St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CC BOS. SCI. 5 FR JL 4.0 125CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528289
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: Brighton Health Commercial	$10.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: EmblemHealth Commercial	$8.50
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. 5 FR JL 4.0 125CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528289
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. 5 FR PIG STR. 125CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528290
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: Brighton Health Commercial	$10.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: EmblemHealth Commercial	$8.50
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. 5 FR PIG STR. 125CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528290
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. 5 FR PINNACLE 10CM

Facility

$19.00

Hospital Charge Code	66528316
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: Brighton Health Commercial	$14.25
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 BOS. SCI. 5 FR WR 100CM

Facility

$18.50

Service Code	HCPCS C1725
Hospital Charge Code	66528291
Hospital Revenue Code	278
Min. Negotiated Rate	$9.25
Max. Negotiated Rate	$9.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.25
Rate for Payer: Hamaspik Choice Inc Medicare	$9.25

CC BOS. SCI. 5 FR WR 100CM

Facility

$18.50

Service Code	HCPCS C1725
Hospital Charge Code	66528291
Hospital Revenue Code	278
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$11.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.64
Rate for Payer: EmblemHealth Commercial	$9.25
Rate for Payer: Fidelis Medicare Advantage	$19.42
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
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.02

CC BOS. SCI. 6 FR AL I 100CM

Facility

$18.50

Hospital Charge Code	66528269
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: Brighton Health Commercial	$13.88
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 BOS. SCI. 6 FR AL II 100CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528293
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: Brighton Health Commercial	$10.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: EmblemHealth Commercial	$8.50
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 II 100CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528293
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 AL III 100CM

Facility

$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: Brighton Health Commercial	$10.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: EmblemHealth Commercial	$8.50
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

$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

$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: Brighton Health Commercial	$12.75
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

$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: Brighton Health Commercial	$12.75
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

$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: Brighton Health Commercial	$12.75
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

$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: Brighton Health Commercial	$12.75
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

$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: Brighton Health Commercial	$12.75
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

$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

$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: Brighton Health Commercial	$10.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: EmblemHealth Commercial	$8.50
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

$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: Brighton Health Commercial	$10.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: EmblemHealth Commercial	$8.50
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

$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

$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

$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: Brighton Health Commercial	$10.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: EmblemHealth Commercial	$8.50
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

$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: Brighton Health Commercial	$10.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: EmblemHealth Commercial	$8.50
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

$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

Know your out-of-pocket cost for care.

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