St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CC BOS. SCI. 6 FR IM 125CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528301
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 IM 125CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528301
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 IMT 100CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528302
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 IMT 100CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528302
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 JL 5.0 I 125CM

Facility

$17.00

Hospital Charge Code	66528303
Hospital Revenue Code	480
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$316.00
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
Rate for Payer: United Healthcare Commercial	$316.00

CC BOS. SCI 6 FR JL 6.0 I 100CM

Facility

$17.00

Hospital Charge Code	66528304
Hospital Revenue Code	480
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$316.00
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
Rate for Payer: United Healthcare Commercial	$316.00

CC BOS. SCI. 6 FR LCB 100CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528305
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 LCB 100CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528305
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 MP A-1 100CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528306
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 MP A-1 100CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528306
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

$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: 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 MP A-2 100CM

Facility

$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 B-1 100CM

Facility

$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: 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 MP B-1 100CM

Facility

$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

$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: 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 PIG STR 110CM

Facility

$17.00

Hospital Charge Code	66528310
Hospital Revenue Code	480
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$316.00
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
Rate for Payer: United Healthcare Commercial	$316.00

CC BOS. SCI. 6 FR PIG STR 125CM

Facility

$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: 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 PIG STR 125CM

Facility

$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 RCB 100CM

Facility

$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

$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: 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 VL 5.0 100CM

Facility

$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

$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: Brighton Health Commercial	$11.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.27
Rate for Payer: EmblemHealth Commercial	$9.80
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

$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

$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: Brighton Health Commercial	$11.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.27
Rate for Payer: EmblemHealth Commercial	$9.80
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

$19.00

Hospital Charge Code	66528402
Hospital Revenue Code	480
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$316.00
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
Rate for Payer: United Healthcare Commercial	$316.00

Know your out-of-pocket cost for care.

All Charges