St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DILATOR SERIAL 20FR TELESCOPE

Facility

$244.48

Hospital Charge Code	64902661
Hospital Revenue Code	270
Min. Negotiated Rate	$85.57
Max. Negotiated Rate	$195.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$134.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$122.24
Rate for Payer: Aetna Government	$122.24
Rate for Payer: Brighton Health Commercial	$183.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$195.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$166.25
Rate for Payer: Group Health Inc Commercial	$122.24
Rate for Payer: Group Health Inc Medicare	$85.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$122.24
Rate for Payer: Hamaspik Choice Inc Medicare	$122.24

DILATOR SERIAL TELESCOPE

Facility

$237.38

Hospital Charge Code	64903568
Hospital Revenue Code	270
Min. Negotiated Rate	$83.08
Max. Negotiated Rate	$189.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$118.69
Rate for Payer: Aetna Government	$118.69
Rate for Payer: Brighton Health Commercial	$178.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$189.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.42
Rate for Payer: Group Health Inc Commercial	$118.69
Rate for Payer: Group Health Inc Medicare	$83.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.69
Rate for Payer: Hamaspik Choice Inc Medicare	$118.69

DILATORS SOFT OS LOCATER DISPOSAB

Facility

$9.78

Hospital Charge Code	64903242
Hospital Revenue Code	270
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$7.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.89
Rate for Payer: Aetna Government	$4.89
Rate for Payer: Brighton Health Commercial	$7.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.65
Rate for Payer: Group Health Inc Commercial	$4.89
Rate for Payer: Group Health Inc Medicare	$3.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.89
Rate for Payer: Hamaspik Choice Inc Medicare	$4.89

DILATOR VASC GARRETT 3.5X210MM

Facility

$57.23

Hospital Charge Code	64904347
Hospital Revenue Code	270
Min. Negotiated Rate	$20.03
Max. Negotiated Rate	$45.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.62
Rate for Payer: Aetna Government	$28.62
Rate for Payer: Brighton Health Commercial	$42.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$45.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$38.92
Rate for Payer: Group Health Inc Commercial	$28.62
Rate for Payer: Group Health Inc Medicare	$20.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.62
Rate for Payer: Hamaspik Choice Inc Medicare	$28.62

DILATOR WIRE BALLN CRE 6-8MM 240C

Facility

$774.38

Hospital Charge Code	64904298
Hospital Revenue Code	270
Min. Negotiated Rate	$271.03
Max. Negotiated Rate	$619.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$425.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$387.19
Rate for Payer: Aetna Government	$387.19
Rate for Payer: Brighton Health Commercial	$580.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$619.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$526.58
Rate for Payer: Group Health Inc Commercial	$387.19
Rate for Payer: Group Health Inc Medicare	$271.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$387.19
Rate for Payer: Hamaspik Choice Inc Medicare	$387.19

DILATOR WIRE BALLOON CRE

Facility

$598.00

Hospital Charge Code	40209791
Hospital Revenue Code	270
Min. Negotiated Rate	$209.30
Max. Negotiated Rate	$478.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$328.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$299.00
Rate for Payer: Aetna Government	$299.00
Rate for Payer: Brighton Health Commercial	$448.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$478.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$406.64
Rate for Payer: Group Health Inc Commercial	$299.00
Rate for Payer: Group Health Inc Medicare	$209.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$299.00
Rate for Payer: Hamaspik Choice Inc Medicare	$299.00

DILATOR WIRE BALLOON CRE 1

Facility

$470.00

Hospital Charge Code	40200266
Hospital Revenue Code	270
Min. Negotiated Rate	$164.50
Max. Negotiated Rate	$376.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$258.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$235.00
Rate for Payer: Aetna Government	$235.00
Rate for Payer: Brighton Health Commercial	$352.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$376.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$319.60
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

DILATOR WIRE BALLOON CRE -15-18

Facility

$581.35

Hospital Charge Code	64904223
Hospital Revenue Code	270
Min. Negotiated Rate	$203.47
Max. Negotiated Rate	$465.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$319.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$290.68
Rate for Payer: Aetna Government	$290.68
Rate for Payer: Brighton Health Commercial	$436.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$465.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$395.32
Rate for Payer: Group Health Inc Commercial	$290.68
Rate for Payer: Group Health Inc Medicare	$203.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$290.68
Rate for Payer: Hamaspik Choice Inc Medicare	$290.68

DILATOR WIRE BALLOON CRE 18-20MM

Facility

$406.00

Hospital Charge Code	40209793
Hospital Revenue Code	270
Min. Negotiated Rate	$142.10
Max. Negotiated Rate	$324.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$223.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$203.00
Rate for Payer: Aetna Government	$203.00
Rate for Payer: Brighton Health Commercial	$304.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$324.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$276.08
Rate for Payer: Group Health Inc Commercial	$203.00
Rate for Payer: Group Health Inc Medicare	$142.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.00
Rate for Payer: Hamaspik Choice Inc Medicare	$203.00

DILATOR WIRE BALLOON CRE 2

Facility

$540.00

Hospital Charge Code	40200267
Hospital Revenue Code	270
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$432.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$297.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$270.00
Rate for Payer: Aetna Government	$270.00
Rate for Payer: Brighton Health Commercial	$405.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$432.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$367.20
Rate for Payer: Group Health Inc Commercial	$270.00
Rate for Payer: Group Health Inc Medicare	$189.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$270.00
Rate for Payer: Hamaspik Choice Inc Medicare	$270.00

