St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CC AORTA, ABDOMNL + BILAT ILIOFEM

Facility

$8,393.53

Service Code	HCPCS 75630 TC
Hospital Charge Code	66528248
Hospital Revenue Code	320
Min. Negotiated Rate	$2,580.26
Max. Negotiated Rate	$4,616.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,616.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,686.08
Rate for Payer: Aetna Government	$3,686.08
Rate for Payer: Affinity Essential Plan 1&2	$2,580.26
Rate for Payer: Affinity Essential Plan 3&4	$2,580.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,580.26
Rate for Payer: Brighton Health Commercial	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,686.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,056.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,432.09
Rate for Payer: Elderplan Medicare Advantage	$3,686.08
Rate for Payer: EmblemHealth Commercial	$2,580.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,133.17
Rate for Payer: Fidelis Essential Plan Aliesa	$3,133.17
Rate for Payer: Fidelis Essential Plan QHP	$3,280.61
Rate for Payer: Fidelis Medicare Advantage	$3,686.08
Rate for Payer: Fidelis Qualified Health Plan	$3,280.61
Rate for Payer: Group Health Inc Commercial	$3,317.47
Rate for Payer: Group Health Inc Medicare	$3,317.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.76
Rate for Payer: Hamaspik Choice Inc Medicare	$3,686.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,317.47
Rate for Payer: Healthfirst Medicare Advantage	$3,686.08
Rate for Payer: Healthfirst QHP	$3,686.08
Rate for Payer: Humana Medicare	$3,759.80
Rate for Payer: Senior Whole Health Medicare Advantage	$3,686.08
Rate for Payer: United Healthcare Medicare Advantage	$3,686.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,686.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,948.86
Rate for Payer: Wellcare Medicare	$3,501.78

CC AORTA, ABDOMNL + BILAT ILIOFEM

Facility

$8,393.53

Service Code	HCPCS 75630 TC
Hospital Charge Code	66528248
Hospital Revenue Code	320
Rate for Payer: Cash Price	$3,686.08

CC AR I (100CM)5F

Facility

$44.80

Hospital Charge Code	66528788
Hospital Revenue Code	480
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.40
Rate for Payer: Aetna Government	$22.40
Rate for Payer: Brighton Health Commercial	$33.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.46
Rate for Payer: Group Health Inc Commercial	$22.40
Rate for Payer: Group Health Inc Medicare	$15.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.40
Rate for Payer: Hamaspik Choice Inc Medicare	$22.40
Rate for Payer: United Healthcare Commercial	$316.00

CC AR I MOD (100CM)5F

Facility

$44.80

Hospital Charge Code	66528789
Hospital Revenue Code	480
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.40
Rate for Payer: Aetna Government	$22.40
Rate for Payer: Brighton Health Commercial	$33.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.46
Rate for Payer: Group Health Inc Commercial	$22.40
Rate for Payer: Group Health Inc Medicare	$15.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.40
Rate for Payer: Hamaspik Choice Inc Medicare	$22.40
Rate for Payer: United Healthcare Commercial	$316.00

CC ARROW 6FR SUPER ARROWFLEX 45CM

Facility

$130.00

Hospital Charge Code	66529919
Hospital Revenue Code	480
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.00
Rate for Payer: Aetna Government	$65.00
Rate for Payer: Brighton Health Commercial	$97.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$104.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$88.40
Rate for Payer: Group Health Inc Commercial	$65.00
Rate for Payer: Group Health Inc Medicare	$45.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00
Rate for Payer: United Healthcare Commercial	$316.00

CC ASSURITY PACEMAKER

Facility

$16,987.50

Service Code	HCPCS C1785
Hospital Charge Code	66571568
Hospital Revenue Code	278
Min. Negotiated Rate	$8,493.75
Max. Negotiated Rate	$8,493.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,493.75
Rate for Payer: Hamaspik Choice Inc Medicare	$8,493.75

