St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ BALLOON/XXL/12-4-120

Facility IP

$657.02

Service Code	HCPCS C1725
Hospital Charge Code	41569448
Hospital Revenue Code	278
Min. Negotiated Rate	$328.51
Max. Negotiated Rate	$328.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.51
Rate for Payer: Hamaspik Choice Inc Medicare	$328.51

ZZ BALLOON/XXL/12-4-75

Facility IP

$657.02

Service Code	HCPCS C1725
Hospital Charge Code	41569450
Hospital Revenue Code	278
Min. Negotiated Rate	$328.51
Max. Negotiated Rate	$328.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.51
Rate for Payer: Hamaspik Choice Inc Medicare	$328.51

ZZ BALLOON/XXL/12-4-75

Facility OP

$657.02

Service Code	HCPCS C1725
Hospital Charge Code	41569450
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$689.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$361.36
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	$328.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$377.79
Rate for Payer: Fidelis Medicare Advantage	$689.87
Rate for Payer: Group Health Inc Commercial	$328.51
Rate for Payer: Group Health Inc Medicare	$229.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.51
Rate for Payer: Hamaspik Choice Inc Medicare	$328.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$427.06

ZZ BALLOON/XXL/14-4-75

Facility OP

$657.02

Service Code	HCPCS C1725
Hospital Charge Code	41569449
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$689.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$361.36
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	$328.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$377.79
Rate for Payer: Fidelis Medicare Advantage	$689.87
Rate for Payer: Group Health Inc Commercial	$328.51
Rate for Payer: Group Health Inc Medicare	$229.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.51
Rate for Payer: Hamaspik Choice Inc Medicare	$328.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$427.06

ZZ BALLOON/XXL/14-4-75

Facility IP

$657.02

Service Code	HCPCS C1725
Hospital Charge Code	41569449
Hospital Revenue Code	278
Min. Negotiated Rate	$328.51
Max. Negotiated Rate	$328.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.51
Rate for Payer: Hamaspik Choice Inc Medicare	$328.51

ZZ BALLOON/XXL/16-4-75

Facility IP

$722.93

Service Code	HCPCS C1725
Hospital Charge Code	41569451
Hospital Revenue Code	278
Min. Negotiated Rate	$361.46
Max. Negotiated Rate	$361.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$361.46
Rate for Payer: Hamaspik Choice Inc Medicare	$361.46

ZZ BALLOON/XXL/16-4-75

Facility OP

$722.93

Service Code	HCPCS C1725
Hospital Charge Code	41569451
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$759.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$397.61
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	$361.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$415.68
Rate for Payer: Fidelis Medicare Advantage	$759.08
Rate for Payer: Group Health Inc Commercial	$361.46
Rate for Payer: Group Health Inc Medicare	$253.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$361.46
Rate for Payer: Hamaspik Choice Inc Medicare	$361.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$469.90

ZZ BALLOON/XXL/18-4-75

Facility IP

$722.93

Service Code	HCPCS C1725
Hospital Charge Code	41569452
Hospital Revenue Code	278
Min. Negotiated Rate	$361.46
Max. Negotiated Rate	$361.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$361.46
Rate for Payer: Hamaspik Choice Inc Medicare	$361.46

ZZ BALLOON/XXL/18-4-75

Facility OP

$722.93

Service Code	HCPCS C1725
Hospital Charge Code	41569452
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$759.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$397.61
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	$361.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$415.68
Rate for Payer: Fidelis Medicare Advantage	$759.08
Rate for Payer: Group Health Inc Commercial	$361.46
Rate for Payer: Group Health Inc Medicare	$253.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$361.46
Rate for Payer: Hamaspik Choice Inc Medicare	$361.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$469.90

ZZ BANANA PEEL SHTH 12 15

Facility OP

$146.72

Service Code	HCPCS C1725
Hospital Charge Code	41567060
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$154.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.70
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	$73.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$84.36
Rate for Payer: Fidelis Medicare Advantage	$154.06
Rate for Payer: Group Health Inc Commercial	$73.36
Rate for Payer: Group Health Inc Medicare	$51.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.36
Rate for Payer: Hamaspik Choice Inc Medicare	$73.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$95.37

ZZ BANANA PEEL SHTH 12 15

Facility IP

$146.72

Service Code	HCPCS C1725
Hospital Charge Code	41567060
Hospital Revenue Code	278
Min. Negotiated Rate	$73.36
Max. Negotiated Rate	$73.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.36
Rate for Payer: Hamaspik Choice Inc Medicare	$73.36

ZZ BANANA PEEL SHTH 14 15

Facility IP

$146.72

Service Code	HCPCS C1725
Hospital Charge Code	41567061
Hospital Revenue Code	278
Min. Negotiated Rate	$73.36
Max. Negotiated Rate	$73.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.36
Rate for Payer: Hamaspik Choice Inc Medicare	$73.36

ZZ BANANA PEEL SHTH 14 15

Facility OP

$146.72

Service Code	HCPCS C1725
Hospital Charge Code	41567061
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$154.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.70
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	$73.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$84.36
Rate for Payer: Fidelis Medicare Advantage	$154.06
Rate for Payer: Group Health Inc Commercial	$73.36
Rate for Payer: Group Health Inc Medicare	$51.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.36
Rate for Payer: Hamaspik Choice Inc Medicare	$73.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$95.37

