St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ BARDSPORT SLIM TITM SNG LUMEN

Facility IP

$840.00

Service Code	HCPCS C1725
Hospital Charge Code	41569832
Hospital Revenue Code	278
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$420.00

ZZ BARD STENT FLEXX

Facility IP

$3,402.00

Service Code	HCPCS C1876
Hospital Charge Code	41569540
Hospital Revenue Code	278
Min. Negotiated Rate	$1,701.00
Max. Negotiated Rate	$1,701.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,701.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,701.00

ZZ BARD STENT FLEXX

Facility OP

$3,402.00

Service Code	HCPCS C1876
Hospital Charge Code	41569540
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,572.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,871.10
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	$1,701.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,956.15
Rate for Payer: Fidelis Medicare Advantage	$3,572.10
Rate for Payer: Group Health Inc Commercial	$1,701.00
Rate for Payer: Group Health Inc Medicare	$1,190.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,701.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,701.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,211.30

ZZ BARD TRACHEOBRONC STENT GRAFT

Facility OP

$5,700.00

Service Code	HCPCS C1874
Hospital Charge Code	66520353
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$5,985.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,135.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,850.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,277.50
Rate for Payer: Fidelis Medicare Advantage	$5,985.00
Rate for Payer: Group Health Inc Commercial	$2,850.00
Rate for Payer: Group Health Inc Medicare	$1,995.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,850.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,850.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,705.00

ZZ BARD TRACHEOBRONC STENT GRAFT

Facility IP

$5,700.00

Service Code	HCPCS C1874
Hospital Charge Code	66520353
Hospital Revenue Code	278
Min. Negotiated Rate	$2,850.00
Max. Negotiated Rate	$2,850.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,850.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,850.00

ZZ BARD UNIV DRAINAGE BAG

Facility OP

$22.18

Hospital Charge Code	41569881
Hospital Revenue Code	270
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$17.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.09
Rate for Payer: Aetna Government	$11.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.08
Rate for Payer: Group Health Inc Commercial	$11.09
Rate for Payer: Group Health Inc Medicare	$7.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.09
Rate for Payer: Hamaspik Choice Inc Medicare	$11.09

ZZ BARD X-PORT 6FR

Facility OP

$661.50

Service Code	HCPCS C1725
Hospital Charge Code	41567895
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$694.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$363.82
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	$330.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$380.36
Rate for Payer: Fidelis Medicare Advantage	$694.58
Rate for Payer: Group Health Inc Commercial	$330.75
Rate for Payer: Group Health Inc Medicare	$231.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$330.75
Rate for Payer: Hamaspik Choice Inc Medicare	$330.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$429.98

ZZ BARD X-PORT 6FR

Facility IP

$661.50

Service Code	HCPCS C1725
Hospital Charge Code	41567895
Hospital Revenue Code	278
Min. Negotiated Rate	$330.75
Max. Negotiated Rate	$330.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$330.75
Rate for Payer: Hamaspik Choice Inc Medicare	$330.75

ZZ BARIUM SULFATE GM 50ML VIAL

Facility OP

$198.45

Hospital Charge Code	41569724
Hospital Revenue Code	270
Min. Negotiated Rate	$69.46
Max. Negotiated Rate	$158.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$109.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$99.22
Rate for Payer: Aetna Government	$99.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$158.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$134.95
Rate for Payer: Group Health Inc Commercial	$99.22
Rate for Payer: Group Health Inc Medicare	$69.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.22
Rate for Payer: Hamaspik Choice Inc Medicare	$99.22

ZZ BASKET/1.5CM/3CM LENGHT/8 WIRE

Facility OP

$422.30

Hospital Charge Code	41569453
Hospital Revenue Code	270
Min. Negotiated Rate	$147.80
Max. Negotiated Rate	$337.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$232.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$211.15
Rate for Payer: Aetna Government	$211.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$337.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$287.16
Rate for Payer: Group Health Inc Commercial	$211.15
Rate for Payer: Group Health Inc Medicare	$147.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$211.15
Rate for Payer: Hamaspik Choice Inc Medicare	$211.15

ZZ BASKET/6.3F/55CM/BIL/STONE

Facility OP

$487.24

Hospital Charge Code	41569454
Hospital Revenue Code	270
Min. Negotiated Rate	$170.53
Max. Negotiated Rate	$389.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$267.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$243.62
Rate for Payer: Aetna Government	$243.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$389.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$331.32
Rate for Payer: Group Health Inc Commercial	$243.62
Rate for Payer: Group Health Inc Medicare	$170.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.62
Rate for Payer: Hamaspik Choice Inc Medicare	$243.62

ZZ BASKET/6.5F/55CM/BIL/STONE

Facility OP

$487.24

Hospital Charge Code	41569456
Hospital Revenue Code	270
Min. Negotiated Rate	$170.53
Max. Negotiated Rate	$389.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$267.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$243.62
Rate for Payer: Aetna Government	$243.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$389.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$331.32
Rate for Payer: Group Health Inc Commercial	$243.62
Rate for Payer: Group Health Inc Medicare	$170.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.62
Rate for Payer: Hamaspik Choice Inc Medicare	$243.62

ZZ BASKET/HELICAL/2.5F/115CM

Facility OP

$214.49

Hospital Charge Code	41569457
Hospital Revenue Code	270
Min. Negotiated Rate	$75.07
Max. Negotiated Rate	$171.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$117.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$107.24
Rate for Payer: Aetna Government	$107.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$171.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$145.85
Rate for Payer: Group Health Inc Commercial	$107.24
Rate for Payer: Group Health Inc Medicare	$75.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.24
Rate for Payer: Hamaspik Choice Inc Medicare	$107.24

