St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CC CATH MAVRK OTW BALL 4.0X12MM

Facility

$1,514.00

Service Code	HCPCS C1725
Hospital Charge Code	66520217
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$1,589.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$832.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$908.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$757.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$870.55
Rate for Payer: EmblemHealth Commercial	$757.00
Rate for Payer: Fidelis Medicare Advantage	$1,589.70
Rate for Payer: Group Health Inc Commercial	$757.00
Rate for Payer: Group Health Inc Medicare	$529.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$757.00
Rate for Payer: Hamaspik Choice Inc Medicare	$757.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$984.10

CC CATH MAVRK OTW BALL 4.0X12MM

Facility

$1,514.00

Service Code	HCPCS C1725
Hospital Charge Code	66520217
Hospital Revenue Code	278
Min. Negotiated Rate	$757.00
Max. Negotiated Rate	$757.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$757.00
Rate for Payer: Hamaspik Choice Inc Medicare	$757.00

CC CATH MAVRK OTW BALL 4.0X9MM

Facility

$1,514.00

Service Code	HCPCS C1725
Hospital Charge Code	66520214
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$1,589.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$832.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$908.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$757.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$870.55
Rate for Payer: EmblemHealth Commercial	$757.00
Rate for Payer: Fidelis Medicare Advantage	$1,589.70
Rate for Payer: Group Health Inc Commercial	$757.00
Rate for Payer: Group Health Inc Medicare	$529.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$757.00
Rate for Payer: Hamaspik Choice Inc Medicare	$757.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$984.10

CC CATH MAVRK OTW BALL 4.0X9MM

Facility

$1,514.00

Service Code	HCPCS C1725
Hospital Charge Code	66520214
Hospital Revenue Code	278
Min. Negotiated Rate	$757.00
Max. Negotiated Rate	$757.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$757.00
Rate for Payer: Hamaspik Choice Inc Medicare	$757.00

CC CATH MAVR MONO BALL 2.0X25MM

Facility

$1,546.00

Service Code	HCPCS C1725
Hospital Charge Code	66520225
Hospital Revenue Code	278
Min. Negotiated Rate	$773.00
Max. Negotiated Rate	$773.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$773.00
Rate for Payer: Hamaspik Choice Inc Medicare	$773.00

CC CATH MAVR MONO BALL 2.0X25MM

Facility

$1,546.00

Service Code	HCPCS C1725
Hospital Charge Code	66520225
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$1,623.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$850.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$927.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$773.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$888.95
Rate for Payer: EmblemHealth Commercial	$773.00
Rate for Payer: Fidelis Medicare Advantage	$1,623.30
Rate for Payer: Group Health Inc Commercial	$773.00
Rate for Payer: Group Health Inc Medicare	$541.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$773.00
Rate for Payer: Hamaspik Choice Inc Medicare	$773.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,004.90

CC CATH MAVR MONO BALL 2.5X12MM

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520222
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$493.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$258.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$282.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$270.25
Rate for Payer: EmblemHealth Commercial	$235.00
Rate for Payer: Fidelis Medicare Advantage	$493.50
Rate for Payer: Group Health Inc Commercial	$235.00
Rate for Payer: Group Health Inc Medicare	$164.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$305.50

CC CATH MAVR MONO BALL 2.5X12MM

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520222
Hospital Revenue Code	278
Min. Negotiated Rate	$235.00
Max. Negotiated Rate	$235.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00

CC CATH QUANTM BALLOON 2.0X12MM

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520227
Hospital Revenue Code	278
Min. Negotiated Rate	$235.00
Max. Negotiated Rate	$235.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00

CC CATH QUANTM BALLOON 2.0X12MM

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520227
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$493.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$258.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$282.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$270.25
Rate for Payer: EmblemHealth Commercial	$235.00
Rate for Payer: Fidelis Medicare Advantage	$493.50
Rate for Payer: Group Health Inc Commercial	$235.00
Rate for Payer: Group Health Inc Medicare	$164.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$305.50

CC CATH QUANTM BALLOON 2.5X12MM

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520228
Hospital Revenue Code	278
Min. Negotiated Rate	$235.00
Max. Negotiated Rate	$235.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00

CC CATH QUANTM BALLOON 2.5X12MM

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520228
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$493.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$258.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$282.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$270.25
Rate for Payer: EmblemHealth Commercial	$235.00
Rate for Payer: Fidelis Medicare Advantage	$493.50
Rate for Payer: Group Health Inc Commercial	$235.00
Rate for Payer: Group Health Inc Medicare	$164.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$305.50

CC CATH QUANTM BALLOON 3.0X12MM

Facility

$1,586.00

Service Code	HCPCS C1725
Hospital Charge Code	66520229
Hospital Revenue Code	278
Min. Negotiated Rate	$793.00
Max. Negotiated Rate	$793.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$793.00
Rate for Payer: Hamaspik Choice Inc Medicare	$793.00

CC CATH QUANTM BALLOON 3.0X12MM

Facility

$1,586.00

Service Code	HCPCS C1725
Hospital Charge Code	66520229
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$1,665.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$872.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$951.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$793.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$911.95
Rate for Payer: EmblemHealth Commercial	$793.00
Rate for Payer: Fidelis Medicare Advantage	$1,665.30
Rate for Payer: Group Health Inc Commercial	$793.00
Rate for Payer: Group Health Inc Medicare	$555.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$793.00
Rate for Payer: Hamaspik Choice Inc Medicare	$793.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,030.90

