St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ COOKS DILATOR 9 38 20

Facility OP

$13.11

Hospital Charge Code	41567300
Hospital Revenue Code	270
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$10.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.56
Rate for Payer: Aetna Government	$6.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.91
Rate for Payer: Group Health Inc Commercial	$6.56
Rate for Payer: Group Health Inc Medicare	$4.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.56
Rate for Payer: Hamaspik Choice Inc Medicare	$6.56

ZZ COOK TULIP FILTER RETRIEVALSET

Facility OP

$595.00

Hospital Charge Code	41567759
Hospital Revenue Code	270
Min. Negotiated Rate	$208.25
Max. Negotiated Rate	$476.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$327.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$297.50
Rate for Payer: Aetna Government	$297.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$476.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$404.60
Rate for Payer: Group Health Inc Commercial	$297.50
Rate for Payer: Group Health Inc Medicare	$208.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$297.50
Rate for Payer: Hamaspik Choice Inc Medicare	$297.50

ZZ COOK ULTRATHANE SUP.PUB.SET

Facility OP

$135.90

Service Code	HCPCS C2627
Hospital Charge Code	41561926
Hospital Revenue Code	278
Min. Negotiated Rate	$47.56
Max. Negotiated Rate	$142.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$73.04
Rate for Payer: Aetna Government	$73.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$67.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$78.14
Rate for Payer: Fidelis Medicare Advantage	$142.70
Rate for Payer: Group Health Inc Commercial	$67.95
Rate for Payer: Group Health Inc Medicare	$47.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.95
Rate for Payer: Hamaspik Choice Inc Medicare	$67.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$88.34

ZZ COOK ULTRATHANE SUP.PUB.SET

Facility IP

$135.90

Service Code	HCPCS C2627
Hospital Charge Code	41561926
Hospital Revenue Code	278
Min. Negotiated Rate	$67.95
Max. Negotiated Rate	$67.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.95
Rate for Payer: Hamaspik Choice Inc Medicare	$67.95

ZZ COOK WILL-OG GASTRO SET

Facility OP

$297.00

Hospital Charge Code	41561909
Hospital Revenue Code	270
Min. Negotiated Rate	$103.95
Max. Negotiated Rate	$237.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$163.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$148.50
Rate for Payer: Aetna Government	$148.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$237.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.96
Rate for Payer: Group Health Inc Commercial	$148.50
Rate for Payer: Group Health Inc Medicare	$103.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.50
Rate for Payer: Hamaspik Choice Inc Medicare	$148.50

ZZ COOK WILLS-OGLESBY GASTROSTOMY

Facility OP

$297.00

Hospital Charge Code	41561894
Hospital Revenue Code	270
Min. Negotiated Rate	$103.95
Max. Negotiated Rate	$237.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$163.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$148.50
Rate for Payer: Aetna Government	$148.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$237.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.96
Rate for Payer: Group Health Inc Commercial	$148.50
Rate for Payer: Group Health Inc Medicare	$103.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.50
Rate for Payer: Hamaspik Choice Inc Medicare	$148.50

ZZ COOK YUEH CATH. NEEDLE 4FR/10C

Facility OP

$38.40

Hospital Charge Code	41567753
Hospital Revenue Code	270
Min. Negotiated Rate	$13.44
Max. Negotiated Rate	$30.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.20
Rate for Payer: Aetna Government	$19.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.11
Rate for Payer: Group Health Inc Commercial	$19.20
Rate for Payer: Group Health Inc Medicare	$13.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.20
Rate for Payer: Hamaspik Choice Inc Medicare	$19.20

ZZ COOK ZILVER 518 STENT

Facility OP

$3,100.00

Service Code	HCPCS C1874
Hospital Charge Code	41561807
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,255.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,705.00
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	$1,550.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,782.50
Rate for Payer: Fidelis Medicare Advantage	$3,255.00
Rate for Payer: Group Health Inc Commercial	$1,550.00
Rate for Payer: Group Health Inc Medicare	$1,085.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,550.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,015.00

ZZ COOK ZILVER 518 STENT

Facility IP

$3,100.00

Service Code	HCPCS C1874
Hospital Charge Code	41561807
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.00
Max. Negotiated Rate	$1,550.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,550.00

ZZ COOK ZILVER 518 STENT

Facility IP

$3,100.00

Service Code	HCPCS C1874
Hospital Charge Code	41561809
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.00
Max. Negotiated Rate	$1,550.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,550.00

ZZ COOK ZILVER 518 STENT

Facility IP

$3,100.00

Service Code	HCPCS C1874
Hospital Charge Code	41561808
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.00
Max. Negotiated Rate	$1,550.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,550.00

ZZ COOK ZILVER 518 STENT

Facility OP

$3,100.00

Service Code	HCPCS C1874
Hospital Charge Code	41561809
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,255.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,705.00
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	$1,550.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,782.50
Rate for Payer: Fidelis Medicare Advantage	$3,255.00
Rate for Payer: Group Health Inc Commercial	$1,550.00
Rate for Payer: Group Health Inc Medicare	$1,085.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,550.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,015.00

