St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZZ NM TC-99M BICISATE, A DOSE

Facility

$867.74

Service Code	HCPCS A9557
Hospital Charge Code	41569586
Hospital Revenue Code	343
Min. Negotiated Rate	$303.71
Max. Negotiated Rate	$694.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$477.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$308.09
Rate for Payer: Aetna Government	$308.09
Rate for Payer: Brighton Health Commercial	$650.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$694.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$590.06
Rate for Payer: Group Health Inc Commercial	$433.87
Rate for Payer: Group Health Inc Medicare	$303.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$433.87
Rate for Payer: Hamaspik Choice Inc Medicare	$433.87

ZZ NM TC-99M CHOLETEC

Facility

$54.76

Service Code	HCPCS A9510
Hospital Charge Code	41568592
Hospital Revenue Code	343
Min. Negotiated Rate	$19.17
Max. Negotiated Rate	$57.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$57.96
Rate for Payer: Aetna Government	$57.96
Rate for Payer: Brighton Health Commercial	$41.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$43.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.24
Rate for Payer: Group Health Inc Commercial	$27.38
Rate for Payer: Group Health Inc Medicare	$19.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.38
Rate for Payer: Hamaspik Choice Inc Medicare	$27.38

ZZ NM TC-99M DTPA

Facility

$52.16

Service Code	HCPCS A9540
Hospital Charge Code	41568591
Hospital Revenue Code	343
Min. Negotiated Rate	$18.26
Max. Negotiated Rate	$41.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.84
Rate for Payer: Aetna Government	$24.84
Rate for Payer: Brighton Health Commercial	$39.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.47
Rate for Payer: Group Health Inc Commercial	$26.08
Rate for Payer: Group Health Inc Medicare	$18.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.08
Rate for Payer: Hamaspik Choice Inc Medicare	$26.08

ZZ NM TC-99M MAA

Facility

$24.94

Service Code	HCPCS A9540
Hospital Charge Code	41568590
Hospital Revenue Code	343
Min. Negotiated Rate	$8.73
Max. Negotiated Rate	$24.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.84
Rate for Payer: Aetna Government	$24.84
Rate for Payer: Brighton Health Commercial	$18.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.96
Rate for Payer: Group Health Inc Commercial	$12.47
Rate for Payer: Group Health Inc Medicare	$8.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.47
Rate for Payer: Hamaspik Choice Inc Medicare	$12.47

ZZ NM TC -99M MAG3

Facility

$324.00

Service Code	HCPCS A9562
Hospital Charge Code	41568606
Hospital Revenue Code	343
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$641.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$178.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$641.51
Rate for Payer: Aetna Government	$641.51
Rate for Payer: Brighton Health Commercial	$243.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$259.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$220.32
Rate for Payer: Group Health Inc Commercial	$162.00
Rate for Payer: Group Health Inc Medicare	$113.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.00
Rate for Payer: Hamaspik Choice Inc Medicare	$162.00

ZZ NM TC-99M SESTAMIBI, A DOSE

Facility

$250.76

Service Code	HCPCS A9500
Hospital Charge Code	41569583
Hospital Revenue Code	343
Min. Negotiated Rate	$87.77
Max. Negotiated Rate	$200.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$88.39
Rate for Payer: Aetna Government	$88.39
Rate for Payer: Brighton Health Commercial	$188.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.52
Rate for Payer: Group Health Inc Commercial	$125.38
Rate for Payer: Group Health Inc Medicare	$87.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.38
Rate for Payer: Hamaspik Choice Inc Medicare	$125.38

ZZ NM TL-201, PER MCI

Facility

$54.72

Service Code	HCPCS A9505
Hospital Charge Code	41569584
Hospital Revenue Code	343
Min. Negotiated Rate	$19.15
Max. Negotiated Rate	$126.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$126.19
Rate for Payer: Aetna Government	$126.19
Rate for Payer: Brighton Health Commercial	$41.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$43.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.21
Rate for Payer: Group Health Inc Commercial	$27.36
Rate for Payer: Group Health Inc Medicare	$19.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.36
Rate for Payer: Hamaspik Choice Inc Medicare	$27.36

ZZ NM ULTRA TAG KIT

Facility

$144.00

Service Code	HCPCS A9512
Hospital Charge Code	41568597
Hospital Revenue Code	343
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$115.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$79.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.32
Rate for Payer: Aetna Government	$1.32
Rate for Payer: Brighton Health Commercial	$108.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$115.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$97.92
Rate for Payer: Group Health Inc Commercial	$72.00
Rate for Payer: Group Health Inc Medicare	$50.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.00
Rate for Payer: Hamaspik Choice Inc Medicare	$72.00

