St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LIFESTENT 5MMX60MMX80CM

Facility

$3,200.00

Service Code	HCPCS C1876
Hospital Charge Code	40004788
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,760.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,920.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,840.00
Rate for Payer: EmblemHealth Commercial	$1,600.00
Rate for Payer: Fidelis Medicare Advantage	$3,360.00
Rate for Payer: Group Health Inc Commercial	$1,600.00
Rate for Payer: Group Health Inc Medicare	$1,120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,080.00

LIFESTENT 5MMX60MMX80CM

Facility

$3,200.00

Service Code	HCPCS C1876
Hospital Charge Code	40004788
Hospital Revenue Code	278
Min. Negotiated Rate	$1,600.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.00

LIFESTENT 5MMX80MMX80CM

Facility

$3,200.00

Service Code	HCPCS C1876
Hospital Charge Code	40004789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,600.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.00

LIFESTENT 5MMX80MMX80CM

Facility

$3,200.00

Service Code	HCPCS C1876
Hospital Charge Code	40004789
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,760.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,920.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,840.00
Rate for Payer: EmblemHealth Commercial	$1,600.00
Rate for Payer: Fidelis Medicare Advantage	$3,360.00
Rate for Payer: Group Health Inc Commercial	$1,600.00
Rate for Payer: Group Health Inc Medicare	$1,120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,080.00

LIFESTENT 6MMX1000MMX100CM

Facility

$4,600.00

Service Code	HCPCS C1876
Hospital Charge Code	40004798
Hospital Revenue Code	278
Min. Negotiated Rate	$2,300.00
Max. Negotiated Rate	$2,300.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,300.00

LIFESTENT 6MMX1000MMX100CM

Facility

$4,600.00

Service Code	HCPCS C1876
Hospital Charge Code	40004798
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$4,830.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,530.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$2,760.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,645.00
Rate for Payer: EmblemHealth Commercial	$2,300.00
Rate for Payer: Fidelis Medicare Advantage	$4,830.00
Rate for Payer: Group Health Inc Commercial	$2,300.00
Rate for Payer: Group Health Inc Medicare	$1,610.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,300.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,990.00

LIFESTENT 6MMX100MMX80CM

Facility

$3,200.00

Service Code	HCPCS C1876
Hospital Charge Code	40004794
Hospital Revenue Code	278
Min. Negotiated Rate	$1,600.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.00

LIFESTENT 6MMX100MMX80CM

Facility

$3,200.00

Service Code	HCPCS C1876
Hospital Charge Code	40004794
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,760.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,920.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,840.00
Rate for Payer: EmblemHealth Commercial	$1,600.00
Rate for Payer: Fidelis Medicare Advantage	$3,360.00
Rate for Payer: Group Health Inc Commercial	$1,600.00
Rate for Payer: Group Health Inc Medicare	$1,120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,080.00

LIFESTENT 6MMX120MMX80CM

Facility

$3,500.00

Service Code	HCPCS C1876
Hospital Charge Code	40004795
Hospital Revenue Code	278
Min. Negotiated Rate	$1,750.00
Max. Negotiated Rate	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,750.00

LIFESTENT 6MMX120MMX80CM

Facility

$3,500.00

Service Code	HCPCS C1876
Hospital Charge Code	40004795
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,675.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,925.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$2,100.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,750.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,012.50
Rate for Payer: EmblemHealth Commercial	$1,750.00
Rate for Payer: Fidelis Medicare Advantage	$3,675.00
Rate for Payer: Group Health Inc Commercial	$1,750.00
Rate for Payer: Group Health Inc Medicare	$1,225.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,750.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,275.00

LIFESTENT 6MMX150MMX80CM

Facility

$3,800.00

Service Code	HCPCS C1876
Hospital Charge Code	40004796
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,990.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,090.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$2,280.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,900.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,185.00
Rate for Payer: EmblemHealth Commercial	$1,900.00
Rate for Payer: Fidelis Medicare Advantage	$3,990.00
Rate for Payer: Group Health Inc Commercial	$1,900.00
Rate for Payer: Group Health Inc Medicare	$1,330.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,900.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,470.00

LIFESTENT 6MMX150MMX80CM

Facility

$3,800.00

Service Code	HCPCS C1876
Hospital Charge Code	40004796
Hospital Revenue Code	278
Min. Negotiated Rate	$1,900.00
Max. Negotiated Rate	$1,900.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,900.00

LIFESTENT 6MMX170MMX80CM

Facility

$4,100.00

Service Code	HCPCS C1876
Hospital Charge Code	40004797
Hospital Revenue Code	278
Min. Negotiated Rate	$2,050.00
Max. Negotiated Rate	$2,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,050.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,050.00

