St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ BIOP NDL QK CR 20 6 20

Facility OP

$87.89

Hospital Charge Code	41567077
Hospital Revenue Code	270
Min. Negotiated Rate	$30.76
Max. Negotiated Rate	$70.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.94
Rate for Payer: Aetna Government	$43.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.77
Rate for Payer: Group Health Inc Commercial	$43.94
Rate for Payer: Group Health Inc Medicare	$30.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.94
Rate for Payer: Hamaspik Choice Inc Medicare	$43.94

ZZ BIOPSH EMBOSPHER 1ML 810GH

Facility IP

$411.08

Service Code	HCPCS C1884
Hospital Charge Code	41569539
Hospital Revenue Code	278
Min. Negotiated Rate	$205.54
Max. Negotiated Rate	$205.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$205.54
Rate for Payer: Hamaspik Choice Inc Medicare	$205.54

ZZ BIOPSH EMBOSPHER 1ML 810GH

Facility OP

$411.08

Service Code	HCPCS C1884
Hospital Charge Code	41569539
Hospital Revenue Code	278
Min. Negotiated Rate	$143.88
Max. Negotiated Rate	$431.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$226.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$205.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$236.37
Rate for Payer: Fidelis Medicare Advantage	$431.63
Rate for Payer: Group Health Inc Commercial	$205.54
Rate for Payer: Group Health Inc Medicare	$143.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$205.54
Rate for Payer: Hamaspik Choice Inc Medicare	$205.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$267.20

ZZ BIOPSH EMBOSPHERE 2ML 620GH

Facility OP

$567.00

Service Code	HCPCS C1884
Hospital Charge Code	41569538
Hospital Revenue Code	278
Min. Negotiated Rate	$180.07
Max. Negotiated Rate	$595.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$311.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$283.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$326.02
Rate for Payer: Fidelis Medicare Advantage	$595.35
Rate for Payer: Group Health Inc Commercial	$283.50
Rate for Payer: Group Health Inc Medicare	$198.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$283.50
Rate for Payer: Hamaspik Choice Inc Medicare	$283.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$368.55

ZZ BIOPSH EMBOSPHERE 2ML 620GH

Facility IP

$567.00

Service Code	HCPCS C1884
Hospital Charge Code	41569538
Hospital Revenue Code	278
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$283.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$283.50
Rate for Payer: Hamaspik Choice Inc Medicare	$283.50

ZZ BIOPSY FORCEPS

Facility OP

$531.56

Hospital Charge Code	41569460
Hospital Revenue Code	270
Min. Negotiated Rate	$186.05
Max. Negotiated Rate	$425.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$292.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.78
Rate for Payer: Aetna Government	$265.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$425.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$361.46
Rate for Payer: Group Health Inc Commercial	$265.78
Rate for Payer: Group Health Inc Medicare	$186.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$265.78
Rate for Payer: Hamaspik Choice Inc Medicare	$265.78

ZZ BIOPSY FORCEPS #502-300L 7.0F

Facility OP

$531.56

Hospital Charge Code	41569004
Hospital Revenue Code	270
Min. Negotiated Rate	$186.05
Max. Negotiated Rate	$425.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$292.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.78
Rate for Payer: Aetna Government	$265.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$425.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$361.46
Rate for Payer: Group Health Inc Commercial	$265.78
Rate for Payer: Group Health Inc Medicare	$186.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$265.78
Rate for Payer: Hamaspik Choice Inc Medicare	$265.78

ZZ BIOPSY FORCEPS #502-302 5.4F

Facility OP

$531.56

Hospital Charge Code	41569005
Hospital Revenue Code	270
Min. Negotiated Rate	$186.05
Max. Negotiated Rate	$425.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$292.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.78
Rate for Payer: Aetna Government	$265.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$425.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$361.46
Rate for Payer: Group Health Inc Commercial	$265.78
Rate for Payer: Group Health Inc Medicare	$186.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$265.78
Rate for Payer: Hamaspik Choice Inc Medicare	$265.78

ZZ BIOPSY TRAY STANDARD

Facility OP

$39.33

Hospital Charge Code	41567004
Hospital Revenue Code	270
Min. Negotiated Rate	$13.77
Max. Negotiated Rate	$31.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.66
Rate for Payer: Aetna Government	$19.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.74
Rate for Payer: Group Health Inc Commercial	$19.66
Rate for Payer: Group Health Inc Medicare	$13.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.66
Rate for Payer: Hamaspik Choice Inc Medicare	$19.66

ZZ BIOSPHERE 100-300

Facility IP

$581.18

Service Code	HCPCS C1884
Hospital Charge Code	41569777
Hospital Revenue Code	278
Min. Negotiated Rate	$290.59
Max. Negotiated Rate	$290.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$290.59
Rate for Payer: Hamaspik Choice Inc Medicare	$290.59

ZZ BIOSPHERE 100-300

Facility OP

$581.18

Service Code	HCPCS C1884
Hospital Charge Code	41569777
Hospital Revenue Code	278
Min. Negotiated Rate	$180.07
Max. Negotiated Rate	$610.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$319.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$290.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$334.18
Rate for Payer: Fidelis Medicare Advantage	$610.24
Rate for Payer: Group Health Inc Commercial	$290.59
Rate for Payer: Group Health Inc Medicare	$203.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$290.59
Rate for Payer: Hamaspik Choice Inc Medicare	$290.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$377.77

