St. Barnabas Hospital

All Charges

Charge

Type

Price

CC BOS. SCI. 6 FR MP A-2 100CM

Facility IP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528307
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-2 100CM

Facility OP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528307
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 MP B-1 100CM

Facility OP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528308
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 MP B-1 100CM

Facility IP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528308
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. 6FR PIG 145 ANG 110C

Facility OP

$17.00

Hospital Charge Code	66528309
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 PIG STR 110CM

Facility OP

$17.00

Hospital Charge Code	66528310
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 PIG STR 125CM

Facility IP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528311
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 PIG STR 125CM

Facility OP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528311
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 RCB 100CM

Facility IP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528312
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 RCB 100CM

Facility OP

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528312
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 VL 5.0 100CM

Facility IP

$19.60

Service Code	HCPCS C1725
Hospital Charge Code	66528314
Hospital Revenue Code	278
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$9.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.80
Rate for Payer: Hamaspik Choice Inc Medicare	$9.80

CC BOS. SCI. 6 FR VL 5.0 100CM

Facility OP

$19.60

Service Code	HCPCS C1725
Hospital Charge Code	66528314
Hospital Revenue Code	278
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.78
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	$9.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.27
Rate for Payer: Fidelis Medicare Advantage	$20.58
Rate for Payer: Group Health Inc Commercial	$9.80
Rate for Payer: Group Health Inc Medicare	$6.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.80
Rate for Payer: Hamaspik Choice Inc Medicare	$9.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.74

CC BOS. SCI. 6 FR VL 6.0 100CM

Facility IP

$19.60

Service Code	HCPCS C1725
Hospital Charge Code	66528315
Hospital Revenue Code	278
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$9.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.80
Rate for Payer: Hamaspik Choice Inc Medicare	$9.80

CC BOS. SCI. 6 FR VL 6.0 100CM

Facility OP

$19.60

Service Code	HCPCS C1725
Hospital Charge Code	66528315
Hospital Revenue Code	278
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.78
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	$9.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.27
Rate for Payer: Fidelis Medicare Advantage	$20.58
Rate for Payer: Group Health Inc Commercial	$9.80
Rate for Payer: Group Health Inc Medicare	$6.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.80
Rate for Payer: Hamaspik Choice Inc Medicare	$9.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.74

CC BOST. SCI. 8FR PINNACLE 10CM

Facility OP

$19.00

Hospital Charge Code	66528402
Hospital Revenue Code	480
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$15.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.50
Rate for Payer: Aetna Government	$9.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.92
Rate for Payer: Group Health Inc Commercial	$9.50
Rate for Payer: Group Health Inc Medicare	$6.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.50
Rate for Payer: Hamaspik Choice Inc Medicare	$9.50

CC BOST. SCIEN. 5 FR MP B-1 100CM

Facility OP

$18.50

Hospital Charge Code	66528239
Hospital Revenue Code	480
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$14.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.25
Rate for Payer: Aetna Government	$9.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.58
Rate for Payer: Group Health Inc Commercial	$9.25
Rate for Payer: Group Health Inc Medicare	$6.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.25
Rate for Payer: Hamaspik Choice Inc Medicare	$9.25

CC BOST. SCIEN. 6 FR FL 3.5 100CM

Facility OP

$18.50

Hospital Charge Code	66528240
Hospital Revenue Code	480
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$14.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.25
Rate for Payer: Aetna Government	$9.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.58
Rate for Payer: Group Health Inc Commercial	$9.25
Rate for Payer: Group Health Inc Medicare	$6.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.25
Rate for Payer: Hamaspik Choice Inc Medicare	$9.25

CC BOST. SCIEN. 6 FR FL 4 100CM

Facility OP

$18.50

Hospital Charge Code	66528241
Hospital Revenue Code	270
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$14.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.25
Rate for Payer: Aetna Government	$9.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.58
Rate for Payer: Group Health Inc Commercial	$9.25
Rate for Payer: Group Health Inc Medicare	$6.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.25
Rate for Payer: Hamaspik Choice Inc Medicare	$9.25

