St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CC DES AB X RX 2.5MMX15MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528952
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00

CC DES AB X RX 2.5MMX15MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528952
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,095.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,145.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$2,340.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,950.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,242.50
Rate for Payer: EmblemHealth Commercial	$1,950.00
Rate for Payer: Fidelis Medicare Advantage	$4,095.00
Rate for Payer: Group Health Inc Commercial	$1,950.00
Rate for Payer: Group Health Inc Medicare	$1,365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,535.00

CC DES AB X RX 2.5MMX18MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528953
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00

CC DES AB X RX 2.5MMX18MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528953
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,095.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,145.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$2,340.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,950.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,242.50
Rate for Payer: EmblemHealth Commercial	$1,950.00
Rate for Payer: Fidelis Medicare Advantage	$4,095.00
Rate for Payer: Group Health Inc Commercial	$1,950.00
Rate for Payer: Group Health Inc Medicare	$1,365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,535.00

CC DES AB X RX 2.5MMX23MM

Facility

$1,950.00

Service Code	HCPCS C1874
Hospital Charge Code	66528954
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 DES AB X RX 2.5MMX23MM

Facility

$1,950.00

Service Code	HCPCS C1874
Hospital Charge Code	66528954
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$2,047.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,072.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
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 DES AB X RX 2.5MMX28MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528955
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00

CC DES AB X RX 2.5MMX28MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528955
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,095.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,145.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$2,340.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,950.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,242.50
Rate for Payer: EmblemHealth Commercial	$1,950.00
Rate for Payer: Fidelis Medicare Advantage	$4,095.00
Rate for Payer: Group Health Inc Commercial	$1,950.00
Rate for Payer: Group Health Inc Medicare	$1,365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,535.00

CC DES AB X RX 2.5MMX8MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528956
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,095.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,145.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$2,340.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,950.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,242.50
Rate for Payer: EmblemHealth Commercial	$1,950.00
Rate for Payer: Fidelis Medicare Advantage	$4,095.00
Rate for Payer: Group Health Inc Commercial	$1,950.00
Rate for Payer: Group Health Inc Medicare	$1,365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,535.00

CC DES AB X RX 2.5MMX8MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528956
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00

CC DES AB X RX 2.75MMX 12MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528957
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,095.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,145.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$2,340.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,950.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,242.50
Rate for Payer: EmblemHealth Commercial	$1,950.00
Rate for Payer: Fidelis Medicare Advantage	$4,095.00
Rate for Payer: Group Health Inc Commercial	$1,950.00
Rate for Payer: Group Health Inc Medicare	$1,365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,535.00

CC DES AB X RX 2.75MMX 12MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528957
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00

CC DES AB X RX 2.75MM X15MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528958
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00

CC DES AB X RX 2.75MM X15MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528958
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,095.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,145.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$2,340.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,950.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,242.50
Rate for Payer: EmblemHealth Commercial	$1,950.00
Rate for Payer: Fidelis Medicare Advantage	$4,095.00
Rate for Payer: Group Health Inc Commercial	$1,950.00
Rate for Payer: Group Health Inc Medicare	$1,365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,535.00

CC DES AB X RX 2.75MMX18MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528959
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00

CC DES AB X RX 2.75MMX18MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528959
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,095.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,145.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$2,340.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,950.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,242.50
Rate for Payer: EmblemHealth Commercial	$1,950.00
Rate for Payer: Fidelis Medicare Advantage	$4,095.00
Rate for Payer: Group Health Inc Commercial	$1,950.00
Rate for Payer: Group Health Inc Medicare	$1,365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,535.00

CC DES AB X RX 2.75MMX23MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528960
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00

CC DES AB X RX 2.75MMX23MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528960
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,095.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,145.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$2,340.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,950.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,242.50
Rate for Payer: EmblemHealth Commercial	$1,950.00
Rate for Payer: Fidelis Medicare Advantage	$4,095.00
Rate for Payer: Group Health Inc Commercial	$1,950.00
Rate for Payer: Group Health Inc Medicare	$1,365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,535.00

CC DES AB X RX 2.75MMX28MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528961
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00

CC DES AB X RX 2.75MMX28MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528961
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,095.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,145.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$2,340.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,950.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,242.50
Rate for Payer: EmblemHealth Commercial	$1,950.00
Rate for Payer: Fidelis Medicare Advantage	$4,095.00
Rate for Payer: Group Health Inc Commercial	$1,950.00
Rate for Payer: Group Health Inc Medicare	$1,365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,535.00

CC DES AB X RX 2.75X8MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528962
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00

CC DES AB X RX 2.75X8MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528962
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,095.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,145.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$2,340.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,950.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,242.50
Rate for Payer: EmblemHealth Commercial	$1,950.00
Rate for Payer: Fidelis Medicare Advantage	$4,095.00
Rate for Payer: Group Health Inc Commercial	$1,950.00
Rate for Payer: Group Health Inc Medicare	$1,365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,535.00

CC DES AB X RX 3.0MMX 12MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528963
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00

CC DES AB X RX 3.0MMX 12MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528963
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,095.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,145.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$2,340.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,950.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,242.50
Rate for Payer: EmblemHealth Commercial	$1,950.00
Rate for Payer: Fidelis Medicare Advantage	$4,095.00
Rate for Payer: Group Health Inc Commercial	$1,950.00
Rate for Payer: Group Health Inc Medicare	$1,365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,535.00

CC DES AB X RX 3.0MMX 15MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528964
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00

Know your out-of-pocket cost for care.

All Charges