ZZ BIOSPHERE 40-120

Facility IP

$567.00

Service Code	HCPCS C1884
Hospital Charge Code	41569778
Hospital Revenue Code	278
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$283.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$283.50
Rate for Payer: Hamaspik Choice Inc Medicare	$283.50

ZZ BIOSPHERE 40-120

Facility OP

$567.00

Service Code	HCPCS C1884
Hospital Charge Code	41569778
Hospital Revenue Code	278
Min. Negotiated Rate	$180.07
Max. Negotiated Rate	$595.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$311.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$283.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$326.02
Rate for Payer: Fidelis Medicare Advantage	$595.35
Rate for Payer: Group Health Inc Commercial	$283.50
Rate for Payer: Group Health Inc Medicare	$198.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$283.50
Rate for Payer: Hamaspik Choice Inc Medicare	$283.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$368.55

ZZ BIRDS NEST FILTER

Facility OP

$2,526.70

Hospital Charge Code	41567133
Hospital Revenue Code	270
Min. Negotiated Rate	$884.34
Max. Negotiated Rate	$2,021.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,389.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,263.35
Rate for Payer: Aetna Government	$1,263.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,021.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,718.16
Rate for Payer: Group Health Inc Commercial	$1,263.35
Rate for Payer: Group Health Inc Medicare	$884.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,263.35
Rate for Payer: Hamaspik Choice Inc Medicare	$1,263.35

ZZ BLUE MANX 6.4 X 40CM

Facility IP

$766.16

Service Code	HCPCS C1725
Hospital Charge Code	41567502
Hospital Revenue Code	278
Min. Negotiated Rate	$383.08
Max. Negotiated Rate	$383.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.08
Rate for Payer: Hamaspik Choice Inc Medicare	$383.08

ZZ BLUE MANX 6.4 X 40CM

Facility OP

$766.16

Service Code	HCPCS C1725
Hospital Charge Code	41567502
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$804.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.39
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	$383.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$440.54
Rate for Payer: Fidelis Medicare Advantage	$804.47
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
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$498.00

ZZ BLUE MAX BAL 9-4/8/75

Facility IP

$766.16

Service Code	HCPCS C1725
Hospital Charge Code	41567214
Hospital Revenue Code	278
Min. Negotiated Rate	$383.08
Max. Negotiated Rate	$383.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.08
Rate for Payer: Hamaspik Choice Inc Medicare	$383.08

ZZ BLUE MAX BAL 9-4/8/75

Facility OP

$766.16

Service Code	HCPCS C1725
Hospital Charge Code	41567214
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$804.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.39
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	$383.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$440.54
Rate for Payer: Fidelis Medicare Advantage	$804.47
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
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$498.00

ZZ BLUE MAX BL 12-4/7/100

Facility OP

$766.16

Service Code	HCPCS C1725
Hospital Charge Code	41567208
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$804.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.39
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	$383.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$440.54
Rate for Payer: Fidelis Medicare Advantage	$804.47
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
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$498.00

ZZ BLUE MAX BL 12-4/7/100

Facility IP

$766.16

Service Code	HCPCS C1725
Hospital Charge Code	41567208
Hospital Revenue Code	278
Min. Negotiated Rate	$383.08
Max. Negotiated Rate	$383.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.08
Rate for Payer: Hamaspik Choice Inc Medicare	$383.08

ZZ BLUE MAX BL 6-2/5.8/75

Facility OP

$766.16

Service Code	HCPCS C1725
Hospital Charge Code	41567209
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$804.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.39
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	$383.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$440.54
Rate for Payer: Fidelis Medicare Advantage	$804.47
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
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$498.00

ZZ BLUE MAX BL 6-2/5.8/75

Facility IP

$766.16

Service Code	HCPCS C1725
Hospital Charge Code	41567209
Hospital Revenue Code	278
Min. Negotiated Rate	$383.08
Max. Negotiated Rate	$383.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.08
Rate for Payer: Hamaspik Choice Inc Medicare	$383.08

ZZ BLUE MAX BL 7-4/5.8/40

Facility OP

$766.16

Service Code	HCPCS C1725
Hospital Charge Code	41567210
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$804.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.39
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	$383.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$440.54
Rate for Payer: Fidelis Medicare Advantage	$804.47
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
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$498.00

ZZ BLUE MAX BL 7-4/5.8/40

Facility IP

$766.16

Service Code	HCPCS C1725
Hospital Charge Code	41567210
Hospital Revenue Code	278
Min. Negotiated Rate	$383.08
Max. Negotiated Rate	$383.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.08
Rate for Payer: Hamaspik Choice Inc Medicare	$383.08

ZZ BLUE MAX BL 8-3/5.8/40

Facility IP

$766.16

Service Code	HCPCS C1725
Hospital Charge Code	41567211
Hospital Revenue Code	278
Min. Negotiated Rate	$383.08
Max. Negotiated Rate	$383.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.08
Rate for Payer: Hamaspik Choice Inc Medicare	$383.08

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