St. Barnabas Hospital

All Charges

Charge

Type

Price

STENT 6MMX200MMX135MM

Facility OP

$4,600.00

Service Code	HCPCS C1877
Hospital Charge Code	40004814
Hospital Revenue Code	278
Min. Negotiated Rate	$127.45
Max. Negotiated Rate	$4,830.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,530.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
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: 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

STENT 6MMX200MMX135MM

Facility IP

$4,600.00

Service Code	HCPCS C1877
Hospital Charge Code	40004814
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

STENT 6MMX80MMX135CM

Facility OP

$3,200.00

Service Code	HCPCS C1877
Hospital Charge Code	40004813
Hospital Revenue Code	278
Min. Negotiated Rate	$127.45
Max. Negotiated Rate	$3,360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,760.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
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: 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

STENT 6MMX80MMX135CM

Facility IP

$3,200.00

Service Code	HCPCS C1877
Hospital Charge Code	40004813
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

STENT 8 X 60 ZILVER

Facility IP

$3,375.00

Service Code	HCPCS C1876
Hospital Charge Code	64904546
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$1,687.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,687.50

STENT 8 X 60 ZILVER

Facility OP

$3,375.00

Service Code	HCPCS C1876
Hospital Charge Code	64904546
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,543.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,856.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,687.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,940.62
Rate for Payer: Fidelis Medicare Advantage	$3,543.75
Rate for Payer: Group Health Inc Commercial	$1,687.50
Rate for Payer: Group Health Inc Medicare	$1,181.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,687.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,193.75

STENT BALLOON EXPD

Facility OP

$8,935.00

Hospital Charge Code	64907336
Hospital Revenue Code	279
Min. Negotiated Rate	$3,127.25
Max. Negotiated Rate	$7,148.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,914.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,467.50
Rate for Payer: Aetna Government	$4,467.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,148.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,075.80
Rate for Payer: Group Health Inc Commercial	$4,467.50
Rate for Payer: Group Health Inc Medicare	$3,127.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,467.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,467.50

STENT BIL DBL PIGTAIL 7FRX10CM

Facility OP

$230.18

Service Code	HCPCS C1877
Hospital Charge Code	64902988
Hospital Revenue Code	278
Min. Negotiated Rate	$80.56
Max. Negotiated Rate	$241.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$115.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.35
Rate for Payer: Fidelis Medicare Advantage	$241.69
Rate for Payer: Group Health Inc Commercial	$115.09
Rate for Payer: Group Health Inc Medicare	$80.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.09
Rate for Payer: Hamaspik Choice Inc Medicare	$115.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$149.62

STENT BIL DBL PIGTAIL 7FRX10CM

Facility IP

$230.18

Service Code	HCPCS C1877
Hospital Charge Code	64902988
Hospital Revenue Code	278
Min. Negotiated Rate	$115.09
Max. Negotiated Rate	$115.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.09
Rate for Payer: Hamaspik Choice Inc Medicare	$115.09

STENT BIL DBL PIGTAIL 7FRX12CM

Facility IP

$230.18

Service Code	HCPCS C1877
Hospital Charge Code	64902990
Hospital Revenue Code	278
Min. Negotiated Rate	$115.09
Max. Negotiated Rate	$115.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.09
Rate for Payer: Hamaspik Choice Inc Medicare	$115.09

STENT BIL DBL PIGTAIL 7FRX12CM

Facility OP

$230.18

Service Code	HCPCS C1877
Hospital Charge Code	64902990
Hospital Revenue Code	278
Min. Negotiated Rate	$80.56
Max. Negotiated Rate	$241.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$115.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.35
Rate for Payer: Fidelis Medicare Advantage	$241.69
Rate for Payer: Group Health Inc Commercial	$115.09
Rate for Payer: Group Health Inc Medicare	$80.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.09
Rate for Payer: Hamaspik Choice Inc Medicare	$115.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$149.62

STENT BIL DBL PIGTAIL 7FRX5CM

Facility OP

$146.90

Service Code	HCPCS C1877
Hospital Charge Code	64902985
Hospital Revenue Code	278
Min. Negotiated Rate	$51.42
Max. Negotiated Rate	$154.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$73.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$84.47
Rate for Payer: Fidelis Medicare Advantage	$154.24
Rate for Payer: Group Health Inc Commercial	$73.45
Rate for Payer: Group Health Inc Medicare	$51.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.45
Rate for Payer: Hamaspik Choice Inc Medicare	$73.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$95.48

STENT BIL DBL PIGTAIL 7FRX5CM

Facility IP

$146.90

Service Code	HCPCS C1877
Hospital Charge Code	64902985
Hospital Revenue Code	278
Min. Negotiated Rate	$73.45
Max. Negotiated Rate	$73.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.45
Rate for Payer: Hamaspik Choice Inc Medicare	$73.45

STENT BIL DBL PIGTAIL 7FRX7CM

Facility IP

$146.90

Service Code	HCPCS C1877
Hospital Charge Code	64902987
Hospital Revenue Code	278
Min. Negotiated Rate	$73.45
Max. Negotiated Rate	$73.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.45
Rate for Payer: Hamaspik Choice Inc Medicare	$73.45

