St. Barnabas Hospital

All Charges

Charge

Type

Price

STIMU BIOCOMP KEEL ST5 5NL 20CC

Facility IP

$3,390.00

Service Code	HCPCS C1713
Hospital Charge Code	40005245
Hospital Revenue Code	278
Min. Negotiated Rate	$1,695.00
Max. Negotiated Rate	$1,695.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,695.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,695.00

STIMULAN 5CC RAPID CURE

Facility OP

$3,737.50

Service Code	HCPCS C1713
Hospital Charge Code	64904794
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,924.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,055.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,868.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,149.06
Rate for Payer: Fidelis Medicare Advantage	$3,924.38
Rate for Payer: Group Health Inc Commercial	$1,868.75
Rate for Payer: Group Health Inc Medicare	$1,308.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,868.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,868.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,429.38

STIMULAN 5CC RAPID CURE

Facility IP

$3,737.50

Service Code	HCPCS C1713
Hospital Charge Code	64904794
Hospital Revenue Code	278
Min. Negotiated Rate	$1,868.75
Max. Negotiated Rate	$1,868.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,868.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,868.75

STIMULAN PASTE 5CC BEADS 12CC

Facility OP

$2,990.00

Service Code	HCPCS C1713
Hospital Charge Code	40204257
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,139.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,644.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,495.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,719.25
Rate for Payer: Fidelis Medicare Advantage	$3,139.50
Rate for Payer: Group Health Inc Commercial	$1,495.00
Rate for Payer: Group Health Inc Medicare	$1,046.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,495.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,495.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,943.50

STIMULAN PASTE 5CC BEADS 12CC

Facility IP

$2,990.00

Service Code	HCPCS C1713
Hospital Charge Code	40204257
Hospital Revenue Code	278
Min. Negotiated Rate	$1,495.00
Max. Negotiated Rate	$1,495.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,495.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,495.00

STIMULAN RAPID CURE BEADS 25CC

Facility IP

$1,024.00

Service Code	HCPCS C1713
Hospital Charge Code	40204259
Hospital Revenue Code	278
Min. Negotiated Rate	$512.00
Max. Negotiated Rate	$512.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$512.00
Rate for Payer: Hamaspik Choice Inc Medicare	$512.00

STIMULAN RAPID CURE BEADS 25CC

Facility OP

$1,024.00

Service Code	HCPCS C1713
Hospital Charge Code	40204259
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,075.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$563.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$512.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$588.80
Rate for Payer: Fidelis Medicare Advantage	$1,075.20
Rate for Payer: Group Health Inc Commercial	$512.00
Rate for Payer: Group Health Inc Medicare	$358.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$512.00
Rate for Payer: Hamaspik Choice Inc Medicare	$512.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$665.60

ST J MED ACCENT PM2210 DDDR IS-1

Facility OP

$11,590.00

Hospital Charge Code	40205264
Hospital Revenue Code	275
Min. Negotiated Rate	$4,056.50
Max. Negotiated Rate	$12,169.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,374.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,795.00
Rate for Payer: Aetna Government	$5,795.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,795.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,664.25
Rate for Payer: Fidelis Medicare Advantage	$12,169.50
Rate for Payer: Group Health Inc Commercial	$5,795.00
Rate for Payer: Group Health Inc Medicare	$4,056.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,795.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,795.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,533.50

ST J. MED ZEPHYR P/M SSIR 5620D/C

Facility OP

$9,990.00

Hospital Charge Code	40205301
Hospital Revenue Code	275
Min. Negotiated Rate	$3,496.50
Max. Negotiated Rate	$10,489.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,494.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,995.00
Rate for Payer: Aetna Government	$4,995.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,995.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,744.25
Rate for Payer: Fidelis Medicare Advantage	$10,489.50
Rate for Payer: Group Health Inc Commercial	$4,995.00
Rate for Payer: Group Health Inc Medicare	$3,496.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,995.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,995.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,493.50

ST JUDE AV PLS DX VLEAD 1368/58CM

Facility IP

$1,590.00

Service Code	HCPCS C1785
Hospital Charge Code	40205391
Hospital Revenue Code	278
Min. Negotiated Rate	$795.00
Max. Negotiated Rate	$795.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$795.00
Rate for Payer: Hamaspik Choice Inc Medicare	$795.00

ST JUDE AV PLS DX VLEAD 1368/58CM

Facility OP

$1,590.00

Service Code	HCPCS C1785
Hospital Charge Code	40205391
Hospital Revenue Code	278
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$1,669.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$874.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.42
Rate for Payer: Aetna Government	$275.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$795.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$914.25
Rate for Payer: Fidelis Medicare Advantage	$1,669.50
Rate for Payer: Group Health Inc Commercial	$795.00
Rate for Payer: Group Health Inc Medicare	$556.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$795.00
Rate for Payer: Hamaspik Choice Inc Medicare	$795.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,033.50