CC ASSURITY PACEMAKER

Facility

$16,987.50

Service Code	HCPCS C1785
Hospital Charge Code	66571568
Hospital Revenue Code	278
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$17,836.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9,343.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.42
Rate for Payer: Aetna Government	$275.42
Rate for Payer: Brighton Health Commercial	$10,192.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,493.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$9,767.81
Rate for Payer: EmblemHealth Commercial	$8,493.75
Rate for Payer: Fidelis Medicare Advantage	$17,836.88
Rate for Payer: Group Health Inc Commercial	$8,493.75
Rate for Payer: Group Health Inc Medicare	$5,945.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,493.75
Rate for Payer: Hamaspik Choice Inc Medicare	$8,493.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11,041.88

CC BAIR HUGGER (TEMP MGMT BLANKET

Facility

$53.00

Hospital Charge Code	66526855
Hospital Revenue Code	270
Min. Negotiated Rate	$18.55
Max. Negotiated Rate	$42.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.50
Rate for Payer: Aetna Government	$26.50
Rate for Payer: Brighton Health Commercial	$39.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$42.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$36.04
Rate for Payer: Group Health Inc Commercial	$26.50
Rate for Payer: Group Health Inc Medicare	$18.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.50
Rate for Payer: Hamaspik Choice Inc Medicare	$26.50

CC BAND HEMOSTAT D-STAT RADIAL

Facility

$1,180.00

Hospital Charge Code	66520237
Hospital Revenue Code	481
Min. Negotiated Rate	$413.00
Max. Negotiated Rate	$6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$649.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$590.00
Rate for Payer: Aetna Government	$590.00
Rate for Payer: Brighton Health Commercial	$6,937.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,959.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,215.78
Rate for Payer: Group Health Inc Commercial	$590.00
Rate for Payer: Group Health Inc Medicare	$413.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$590.00
Rate for Payer: Hamaspik Choice Inc Medicare	$590.00

CC BAND TR RAD COMP DEV 24CM REG

Facility

$395.00

Hospital Charge Code	66520205
Hospital Revenue Code	270
Min. Negotiated Rate	$138.25
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$217.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$197.50
Rate for Payer: Aetna Government	$197.50
Rate for Payer: Brighton Health Commercial	$296.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$316.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$268.60
Rate for Payer: Group Health Inc Commercial	$197.50
Rate for Payer: Group Health Inc Medicare	$138.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$197.50
Rate for Payer: Hamaspik Choice Inc Medicare	$197.50

CC BAND TR RAD COMP DEV 29CM LON

Facility

$395.00

Hospital Charge Code	66520206
Hospital Revenue Code	270
Min. Negotiated Rate	$138.25
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$217.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$197.50
Rate for Payer: Aetna Government	$197.50
Rate for Payer: Brighton Health Commercial	$296.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$316.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$268.60
Rate for Payer: Group Health Inc Commercial	$197.50
Rate for Payer: Group Health Inc Medicare	$138.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$197.50
Rate for Payer: Hamaspik Choice Inc Medicare	$197.50

CC BMS AB MINI VISION 2.0MMX12MM

Facility

$1,950.00

Service Code	HCPCS C1876
Hospital Charge Code	66528909
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,047.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,072.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,170.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$975.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,121.25
Rate for Payer: EmblemHealth Commercial	$975.00
Rate for Payer: Fidelis Medicare Advantage	$2,047.50
Rate for Payer: Group Health Inc Commercial	$975.00
Rate for Payer: Group Health Inc Medicare	$682.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,267.50

CC BMS AB MINI VISION 2.0MMX12MM

Facility

$1,950.00

Service Code	HCPCS C1876
Hospital Charge Code	66528909
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$975.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00

