St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BREAST REDUCTION

Facility

$15,862.45

Service Code	HCPCS 19318
Hospital Charge Code	40062300
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$11,896.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7,541.13
Rate for Payer: Aetna Government	$7,541.13
Rate for Payer: Affinity Essential Plan 1&2	$5,278.79
Rate for Payer: Affinity Essential Plan 3&4	$5,278.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$5,278.79
Rate for Payer: Brighton Health Commercial	$11,896.84
Rate for Payer: Cash Price	$7,541.13
Rate for Payer: Cash Price	$7,541.13
Rate for Payer: Cash Price	$7,541.13
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$7,541.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$7,541.13
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$6,409.96
Rate for Payer: Fidelis Essential Plan QHP	$6,711.61
Rate for Payer: Fidelis Medicare Advantage	$7,541.13
Rate for Payer: Fidelis Qualified Health Plan	$6,711.61
Rate for Payer: Group Health Inc Commercial	$7,541.13
Rate for Payer: Group Health Inc Medicare	$7,541.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,931.22
Rate for Payer: Hamaspik Choice Inc Medicare	$7,541.13
Rate for Payer: Healthfirst Medicare Advantage	$6,409.96
Rate for Payer: Healthfirst QHP	$7,541.13
Rate for Payer: Humana Medicare	$7,691.95
Rate for Payer: Senior Whole Health Medicare Advantage	$7,541.13
Rate for Payer: United Healthcare Commercial	$2,683.00
Rate for Payer: United Healthcare Medicare Advantage	$7,541.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,541.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6,032.90
Rate for Payer: Wellcare Medicare	$7,164.07

BREAST REDUCTION

Facility

$15,862.45

Service Code	HCPCS 19318
Hospital Charge Code	40062300
Hospital Revenue Code	360
Rate for Payer: Cash Price	$7,541.13

BREAST SIZER 76951

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201638
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$402.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$39.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: EmblemHealth Commercial	$32.50
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

BREAST SIZER 76951

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201638
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

BREAST SIZER 76952

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201639
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$402.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$39.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: EmblemHealth Commercial	$32.50
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

BREAST SIZER 76952

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201639
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

BREAST SIZER 76953

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40207451
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$402.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$39.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: EmblemHealth Commercial	$32.50
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

BREAST SIZER 76953

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40207451
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

BREAST SIZER 76954

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40207452
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

BREAST SIZER 76954

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40207452
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$402.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$39.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: EmblemHealth Commercial	$32.50
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

BREAST SIZER 76955

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201546
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

BREAST SIZER 76955

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201546
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$402.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$39.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: EmblemHealth Commercial	$32.50
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

BREAST SIZER 76980

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201548
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$402.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$39.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: EmblemHealth Commercial	$32.50
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

BREAST SIZER 76980

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201548
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

BREAST SIZER 76991

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201636
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$402.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$39.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: EmblemHealth Commercial	$32.50
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

BREAST SIZER 76991

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201636
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

BREAST SIZER 76992

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201637
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

BREAST SIZER 76992

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201637
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$402.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$39.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: EmblemHealth Commercial	$32.50
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

BREAST SIZER 76993

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201547
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

BREAST SIZER 76993

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201547
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$402.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$39.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: EmblemHealth Commercial	$32.50
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

BREAST SIZER 77464

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201549
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$402.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$39.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: EmblemHealth Commercial	$32.50
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

BREAST SIZER 77464

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	40201549
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

BRENTUXIMAB VEDOTIN 50MG/10ML PF

Facility

$383.10

Service Code	HCPCS J9042
Hospital Charge Code	41648891
Hospital Revenue Code	636
Min. Negotiated Rate	$161.43
Max. Negotiated Rate	$249.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$210.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$230.61
Rate for Payer: Aetna Government	$230.61
Rate for Payer: Affinity Essential Plan 1&2	$161.43
Rate for Payer: Affinity Essential Plan 3&4	$161.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$161.43
Rate for Payer: Brighton Health Commercial	$229.86
Rate for Payer: Cash Price	$230.61
Rate for Payer: Cash Price	$230.61
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$230.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$191.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$220.28
Rate for Payer: Elderplan Medicare Advantage	$230.61
Rate for Payer: EmblemHealth Commercial	$230.61
Rate for Payer: Fidelis CHP/HARP/Medicaid	$230.61
Rate for Payer: Fidelis Essential Plan Aliesa	$230.61
Rate for Payer: Fidelis Essential Plan QHP	$242.14
Rate for Payer: Fidelis Medicare Advantage	$230.61
Rate for Payer: Fidelis Qualified Health Plan	$242.14
Rate for Payer: Group Health Inc Commercial	$230.61
Rate for Payer: Group Health Inc Medicare	$230.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.55
Rate for Payer: Hamaspik Choice Inc Medicare	$191.55
Rate for Payer: Healthfirst Medicare Advantage	$196.02
Rate for Payer: Healthfirst QHP	$230.61
Rate for Payer: Humana Medicare	$235.23
Rate for Payer: Senior Whole Health Medicare Advantage	$230.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$244.59
Rate for Payer: SOMOS Essential	$244.59
Rate for Payer: United Healthcare Commercial	$213.65
Rate for Payer: United Healthcare Medicare Advantage	$230.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$249.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$184.49
Rate for Payer: Wellcare Medicare	$219.08

BRENTUXIMAB VEDOTIN 50MG/10ML PF

Facility

$383.10

Service Code	HCPCS J9042
Hospital Charge Code	41648891
Hospital Revenue Code	636
Min. Negotiated Rate	$191.55
Max. Negotiated Rate	$191.55
Rate for Payer: Cash Price	$230.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.55
Rate for Payer: Hamaspik Choice Inc Medicare	$191.55

BRENTUXIMAB VEDOTIN 50MG/10ML PF

Facility

$383.10

Service Code	HCPCS J9042
Hospital Charge Code	41658891
Hospital Revenue Code	636
Min. Negotiated Rate	$191.55
Max. Negotiated Rate	$191.55
Rate for Payer: Cash Price	$230.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.55
Rate for Payer: Hamaspik Choice Inc Medicare	$191.55

Know your out-of-pocket cost for care.

All Charges