ZZ BAXTER ADHERENT CLOT CATH

Facility OP

$552.83

Hospital Charge Code	41569625
Hospital Revenue Code	270
Min. Negotiated Rate	$193.49
Max. Negotiated Rate	$442.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$304.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$276.42
Rate for Payer: Aetna Government	$276.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$442.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$375.92
Rate for Payer: Group Health Inc Commercial	$276.42
Rate for Payer: Group Health Inc Medicare	$193.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$276.42
Rate for Payer: Hamaspik Choice Inc Medicare	$276.42

ZZ BD NEXIVA DIFFUSICS

Facility OP

$20.00

Hospital Charge Code	66520350
Hospital Revenue Code	270
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$16.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.00
Rate for Payer: Aetna Government	$10.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.60
Rate for Payer: Group Health Inc Commercial	$10.00
Rate for Payer: Group Health Inc Medicare	$7.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10.00

ZZ BELLY BAG/BILATERAL

Facility OP

$25.26

Hospital Charge Code	41569458
Hospital Revenue Code	270
Min. Negotiated Rate	$8.84
Max. Negotiated Rate	$20.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.63
Rate for Payer: Aetna Government	$12.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.18
Rate for Payer: Group Health Inc Commercial	$12.63
Rate for Payer: Group Health Inc Medicare	$8.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.63
Rate for Payer: Hamaspik Choice Inc Medicare	$12.63

ZZ BELLY BAG/UNILATERAL

Facility OP

$23.21

Hospital Charge Code	41569459
Hospital Revenue Code	270
Min. Negotiated Rate	$8.12
Max. Negotiated Rate	$18.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.60
Rate for Payer: Aetna Government	$11.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.78
Rate for Payer: Group Health Inc Commercial	$11.60
Rate for Payer: Group Health Inc Medicare	$8.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.60
Rate for Payer: Hamaspik Choice Inc Medicare	$11.60

ZZ BERENSTEIN CATH 5 40

Facility IP

$48.91

Service Code	HCPCS C1725
Hospital Charge Code	41567170
Hospital Revenue Code	278
Min. Negotiated Rate	$24.46
Max. Negotiated Rate	$24.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.46
Rate for Payer: Hamaspik Choice Inc Medicare	$24.46

ZZ BERENSTEIN CATH 5 40

Facility OP

$48.91

Service Code	HCPCS C1725
Hospital Charge Code	41567170
Hospital Revenue Code	278
Min. Negotiated Rate	$17.12
Max. Negotiated Rate	$51.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.90
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	$24.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.12
Rate for Payer: Fidelis Medicare Advantage	$51.36
Rate for Payer: Group Health Inc Commercial	$24.46
Rate for Payer: Group Health Inc Medicare	$17.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.46
Rate for Payer: Hamaspik Choice Inc Medicare	$24.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.79

ZZ BERENSTEIN CATH 5 65

Facility OP

$48.91

Service Code	HCPCS C1725
Hospital Charge Code	41567169
Hospital Revenue Code	278
Min. Negotiated Rate	$17.12
Max. Negotiated Rate	$51.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.90
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	$24.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.12
Rate for Payer: Fidelis Medicare Advantage	$51.36
Rate for Payer: Group Health Inc Commercial	$24.46
Rate for Payer: Group Health Inc Medicare	$17.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.46
Rate for Payer: Hamaspik Choice Inc Medicare	$24.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.79

ZZ BERENSTEIN CATH 5 65

Facility IP

$48.91

Service Code	HCPCS C1725
Hospital Charge Code	41567169
Hospital Revenue Code	278
Min. Negotiated Rate	$24.46
Max. Negotiated Rate	$24.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.46
Rate for Payer: Hamaspik Choice Inc Medicare	$24.46

ZZ BETSON WR TSFB 35 145

Facility OP

$49.97

Service Code	HCPCS C1769
Hospital Charge Code	41567092
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$52.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.73
Rate for Payer: Fidelis Medicare Advantage	$52.47
Rate for Payer: Group Health Inc Commercial	$24.98
Rate for Payer: Group Health Inc Medicare	$17.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.98
Rate for Payer: Hamaspik Choice Inc Medicare	$24.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$32.48

ZZ BETSON WR TSFB 35 145

Facility IP

$49.97

Service Code	HCPCS C1769
Hospital Charge Code	41567092
Hospital Revenue Code	278
Min. Negotiated Rate	$24.98
Max. Negotiated Rate	$24.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.98
Rate for Payer: Hamaspik Choice Inc Medicare	$24.98

ZZ BILIAR CTH AMPLA 10/30

Facility IP

$231.41

Service Code	HCPCS C1725
Hospital Charge Code	41567223
Hospital Revenue Code	278
Min. Negotiated Rate	$115.70
Max. Negotiated Rate	$115.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.70
Rate for Payer: Hamaspik Choice Inc Medicare	$115.70

ZZ BILIAR CTH AMPLA 10/30

Facility OP

$231.41

Service Code	HCPCS C1725
Hospital Charge Code	41567223
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$242.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$127.28
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	$115.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$133.06
Rate for Payer: Fidelis Medicare Advantage	$242.98
Rate for Payer: Group Health Inc Commercial	$115.70
Rate for Payer: Group Health Inc Medicare	$80.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.70
Rate for Payer: Hamaspik Choice Inc Medicare	$115.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$150.42

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