St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CC BMS MED INTEGRITY 3.0MMX 18MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529288
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 3.0MMX 18MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529288
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 3.0MM X22MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529289
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 3.0MM X22MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529289
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 3.0MM X 26MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529290
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 3.0MM X 26MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529290
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 3.0MMX9MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529291
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 3.0MMX9MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529291
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 3.5MM X 12MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529296
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 3.5MM X 12MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529296
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 3.5MM X 15MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529300
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 3.5MM X 15MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529300
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 3.5MM X 18MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529337
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 3.5MM X 18MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529337
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 3.5MM X 9MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529343
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 3.5MM X 9MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529343
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 3.5X 9-30MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529342
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 3.5X 9-30MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529342
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 4.0MM X 12MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529345
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 4.0MM X 12MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529345
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 4.0MM X 15MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529350
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 4.0MM X 15MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529350
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 4.0MM X 9MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529388
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 4.0MM X 9MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529388
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 4.0X9-30MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529386
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