LIFESTENT 6MMX170MMX80CM

Facility

$4,100.00

Service Code	HCPCS C1876
Hospital Charge Code	40004797
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$4,305.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,255.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$2,460.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,050.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,357.50
Rate for Payer: EmblemHealth Commercial	$2,050.00
Rate for Payer: Fidelis Medicare Advantage	$4,305.00
Rate for Payer: Group Health Inc Commercial	$2,050.00
Rate for Payer: Group Health Inc Medicare	$1,435.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,050.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,050.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,665.00

LIFESTENT 6MMX40MMX80CM

Facility

$3,200.00

Service Code	HCPCS C1876
Hospital Charge Code	40004791
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,760.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,920.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,840.00
Rate for Payer: EmblemHealth Commercial	$1,600.00
Rate for Payer: Fidelis Medicare Advantage	$3,360.00
Rate for Payer: Group Health Inc Commercial	$1,600.00
Rate for Payer: Group Health Inc Medicare	$1,120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,080.00

LIFESTENT 6MMX40MMX80CM

Facility

$3,200.00

Service Code	HCPCS C1876
Hospital Charge Code	40004791
Hospital Revenue Code	278
Min. Negotiated Rate	$1,600.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.00

LIFESTENT 6MMX60MMX80CM

Facility

$3,200.00

Service Code	HCPCS C1876
Hospital Charge Code	40004792
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,760.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,920.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,840.00
Rate for Payer: EmblemHealth Commercial	$1,600.00
Rate for Payer: Fidelis Medicare Advantage	$3,360.00
Rate for Payer: Group Health Inc Commercial	$1,600.00
Rate for Payer: Group Health Inc Medicare	$1,120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,080.00

LIFESTENT 6MMX60MMX80CM

Facility

$3,200.00

Service Code	HCPCS C1876
Hospital Charge Code	40004792
Hospital Revenue Code	278
Min. Negotiated Rate	$1,600.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.00

LIFESTENT 6MMX80MMX80CM

Facility

$3,200.00

Service Code	HCPCS C1876
Hospital Charge Code	40004793
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,760.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,920.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,840.00
Rate for Payer: EmblemHealth Commercial	$1,600.00
Rate for Payer: Fidelis Medicare Advantage	$3,360.00
Rate for Payer: Group Health Inc Commercial	$1,600.00
Rate for Payer: Group Health Inc Medicare	$1,120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,080.00

LIFESTENT 6MMX80MMX80CM

Facility

$3,200.00

Service Code	HCPCS C1876
Hospital Charge Code	40004793
Hospital Revenue Code	278
Min. Negotiated Rate	$1,600.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.00

LIFESTENT XL 6FR, 6X150X.035

Facility

$4,750.00

Service Code	HCPCS C1876
Hospital Charge Code	64905670
Hospital Revenue Code	278
Min. Negotiated Rate	$2,375.00
Max. Negotiated Rate	$2,375.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,375.00

LIFESTENT XL 6FR, 6X150X.035

Facility

$4,750.00

Service Code	HCPCS C1876
Hospital Charge Code	64905670
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$4,987.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,612.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$2,850.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,375.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,731.25
Rate for Payer: EmblemHealth Commercial	$2,375.00
Rate for Payer: Fidelis Medicare Advantage	$4,987.50
Rate for Payer: Group Health Inc Commercial	$2,375.00
Rate for Payer: Group Health Inc Medicare	$1,662.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,375.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,087.50

LIFSTNT XL BIL 6FR 6MMX150MMX.035

Facility

$3,800.00

Service Code	HCPCS C2623
Hospital Charge Code	40004751
Hospital Revenue Code	278
Min. Negotiated Rate	$1,900.00
Max. Negotiated Rate	$1,900.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,900.00

LIFSTNT XL BIL 6FR 6MMX150MMX.035

Facility

$3,800.00

Service Code	HCPCS C2623
Hospital Charge Code	40004751
Hospital Revenue Code	278
Min. Negotiated Rate	$1,330.00
Max. Negotiated Rate	$3,990.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,090.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,900.00
Rate for Payer: Aetna Government	$1,900.00
Rate for Payer: Brighton Health Commercial	$2,280.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,900.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,185.00
Rate for Payer: EmblemHealth Commercial	$1,900.00
Rate for Payer: Fidelis Medicare Advantage	$3,990.00
Rate for Payer: Group Health Inc Commercial	$1,900.00
Rate for Payer: Group Health Inc Medicare	$1,330.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,900.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,470.00

LIGACLIP ALL-PORT

Facility

$2,059.25

Hospital Charge Code	64902865
Hospital Revenue Code	270
Min. Negotiated Rate	$720.74
Max. Negotiated Rate	$1,647.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,132.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,029.62
Rate for Payer: Aetna Government	$1,029.62
Rate for Payer: Brighton Health Commercial	$1,544.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,647.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,400.29
Rate for Payer: Group Health Inc Commercial	$1,029.62
Rate for Payer: Group Health Inc Medicare	$720.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,029.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,029.62

Know your out-of-pocket cost for care.

All Charges