ZZ NOTCH BIOP NDL 20 3.5

Facility

$15.59

Hospital Charge Code	41567089
Hospital Revenue Code	270
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$12.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.80
Rate for Payer: Aetna Government	$7.80
Rate for Payer: Brighton Health Commercial	$11.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.60
Rate for Payer: Group Health Inc Commercial	$7.80
Rate for Payer: Group Health Inc Medicare	$5.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.80
Rate for Payer: Hamaspik Choice Inc Medicare	$7.80

ZZ NOTCH BIOP NDL 22 3.5

Facility

$15.59

Hospital Charge Code	41567090
Hospital Revenue Code	270
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$12.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.80
Rate for Payer: Aetna Government	$7.80
Rate for Payer: Brighton Health Commercial	$11.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.60
Rate for Payer: Group Health Inc Commercial	$7.80
Rate for Payer: Group Health Inc Medicare	$5.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.80
Rate for Payer: Hamaspik Choice Inc Medicare	$7.80

ZZ NOTCH BIOP NDL 22 5.5

Facility

$30.83

Hospital Charge Code	41567091
Hospital Revenue Code	270
Min. Negotiated Rate	$10.79
Max. Negotiated Rate	$24.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.42
Rate for Payer: Aetna Government	$15.42
Rate for Payer: Brighton Health Commercial	$23.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.96
Rate for Payer: Group Health Inc Commercial	$15.42
Rate for Payer: Group Health Inc Medicare	$10.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.42
Rate for Payer: Hamaspik Choice Inc Medicare	$15.42

ZZ OCCLU BAL CTH 5/2/100

Facility

$440.14

Hospital Charge Code	41567217
Hospital Revenue Code	270
Min. Negotiated Rate	$154.05
Max. Negotiated Rate	$352.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$242.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$220.07
Rate for Payer: Aetna Government	$220.07
Rate for Payer: Brighton Health Commercial	$330.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$352.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$299.30
Rate for Payer: Group Health Inc Commercial	$220.07
Rate for Payer: Group Health Inc Medicare	$154.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.07
Rate for Payer: Hamaspik Choice Inc Medicare	$220.07

ZZ OCCLU BAL CTH 7/2/100

Facility

$440.14

Hospital Charge Code	41567218
Hospital Revenue Code	270
Min. Negotiated Rate	$154.05
Max. Negotiated Rate	$352.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$242.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$220.07
Rate for Payer: Aetna Government	$220.07
Rate for Payer: Brighton Health Commercial	$330.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$352.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$299.30
Rate for Payer: Group Health Inc Commercial	$220.07
Rate for Payer: Group Health Inc Medicare	$154.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.07
Rate for Payer: Hamaspik Choice Inc Medicare	$220.07

ZZ OCCLU BALL CTH 8/2/100

Facility

$472.74

Hospital Charge Code	41567219
Hospital Revenue Code	270
Min. Negotiated Rate	$165.46
Max. Negotiated Rate	$378.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$260.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$236.37
Rate for Payer: Aetna Government	$236.37
Rate for Payer: Brighton Health Commercial	$354.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$378.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$321.46
Rate for Payer: Group Health Inc Commercial	$236.37
Rate for Payer: Group Health Inc Medicare	$165.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$236.37
Rate for Payer: Hamaspik Choice Inc Medicare	$236.37

ZZ OLBERT BAL 7-4/5.8/90

Facility

$635.75

Hospital Charge Code	41567273
Hospital Revenue Code	270
Min. Negotiated Rate	$222.51
Max. Negotiated Rate	$508.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$349.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$317.88
Rate for Payer: Aetna Government	$317.88
Rate for Payer: Brighton Health Commercial	$476.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$508.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$432.31
Rate for Payer: Group Health Inc Commercial	$317.88
Rate for Payer: Group Health Inc Medicare	$222.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$317.88
Rate for Payer: Hamaspik Choice Inc Medicare	$317.88

ZZ OLBERT BAL 7-4/6/90

Facility

$586.85

Hospital Charge Code	41567274
Hospital Revenue Code	270
Min. Negotiated Rate	$205.40
Max. Negotiated Rate	$469.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$322.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$293.42
Rate for Payer: Aetna Government	$293.42
Rate for Payer: Brighton Health Commercial	$440.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$469.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$399.06
Rate for Payer: Group Health Inc Commercial	$293.42
Rate for Payer: Group Health Inc Medicare	$205.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$293.42
Rate for Payer: Hamaspik Choice Inc Medicare	$293.42

