St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ ASP & IRRIG DEVICE

Facility OP

$635.75

Hospital Charge Code	41567290
Hospital Revenue Code	270
Min. Negotiated Rate	$222.51
Max. Negotiated Rate	$508.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$349.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$317.88
Rate for Payer: Aetna Government	$317.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$508.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$432.31
Rate for Payer: Group Health Inc Commercial	$317.88
Rate for Payer: Group Health Inc Medicare	$222.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$317.88
Rate for Payer: Hamaspik Choice Inc Medicare	$317.88

ZZ ATHERECTOMY CATHETER

Facility OP

$2,575.60

Hospital Charge Code	41567196
Hospital Revenue Code	270
Min. Negotiated Rate	$901.46
Max. Negotiated Rate	$2,060.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,416.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,287.80
Rate for Payer: Aetna Government	$1,287.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,060.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,751.41
Rate for Payer: Group Health Inc Commercial	$1,287.80
Rate for Payer: Group Health Inc Medicare	$901.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,287.80
Rate for Payer: Hamaspik Choice Inc Medicare	$1,287.80

ZZ BACKUP MEIER GUIDEWIRE .035

Facility OP

$192.78

Hospital Charge Code	41569818
Hospital Revenue Code	270
Min. Negotiated Rate	$67.47
Max. Negotiated Rate	$154.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$106.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$96.39
Rate for Payer: Aetna Government	$96.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$154.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$131.09
Rate for Payer: Group Health Inc Commercial	$96.39
Rate for Payer: Group Health Inc Medicare	$67.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.39
Rate for Payer: Hamaspik Choice Inc Medicare	$96.39

ZZ BAL CTH 6MM X 4CM(40CM)

Facility OP

$766.16

Hospital Charge Code	41567512
Hospital Revenue Code	270
Min. Negotiated Rate	$268.16
Max. Negotiated Rate	$612.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$383.08
Rate for Payer: Aetna Government	$383.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$612.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$520.99
Rate for Payer: Group Health Inc Commercial	$383.08
Rate for Payer: Group Health Inc Medicare	$268.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.08
Rate for Payer: Hamaspik Choice Inc Medicare	$383.08

ZZ BALKIN U&O 5.5 38 40

Facility IP

$101.00

Service Code	HCPCS C1894
Hospital Charge Code	41567016
Hospital Revenue Code	278
Min. Negotiated Rate	$50.50
Max. Negotiated Rate	$50.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.50
Rate for Payer: Hamaspik Choice Inc Medicare	$50.50

ZZ BALKIN U&O 5.5 38 40

Facility OP

$101.00

Service Code	HCPCS C1894
Hospital Charge Code	41567016
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$106.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.08
Rate for Payer: Fidelis Medicare Advantage	$106.05
Rate for Payer: Group Health Inc Commercial	$50.50
Rate for Payer: Group Health Inc Medicare	$35.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.50
Rate for Payer: Hamaspik Choice Inc Medicare	$50.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.65

ZZ BALKIN U&O 6 38 40

Facility OP

$101.00

Service Code	HCPCS C1894
Hospital Charge Code	41567018
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$106.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.08
Rate for Payer: Fidelis Medicare Advantage	$106.05
Rate for Payer: Group Health Inc Commercial	$50.50
Rate for Payer: Group Health Inc Medicare	$35.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.50
Rate for Payer: Hamaspik Choice Inc Medicare	$50.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.65

ZZ BALKIN U&O 6 38 40

Facility IP

$101.00

Service Code	HCPCS C1894
Hospital Charge Code	41567018
Hospital Revenue Code	278
Min. Negotiated Rate	$50.50
Max. Negotiated Rate	$50.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.50
Rate for Payer: Hamaspik Choice Inc Medicare	$50.50

ZZ BALKIN U&O 7 38 40

Facility OP

$101.00

Service Code	HCPCS C1894
Hospital Charge Code	41567019
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$106.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.08
Rate for Payer: Fidelis Medicare Advantage	$106.05
Rate for Payer: Group Health Inc Commercial	$50.50
Rate for Payer: Group Health Inc Medicare	$35.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.50
Rate for Payer: Hamaspik Choice Inc Medicare	$50.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.65

ZZ BALKIN U&O 7 38 40

Facility IP

$101.00

Service Code	HCPCS C1894
Hospital Charge Code	41567019
Hospital Revenue Code	278
Min. Negotiated Rate	$50.50
Max. Negotiated Rate	$50.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.50
Rate for Payer: Hamaspik Choice Inc Medicare	$50.50

ZZ BALKIN U&O 8 38 40

Facility OP

$101.00

Service Code	HCPCS C1894
Hospital Charge Code	41567017
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$106.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.08
Rate for Payer: Fidelis Medicare Advantage	$106.05
Rate for Payer: Group Health Inc Commercial	$50.50
Rate for Payer: Group Health Inc Medicare	$35.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.50
Rate for Payer: Hamaspik Choice Inc Medicare	$50.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.65

ZZ BALKIN U&O 8 38 40

Facility IP

$101.00

Service Code	HCPCS C1894
Hospital Charge Code	41567017
Hospital Revenue Code	278
Min. Negotiated Rate	$50.50
Max. Negotiated Rate	$50.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.50
Rate for Payer: Hamaspik Choice Inc Medicare	$50.50

