St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ DRAINAGE/PCN/10F FIRM

Facility OP

$172.23

Service Code	HCPCS C1729
Hospital Charge Code	41569340
Hospital Revenue Code	278
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$180.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.42
Rate for Payer: Aetna Government	$2.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$86.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$99.03
Rate for Payer: Fidelis Medicare Advantage	$180.84
Rate for Payer: Group Health Inc Commercial	$86.12
Rate for Payer: Group Health Inc Medicare	$60.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.12
Rate for Payer: Hamaspik Choice Inc Medicare	$86.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$111.95

ZZ DRAINAGE/PCN/12F

Facility IP

$172.23

Service Code	HCPCS C1725
Hospital Charge Code	41569341
Hospital Revenue Code	278
Min. Negotiated Rate	$86.12
Max. Negotiated Rate	$86.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.12
Rate for Payer: Hamaspik Choice Inc Medicare	$86.12

ZZ DRAINAGE/PCN/12F

Facility OP

$172.23

Service Code	HCPCS C1725
Hospital Charge Code	41569341
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$180.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.73
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	$86.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$99.03
Rate for Payer: Fidelis Medicare Advantage	$180.84
Rate for Payer: Group Health Inc Commercial	$86.12
Rate for Payer: Group Health Inc Medicare	$60.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.12
Rate for Payer: Hamaspik Choice Inc Medicare	$86.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$111.95

ZZ DRAINAGE/PCN/8F FIRM

Facility OP

$172.23

Service Code	HCPCS C1725
Hospital Charge Code	41569344
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$180.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.73
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	$86.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$99.03
Rate for Payer: Fidelis Medicare Advantage	$180.84
Rate for Payer: Group Health Inc Commercial	$86.12
Rate for Payer: Group Health Inc Medicare	$60.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.12
Rate for Payer: Hamaspik Choice Inc Medicare	$86.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$111.95

ZZ DRAINAGE/PCN/8F FIRM

Facility IP

$172.23

Service Code	HCPCS C1725
Hospital Charge Code	41569344
Hospital Revenue Code	278
Min. Negotiated Rate	$86.12
Max. Negotiated Rate	$86.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.12
Rate for Payer: Hamaspik Choice Inc Medicare	$86.12

ZZ DRAINAGE/SUMP/12F LOCKING

Facility IP

$244.52

Service Code	HCPCS C1725
Hospital Charge Code	41569490
Hospital Revenue Code	278
Min. Negotiated Rate	$122.26
Max. Negotiated Rate	$122.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$122.26
Rate for Payer: Hamaspik Choice Inc Medicare	$122.26

ZZ DRAINAGE/SUMP/12F LOCKING

Facility OP

$244.52

Service Code	HCPCS C1725
Hospital Charge Code	41569490
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$256.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$134.49
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	$122.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$140.60
Rate for Payer: Fidelis Medicare Advantage	$256.75
Rate for Payer: Group Health Inc Commercial	$122.26
Rate for Payer: Group Health Inc Medicare	$85.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$122.26
Rate for Payer: Hamaspik Choice Inc Medicare	$122.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$158.94

ZZ D-STAT FLOWABLE HEMOSTAT

Facility IP

$262.50

Service Code	HCPCS C1725
Hospital Charge Code	41567893
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.25
Rate for Payer: Hamaspik Choice Inc Medicare	$131.25

ZZ D-STAT FLOWABLE HEMOSTAT

Facility OP

$262.50

Service Code	HCPCS C1725
Hospital Charge Code	41567893
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$275.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$144.38
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	$131.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$150.94
Rate for Payer: Fidelis Medicare Advantage	$275.62
Rate for Payer: Group Health Inc Commercial	$131.25
Rate for Payer: Group Health Inc Medicare	$91.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.25
Rate for Payer: Hamaspik Choice Inc Medicare	$131.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$170.62

ZZ DURO-JECT BONE CEME. INJ.

Facility OP

$484.50

Hospital Charge Code	41569964
Hospital Revenue Code	279
Min. Negotiated Rate	$169.58
Max. Negotiated Rate	$387.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$266.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$242.25
Rate for Payer: Aetna Government	$242.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$387.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$329.46
Rate for Payer: Group Health Inc Commercial	$242.25
Rate for Payer: Group Health Inc Medicare	$169.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$242.25
Rate for Payer: Hamaspik Choice Inc Medicare	$242.25

ZZ EASY CORE BIOPSY SYS 18GX10CM

Facility OP

$127.40

Hospital Charge Code	41569897
Hospital Revenue Code	270
Min. Negotiated Rate	$44.59
Max. Negotiated Rate	$101.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.70
Rate for Payer: Aetna Government	$63.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$101.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.63
Rate for Payer: Group Health Inc Commercial	$63.70
Rate for Payer: Group Health Inc Medicare	$44.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.70
Rate for Payer: Hamaspik Choice Inc Medicare	$63.70

ZZ EBU GUIDE CATHETER

Facility IP

$116.60

Service Code	HCPCS C1725
Hospital Charge Code	41569912
Hospital Revenue Code	278
Min. Negotiated Rate	$58.30
Max. Negotiated Rate	$58.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.30
Rate for Payer: Hamaspik Choice Inc Medicare	$58.30