CC BOST. SCIEN. 6 FR FR 4 100CM

Facility OP

$18.50

Hospital Charge Code	66528242
Hospital Revenue Code	270
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$14.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.25
Rate for Payer: Aetna Government	$9.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.58
Rate for Payer: Group Health Inc Commercial	$9.25
Rate for Payer: Group Health Inc Medicare	$6.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.25
Rate for Payer: Hamaspik Choice Inc Medicare	$9.25

CC BOST. SCIEN. 6 FR IM 100CM

Facility OP

$18.50

Hospital Charge Code	66528243
Hospital Revenue Code	270
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$14.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.25
Rate for Payer: Aetna Government	$9.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.58
Rate for Payer: Group Health Inc Commercial	$9.25
Rate for Payer: Group Health Inc Medicare	$6.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.25
Rate for Payer: Hamaspik Choice Inc Medicare	$9.25

CC BOST. SCIEN. 6FR PINNACLE 10CM

Facility OP

$19.00

Hospital Charge Code	66528257
Hospital Revenue Code	270
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$15.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.50
Rate for Payer: Aetna Government	$9.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.92
Rate for Payer: Group Health Inc Commercial	$9.50
Rate for Payer: Group Health Inc Medicare	$6.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.50
Rate for Payer: Hamaspik Choice Inc Medicare	$9.50

CC BOST. SCIEN. 7FR PINNACLE 10CM

Facility OP

$19.00

Hospital Charge Code	66528258
Hospital Revenue Code	270
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$15.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.50
Rate for Payer: Aetna Government	$9.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.92
Rate for Payer: Group Health Inc Commercial	$9.50
Rate for Payer: Group Health Inc Medicare	$6.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.50
Rate for Payer: Hamaspik Choice Inc Medicare	$9.50

CC BRNCHSC W/THER ASPIR 1ST

Facility OP

$4,535.55

Service Code	HCPCS 31645
Hospital Charge Code	66581567
Hospital Revenue Code	361
Min. Negotiated Rate	$153.52
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,962.76
Rate for Payer: Aetna Government	$1,962.76
Rate for Payer: Cash Price	$1,962.76
Rate for Payer: Cash Price	$1,962.76
Rate for Payer: Cash Price	$1,962.76
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,962.76
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	$1,962.76
Rate for Payer: EmblemHealth Commercial	$745.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$153.52
Rate for Payer: Fidelis Essential Plan Aliesa	$1,668.35
Rate for Payer: Fidelis Essential Plan QHP	$1,746.86
Rate for Payer: Fidelis Medicare Advantage	$1,962.76
Rate for Payer: Fidelis Qualified Health Plan	$1,746.86
Rate for Payer: Group Health Inc Commercial	$1,962.76
Rate for Payer: Group Health Inc Medicare	$1,962.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,267.78
Rate for Payer: Hamaspik Choice Inc Medicare	$1,962.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$170.58
Rate for Payer: Healthfirst Medicare Advantage	$1,668.35
Rate for Payer: Healthfirst QHP	$1,962.76
Rate for Payer: Senior Whole Health Medicare Advantage	$1,962.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,962.76
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,570.21
Rate for Payer: Wellcare Medicare	$1,864.62

CC BRONCH EBUS IVNTJ PERPH LES

Facility OP

$3,872.52

Service Code	HCPCS 31654
Hospital Charge Code	66581564
Hospital Revenue Code	361
Min. Negotiated Rate	$69.06
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,880.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.87
Rate for Payer: Aetna Government	$69.87
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: EmblemHealth Commercial	$745.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$69.06
Rate for Payer: Group Health Inc Commercial	$1,936.26
Rate for Payer: Group Health Inc Medicare	$1,355.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,936.26
Rate for Payer: Hamaspik Choice Inc Medicare	$1,936.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$76.73

CC B.S. 035 TER STR STIFF 150CM

Facility OP

$97.15

Service Code	HCPCS C1769
Hospital Charge Code	66528324
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$102.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.86
Rate for Payer: Fidelis Medicare Advantage	$102.01
Rate for Payer: Group Health Inc Commercial	$48.58
Rate for Payer: Group Health Inc Medicare	$34.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.58
Rate for Payer: Hamaspik Choice Inc Medicare	$48.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$63.15

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