.34
Rate for Payer: Brighton Health Commercial	$131.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$140.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$119.00
Rate for Payer: Group Health Inc Commercial	$87.50
Rate for Payer: Group Health Inc Medicare	$61.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.50
Rate for Payer: Hamaspik Choice Inc Medicare	$87.50

Know your out-of-pocket cost for care.

All Charges