CC BMS AB MINI VISION 2.0MMX18MM

Facility

$1,950.00

Service Code	HCPCS C1876
Hospital Charge Code	66528911
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,047.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,072.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,170.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$975.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,121.25
Rate for Payer: EmblemHealth Commercial	$975.00
Rate for Payer: Fidelis Medicare Advantage	$2,047.50
Rate for Payer: Group Health Inc Commercial	$975.00
Rate for Payer: Group Health Inc Medicare	$682.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,267.50

CC BMS AB MINI VISION 2.0MMX18MM

Facility

$1,950.00

Service Code	HCPCS C1876
Hospital Charge Code	66528911
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$975.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00

CC BMS AB MINI VISION 2.0MMX23MM

Facility

$1,950.00

Service Code	HCPCS C1876
Hospital Charge Code	66528912
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,047.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,072.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,170.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$975.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,121.25
Rate for Payer: EmblemHealth Commercial	$975.00
Rate for Payer: Fidelis Medicare Advantage	$2,047.50
Rate for Payer: Group Health Inc Commercial	$975.00
Rate for Payer: Group Health Inc Medicare	$682.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,267.50

CC BMS AB MINI VISION 2.0MMX23MM

Facility

$1,950.00

Service Code	HCPCS C1876
Hospital Charge Code	66528912
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$975.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00

CC BMS AB MINI VISION 2.0MMX8MM

Facility

$1,950.00

Service Code	HCPCS C1876
Hospital Charge Code	66528913
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,047.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,072.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,170.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$975.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,121.25
Rate for Payer: EmblemHealth Commercial	$975.00
Rate for Payer: Fidelis Medicare Advantage	$2,047.50
Rate for Payer: Group Health Inc Commercial	$975.00
Rate for Payer: Group Health Inc Medicare	$682.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,267.50

CC BMS AB MINI VISION 2.0MMX8MM

Facility

$1,950.00

Service Code	HCPCS C1876
Hospital Charge Code	66528913
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$975.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00

CC BMS AB MINI VISION 2.25MMX12MM

Facility

$1,950.00

Service Code	HCPCS C1876
Hospital Charge Code	66528914
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,047.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,072.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,170.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$975.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,121.25
Rate for Payer: EmblemHealth Commercial	$975.00
Rate for Payer: Fidelis Medicare Advantage	$2,047.50
Rate for Payer: Group Health Inc Commercial	$975.00
Rate for Payer: Group Health Inc Medicare	$682.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,267.50

CC BMS AB MINI VISION 2.25MMX12MM

Facility

$1,950.00

Service Code	HCPCS C1876
Hospital Charge Code	66528914
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$975.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00

CC BMS AB MINI VISION 2.25MMX18MM

Facility

$1,950.00

Service Code	HCPCS C1876
Hospital Charge Code	66528916
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,047.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,072.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,170.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$975.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,121.25
Rate for Payer: EmblemHealth Commercial	$975.00
Rate for Payer: Fidelis Medicare Advantage	$2,047.50
Rate for Payer: Group Health Inc Commercial	$975.00
Rate for Payer: Group Health Inc Medicare	$682.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,267.50

CC BMS AB MINI VISION 2.25MMX18MM

Facility

$1,950.00

Service Code	HCPCS C1876
Hospital Charge Code	66528916
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$975.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00

CC BMS AB MINI VISION 2.25X8MM

Facility

$1,950.00

Service Code	HCPCS C1876
Hospital Charge Code	66528917
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$975.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00

CC BMS AB MINI VISION 2.25X8MM

Facility

$1,950.00

Service Code	HCPCS C1876
Hospital Charge Code	66528917
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,047.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,072.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,170.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$975.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,121.25
Rate for Payer: EmblemHealth Commercial	$975.00
Rate for Payer: Fidelis Medicare Advantage	$2,047.50
Rate for Payer: Group Health Inc Commercial	$975.00
Rate for Payer: Group Health Inc Medicare	$682.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,267.50

Know your out-of-pocket cost for care.

All Charges