St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BS AMS700 LG 18 X 12

Facility

$25,059.64

Service Code	HCPCS C1813
Hospital Charge Code	40009999
Hospital Revenue Code	278
Min. Negotiated Rate	$12,529.82
Max. Negotiated Rate	$12,529.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$12,529.82
Rate for Payer: Hamaspik Choice Inc Medicare	$12,529.82

BS AMS700 LG 18 X 12

Facility

$25,059.64

Service Code	HCPCS C1813
Hospital Charge Code	40009999
Hospital Revenue Code	278
Min. Negotiated Rate	$3,775.00
Max. Negotiated Rate	$26,312.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13,782.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,775.00
Rate for Payer: Aetna Government	$3,775.00
Rate for Payer: Brighton Health Commercial	$15,035.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12,529.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$14,409.29
Rate for Payer: EmblemHealth Commercial	$12,529.82
Rate for Payer: Fidelis Medicare Advantage	$26,312.62
Rate for Payer: Group Health Inc Commercial	$12,529.82
Rate for Payer: Group Health Inc Medicare	$8,770.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$12,529.82
Rate for Payer: Hamaspik Choice Inc Medicare	$12,529.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16,288.77

B.S. ANGIOGRAPHIN CATH

Facility

$65.50

Hospital Charge Code	40206286
Hospital Revenue Code	270
Min. Negotiated Rate	$22.92
Max. Negotiated Rate	$52.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$36.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.75
Rate for Payer: Aetna Government	$32.75
Rate for Payer: Brighton Health Commercial	$49.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.54
Rate for Payer: Group Health Inc Commercial	$32.75
Rate for Payer: Group Health Inc Medicare	$22.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.75
Rate for Payer: Hamaspik Choice Inc Medicare	$32.75

B.S. FILTER WIRE LG/SM X190

Facility

$3,188.00

Service Code	HCPCS C1887
Hospital Charge Code	66522109
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$3,347.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,753.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Brighton Health Commercial	$1,912.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,594.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,833.10
Rate for Payer: EmblemHealth Commercial	$1,594.00
Rate for Payer: Fidelis Medicare Advantage	$3,347.40
Rate for Payer: Group Health Inc Commercial	$1,594.00
Rate for Payer: Group Health Inc Medicare	$1,115.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,594.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,594.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,072.20

B.S. FILTER WIRE LG/SM X190

Facility

$3,188.00

Service Code	HCPCS C1887
Hospital Charge Code	66522109
Hospital Revenue Code	278
Min. Negotiated Rate	$1,594.00
Max. Negotiated Rate	$1,594.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,594.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,594.00

B.S. G DEXTRUS A LEAD 4136 53CM

Facility

$1,200.00

Service Code	HCPCS C1785
Hospital Charge Code	40205675
Hospital Revenue Code	278
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$1,260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.42
Rate for Payer: Aetna Government	$275.42
Rate for Payer: Brighton Health Commercial	$720.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.00
Rate for Payer: EmblemHealth Commercial	$600.00
Rate for Payer: Fidelis Medicare Advantage	$1,260.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$780.00

B.S. G DEXTRUS A LEAD 4136 53CM

Facility

$1,200.00

Service Code	HCPCS C1785
Hospital Charge Code	40205675
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00

B.S. G DEXTRUS V LEAD 4136 60CM

Facility

$1,200.00

Service Code	HCPCS C1785
Hospital Charge Code	40205676
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00

B.S. G DEXTRUS V LEAD 4136 60CM

Facility

$1,200.00

Service Code	HCPCS C1785
Hospital Charge Code	40205676
Hospital Revenue Code	278
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$1,260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.42
Rate for Payer: Aetna Government	$275.42
Rate for Payer: Brighton Health Commercial	$720.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.00
Rate for Payer: EmblemHealth Commercial	$600.00
Rate for Payer: Fidelis Medicare Advantage	$1,260.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$780.00

BSKET TRAPZID LITHO COMPT

Facility

$698.00

Hospital Charge Code	40200271
Hospital Revenue Code	270
Min. Negotiated Rate	$244.30
Max. Negotiated Rate	$558.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$383.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$349.00
Rate for Payer: Aetna Government	$349.00
Rate for Payer: Brighton Health Commercial	$523.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$558.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$474.64
Rate for Payer: Group Health Inc Commercial	$349.00
Rate for Payer: Group Health Inc Medicare	$244.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$349.00
Rate for Payer: Hamaspik Choice Inc Medicare	$349.00

B.S. PED BX NEEDLE 2.0X160CM

Facility

$804.00

Hospital Charge Code	40205150
Hospital Revenue Code	270
Min. Negotiated Rate	$281.40
Max. Negotiated Rate	$643.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$442.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.00
Rate for Payer: Aetna Government	$402.00
Rate for Payer: Brighton Health Commercial	$603.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$643.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$546.72
Rate for Payer: Group Health Inc Commercial	$402.00
Rate for Payer: Group Health Inc Medicare	$281.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$402.00
Rate for Payer: Hamaspik Choice Inc Medicare	$402.00

