St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ BARD LUMINEX STNT 8X30

Facility OP

$3,969.00

Service Code	HCPCS C1876
Hospital Charge Code	41569550
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$4,167.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,182.95
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	$1,984.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,282.18
Rate for Payer: Fidelis Medicare Advantage	$4,167.45
Rate for Payer: Group Health Inc Commercial	$1,984.50
Rate for Payer: Group Health Inc Medicare	$1,389.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,984.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,984.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,579.85

ZZ BARD LUMINEX STNT 8X40

Facility IP

$3,969.00

Service Code	HCPCS C1876
Hospital Charge Code	41569549
Hospital Revenue Code	278
Min. Negotiated Rate	$1,984.50
Max. Negotiated Rate	$1,984.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,984.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,984.50

ZZ BARD LUMINEX STNT 8X40

Facility OP

$3,969.00

Service Code	HCPCS C1876
Hospital Charge Code	41569549
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$4,167.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,182.95
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	$1,984.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,282.18
Rate for Payer: Fidelis Medicare Advantage	$4,167.45
Rate for Payer: Group Health Inc Commercial	$1,984.50
Rate for Payer: Group Health Inc Medicare	$1,389.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,984.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,984.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,579.85

ZZ BARD LUMINEX STNT 8X60

Facility OP

$4,252.50

Service Code	HCPCS C1876
Hospital Charge Code	41569548
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$4,465.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,338.88
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	$2,126.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,445.19
Rate for Payer: Fidelis Medicare Advantage	$4,465.12
Rate for Payer: Group Health Inc Commercial	$2,126.25
Rate for Payer: Group Health Inc Medicare	$1,488.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,126.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,126.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,764.12

ZZ BARD LUMINEX STNT 8X60

Facility IP

$4,252.50

Service Code	HCPCS C1876
Hospital Charge Code	41569548
Hospital Revenue Code	278
Min. Negotiated Rate	$2,126.25
Max. Negotiated Rate	$2,126.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,126.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,126.25

ZZ BARD LUMNEX STNT 10X40

Facility OP

$3,969.00

Service Code	HCPCS C1876
Hospital Charge Code	41569553
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$4,167.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,182.95
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	$1,984.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,282.18
Rate for Payer: Fidelis Medicare Advantage	$4,167.45
Rate for Payer: Group Health Inc Commercial	$1,984.50
Rate for Payer: Group Health Inc Medicare	$1,389.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,984.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,984.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,579.85

ZZ BARD LUMNEX STNT 10X40

Facility IP

$3,969.00

Service Code	HCPCS C1876
Hospital Charge Code	41569553
Hospital Revenue Code	278
Min. Negotiated Rate	$1,984.50
Max. Negotiated Rate	$1,984.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,984.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,984.50

ZZ BARD LUMNEX STNT 10X60

Facility OP

$4,252.50

Service Code	HCPCS C1876
Hospital Charge Code	41569554
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$4,465.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,338.88
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	$2,126.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,445.19
Rate for Payer: Fidelis Medicare Advantage	$4,465.12
Rate for Payer: Group Health Inc Commercial	$2,126.25
Rate for Payer: Group Health Inc Medicare	$1,488.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,126.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,126.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,764.12

ZZ BARD LUMNEX STNT 10X60

Facility IP

$4,252.50

Service Code	HCPCS C1876
Hospital Charge Code	41569554
Hospital Revenue Code	278
Min. Negotiated Rate	$2,126.25
Max. Negotiated Rate	$2,126.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,126.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,126.25

ZZ BARD LUMNEX STNT 12X40

Facility OP

$3,969.00

Service Code	HCPCS C1876
Hospital Charge Code	41569551
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$4,167.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,182.95
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	$1,984.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,282.18
Rate for Payer: Fidelis Medicare Advantage	$4,167.45
Rate for Payer: Group Health Inc Commercial	$1,984.50
Rate for Payer: Group Health Inc Medicare	$1,389.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,984.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,984.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,579.85

ZZ BARD LUMNEX STNT 12X40

Facility IP

$3,969.00

Service Code	HCPCS C1876
Hospital Charge Code	41569551
Hospital Revenue Code	278
Min. Negotiated Rate	$1,984.50
Max. Negotiated Rate	$1,984.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,984.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,984.50

ZZ BARD LUMNEX STNT 12X60

Facility OP

$4,252.50

Service Code	HCPCS C1876
Hospital Charge Code	41569552
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$4,465.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,338.88
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	$2,126.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,445.19
Rate for Payer: Fidelis Medicare Advantage	$4,465.12
Rate for Payer: Group Health Inc Commercial	$2,126.25
Rate for Payer: Group Health Inc Medicare	$1,488.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,126.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,126.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,764.12

ZZ BARD LUMNEX STNT 12X60

Facility IP

$4,252.50

Service Code	HCPCS C1876
Hospital Charge Code	41569552
Hospital Revenue Code	278
Min. Negotiated Rate	$2,126.25
Max. Negotiated Rate	$2,126.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,126.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,126.25

