St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

CC DES AB X RX 3.0MMX 18MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528965
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 18MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528965
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 3.0MMX28MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528966
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 3.0MMX28MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528966
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 3.0MMX8MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528967
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 3.0MMX8MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528967
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 3.5MMX12MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528968
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 3.5MMX12MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528968
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 3.5MMX 15MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528969
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 3.5MMX 15MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528969
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 3.5MMX18MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528970
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 3.5MMX18MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528970
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 3.5MMX23MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528971
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 3.5MMX23MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528971
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 3.5MMX28MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528972
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 3.5MMX28MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528972
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 3.5MMX8MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528973
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 3.5MMX8MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528973
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 4.0MMX12MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528974
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 4.0MMX12MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528974
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 4.0MMX15MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528975
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 4.0MMX15MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528975
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 4.0MMX18MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528976
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 4.0MMX18MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528976
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

Know your out-of-pocket cost for care.

All Charges