St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

COVERS, CLEAN PROBE

Facility

$2.73

Hospital Charge Code	64903824
Hospital Revenue Code	270
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$2.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.36
Rate for Payer: Aetna Government	$1.36
Rate for Payer: Brighton Health Commercial	$2.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.86
Rate for Payer: Group Health Inc Commercial	$1.36
Rate for Payer: Group Health Inc Medicare	$0.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.36
Rate for Payer: Hamaspik Choice Inc Medicare	$1.36

COVERS,LIGHT HANDLE,FLEXI PRPLE

Facility

$53.06

Hospital Charge Code	64901312
Hospital Revenue Code	270
Min. Negotiated Rate	$18.57
Max. Negotiated Rate	$42.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.53
Rate for Payer: Aetna Government	$26.53
Rate for Payer: Brighton Health Commercial	$39.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$42.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$36.08
Rate for Payer: Group Health Inc Commercial	$26.53
Rate for Payer: Group Health Inc Medicare	$18.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.53
Rate for Payer: Hamaspik Choice Inc Medicare	$26.53

COVERS MINI-ALPHA MOP

Facility

$6.03

Hospital Charge Code	64902608
Hospital Revenue Code	270
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$4.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.02
Rate for Payer: Aetna Government	$3.02
Rate for Payer: Brighton Health Commercial	$4.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.10
Rate for Payer: Group Health Inc Commercial	$3.02
Rate for Payer: Group Health Inc Medicare	$2.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.02
Rate for Payer: Hamaspik Choice Inc Medicare	$3.02

COVER SWITCH FOOT

Facility

$700.00

Hospital Charge Code	64902885
Hospital Revenue Code	270
Min. Negotiated Rate	$245.00
Max. Negotiated Rate	$560.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$385.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$350.00
Rate for Payer: Aetna Government	$350.00
Rate for Payer: Brighton Health Commercial	$525.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$560.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$476.00
Rate for Payer: Group Health Inc Commercial	$350.00
Rate for Payer: Group Health Inc Medicare	$245.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00

COVER ULTRASND PROBE W/GEL ST

Facility

$16.98

Hospital Charge Code	64903898
Hospital Revenue Code	270
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$13.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.49
Rate for Payer: Aetna Government	$8.49
Rate for Payer: Brighton Health Commercial	$12.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.55
Rate for Payer: Group Health Inc Commercial	$8.49
Rate for Payer: Group Health Inc Medicare	$5.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.49
Rate for Payer: Hamaspik Choice Inc Medicare	$8.49

COVER UN3 BURRHOLE 20MM 53-34520

Facility

$224.33

Service Code	HCPCS C1713
Hospital Charge Code	64906506
Hospital Revenue Code	278
Min. Negotiated Rate	$112.16
Max. Negotiated Rate	$112.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.16
Rate for Payer: Hamaspik Choice Inc Medicare	$112.16

COVER UN3 BURRHOLE 20MM 53-34520

Facility

$224.33

Service Code	HCPCS C1713
Hospital Charge Code	64906506
Hospital Revenue Code	278
Min. Negotiated Rate	$78.52
Max. Negotiated Rate	$235.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$123.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$134.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$112.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$128.99
Rate for Payer: EmblemHealth Commercial	$112.16
Rate for Payer: Fidelis Medicare Advantage	$235.55
Rate for Payer: Group Health Inc Commercial	$112.16
Rate for Payer: Group Health Inc Medicare	$78.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.16
Rate for Payer: Hamaspik Choice Inc Medicare	$112.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$145.81

COVID-19 BIVALENT 12&OLDER PFIZER

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41640385
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

COVID-19 BIVALENT 12&OLDER PFIZER

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41650385
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

COVID-19 BIVALENT 12&OLDER PFIZER

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41640385
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

COVID-19 BIVALENT 12&OLDER PFIZER

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41650385
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

COVID-19 BIVALENT 5-11YRS PFIZER

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41640384
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

COVID-19 BIVALENT 5-11YRS PFIZER

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41650384
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

COVID-19 BIVALENT 5-11YRS PFIZER

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41640384
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

COVID-19 BIVALENT 5-11YRS PFIZER

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41650384
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

COVID-19 BIVALENT 6MON-4YR PFIZER

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41640397
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

COVID-19 BIVALENT 6MON-4YR PFIZER

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41650397
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

COVID-19 BIVALENT 6MON-4YR PFIZER

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41650397
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

COVID-19 BIVALENT 6MON-4YR PFIZER

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41640397
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

COVID-19 MRNA VAC-TRIS(PFIZER) 30 MCG/0.3ML IM SUSP [181394]

Facility

$0.01

Service Code	HCPCS 91305
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01

COVID-19 MRNA VAC-TRIS(PFIZER) 30 MCG/0.3ML IM SUSP [181394]

Facility

$0.00

Service Code	HCPCS 91305
Hospital Charge Code	59267102504
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.00
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.00

COVID-19 MRNA VAC-TRIS(PFIZER) 30 MCG/0.3ML IM SUSP [181394]

Facility

$460.00

Service Code	HCPCS 91305
Hospital Charge Code	00069236210
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$368.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$253.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$345.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$368.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$312.80
Rate for Payer: Group Health Inc Commercial	$230.00
Rate for Payer: Group Health Inc Medicare	$161.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$230.00
Rate for Payer: Hamaspik Choice Inc Medicare	$230.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$299.00

COVID19NYR

Facility

$97.50

Service Code	HCPCS U0003
Hospital Charge Code	40601995
Hospital Revenue Code	306
Min. Negotiated Rate	$34.12
Max. Negotiated Rate	$90.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75.00
Rate for Payer: Aetna Government	$75.00
Rate for Payer: Brighton Health Commercial	$73.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$66.30
Rate for Payer: Group Health Inc Commercial	$48.75
Rate for Payer: Group Health Inc Medicare	$34.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.75
Rate for Payer: Hamaspik Choice Inc Medicare	$48.75
Rate for Payer: United Healthcare Commercial	$90.00

COVID-19 PEDS VACCINE (PFIZER)

Facility

$0.01

Service Code	HCPCS 91307
Hospital Charge Code	41640280
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

COVID-19 PEDS VACCINE (PFIZER)

Facility

$0.01

Service Code	HCPCS 91307
Hospital Charge Code	41650280
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

Know your out-of-pocket cost for care.

All Charges