St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ EMBOLIZA COIL 38 2 3

Facility IP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567336
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 38 3 2

Facility OP

$66.98

Hospital Charge Code	41567337
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 3 5

Facility OP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567338
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 38 3 5

Facility IP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567338
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 38 4 3

Facility IP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567339
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 38 4 3

Facility OP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567339
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 38 5 10

Facility IP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567141
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 38 5 10

Facility OP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567141
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 38 5 15

Facility IP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567142
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 38 5 15

Facility OP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567142
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 38 5 5

Facility IP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567341
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 38 5 5

Facility OP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567341
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 38 5 8

Facility OP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567340
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 38 5 8

Facility IP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567340
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 52 10 15

Facility IP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567342
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 52 10 15

Facility OP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567342
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 52 15 15

Facility OP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567343
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 52 15 15

Facility IP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567343
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 EMBOLIZATION PORT/100-200

Facility IP

$180.88

Service Code	HCPCS C1884
Hospital Charge Code	41569496
Hospital Revenue Code	278
Min. Negotiated Rate	$90.44
Max. Negotiated Rate	$90.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.44
Rate for Payer: Hamaspik Choice Inc Medicare	$90.44

ZZ EMBOLIZATION PORT/100-200

Facility OP

$180.88

Service Code	HCPCS C1884
Hospital Charge Code	41569496
Hospital Revenue Code	278
Min. Negotiated Rate	$63.31
Max. Negotiated Rate	$189.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$99.48
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	$90.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$104.01
Rate for Payer: Fidelis Medicare Advantage	$189.92
Rate for Payer: Group Health Inc Commercial	$90.44
Rate for Payer: Group Health Inc Medicare	$63.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.44
Rate for Payer: Hamaspik Choice Inc Medicare	$90.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$117.57

ZZ EMBOLIZATION PORT/200-300

Facility OP

$180.88

Service Code	HCPCS C1884
Hospital Charge Code	41569494
Hospital Revenue Code	278
Min. Negotiated Rate	$63.31
Max. Negotiated Rate	$189.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$99.48
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	$90.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$104.01
Rate for Payer: Fidelis Medicare Advantage	$189.92
Rate for Payer: Group Health Inc Commercial	$90.44
Rate for Payer: Group Health Inc Medicare	$63.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.44
Rate for Payer: Hamaspik Choice Inc Medicare	$90.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$117.57

ZZ EMBOLIZATION PORT/200-300

Facility IP

$180.88

Service Code	HCPCS C1884
Hospital Charge Code	41569494
Hospital Revenue Code	278
Min. Negotiated Rate	$90.44
Max. Negotiated Rate	$90.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.44
Rate for Payer: Hamaspik Choice Inc Medicare	$90.44

ZZ EMBOLIZATION PORT/300-500

Facility OP

$180.88

Service Code	HCPCS C1884
Hospital Charge Code	41569495
Hospital Revenue Code	278
Min. Negotiated Rate	$63.31
Max. Negotiated Rate	$189.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$99.48
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	$90.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$104.01
Rate for Payer: Fidelis Medicare Advantage	$189.92
Rate for Payer: Group Health Inc Commercial	$90.44
Rate for Payer: Group Health Inc Medicare	$63.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.44
Rate for Payer: Hamaspik Choice Inc Medicare	$90.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$117.57

ZZ EMBOLIZATION PORT/300-500

Facility IP

$180.88

Service Code	HCPCS C1884
Hospital Charge Code	41569495
Hospital Revenue Code	278
Min. Negotiated Rate	$90.44
Max. Negotiated Rate	$90.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.44
Rate for Payer: Hamaspik Choice Inc Medicare	$90.44

ZZ EMBOLIZATION PORT/500-700

Facility IP

$180.88

Service Code	HCPCS C1884
Hospital Charge Code	41569492
Hospital Revenue Code	278
Min. Negotiated Rate	$90.44
Max. Negotiated Rate	$90.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.44
Rate for Payer: Hamaspik Choice Inc Medicare	$90.44

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