St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CC BMS AB V ULTRA 4.5MMX28MM

Facility

$1,950.00

Service Code	HCPCS C1876
Hospital Charge Code	66528947
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 V ULTRA 4.5MMX28MM

Facility

$1,950.00

Service Code	HCPCS C1876
Hospital Charge Code	66528947
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 V ULTRA 5.0MMX13MM

Facility

$1,950.00

Service Code	HCPCS C1876
Hospital Charge Code	66528948
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 V ULTRA 5.0MMX13MM

Facility

$1,950.00

Service Code	HCPCS C1876
Hospital Charge Code	66528948
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 V ULTRA 5.0MMX18MM

Facility

$1,950.00

Service Code	HCPCS C1876
Hospital Charge Code	66528949
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 V ULTRA 5.0MMX18MM

Facility

$1,950.00

Service Code	HCPCS C1876
Hospital Charge Code	66528949
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 V ULTRA 5.0MMX 28MM

Facility

$1,950.00

Service Code	HCPCS C1876
Hospital Charge Code	66528950
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 V ULTRA 5.0MMX 28MM

Facility

$1,950.00

Service Code	HCPCS C1876
Hospital Charge Code	66528950
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 B.S. VERIFLEX 4.0MMX12MM

Facility

$3,296.00

Service Code	HCPCS C1876
Hospital Charge Code	66520113
Hospital Revenue Code	278
Min. Negotiated Rate	$1,648.00
Max. Negotiated Rate	$1,648.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,648.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,648.00

CC BMS B.S. VERIFLEX 4.0MMX12MM

Facility

$3,296.00

Service Code	HCPCS C1876
Hospital Charge Code	66520113
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,460.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,812.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,977.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,648.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,895.20
Rate for Payer: EmblemHealth Commercial	$1,648.00
Rate for Payer: Fidelis Medicare Advantage	$3,460.80
Rate for Payer: Group Health Inc Commercial	$1,648.00
Rate for Payer: Group Health Inc Medicare	$1,153.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,648.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,648.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,142.40

CC BMS MED INTEGRITY 2.25MM X12MM

Facility

$1,650.00

Service Code	HCPCS C1887
Hospital Charge Code	66529127
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$825.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$825.00
Rate for Payer: Hamaspik Choice Inc Medicare	$825.00

CC BMS MED INTEGRITY 2.25MM X12MM

Facility

$1,650.00

Service Code	HCPCS C1887
Hospital Charge Code	66529127
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$1,732.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$907.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Brighton Health Commercial	$990.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$825.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$948.75
Rate for Payer: EmblemHealth Commercial	$825.00
Rate for Payer: Fidelis Medicare Advantage	$1,732.50
Rate for Payer: Group Health Inc Commercial	$825.00
Rate for Payer: Group Health Inc Medicare	$577.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$825.00
Rate for Payer: Hamaspik Choice Inc Medicare	$825.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,072.50

CC BMS MED INTEGRITY 2.25MMX14MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529128
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$825.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$825.00
Rate for Payer: Hamaspik Choice Inc Medicare	$825.00

CC BMS MED INTEGRITY 2.25MMX14MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529128
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$1,732.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$907.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$990.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$825.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$948.75
Rate for Payer: EmblemHealth Commercial	$825.00
Rate for Payer: Fidelis Medicare Advantage	$1,732.50
Rate for Payer: Group Health Inc Commercial	$825.00
Rate for Payer: Group Health Inc Medicare	$577.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$825.00
Rate for Payer: Hamaspik Choice Inc Medicare	$825.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,072.50

CC BMS MED INTEGRITY 2.25MMX 18MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529129
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$825.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$825.00
Rate for Payer: Hamaspik Choice Inc Medicare	$825.00

CC BMS MED INTEGRITY 2.25MMX 18MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529129
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$1,732.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$907.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$990.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$825.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$948.75
Rate for Payer: EmblemHealth Commercial	$825.00
Rate for Payer: Fidelis Medicare Advantage	$1,732.50
Rate for Payer: Group Health Inc Commercial	$825.00
Rate for Payer: Group Health Inc Medicare	$577.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$825.00
Rate for Payer: Hamaspik Choice Inc Medicare	$825.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,072.50

CC BMS MED INTEGRITY 2.25MMX 22MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529130
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$825.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$825.00
Rate for Payer: Hamaspik Choice Inc Medicare	$825.00

CC BMS MED INTEGRITY 2.25MMX 22MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529130
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$1,732.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$907.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$990.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$825.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$948.75
Rate for Payer: EmblemHealth Commercial	$825.00
Rate for Payer: Fidelis Medicare Advantage	$1,732.50
Rate for Payer: Group Health Inc Commercial	$825.00
Rate for Payer: Group Health Inc Medicare	$577.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$825.00
Rate for Payer: Hamaspik Choice Inc Medicare	$825.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,072.50

CC BMS MED INTEGRITY 2.25MMX 26MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529131
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$825.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$825.00
Rate for Payer: Hamaspik Choice Inc Medicare	$825.00

CC BMS MED INTEGRITY 2.25MMX 26MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529131
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$1,732.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$907.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$990.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$825.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$948.75
Rate for Payer: EmblemHealth Commercial	$825.00
Rate for Payer: Fidelis Medicare Advantage	$1,732.50
Rate for Payer: Group Health Inc Commercial	$825.00
Rate for Payer: Group Health Inc Medicare	$577.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$825.00
Rate for Payer: Hamaspik Choice Inc Medicare	$825.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,072.50

CC BMS MED INTEGRITY 2.25MMX 8MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529196
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$1,732.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$907.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$990.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$825.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$948.75
Rate for Payer: EmblemHealth Commercial	$825.00
Rate for Payer: Fidelis Medicare Advantage	$1,732.50
Rate for Payer: Group Health Inc Commercial	$825.00
Rate for Payer: Group Health Inc Medicare	$577.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$825.00
Rate for Payer: Hamaspik Choice Inc Medicare	$825.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,072.50

CC BMS MED INTEGRITY 2.25MMX 8MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529196
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$825.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$825.00
Rate for Payer: Hamaspik Choice Inc Medicare	$825.00

CC BMS MED INTEGRITY 2.5MM X 14MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529199
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$825.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$825.00
Rate for Payer: Hamaspik Choice Inc Medicare	$825.00

CC BMS MED INTEGRITY 2.5MM X 14MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529199
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$1,732.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$907.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$990.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$825.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$948.75
Rate for Payer: EmblemHealth Commercial	$825.00
Rate for Payer: Fidelis Medicare Advantage	$1,732.50
Rate for Payer: Group Health Inc Commercial	$825.00
Rate for Payer: Group Health Inc Medicare	$577.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$825.00
Rate for Payer: Hamaspik Choice Inc Medicare	$825.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,072.50

CC BMS MED INTEGRITY 2.5MM X 18MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529183
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$825.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$825.00
Rate for Payer: Hamaspik Choice Inc Medicare	$825.00

Know your out-of-pocket cost for care.

All Charges