St. Barnabas Hospital

All Charges

Charge

Type

Price

CC BOS. SCI. 6 FR AL III 100CM

Facility OP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528294
Hospital Revenue Code	278
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: Fidelis Medicare Advantage	$17.85
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

CC BOS. SCI. 6 FR AL III 100CM

Facility IP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528294
Hospital Revenue Code	278
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

CC BOS. SCI. 6 FR AR I 100 CM

Facility OP

$17.00

Hospital Charge Code	66528295
Hospital Revenue Code	270
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$13.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.50
Rate for Payer: Aetna Government	$8.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.56
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

CC BOS. SCI. 6 FR AR II 100CM

Facility OP

$17.00

Hospital Charge Code	66528273
Hospital Revenue Code	270
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$13.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.50
Rate for Payer: Aetna Government	$8.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.56
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

CC BOS. SCI. 6 FR AR MOD 100CM

Facility OP

$17.00

Hospital Charge Code	66528274
Hospital Revenue Code	270
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$13.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.50
Rate for Payer: Aetna Government	$8.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.56
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

CC BOS. SCI. 6 FR FL 4.5 100CM

Facility OP

$17.00

Hospital Charge Code	66528296
Hospital Revenue Code	270
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$13.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.50
Rate for Payer: Aetna Government	$8.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.56
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

CC BOS. SCI 6 FR FL 5 100CM

Facility OP

$17.00

Hospital Charge Code	66528270
Hospital Revenue Code	270
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$13.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.50
Rate for Payer: Aetna Government	$8.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.56
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

CC BOS. SCI. 6 FR FR 3.5 100CM

Facility IP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528298
Hospital Revenue Code	278
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

CC BOS. SCI. 6 FR FR 3.5 100CM

Facility OP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528298
Hospital Revenue Code	278
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: Fidelis Medicare Advantage	$17.85
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

CC BOS. SCI. 6 FR FR 5 100CM

Facility OP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528299
Hospital Revenue Code	278
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: Fidelis Medicare Advantage	$17.85
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

CC BOS. SCI. 6 FR FR 5 100CM

Facility IP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528299
Hospital Revenue Code	278
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

CC BOS. SCI. 6 FR FR 5 125CM

Facility IP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528275
Hospital Revenue Code	278
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

CC BOS. SCI. 6 FR FR 5 125CM

Facility OP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528275
Hospital Revenue Code	278
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: Fidelis Medicare Advantage	$17.85
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

CC BOS. SCI. 6 FR FR 6 100CM

Facility IP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528300
Hospital Revenue Code	278
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

CC BOS. SCI. 6 FR FR 6 100CM

Facility OP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528300
Hospital Revenue Code	278
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: Fidelis Medicare Advantage	$17.85
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

CC BOS. SCI. 6 FR IM 125CM

Facility OP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528301
Hospital Revenue Code	278
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: Fidelis Medicare Advantage	$17.85
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

CC BOS. SCI. 6 FR IM 125CM

Facility IP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528301
Hospital Revenue Code	278
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

CC BOS. SCI. 6 FR IMT 100CM

Facility OP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528302
Hospital Revenue Code	278
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: Fidelis Medicare Advantage	$17.85
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

CC BOS. SCI. 6 FR IMT 100CM

Facility IP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528302
Hospital Revenue Code	278
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

CC BOS. SCI 6 FR JL 5.0 I 125CM

Facility OP

$17.00

Hospital Charge Code	66528303
Hospital Revenue Code	480
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$13.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.50
Rate for Payer: Aetna Government	$8.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.56
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

CC BOS. SCI 6 FR JL 6.0 I 100CM

Facility OP

$17.00

Hospital Charge Code	66528304
Hospital Revenue Code	480
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$13.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.50
Rate for Payer: Aetna Government	$8.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.56
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

CC BOS. SCI. 6 FR LCB 100CM

Facility OP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528305
Hospital Revenue Code	278
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: Fidelis Medicare Advantage	$17.85
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

CC BOS. SCI. 6 FR LCB 100CM

Facility IP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528305
Hospital Revenue Code	278
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

CC BOS. SCI. 6 FR MP A-1 100CM

Facility IP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528306
Hospital Revenue Code	278
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

CC BOS. SCI. 6 FR MP A-1 100CM

Facility OP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528306
Hospital Revenue Code	278
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: Fidelis Medicare Advantage	$17.85
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

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