St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ BLUE MAX BL 8-3/5.8/40

Facility OP

$766.16

Service Code	HCPCS C1725
Hospital Charge Code	41567211
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 8-3/8/75

Facility IP

$766.16

Service Code	HCPCS C1725
Hospital Charge Code	41567212
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 8-3/8/75

Facility OP

$766.16

Service Code	HCPCS C1725
Hospital Charge Code	41567212
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 9-4/5.8/40

Facility IP

$766.16

Service Code	HCPCS C1725
Hospital Charge Code	41567213
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 9-4/5.8/40

Facility OP

$766.16

Service Code	HCPCS C1725
Hospital Charge Code	41567213
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 BONE BX NDL 13-10

Facility OP

$104.19

Hospital Charge Code	41569785
Hospital Revenue Code	270
Min. Negotiated Rate	$36.47
Max. Negotiated Rate	$83.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$52.10
Rate for Payer: Aetna Government	$52.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$83.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$70.85
Rate for Payer: Group Health Inc Commercial	$52.10
Rate for Payer: Group Health Inc Medicare	$36.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.10
Rate for Payer: Hamaspik Choice Inc Medicare	$52.10

ZZ BOOMERANG CLOSURE SYST.

Facility OP

$300.00

Hospital Charge Code	41569959
Hospital Revenue Code	279
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$240.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$150.00
Rate for Payer: Aetna Government	$150.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$240.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$204.00
Rate for Payer: Group Health Inc Commercial	$150.00
Rate for Payer: Group Health Inc Medicare	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00

ZZ BRACHYTH.NON-HIGH IRIDIUM 192

Facility IP

$2,550.00

Service Code	HCPCS C1719
Hospital Charge Code	41569952
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$1,275.00
Rate for Payer: Cash Price	$422.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,275.00

ZZ BRACHYTH.NON-HIGH IRIDIUM 192

Facility OP

$2,550.00

Service Code	HCPCS C1719
Hospital Charge Code	41569952
Hospital Revenue Code	278
Min. Negotiated Rate	$338.30
Max. Negotiated Rate	$1,657.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,402.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$422.88
Rate for Payer: Aetna Government	$422.88
Rate for Payer: Cash Price	$422.88
Rate for Payer: Cash Price	$422.88
Rate for Payer: Cash Price	$422.88
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$422.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,275.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,466.25
Rate for Payer: Elderplan Medicare Advantage	$422.88
Rate for Payer: Fidelis Medicare Advantage	$422.88
Rate for Payer: Group Health Inc Commercial	$422.88
Rate for Payer: Group Health Inc Medicare	$422.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,275.00
Rate for Payer: Healthfirst Medicare Advantage	$359.45
Rate for Payer: Healthfirst QHP	$422.88
Rate for Payer: Senior Whole Health Medicare Advantage	$422.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,657.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$338.30

ZZ BS 2CM PERIPH CUTTING BALLOON

Facility OP

$1,906.00

Hospital Charge Code	41563500
Hospital Revenue Code	272
Min. Negotiated Rate	$667.10
Max. Negotiated Rate	$1,524.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,048.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$953.00
Rate for Payer: Aetna Government	$953.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,524.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,296.08
Rate for Payer: Group Health Inc Commercial	$953.00
Rate for Payer: Group Health Inc Medicare	$667.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$953.00
Rate for Payer: Hamaspik Choice Inc Medicare	$953.00

ZZ BS BALLONS 18MMX4CMX75CM

Facility OP

$260.00

Hospital Charge Code	41540621
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 BS BALLOONS 14MMX4CMX75CM

Facility OP

$260.00

Hospital Charge Code	41541115
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 BS BALLOONS 14MMX4CMX75CM

Facility OP

$260.00

Hospital Charge Code	41540620
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 BS BALLOONS 16MMX4CMX75CM

Facility OP

$260.00

Hospital Charge Code	41540622
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 BS BALLOONS 16MMX4CMX75CM

Facility OP

$260.00

Hospital Charge Code	41541119
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 BS BALLOONS 18MM4CMX75CM

Facility OP

$260.00

Hospital Charge Code	41541117
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 BS COYOTE ES 4F 2.0MMX40MM

Facility OP

$668.00

Service Code	HCPCS C1725
Hospital Charge Code	41561950
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$701.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$367.40
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	$334.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$384.10
Rate for Payer: Fidelis Medicare Advantage	$701.40
Rate for Payer: Group Health Inc Commercial	$334.00
Rate for Payer: Group Health Inc Medicare	$233.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$334.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$434.20

ZZ BS COYOTE ES 4F 2.0MMX40MM

Facility IP

$668.00

Service Code	HCPCS C1725
Hospital Charge Code	41561950
Hospital Revenue Code	278
Min. Negotiated Rate	$334.00
Max. Negotiated Rate	$334.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$334.00

ZZ BS COYOTE ES 4F 2.5MMX40MM

Facility IP

$668.00

Service Code	HCPCS C1725
Hospital Charge Code	41561949
Hospital Revenue Code	278
Min. Negotiated Rate	$334.00
Max. Negotiated Rate	$334.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$334.00

ZZ BS COYOTE ES 4F 2.5MMX40MM

Facility OP

$668.00

Service Code	HCPCS C1725
Hospital Charge Code	41561949
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$701.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$367.40
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	$334.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$384.10
Rate for Payer: Fidelis Medicare Advantage	$701.40
Rate for Payer: Group Health Inc Commercial	$334.00
Rate for Payer: Group Health Inc Medicare	$233.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$334.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$434.20

ZZ BS COYOTE ES 4F 3.0MMX40MM

Facility IP

$668.00

Service Code	HCPCS C1725
Hospital Charge Code	41561948
Hospital Revenue Code	278
Min. Negotiated Rate	$334.00
Max. Negotiated Rate	$334.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$334.00

ZZ BS COYOTE ES 4F 3.0MMX40MM

Facility OP

$668.00

Service Code	HCPCS C1725
Hospital Charge Code	41561948
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$701.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$367.40
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	$334.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$384.10
Rate for Payer: Fidelis Medicare Advantage	$701.40
Rate for Payer: Group Health Inc Commercial	$334.00
Rate for Payer: Group Health Inc Medicare	$233.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$334.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$434.20

ZZ BS COYOTE ES 4F 4.0MMX40MM

Facility OP

$668.00

Service Code	HCPCS C1725
Hospital Charge Code	41561947
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$701.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$367.40
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	$334.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$384.10
Rate for Payer: Fidelis Medicare Advantage	$701.40
Rate for Payer: Group Health Inc Commercial	$334.00
Rate for Payer: Group Health Inc Medicare	$233.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$334.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$434.20

ZZ BS COYOTE ES 4F 4.0MMX40MM

Facility IP

$668.00

Service Code	HCPCS C1725
Hospital Charge Code	41561947
Hospital Revenue Code	278
Min. Negotiated Rate	$334.00
Max. Negotiated Rate	$334.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$334.00

ZZ BS DIREXION HIFLO MICROCATH

Facility OP

$1,950.20

Hospital Charge Code	41561363
Hospital Revenue Code	272
Min. Negotiated Rate	$682.57
Max. Negotiated Rate	$1,560.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,072.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$975.10
Rate for Payer: Aetna Government	$975.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,560.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,326.14
Rate for Payer: Group Health Inc Commercial	$975.10
Rate for Payer: Group Health Inc Medicare	$682.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.10
Rate for Payer: Hamaspik Choice Inc Medicare	$975.10

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