ZZ BALLON/UT/DIAMOND/8-4-40

Facility OP

$370.00

Service Code	HCPCS C1725
Hospital Charge Code	41567755
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$388.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$203.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$185.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$212.75
Rate for Payer: Fidelis Medicare Advantage	$388.50
Rate for Payer: Group Health Inc Commercial	$185.00
Rate for Payer: Group Health Inc Medicare	$129.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.00
Rate for Payer: Hamaspik Choice Inc Medicare	$185.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$240.50

ZZ BALLON/UT/DIAMOND/8-4-40

Facility IP

$370.00

Service Code	HCPCS C1725
Hospital Charge Code	41567755
Hospital Revenue Code	278
Min. Negotiated Rate	$185.00
Max. Negotiated Rate	$185.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.00
Rate for Payer: Hamaspik Choice Inc Medicare	$185.00

ZZ BALLOON/5-2/90CM/5F/MARSHALL

Facility OP

$542.20

Hospital Charge Code	41569133
Hospital Revenue Code	270
Min. Negotiated Rate	$189.77
Max. Negotiated Rate	$433.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$298.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$271.10
Rate for Payer: Aetna Government	$271.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$433.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$368.70
Rate for Payer: Group Health Inc Commercial	$271.10
Rate for Payer: Group Health Inc Medicare	$189.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$271.10
Rate for Payer: Hamaspik Choice Inc Medicare	$271.10

ZZ BALLOON/6-2/90CM/5F/MARSHALL

Facility OP

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569134
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$569.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$298.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$311.76
Rate for Payer: Fidelis Medicare Advantage	$569.31
Rate for Payer: Group Health Inc Commercial	$271.10
Rate for Payer: Group Health Inc Medicare	$189.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$271.10
Rate for Payer: Hamaspik Choice Inc Medicare	$271.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$352.43

ZZ BALLOON/6-2/90CM/5F/MARSHALL

Facility IP

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569134
Hospital Revenue Code	278
Min. Negotiated Rate	$271.10
Max. Negotiated Rate	$271.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$271.10
Rate for Payer: Hamaspik Choice Inc Medicare	$271.10

ZZ BALLOON/6-4/90CM/5F/MARSHALL

Facility OP

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569135
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$569.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$298.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$311.76
Rate for Payer: Fidelis Medicare Advantage	$569.31
Rate for Payer: Group Health Inc Commercial	$271.10
Rate for Payer: Group Health Inc Medicare	$189.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$271.10
Rate for Payer: Hamaspik Choice Inc Medicare	$271.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$352.43

ZZ BALLOON/6-4/90CM/5F/MARSHALL

Facility IP

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569135
Hospital Revenue Code	278
Min. Negotiated Rate	$271.10
Max. Negotiated Rate	$271.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$271.10
Rate for Payer: Hamaspik Choice Inc Medicare	$271.10

ZZ BALLOON/7-4/90CM/6F/MARSHALL

Facility OP

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569136
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$569.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$298.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$311.76
Rate for Payer: Fidelis Medicare Advantage	$569.31
Rate for Payer: Group Health Inc Commercial	$271.10
Rate for Payer: Group Health Inc Medicare	$189.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$271.10
Rate for Payer: Hamaspik Choice Inc Medicare	$271.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$352.43

ZZ BALLOON/7-4/90CM/6F/MARSHALL

Facility IP

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569136
Hospital Revenue Code	278
Min. Negotiated Rate	$271.10
Max. Negotiated Rate	$271.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$271.10
Rate for Payer: Hamaspik Choice Inc Medicare	$271.10

ZZ BALLOON/8-2/90CM/6F/MARSHALL

Facility IP

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569137
Hospital Revenue Code	278
Min. Negotiated Rate	$271.10
Max. Negotiated Rate	$271.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$271.10
Rate for Payer: Hamaspik Choice Inc Medicare	$271.10

ZZ BALLOON/8-2/90CM/6F/MARSHALL

Facility OP

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569137
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$569.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$298.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$311.76
Rate for Payer: Fidelis Medicare Advantage	$569.31
Rate for Payer: Group Health Inc Commercial	$271.10
Rate for Payer: Group Health Inc Medicare	$189.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$271.10
Rate for Payer: Hamaspik Choice Inc Medicare	$271.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$352.43

ZZ BALLOON/8-3/BLUEMAX/75

Facility IP

$550.70

Service Code	HCPCS C1725
Hospital Charge Code	41569138
Hospital Revenue Code	278
Min. Negotiated Rate	$275.35
Max. Negotiated Rate	$275.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.35
Rate for Payer: Hamaspik Choice Inc Medicare	$275.35

ZZ BALLOON/8-3/BLUEMAX/75

Facility OP

$550.70

Service Code	HCPCS C1725
Hospital Charge Code	41569138
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$578.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$302.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$275.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$316.65
Rate for Payer: Fidelis Medicare Advantage	$578.24
Rate for Payer: Group Health Inc Commercial	$275.35
Rate for Payer: Group Health Inc Medicare	$192.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.35
Rate for Payer: Hamaspik Choice Inc Medicare	$275.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$357.96

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