ST JUDE F5 PACING CATH #401764

Facility OP

$211.60

Service Code	HCPCS C1756
Hospital Charge Code	66572896
Hospital Revenue Code	278
Min. Negotiated Rate	$74.06
Max. Negotiated Rate	$222.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$116.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$172.46
Rate for Payer: Aetna Government	$172.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$105.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$121.67
Rate for Payer: Fidelis Medicare Advantage	$222.18
Rate for Payer: Group Health Inc Commercial	$105.80
Rate for Payer: Group Health Inc Medicare	$74.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.80
Rate for Payer: Hamaspik Choice Inc Medicare	$105.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$137.54

ST JUDE F5 PACING CATH #401764

Facility IP

$211.60

Service Code	HCPCS C1756
Hospital Charge Code	66572896
Hospital Revenue Code	278
Min. Negotiated Rate	$105.80
Max. Negotiated Rate	$105.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.80
Rate for Payer: Hamaspik Choice Inc Medicare	$105.80

ST JUDE LEAD 1888TC/52CM

Facility OP

$1,200.00

Service Code	HCPCS C1785
Hospital Charge Code	40205265
Hospital Revenue Code	278
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$1,260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.42
Rate for Payer: Aetna Government	$275.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.00
Rate for Payer: Fidelis Medicare Advantage	$1,260.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$780.00

ST JUDE LEAD 1888TC/52CM

Facility IP

$1,200.00

Service Code	HCPCS C1785
Hospital Charge Code	40205265
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00

ST JUDE MED ENDURITY PACEMAKER

Facility OP

$11,590.00

Service Code	HCPCS C1785
Hospital Charge Code	66573272
Hospital Revenue Code	275
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$12,169.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,374.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.42
Rate for Payer: Aetna Government	$275.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,795.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,664.25
Rate for Payer: Fidelis Medicare Advantage	$12,169.50
Rate for Payer: Group Health Inc Commercial	$5,795.00
Rate for Payer: Group Health Inc Medicare	$4,056.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,795.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,795.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,533.50

ST JUDE MEDICAL ACCENT PM 1210

Facility OP

$10,590.00

Hospital Charge Code	40205580
Hospital Revenue Code	275
Min. Negotiated Rate	$3,706.50
Max. Negotiated Rate	$11,119.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,824.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,295.00
Rate for Payer: Aetna Government	$5,295.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,295.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,089.25
Rate for Payer: Fidelis Medicare Advantage	$11,119.50
Rate for Payer: Group Health Inc Commercial	$5,295.00
Rate for Payer: Group Health Inc Medicare	$3,706.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,295.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,295.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,883.50

ST. JUDE MEDICAL P/M PM2110

Facility OP

$10,990.00

Hospital Charge Code	40205823
Hospital Revenue Code	275
Min. Negotiated Rate	$3,846.50
Max. Negotiated Rate	$11,539.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,044.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,495.00
Rate for Payer: Aetna Government	$5,495.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,495.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,319.25
Rate for Payer: Fidelis Medicare Advantage	$11,539.50
Rate for Payer: Group Health Inc Commercial	$5,495.00
Rate for Payer: Group Health Inc Medicare	$3,846.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,495.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,495.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,143.50

ST JUDE MED TENDRIL STS LEAD

Facility OP

$1,200.00

Service Code	HCPCS C1898
Hospital Charge Code	66573273
Hospital Revenue Code	275
Min. Negotiated Rate	$98.92
Max. Negotiated Rate	$1,260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$98.92
Rate for Payer: Aetna Government	$98.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.00
Rate for Payer: Fidelis Medicare Advantage	$1,260.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$780.00

ST. JUDE MED V LEAD 1888/46CM

Facility IP

$1,200.00

Service Code	HCPCS C1892
Hospital Charge Code	40205272
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00

ST. JUDE MED V LEAD 1888/46CM

Facility OP

$1,200.00

Service Code	HCPCS C1892
Hospital Charge Code	40205272
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$1,260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.00
Rate for Payer: Fidelis Medicare Advantage	$1,260.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$780.00

ST JUDE MED ZEPHYR DDDR 5820 P/M

Facility OP

$9,800.00

Hospital Charge Code	40205175
Hospital Revenue Code	275
Min. Negotiated Rate	$3,430.00
Max. Negotiated Rate	$10,290.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,390.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,900.00
Rate for Payer: Aetna Government	$4,900.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,900.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,635.00
Rate for Payer: Fidelis Medicare Advantage	$10,290.00
Rate for Payer: Group Health Inc Commercial	$4,900.00
Rate for Payer: Group Health Inc Medicare	$3,430.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,900.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,370.00

ST JUDE TENDRIL LEAD 1888TC/46CM

Facility OP

$1,200.00

Service Code	HCPCS C1785
Hospital Charge Code	40205266
Hospital Revenue Code	278
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$1,260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.42
Rate for Payer: Aetna Government	$275.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.00
Rate for Payer: Fidelis Medicare Advantage	$1,260.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$780.00

ST JUDE TENDRIL LEAD 1888TC/46CM

Facility IP

$1,200.00

Service Code	HCPCS C1785
Hospital Charge Code	40205266
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00

ST JUDE V LEAD 1888/58CM

Facility OP

$1,200.00

Service Code	HCPCS C1892
Hospital Charge Code	40205302
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$1,260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.00
Rate for Payer: Fidelis Medicare Advantage	$1,260.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$780.00

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