STENT BIL DBL PIGTAIL 7FRX7CM

Facility OP

$146.90

Service Code	HCPCS C1877
Hospital Charge Code	64902987
Hospital Revenue Code	278
Min. Negotiated Rate	$51.42
Max. Negotiated Rate	$154.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$73.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$84.47
Rate for Payer: Fidelis Medicare Advantage	$154.24
Rate for Payer: Group Health Inc Commercial	$73.45
Rate for Payer: Group Health Inc Medicare	$51.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.45
Rate for Payer: Hamaspik Choice Inc Medicare	$73.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$95.48

STENT BILIARY PLASTIC 10F 7CM

Facility IP

$456.03

Service Code	HCPCS C1877
Hospital Charge Code	64901221
Hospital Revenue Code	278
Min. Negotiated Rate	$228.02
Max. Negotiated Rate	$228.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$228.02
Rate for Payer: Hamaspik Choice Inc Medicare	$228.02

STENT BILIARY PLASTIC 10F 7CM

Facility OP

$456.03

Service Code	HCPCS C1877
Hospital Charge Code	64901221
Hospital Revenue Code	278
Min. Negotiated Rate	$127.45
Max. Negotiated Rate	$478.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$250.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$228.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$262.22
Rate for Payer: Fidelis Medicare Advantage	$478.83
Rate for Payer: Group Health Inc Commercial	$228.02
Rate for Payer: Group Health Inc Medicare	$159.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$228.02
Rate for Payer: Hamaspik Choice Inc Medicare	$228.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$296.42

STENT BILIARY PLASTIC 7FR X 7CM

Facility IP

$456.03

Service Code	HCPCS C1877
Hospital Charge Code	64901219
Hospital Revenue Code	278
Min. Negotiated Rate	$228.02
Max. Negotiated Rate	$228.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$228.02
Rate for Payer: Hamaspik Choice Inc Medicare	$228.02

STENT BILIARY PLASTIC 7FR X 7CM

Facility OP

$456.03

Service Code	HCPCS C1877
Hospital Charge Code	64901219
Hospital Revenue Code	278
Min. Negotiated Rate	$127.45
Max. Negotiated Rate	$478.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$250.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$228.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$262.22
Rate for Payer: Fidelis Medicare Advantage	$478.83
Rate for Payer: Group Health Inc Commercial	$228.02
Rate for Payer: Group Health Inc Medicare	$159.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$228.02
Rate for Payer: Hamaspik Choice Inc Medicare	$228.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$296.42

STENT BILIARY PLASTIC RX 10F 12CM

Facility OP

$312.50

Hospital Charge Code	64904505
Hospital Revenue Code	270
Min. Negotiated Rate	$109.38
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$171.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$156.25
Rate for Payer: Aetna Government	$156.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$212.50
Rate for Payer: Group Health Inc Commercial	$156.25
Rate for Payer: Group Health Inc Medicare	$109.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.25
Rate for Payer: Hamaspik Choice Inc Medicare	$156.25

STENT BILI PALMAZ XL TRANSHEPATIC

Facility OP

$2,725.00

Service Code	HCPCS C1876
Hospital Charge Code	64902024
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,861.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,498.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,362.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,566.88
Rate for Payer: Fidelis Medicare Advantage	$2,861.25
Rate for Payer: Group Health Inc Commercial	$1,362.50
Rate for Payer: Group Health Inc Medicare	$953.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,362.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,362.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,771.25

STENT BILI PALMAZ XL TRANSHEPATIC

Facility IP

$2,725.00

Service Code	HCPCS C1876
Hospital Charge Code	64902024
Hospital Revenue Code	278
Min. Negotiated Rate	$1,362.50
Max. Negotiated Rate	$1,362.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,362.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,362.50

STENT CRTD MNRL

Facility IP

$6,987.50

Service Code	HCPCS C1784
Hospital Charge Code	64907320
Hospital Revenue Code	278
Min. Negotiated Rate	$3,493.75
Max. Negotiated Rate	$3,493.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,493.75
Rate for Payer: Hamaspik Choice Inc Medicare	$3,493.75

STENT CRTD MNRL

Facility OP

$6,987.50

Service Code	HCPCS C1784
Hospital Charge Code	64907320
Hospital Revenue Code	278
Min. Negotiated Rate	$21.79
Max. Negotiated Rate	$7,336.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,843.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.79
Rate for Payer: Aetna Government	$21.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,493.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,017.81
Rate for Payer: Fidelis Medicare Advantage	$7,336.88
Rate for Payer: Group Health Inc Commercial	$3,493.75
Rate for Payer: Group Health Inc Medicare	$2,445.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,493.75
Rate for Payer: Hamaspik Choice Inc Medicare	$3,493.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,541.88

STENT DIVERSION 6FR.

Facility OP

$515.48

Service Code	HCPCS C1877
Hospital Charge Code	64903070
Hospital Revenue Code	278
Min. Negotiated Rate	$127.45
Max. Negotiated Rate	$541.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$283.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$257.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$296.40
Rate for Payer: Fidelis Medicare Advantage	$541.25
Rate for Payer: Group Health Inc Commercial	$257.74
Rate for Payer: Group Health Inc Medicare	$180.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$257.74
Rate for Payer: Hamaspik Choice Inc Medicare	$257.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$335.06

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