ZZ COOK ZILVER 518 STENT

Facility OP

$3,100.00

Service Code	HCPCS C1874
Hospital Charge Code	41561808
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,255.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,705.00
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	$1,550.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,782.50
Rate for Payer: Fidelis Medicare Advantage	$3,255.00
Rate for Payer: Group Health Inc Commercial	$1,550.00
Rate for Payer: Group Health Inc Medicare	$1,085.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,550.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,015.00

ZZ COOK ZILVER 635 STENT

Facility OP

$2,600.00

Service Code	HCPCS C1874
Hospital Charge Code	41561810
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$2,730.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,430.00
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	$1,300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,495.00
Rate for Payer: Fidelis Medicare Advantage	$2,730.00
Rate for Payer: Group Health Inc Commercial	$1,300.00
Rate for Payer: Group Health Inc Medicare	$910.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,300.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,690.00

ZZ COOK ZILVER 635 STENT

Facility IP

$2,600.00

Service Code	HCPCS C1874
Hospital Charge Code	41561810
Hospital Revenue Code	278
Min. Negotiated Rate	$1,300.00
Max. Negotiated Rate	$1,300.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,300.00

ZZ COPE MANDRIL WR 18-60

Facility OP

$89.66

Service Code	HCPCS C1769
Hospital Charge Code	41567093
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$94.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$49.31
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	$44.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.55
Rate for Payer: Fidelis Medicare Advantage	$94.14
Rate for Payer: Group Health Inc Commercial	$44.83
Rate for Payer: Group Health Inc Medicare	$31.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.83
Rate for Payer: Hamaspik Choice Inc Medicare	$44.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$58.28

ZZ COPE MANDRIL WR 18-60

Facility IP

$89.66

Service Code	HCPCS C1769
Hospital Charge Code	41567093
Hospital Revenue Code	278
Min. Negotiated Rate	$44.83
Max. Negotiated Rate	$44.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.83
Rate for Payer: Hamaspik Choice Inc Medicare	$44.83

ZZ CORDIS 4F C2 TEMPO 4

Facility OP

$42.00

Hospital Charge Code	41564619
Hospital Revenue Code	272
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$33.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.00
Rate for Payer: Aetna Government	$21.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.56
Rate for Payer: Group Health Inc Commercial	$21.00
Rate for Payer: Group Health Inc Medicare	$14.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.00
Rate for Payer: Hamaspik Choice Inc Medicare	$21.00

ZZ CORDIS AGILITY 14 014X025

Facility IP

$472.50

Service Code	HCPCS C1725
Hospital Charge Code	41569866
Hospital Revenue Code	278
Min. Negotiated Rate	$236.25
Max. Negotiated Rate	$236.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$236.25
Rate for Payer: Hamaspik Choice Inc Medicare	$236.25

ZZ CORDIS AGILITY 14 014X025

Facility OP

$472.50

Service Code	HCPCS C1725
Hospital Charge Code	41569866
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$496.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$259.88
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	$236.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$271.69
Rate for Payer: Fidelis Medicare Advantage	$496.12
Rate for Payer: Group Health Inc Commercial	$236.25
Rate for Payer: Group Health Inc Medicare	$165.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$236.25
Rate for Payer: Hamaspik Choice Inc Medicare	$236.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$307.12

ZZ CORDIS BRIT TIP-SHTH 6X90

Facility OP

$184.28

Hospital Charge Code	41569629
Hospital Revenue Code	270
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$147.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$101.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$92.14
Rate for Payer: Aetna Government	$92.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$125.31
Rate for Payer: Group Health Inc Commercial	$92.14
Rate for Payer: Group Health Inc Medicare	$64.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.14
Rate for Payer: Hamaspik Choice Inc Medicare	$92.14

ZZ CORDIS BRIT TIP-SHTH 7X90

Facility OP

$184.28

Hospital Charge Code	41569630
Hospital Revenue Code	270
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$147.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$101.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$92.14
Rate for Payer: Aetna Government	$92.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$125.31
Rate for Payer: Group Health Inc Commercial	$92.14
Rate for Payer: Group Health Inc Medicare	$64.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.14
Rate for Payer: Hamaspik Choice Inc Medicare	$92.14

ZZ CORDIS EXOSEAL 5F/6F

Facility OP

$225.00

Hospital Charge Code	41563211
Hospital Revenue Code	272
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$180.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$123.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$112.50
Rate for Payer: Aetna Government	$112.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$180.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.00
Rate for Payer: Group Health Inc Commercial	$112.50
Rate for Payer: Group Health Inc Medicare	$78.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.50
Rate for Payer: Hamaspik Choice Inc Medicare	$112.50

ZZ CORDIS PROWLER PLUS 042X150

Facility IP

$997.50

Service Code	HCPCS C1725
Hospital Charge Code	41569867
Hospital Revenue Code	278
Min. Negotiated Rate	$498.75
Max. Negotiated Rate	$498.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$498.75
Rate for Payer: Hamaspik Choice Inc Medicare	$498.75

ZZ CORDIS PROWLER PLUS 042X150

Facility OP

$997.50

Service Code	HCPCS C1725
Hospital Charge Code	41569867
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$1,047.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$548.62
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	$498.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$573.56
Rate for Payer: Fidelis Medicare Advantage	$1,047.38
Rate for Payer: Group Health Inc Commercial	$498.75
Rate for Payer: Group Health Inc Medicare	$349.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$498.75
Rate for Payer: Hamaspik Choice Inc Medicare	$498.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$648.38

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