St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HFN RH 130 DEG 9MM X 340MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006029
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN RH 130 DEG 9MM X 340MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006029
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN RH 130 DEG 9MM X 360MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006030
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN RH 130 DEG 9MM X 360MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006030
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN RH 130 DEG 9MM X 400MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006032
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN RH 130 DEG 9MM X 400MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006032
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN RH 130 DEG 9MM X 420MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006033
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN RH 130 DEG 9MM X 420MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006033
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN RH 130 DEG 9MM X 440MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006034
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN RH 130 DEG 9MM X 440MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006034
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN RH 130 DEG 9MM X 460MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006035
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN RH 130 DEG 9MM X 460MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006035
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN RH 140 DEG 9MM X 380MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006031
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN RH 140 DEG 9MM X 380MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40006031
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN RH DEG 9MM X 420MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005967
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN RH DEG 9MM X 420MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005967
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HG A1C>EQUAL 7.0%<8.0%

Facility

$0.01

Service Code	HCPCS 3051F
Hospital Charge Code	30300191
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

HG A1C>EQUAL 8.0%<9.0%

Facility

$0.01

Service Code	HCPCS 3052F
Hospital Charge Code	30300192
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

HG A1C LEVEL LT. 7.0%

Facility

$0.01

Service Code	HCPCS 3044F
Hospital Charge Code	30307857
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

HGB FRAC PROFILE

Facility

$45.15

Service Code	HCPCS 83021
Hospital Charge Code	40609209
Hospital Revenue Code	305
Rate for Payer: Cash Price	$18.06

HGB FRAC PROFILE

Facility

$45.15

Service Code	HCPCS 83021
Hospital Charge Code	40609209
Hospital Revenue Code	305
Min. Negotiated Rate	$12.64
Max. Negotiated Rate	$33.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.06
Rate for Payer: Aetna Government	$18.06
Rate for Payer: Affinity Essential Plan 1&2	$12.64
Rate for Payer: Affinity Essential Plan 3&4	$12.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$12.64
Rate for Payer: Brighton Health Commercial	$33.86
Rate for Payer: Cash Price	$18.06
Rate for Payer: Cash Price	$18.06
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$18.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.29
Rate for Payer: Elderplan Medicare Advantage	$18.06
Rate for Payer: EmblemHealth Commercial	$18.06
Rate for Payer: Fidelis Essential Plan Aliesa	$15.35
Rate for Payer: Fidelis Essential Plan QHP	$16.07
Rate for Payer: Fidelis Medicare Advantage	$18.06
Rate for Payer: Fidelis Qualified Health Plan	$16.07
Rate for Payer: Group Health Inc Commercial	$18.06
Rate for Payer: Group Health Inc Medicare	$18.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.58
Rate for Payer: Hamaspik Choice Inc Medicare	$18.06
Rate for Payer: Healthfirst Medicare Advantage	$18.06
Rate for Payer: Healthfirst QHP	$18.06
Rate for Payer: Humana Medicare	$18.42
Rate for Payer: Senior Whole Health Medicare Advantage	$18.06
Rate for Payer: United Healthcare Commercial	$22.87
Rate for Payer: United Healthcare Medicare Advantage	$18.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$14.45
Rate for Payer: Wellcare Medicare	$16.25

HIB CONJUGATE 0.5ML VIAL

Facility

$54.00

Service Code	HCPCS 90647
Hospital Charge Code	41649580
Hospital Revenue Code	636
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$35.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.48
Rate for Payer: Aetna Government	$28.48
Rate for Payer: Brighton Health Commercial	$32.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.05
Rate for Payer: Group Health Inc Commercial	$27.00
Rate for Payer: Group Health Inc Medicare	$18.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.00
Rate for Payer: Hamaspik Choice Inc Medicare	$27.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$35.10

HIB CONJUGATE 0.5ML VIAL

Facility

$54.00

Service Code	HCPCS 90647
Hospital Charge Code	41649580
Hospital Revenue Code	636
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.00
Rate for Payer: Hamaspik Choice Inc Medicare	$27.00

HIB CONJUGATE 0.5ML VIAL

Facility

$54.00

Service Code	HCPCS 90647
Hospital Charge Code	41659580
Hospital Revenue Code	636
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.00
Rate for Payer: Hamaspik Choice Inc Medicare	$27.00

HIB CONJUGATE 0.5ML VIAL

Facility

$54.00

Service Code	HCPCS 90647
Hospital Charge Code	41659580
Hospital Revenue Code	636
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$35.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.48
Rate for Payer: Aetna Government	$28.48
Rate for Payer: Brighton Health Commercial	$32.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.05
Rate for Payer: Group Health Inc Commercial	$27.00
Rate for Payer: Group Health Inc Medicare	$18.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.00
Rate for Payer: Hamaspik Choice Inc Medicare	$27.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$35.10

Know your out-of-pocket cost for care.

All Charges