DILATOR WIRE BALLOON CRE 8-10MM

Facility

$460.00

Hospital Charge Code	40209794
Hospital Revenue Code	270
Min. Negotiated Rate	$161.00
Max. Negotiated Rate	$368.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$253.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$230.00
Rate for Payer: Aetna Government	$230.00
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

DILATOR WIRE BALLOON CRE -8-9-10

Facility

$747.50

Hospital Charge Code	64904221
Hospital Revenue Code	270
Min. Negotiated Rate	$261.62
Max. Negotiated Rate	$598.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$411.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$373.75
Rate for Payer: Aetna Government	$373.75
Rate for Payer: Brighton Health Commercial	$560.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$598.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$508.30
Rate for Payer: Group Health Inc Commercial	$373.75
Rate for Payer: Group Health Inc Medicare	$261.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$373.75
Rate for Payer: Hamaspik Choice Inc Medicare	$373.75

DILATOR WIRE BLLN CRE 10-11-12MM

Facility

$460.00

Hospital Charge Code	40209792
Hospital Revenue Code	270
Min. Negotiated Rate	$161.00
Max. Negotiated Rate	$368.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$253.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$230.00
Rate for Payer: Aetna Government	$230.00
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

DILATR WIRE BALLN CRE 10-12M 240C

Facility

$747.50

Hospital Charge Code	64903944
Hospital Revenue Code	270
Min. Negotiated Rate	$261.62
Max. Negotiated Rate	$598.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$411.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$373.75
Rate for Payer: Aetna Government	$373.75
Rate for Payer: Brighton Health Commercial	$560.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$598.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$508.30
Rate for Payer: Group Health Inc Commercial	$373.75
Rate for Payer: Group Health Inc Medicare	$261.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$373.75
Rate for Payer: Hamaspik Choice Inc Medicare	$373.75

DILATR WIRE BALLN CRE 12-15M 240C

Facility

$747.50

Hospital Charge Code	64903942
Hospital Revenue Code	270
Min. Negotiated Rate	$261.62
Max. Negotiated Rate	$598.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$411.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$373.75
Rate for Payer: Aetna Government	$373.75
Rate for Payer: Brighton Health Commercial	$560.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$598.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$508.30
Rate for Payer: Group Health Inc Commercial	$373.75
Rate for Payer: Group Health Inc Medicare	$261.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$373.75
Rate for Payer: Hamaspik Choice Inc Medicare	$373.75

DIL RETINA EXAM INTERP REV

Facility

$0.01

Service Code	HCPCS 2022F
Hospital Charge Code	30305435
Hospital Revenue Code	969
Max. Negotiated Rate	$2,915.00
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	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
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

DILTIAZEM 120 MG ERC

Facility

$0.46

Hospital Charge Code	41653947
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.30

DILTIAZEM 120 MG ERC

Facility

$0.46

Hospital Charge Code	41643947
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.30

DILTIAZEM 125 MG/25 ML INJ

Facility

$5.00

Hospital Charge Code	41652473
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$4.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.50
Rate for Payer: Aetna Government	$2.50
Rate for Payer: Brighton Health Commercial	$3.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.25

DILTIAZEM 125 MG/25 ML INJ

Facility

$5.00

Hospital Charge Code	41642473
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$4.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.50
Rate for Payer: Aetna Government	$2.50
Rate for Payer: Brighton Health Commercial	$3.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.25

DILTIAZEM 180 MG ERC

Facility

$0.52

Hospital Charge Code	41644125
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.35
Rate for Payer: Group Health Inc Commercial	$0.26
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26
Rate for Payer: Hamaspik Choice Inc Medicare	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

DILTIAZEM 180 MG ERC

Facility

$0.52

Hospital Charge Code	41654125
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.35
Rate for Payer: Group Health Inc Commercial	$0.26
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26
Rate for Payer: Hamaspik Choice Inc Medicare	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

DILTIAZEM 240 MG ERC

Facility

$0.77

Hospital Charge Code	41643948
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.39
Rate for Payer: Aetna Government	$0.39
Rate for Payer: Brighton Health Commercial	$0.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.52
Rate for Payer: Group Health Inc Commercial	$0.39
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39
Rate for Payer: Hamaspik Choice Inc Medicare	$0.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.50

DILTIAZEM 240 MG ERC

Facility

$0.77

Hospital Charge Code	41653948
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.39
Rate for Payer: Aetna Government	$0.39
Rate for Payer: Brighton Health Commercial	$0.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.52
Rate for Payer: Group Health Inc Commercial	$0.39
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39
Rate for Payer: Hamaspik Choice Inc Medicare	$0.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.50

DILTIAZEM 25 MG/5 ML INJ

Facility

$1.09

Hospital Charge Code	41643272
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.55
Rate for Payer: Aetna Government	$0.55
Rate for Payer: Brighton Health Commercial	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.74
Rate for Payer: Group Health Inc Commercial	$0.55
Rate for Payer: Group Health Inc Medicare	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.55
Rate for Payer: Hamaspik Choice Inc Medicare	$0.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.71

Know your out-of-pocket cost for care.

All Charges