ZZ BANANA PEEL SHTH 9 15

Facility OP

$146.72

Service Code	HCPCS C1725
Hospital Charge Code	41567058
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$154.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.70
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	$73.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$84.36
Rate for Payer: Fidelis Medicare Advantage	$154.06
Rate for Payer: Group Health Inc Commercial	$73.36
Rate for Payer: Group Health Inc Medicare	$51.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.36
Rate for Payer: Hamaspik Choice Inc Medicare	$73.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$95.37

ZZ BANANA PEEL SHTH 9 15

Facility IP

$146.72

Service Code	HCPCS C1725
Hospital Charge Code	41567058
Hospital Revenue Code	278
Min. Negotiated Rate	$73.36
Max. Negotiated Rate	$73.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.36
Rate for Payer: Hamaspik Choice Inc Medicare	$73.36

ZZ BARD BIOPSY INSTRUMENT KIT

Facility OP

$210.00

Hospital Charge Code	41562920
Hospital Revenue Code	272
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$168.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$115.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$105.00
Rate for Payer: Aetna Government	$105.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$168.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$142.80
Rate for Payer: Group Health Inc Commercial	$105.00
Rate for Payer: Group Health Inc Medicare	$73.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.00
Rate for Payer: Hamaspik Choice Inc Medicare	$105.00

ZZ BARD BIOPSY TISSUE MARKER

Facility OP

$210.00

Hospital Charge Code	41562921
Hospital Revenue Code	272
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$168.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$115.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$105.00
Rate for Payer: Aetna Government	$105.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$168.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$142.80
Rate for Payer: Group Health Inc Commercial	$105.00
Rate for Payer: Group Health Inc Medicare	$73.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.00
Rate for Payer: Hamaspik Choice Inc Medicare	$105.00

ZZ BARD CONQUEST BALLOON 10X4X75

Facility OP

$722.93

Service Code	HCPCS C1725
Hospital Charge Code	41569695
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$759.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$397.61
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	$361.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$415.68
Rate for Payer: Fidelis Medicare Advantage	$759.08
Rate for Payer: Group Health Inc Commercial	$361.46
Rate for Payer: Group Health Inc Medicare	$253.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$361.46
Rate for Payer: Hamaspik Choice Inc Medicare	$361.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$469.90

ZZ BARD CONQUEST BALLOON 10X4X75

Facility IP

$722.93

Service Code	HCPCS C1725
Hospital Charge Code	41569695
Hospital Revenue Code	278
Min. Negotiated Rate	$361.46
Max. Negotiated Rate	$361.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$361.46
Rate for Payer: Hamaspik Choice Inc Medicare	$361.46

ZZ BARD CONQUEST BALLOON 12X4X75

Facility OP

$779.63

Service Code	HCPCS C1725
Hospital Charge Code	41569696
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$818.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$428.80
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	$389.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$448.29
Rate for Payer: Fidelis Medicare Advantage	$818.61
Rate for Payer: Group Health Inc Commercial	$389.82
Rate for Payer: Group Health Inc Medicare	$272.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$389.82
Rate for Payer: Hamaspik Choice Inc Medicare	$389.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$506.76

ZZ BARD CONQUEST BALLOON 12X4X75

Facility IP

$779.63

Service Code	HCPCS C1725
Hospital Charge Code	41569696
Hospital Revenue Code	278
Min. Negotiated Rate	$389.82
Max. Negotiated Rate	$389.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$389.82
Rate for Payer: Hamaspik Choice Inc Medicare	$389.82

ZZ BARD CONQUEST BALLOON 7X4X75

Facility IP

$722.93

Service Code	HCPCS C1726
Hospital Charge Code	41569694
Hospital Revenue Code	278
Min. Negotiated Rate	$361.46
Max. Negotiated Rate	$361.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$361.46
Rate for Payer: Hamaspik Choice Inc Medicare	$361.46

ZZ BARD CONQUEST BALLOON 7X4X75

Facility OP

$722.93

Service Code	HCPCS C1726
Hospital Charge Code	41569694
Hospital Revenue Code	278
Min. Negotiated Rate	$17.43
Max. Negotiated Rate	$759.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$397.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.43
Rate for Payer: Aetna Government	$17.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$361.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$415.68
Rate for Payer: Fidelis Medicare Advantage	$759.08
Rate for Payer: Group Health Inc Commercial	$361.46
Rate for Payer: Group Health Inc Medicare	$253.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$361.46
Rate for Payer: Hamaspik Choice Inc Medicare	$361.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$469.90

ZZ BARD CONQUEST BALLOON 8X4X75

Facility OP

$722.93

Service Code	HCPCS C1726
Hospital Charge Code	41569693
Hospital Revenue Code	278
Min. Negotiated Rate	$17.43
Max. Negotiated Rate	$759.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$397.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.43
Rate for Payer: Aetna Government	$17.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$361.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$415.68
Rate for Payer: Fidelis Medicare Advantage	$759.08
Rate for Payer: Group Health Inc Commercial	$361.46
Rate for Payer: Group Health Inc Medicare	$253.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$361.46
Rate for Payer: Hamaspik Choice Inc Medicare	$361.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$469.90

ZZ BARD CONQUEST BALLOON 8X4X75

Facility IP

$722.93

Service Code	HCPCS C1726
Hospital Charge Code	41569693
Hospital Revenue Code	278
Min. Negotiated Rate	$361.46
Max. Negotiated Rate	$361.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$361.46
Rate for Payer: Hamaspik Choice Inc Medicare	$361.46

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