ZZ BARD MAX CORE NDL BIOPSY

Facility OP

$102.06

Hospital Charge Code	41569622
Hospital Revenue Code	270
Min. Negotiated Rate	$35.72
Max. Negotiated Rate	$81.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.03
Rate for Payer: Aetna Government	$51.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.40
Rate for Payer: Group Health Inc Commercial	$51.03
Rate for Payer: Group Health Inc Medicare	$35.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.03
Rate for Payer: Hamaspik Choice Inc Medicare	$51.03

ZZ BARD MAX CORE TRU GUIDE

Facility OP

$36.86

Hospital Charge Code	41569623
Hospital Revenue Code	270
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$29.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.43
Rate for Payer: Aetna Government	$18.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.06
Rate for Payer: Group Health Inc Commercial	$18.43
Rate for Payer: Group Health Inc Medicare	$12.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.43
Rate for Payer: Hamaspik Choice Inc Medicare	$18.43

ZZ BARD MIDLINE KIT

Facility OP

$283.72

Hospital Charge Code	41543140
Hospital Revenue Code	272
Min. Negotiated Rate	$99.30
Max. Negotiated Rate	$226.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$156.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$141.86
Rate for Payer: Aetna Government	$141.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$226.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$192.93
Rate for Payer: Group Health Inc Commercial	$141.86
Rate for Payer: Group Health Inc Medicare	$99.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.86
Rate for Payer: Hamaspik Choice Inc Medicare	$141.86

ZZ BARD PH 9.5FR

Facility OP

$1,172.00

Service Code	HCPCS C1751
Hospital Charge Code	41561917
Hospital Revenue Code	278
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$1,230.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$644.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.08
Rate for Payer: Aetna Government	$7.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$586.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$673.90
Rate for Payer: Fidelis Medicare Advantage	$1,230.60
Rate for Payer: Group Health Inc Commercial	$586.00
Rate for Payer: Group Health Inc Medicare	$410.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$586.00
Rate for Payer: Hamaspik Choice Inc Medicare	$586.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$761.80

ZZ BARD PH 9.5FR

Facility IP

$1,172.00

Service Code	HCPCS C1751
Hospital Charge Code	41561917
Hospital Revenue Code	278
Min. Negotiated Rate	$586.00
Max. Negotiated Rate	$586.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$586.00
Rate for Payer: Hamaspik Choice Inc Medicare	$586.00

ZZ BARD POWERGLIDE CATHETER

Facility OP

$104.00

Hospital Charge Code	41561361
Hospital Revenue Code	272
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$83.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$52.00
Rate for Payer: Aetna Government	$52.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$83.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$70.72
Rate for Payer: Group Health Inc Commercial	$52.00
Rate for Payer: Group Health Inc Medicare	$36.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.00
Rate for Payer: Hamaspik Choice Inc Medicare	$52.00

ZZ BARD POWERPORT CLEARVUE

Facility IP

$500.00

Service Code	HCPCS C1788
Hospital Charge Code	41563105
Hospital Revenue Code	278
Min. Negotiated Rate	$250.00
Max. Negotiated Rate	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

ZZ BARD POWERPORT CLEARVUE

Facility OP

$500.00

Service Code	HCPCS C1788
Hospital Charge Code	41563105
Hospital Revenue Code	278
Min. Negotiated Rate	$19.03
Max. Negotiated Rate	$525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.03
Rate for Payer: Aetna Government	$19.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$287.50
Rate for Payer: Fidelis Medicare Advantage	$525.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$325.00

ZZ BARD PTA CATH 12MMX4CM

Facility OP

$260.00

Hospital Charge Code	41564608
Hospital Revenue Code	272
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$208.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$143.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$130.00
Rate for Payer: Aetna Government	$130.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$208.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$176.80
Rate for Payer: Group Health Inc Commercial	$130.00
Rate for Payer: Group Health Inc Medicare	$91.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.00
Rate for Payer: Hamaspik Choice Inc Medicare	$130.00

ZZ BARD RECOVERY CONE SYS.

Facility OP

$1,249.50

Hospital Charge Code	41569865
Hospital Revenue Code	270
Min. Negotiated Rate	$437.32
Max. Negotiated Rate	$999.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$687.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$624.75
Rate for Payer: Aetna Government	$624.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$999.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$849.66
Rate for Payer: Group Health Inc Commercial	$624.75
Rate for Payer: Group Health Inc Medicare	$437.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$624.75
Rate for Payer: Hamaspik Choice Inc Medicare	$624.75

ZZ BARD RECOVERY FILTER SYSTEM

Facility OP

$3,954.83

Hospital Charge Code	41569820
Hospital Revenue Code	270
Min. Negotiated Rate	$1,384.19
Max. Negotiated Rate	$3,163.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,175.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,977.42
Rate for Payer: Aetna Government	$1,977.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,163.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,689.28
Rate for Payer: Group Health Inc Commercial	$1,977.42
Rate for Payer: Group Health Inc Medicare	$1,384.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,977.42
Rate for Payer: Hamaspik Choice Inc Medicare	$1,977.42

ZZ BARDSPORT SLIM TITM SNG LUMEN

Facility OP

$840.00

Service Code	HCPCS C1725
Hospital Charge Code	41569832
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$882.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$462.00
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	$420.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$483.00
Rate for Payer: Fidelis Medicare Advantage	$882.00
Rate for Payer: Group Health Inc Commercial	$420.00
Rate for Payer: Group Health Inc Medicare	$294.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$420.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$546.00

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