CC CATH QUANTM BALLOON 4.0X12MM

Facility

$1,586.00

Service Code	HCPCS C1725
Hospital Charge Code	66520230
Hospital Revenue Code	278
Min. Negotiated Rate	$793.00
Max. Negotiated Rate	$793.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$793.00
Rate for Payer: Hamaspik Choice Inc Medicare	$793.00

CC CATH QUANTM BALLOON 4.0X12MM

Facility

$1,586.00

Service Code	HCPCS C1725
Hospital Charge Code	66520230
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$1,665.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$872.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$951.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$793.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$911.95
Rate for Payer: EmblemHealth Commercial	$793.00
Rate for Payer: Fidelis Medicare Advantage	$1,665.30
Rate for Payer: Group Health Inc Commercial	$793.00
Rate for Payer: Group Health Inc Medicare	$555.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$793.00
Rate for Payer: Hamaspik Choice Inc Medicare	$793.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,030.90

CC CATH QUANTM BALLOON 5.0X12MM

Facility

$1,586.00

Service Code	HCPCS C1725
Hospital Charge Code	66520231
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$1,665.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$872.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$951.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$793.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$911.95
Rate for Payer: EmblemHealth Commercial	$793.00
Rate for Payer: Fidelis Medicare Advantage	$1,665.30
Rate for Payer: Group Health Inc Commercial	$793.00
Rate for Payer: Group Health Inc Medicare	$555.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$793.00
Rate for Payer: Hamaspik Choice Inc Medicare	$793.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,030.90

CC CATH QUANTM BALLOON 5.0X12MM

Facility

$1,586.00

Service Code	HCPCS C1725
Hospital Charge Code	66520231
Hospital Revenue Code	278
Min. Negotiated Rate	$793.00
Max. Negotiated Rate	$793.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$793.00
Rate for Payer: Hamaspik Choice Inc Medicare	$793.00

CC CATH QUANT OTW BALL2.0X12MM

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520232
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$493.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$258.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$282.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$270.25
Rate for Payer: EmblemHealth Commercial	$235.00
Rate for Payer: Fidelis Medicare Advantage	$493.50
Rate for Payer: Group Health Inc Commercial	$235.00
Rate for Payer: Group Health Inc Medicare	$164.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$305.50

CC CATH QUANT OTW BALL2.0X12MM

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520232
Hospital Revenue Code	278
Min. Negotiated Rate	$235.00
Max. Negotiated Rate	$235.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00

CC CATH QUANT OTW BALL 2.5X12MM

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520233
Hospital Revenue Code	278
Min. Negotiated Rate	$235.00
Max. Negotiated Rate	$235.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00

CC CATH QUANT OTW BALL 2.5X12MM

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520233
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$493.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$258.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$282.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$270.25
Rate for Payer: EmblemHealth Commercial	$235.00
Rate for Payer: Fidelis Medicare Advantage	$493.50
Rate for Payer: Group Health Inc Commercial	$235.00
Rate for Payer: Group Health Inc Medicare	$164.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$305.50

CC CATH QUANT OTW BALL 3.5X12MM

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520234
Hospital Revenue Code	278
Min. Negotiated Rate	$235.00
Max. Negotiated Rate	$235.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00

CC CATH QUANT OTW BALL 3.5X12MM

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520234
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$493.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$258.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$282.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$270.25
Rate for Payer: EmblemHealth Commercial	$235.00
Rate for Payer: Fidelis Medicare Advantage	$493.50
Rate for Payer: Group Health Inc Commercial	$235.00
Rate for Payer: Group Health Inc Medicare	$164.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$305.50

CC CIERADIOGRAPHY/FLOUROSCOPY

Facility

$339.45

Service Code	HCPCS 76120 TC
Hospital Charge Code	66528382
Hospital Revenue Code	329
Min. Negotiated Rate	$89.00
Max. Negotiated Rate	$186.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.14
Rate for Payer: Aetna Government	$127.14
Rate for Payer: Affinity Essential Plan 1&2	$89.00
Rate for Payer: Affinity Essential Plan 3&4	$89.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$89.00
Rate for Payer: Brighton Health Commercial	$127.14
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cash Price	$127.14
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$167.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$141.40
Rate for Payer: Elderplan Medicare Advantage	$127.14
Rate for Payer: EmblemHealth Commercial	$89.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$108.07
Rate for Payer: Fidelis Essential Plan Aliesa	$108.07
Rate for Payer: Fidelis Essential Plan QHP	$113.15
Rate for Payer: Fidelis Medicare Advantage	$127.14
Rate for Payer: Fidelis Qualified Health Plan	$113.15
Rate for Payer: Group Health Inc Commercial	$114.43
Rate for Payer: Group Health Inc Medicare	$114.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$127.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$114.43
Rate for Payer: Healthfirst Medicare Advantage	$127.14
Rate for Payer: Healthfirst QHP	$127.14
Rate for Payer: Humana Medicare	$129.68
Rate for Payer: Senior Whole Health Medicare Advantage	$127.14
Rate for Payer: United Healthcare Medicare Advantage	$127.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$127.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$101.71
Rate for Payer: Wellcare Medicare	$120.78

Know your out-of-pocket cost for care.

All Charges