ZZ OLBERT BAL 8-4/5.8/90

Facility

$635.75

Hospital Charge Code	41567271
Hospital Revenue Code	270
Min. Negotiated Rate	$222.51
Max. Negotiated Rate	$508.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$349.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$317.88
Rate for Payer: Aetna Government	$317.88
Rate for Payer: Brighton Health Commercial	$476.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$508.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$432.31
Rate for Payer: Group Health Inc Commercial	$317.88
Rate for Payer: Group Health Inc Medicare	$222.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$317.88
Rate for Payer: Hamaspik Choice Inc Medicare	$317.88

ZZ OLBERT BAL 9-4/7/90

Facility

$635.75

Hospital Charge Code	41567270
Hospital Revenue Code	270
Min. Negotiated Rate	$222.51
Max. Negotiated Rate	$508.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$349.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$317.88
Rate for Payer: Aetna Government	$317.88
Rate for Payer: Brighton Health Commercial	$476.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$508.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$432.31
Rate for Payer: Group Health Inc Commercial	$317.88
Rate for Payer: Group Health Inc Medicare	$222.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$317.88
Rate for Payer: Hamaspik Choice Inc Medicare	$317.88

ZZ OLBERT BALL 10-4/7.8/90

Facility

$635.75

Hospital Charge Code	41567269
Hospital Revenue Code	270
Min. Negotiated Rate	$222.51
Max. Negotiated Rate	$508.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$349.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$317.88
Rate for Payer: Aetna Government	$317.88
Rate for Payer: Brighton Health Commercial	$476.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$508.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$432.31
Rate for Payer: Group Health Inc Commercial	$317.88
Rate for Payer: Group Health Inc Medicare	$222.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$317.88
Rate for Payer: Hamaspik Choice Inc Medicare	$317.88

ZZ OLBERT BALL 12-4/7.5/90

Facility

$652.05

Hospital Charge Code	41567268
Hospital Revenue Code	270
Min. Negotiated Rate	$228.22
Max. Negotiated Rate	$521.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$358.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$326.02
Rate for Payer: Aetna Government	$326.02
Rate for Payer: Brighton Health Commercial	$489.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$521.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$443.39
Rate for Payer: Group Health Inc Commercial	$326.02
Rate for Payer: Group Health Inc Medicare	$228.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$326.02
Rate for Payer: Hamaspik Choice Inc Medicare	$326.02

ZZ OLBERT BALL 5-4/5.8/90

Facility

$635.75

Hospital Charge Code	41567275
Hospital Revenue Code	270
Min. Negotiated Rate	$222.51
Max. Negotiated Rate	$508.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$349.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$317.88
Rate for Payer: Aetna Government	$317.88
Rate for Payer: Brighton Health Commercial	$476.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$508.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$432.31
Rate for Payer: Group Health Inc Commercial	$317.88
Rate for Payer: Group Health Inc Medicare	$222.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$317.88
Rate for Payer: Hamaspik Choice Inc Medicare	$317.88

ZZ OLBERT BALL 7-2.5/5.8/90

Facility

$635.75

Hospital Charge Code	41567272
Hospital Revenue Code	270
Min. Negotiated Rate	$222.51
Max. Negotiated Rate	$508.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$349.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$317.88
Rate for Payer: Aetna Government	$317.88
Rate for Payer: Brighton Health Commercial	$476.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$508.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$432.31
Rate for Payer: Group Health Inc Commercial	$317.88
Rate for Payer: Group Health Inc Medicare	$222.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$317.88
Rate for Payer: Hamaspik Choice Inc Medicare	$317.88

ZZ OMNIFLUSH CATHETER 4

Facility

$48.55

Hospital Charge Code	41567168
Hospital Revenue Code	270
Min. Negotiated Rate	$16.99
Max. Negotiated Rate	$38.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.28
Rate for Payer: Aetna Government	$24.28
Rate for Payer: Brighton Health Commercial	$36.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.01
Rate for Payer: Group Health Inc Commercial	$24.28
Rate for Payer: Group Health Inc Medicare	$16.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.28
Rate for Payer: Hamaspik Choice Inc Medicare	$24.28

ZZ OMNIFLUSH CATHETER 5

Facility

$48.55

Hospital Charge Code	41567167
Hospital Revenue Code	270
Min. Negotiated Rate	$16.99
Max. Negotiated Rate	$38.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.28
Rate for Payer: Aetna Government	$24.28
Rate for Payer: Brighton Health Commercial	$36.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.01
Rate for Payer: Group Health Inc Commercial	$24.28
Rate for Payer: Group Health Inc Medicare	$16.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.28
Rate for Payer: Hamaspik Choice Inc Medicare	$24.28

ZZ OMNIPAQUE 300/100ML PER ML

Facility

$1.00

Service Code	HCPCS Q9967
Hospital Charge Code	41563111
Hospital Revenue Code	255
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.14
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.15
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

Know your out-of-pocket cost for care.

All Charges