ZZ EBU GUIDE CATHETER

Facility OP

$116.60

Service Code	HCPCS C1725
Hospital Charge Code	41569912
Hospital Revenue Code	278
Min. Negotiated Rate	$40.81
Max. Negotiated Rate	$122.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.13
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	$58.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$67.04
Rate for Payer: Fidelis Medicare Advantage	$122.43
Rate for Payer: Group Health Inc Commercial	$58.30
Rate for Payer: Group Health Inc Medicare	$40.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.30
Rate for Payer: Hamaspik Choice Inc Medicare	$58.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$75.79

ZZ EDLIFE FOG. CLOT CATH

Facility OP

$552.83

Hospital Charge Code	41569563
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 EKOS ENDOVASCULAR DEVICE 12CM

Facility OP

$3,395.00

Hospital Charge Code	41540603
Hospital Revenue Code	272
Min. Negotiated Rate	$1,188.25
Max. Negotiated Rate	$2,716.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,867.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,697.50
Rate for Payer: Aetna Government	$1,697.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,716.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,308.60
Rate for Payer: Group Health Inc Commercial	$1,697.50
Rate for Payer: Group Health Inc Medicare	$1,188.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,697.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,697.50

ZZ EKOS ENDOVASCULAR DEVICE 18CM

Facility OP

$3,395.00

Hospital Charge Code	41540604
Hospital Revenue Code	272
Min. Negotiated Rate	$1,188.25
Max. Negotiated Rate	$2,716.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,867.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,697.50
Rate for Payer: Aetna Government	$1,697.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,716.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,308.60
Rate for Payer: Group Health Inc Commercial	$1,697.50
Rate for Payer: Group Health Inc Medicare	$1,188.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,697.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,697.50

ZZ EL FOGARTY 5.5F

Facility OP

$178.72

Hospital Charge Code	41561898
Hospital Revenue Code	270
Min. Negotiated Rate	$62.55
Max. Negotiated Rate	$142.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$98.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$89.36
Rate for Payer: Aetna Government	$89.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$142.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$121.53
Rate for Payer: Group Health Inc Commercial	$89.36
Rate for Payer: Group Health Inc Medicare	$62.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.36
Rate for Payer: Hamaspik Choice Inc Medicare	$89.36

ZZ EMBOCATH

Facility OP

$708.75

Service Code	HCPCS C1884
Hospital Charge Code	41569767
Hospital Revenue Code	278
Min. Negotiated Rate	$180.07
Max. Negotiated Rate	$744.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$389.81
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	$354.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$407.53
Rate for Payer: Fidelis Medicare Advantage	$744.19
Rate for Payer: Group Health Inc Commercial	$354.38
Rate for Payer: Group Health Inc Medicare	$248.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$354.38
Rate for Payer: Hamaspik Choice Inc Medicare	$354.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$460.69

ZZ EMBOCATH

Facility IP

$708.75

Service Code	HCPCS C1884
Hospital Charge Code	41569767
Hospital Revenue Code	278
Min. Negotiated Rate	$354.38
Max. Negotiated Rate	$354.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$354.38
Rate for Payer: Hamaspik Choice Inc Medicare	$354.38

ZZ EMBOLIZA COIL

Facility IP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41560054
Hospital Revenue Code	278
Min. Negotiated Rate	$33.49
Max. Negotiated Rate	$33.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.49
Rate for Payer: Hamaspik Choice Inc Medicare	$33.49

ZZ EMBOLIZA COIL

Facility OP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41560054
Hospital Revenue Code	278
Min. Negotiated Rate	$23.44
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$36.84
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	$33.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$38.51
Rate for Payer: Fidelis Medicare Advantage	$70.33
Rate for Payer: Group Health Inc Commercial	$33.49
Rate for Payer: Group Health Inc Medicare	$23.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.49
Rate for Payer: Hamaspik Choice Inc Medicare	$33.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$43.54

ZZ EMBOLIZA COIL 35 3 3

Facility OP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567334
Hospital Revenue Code	278
Min. Negotiated Rate	$23.44
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$36.84
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	$33.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$38.51
Rate for Payer: Fidelis Medicare Advantage	$70.33
Rate for Payer: Group Health Inc Commercial	$33.49
Rate for Payer: Group Health Inc Medicare	$23.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.49
Rate for Payer: Hamaspik Choice Inc Medicare	$33.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$43.54

ZZ EMBOLIZA COIL 35 3 3

Facility IP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567334
Hospital Revenue Code	278
Min. Negotiated Rate	$33.49
Max. Negotiated Rate	$33.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.49
Rate for Payer: Hamaspik Choice Inc Medicare	$33.49

ZZ EMBOLIZA COIL 35 3 4

Facility OP

$66.98

Hospital Charge Code	41567335
Hospital Revenue Code	270
Min. Negotiated Rate	$23.44
Max. Negotiated Rate	$53.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$36.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$33.49
Rate for Payer: Aetna Government	$33.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$53.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$45.55
Rate for Payer: Group Health Inc Commercial	$33.49
Rate for Payer: Group Health Inc Medicare	$23.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.49
Rate for Payer: Hamaspik Choice Inc Medicare	$33.49

ZZ EMBOLIZA COIL 38 2 3

Facility OP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567336
Hospital Revenue Code	278
Min. Negotiated Rate	$23.44
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$36.84
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	$33.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$38.51
Rate for Payer: Fidelis Medicare Advantage	$70.33
Rate for Payer: Group Health Inc Commercial	$33.49
Rate for Payer: Group Health Inc Medicare	$23.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.49
Rate for Payer: Hamaspik Choice Inc Medicare	$33.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$43.54

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