BSPLT TIB TRI BDD

Facility

$3,875.00

Service Code	HCPCS C1776
Hospital Charge Code	64907213
Hospital Revenue Code	278
Min. Negotiated Rate	$1,937.50
Max. Negotiated Rate	$1,937.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,937.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,937.50

BSPLT TIB TRI BDD

Facility

$3,875.00

Service Code	HCPCS C1776
Hospital Charge Code	64907213
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,068.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,131.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,325.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,937.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,228.12
Rate for Payer: EmblemHealth Commercial	$1,937.50
Rate for Payer: Fidelis Medicare Advantage	$4,068.75
Rate for Payer: Group Health Inc Commercial	$1,937.50
Rate for Payer: Group Health Inc Medicare	$1,356.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,937.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,937.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,518.75

BSPLT TRI 5520

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64907210
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,462.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,337.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,550.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,443.75
Rate for Payer: EmblemHealth Commercial	$2,125.00
Rate for Payer: Fidelis Medicare Advantage	$4,462.50
Rate for Payer: Group Health Inc Commercial	$2,125.00
Rate for Payer: Group Health Inc Medicare	$1,487.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,762.50

BSPLT TRI 5520

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64907210
Hospital Revenue Code	278
Min. Negotiated Rate	$2,125.00
Max. Negotiated Rate	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00

BSPLT TRI TS 5521

Facility

$3,625.00

Service Code	HCPCS C1776
Hospital Charge Code	64907211
Hospital Revenue Code	278
Min. Negotiated Rate	$1,812.50
Max. Negotiated Rate	$1,812.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,812.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,812.50

BSPLT TRI TS 5521

Facility

$3,625.00

Service Code	HCPCS C1776
Hospital Charge Code	64907211
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,806.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,993.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,175.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,812.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,084.38
Rate for Payer: EmblemHealth Commercial	$1,812.50
Rate for Payer: Fidelis Medicare Advantage	$3,806.25
Rate for Payer: Group Health Inc Commercial	$1,812.50
Rate for Payer: Group Health Inc Medicare	$1,268.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,812.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,812.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,356.25

BSPLT TRI UNIV

Facility

$1,263.50

Service Code	HCPCS C1776
Hospital Charge Code	64907212
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,326.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$758.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$631.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$726.51
Rate for Payer: EmblemHealth Commercial	$631.75
Rate for Payer: Fidelis Medicare Advantage	$1,326.68
Rate for Payer: Group Health Inc Commercial	$631.75
Rate for Payer: Group Health Inc Medicare	$442.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$631.75
Rate for Payer: Hamaspik Choice Inc Medicare	$631.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$821.28

BSPLT TRI UNIV

Facility

$1,263.50

Service Code	HCPCS C1776
Hospital Charge Code	64907212
Hospital Revenue Code	278
Min. Negotiated Rate	$631.75
Max. Negotiated Rate	$631.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$631.75
Rate for Payer: Hamaspik Choice Inc Medicare	$631.75

B.S. SENSOR W/WIRE 0.038X 150CM

Facility

$119.00

Service Code	HCPCS C1713
Hospital Charge Code	40205798
Hospital Revenue Code	278
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$59.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.50
Rate for Payer: Hamaspik Choice Inc Medicare	$59.50

B.S. SENSOR W/WIRE 0.038X 150CM

Facility

$119.00

Service Code	HCPCS C1713
Hospital Charge Code	40205798
Hospital Revenue Code	278
Min. Negotiated Rate	$41.65
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$65.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$71.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$59.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.42
Rate for Payer: EmblemHealth Commercial	$59.50
Rate for Payer: Fidelis Medicare Advantage	$124.95
Rate for Payer: Group Health Inc Commercial	$59.50
Rate for Payer: Group Health Inc Medicare	$41.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.50
Rate for Payer: Hamaspik Choice Inc Medicare	$59.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$77.35

BSS IO SOLN [37579]

Facility

$0.09

Service Code	NDC 00065079550
Hospital Charge Code	00065079550
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

BSS IO SOLN [37579]

Facility

$0.97

Service Code	NDC 00065079515
Hospital Charge Code	00065079515
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.49
Rate for Payer: Aetna Government	$0.49
Rate for Payer: Brighton Health Commercial	$0.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.66
Rate for Payer: Group Health Inc Commercial	$0.49
Rate for Payer: Group Health Inc Medicare	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49
Rate for Payer: Hamaspik Choice Inc Medicare	$0.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.63

BSS IO SOLN [37579]

Facility

$0.09

Service Code	NDC 00065179504
Hospital Charge Code	00065179504
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

B.S. THE MAGNET EXCHANGE DEVICE

Facility

$226.00

Hospital Charge Code	66522097
Hospital Revenue Code	270
Min. Negotiated Rate	$79.10
Max. Negotiated Rate	$180.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$124.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$113.00
Rate for Payer: Aetna Government	$113.00
Rate for Payer: Brighton Health Commercial	$169.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$180.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.68
Rate for Payer: Group Health Inc Commercial	$113.00
Rate for Payer: Group Health Inc Medicare	$79.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.00
Rate for Payer: Hamaspik Choice Inc Medicare	$113.00

Know your out-of-pocket cost for care.

All Charges