St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ EMBOLIZATION PORT/500-700

Facility OP

$180.88

Service Code	HCPCS C1884
Hospital Charge Code	41569492
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/700-1000

Facility IP

$180.88

Service Code	HCPCS C1884
Hospital Charge Code	41569493
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/700-1000

Facility OP

$180.88

Service Code	HCPCS C1884
Hospital Charge Code	41569493
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 EMBOLIZ COIL 52 10 15

Facility IP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567143
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 EMBOLIZ COIL 52 10 15

Facility OP

$66.98

Service Code	HCPCS C1884
Hospital Charge Code	41567143
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 EMBOSPHERE 300-500

Facility IP

$2,500.00

Service Code	HCPCS C1884
Hospital Charge Code	41563139
Hospital Revenue Code	278
Min. Negotiated Rate	$1,250.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,250.00

ZZ EMBOSPHERE 300-500

Facility OP

$2,500.00

Service Code	HCPCS C1884
Hospital Charge Code	41563139
Hospital Revenue Code	278
Min. Negotiated Rate	$180.07
Max. Negotiated Rate	$2,625.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,375.00
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	$1,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,437.50
Rate for Payer: Fidelis Medicare Advantage	$2,625.00
Rate for Payer: Group Health Inc Commercial	$1,250.00
Rate for Payer: Group Health Inc Medicare	$875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,625.00

ZZ EMBOSPHERE 500-700

Facility OP

$2,905.88

Service Code	HCPCS C1884
Hospital Charge Code	41569765
Hospital Revenue Code	278
Min. Negotiated Rate	$180.07
Max. Negotiated Rate	$3,051.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,598.23
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	$1,452.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,670.88
Rate for Payer: Fidelis Medicare Advantage	$3,051.17
Rate for Payer: Group Health Inc Commercial	$1,452.94
Rate for Payer: Group Health Inc Medicare	$1,017.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,452.94
Rate for Payer: Hamaspik Choice Inc Medicare	$1,452.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,888.82

ZZ EMBOSPHERE 500-700

Facility IP

$2,905.88

Service Code	HCPCS C1884
Hospital Charge Code	41569765
Hospital Revenue Code	278
Min. Negotiated Rate	$1,452.94
Max. Negotiated Rate	$1,452.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,452.94
Rate for Payer: Hamaspik Choice Inc Medicare	$1,452.94

ZZ EMBOSPHERE 700-900

Facility IP

$1,488.38

Service Code	HCPCS C1884
Hospital Charge Code	41569766
Hospital Revenue Code	278
Min. Negotiated Rate	$744.19
Max. Negotiated Rate	$744.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$744.19
Rate for Payer: Hamaspik Choice Inc Medicare	$744.19

ZZ EMBOSPHERE 700-900

Facility OP

$1,488.38

Service Code	HCPCS C1884
Hospital Charge Code	41569766
Hospital Revenue Code	278
Min. Negotiated Rate	$180.07
Max. Negotiated Rate	$1,562.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$818.61
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	$744.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$855.82
Rate for Payer: Fidelis Medicare Advantage	$1,562.80
Rate for Payer: Group Health Inc Commercial	$744.19
Rate for Payer: Group Health Inc Medicare	$520.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$744.19
Rate for Payer: Hamaspik Choice Inc Medicare	$744.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$967.45

ZZ EMBOSPHERE 900-1200

Facility OP

$106.00

Service Code	HCPCS C1884
Hospital Charge Code	41561915
Hospital Revenue Code	278
Min. Negotiated Rate	$37.10
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.30
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	$53.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$60.95
Rate for Payer: Fidelis Medicare Advantage	$111.30
Rate for Payer: Group Health Inc Commercial	$53.00
Rate for Payer: Group Health Inc Medicare	$37.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.00
Rate for Payer: Hamaspik Choice Inc Medicare	$53.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$68.90

ZZ EMBOSPHERE 900-1200

Facility IP

$106.00

Service Code	HCPCS C1884
Hospital Charge Code	41561915
Hospital Revenue Code	278
Min. Negotiated Rate	$53.00
Max. Negotiated Rate	$53.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.00
Rate for Payer: Hamaspik Choice Inc Medicare	$53.00

ZZ EMBOZENE 2ML 500UM

Facility OP

$350.00

Hospital Charge Code	41561351
Hospital Revenue Code	272
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$280.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.00
Rate for Payer: Aetna Government	$175.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$280.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$238.00
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

ZZ EMBOZENE 2ML 700UM

Facility OP

$350.00

Hospital Charge Code	41561352
Hospital Revenue Code	272
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$280.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.00
Rate for Payer: Aetna Government	$175.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$280.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$238.00
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

ZZ EMBOZENE 2ML 900UM

Facility OP

$350.00

Hospital Charge Code	41561353
Hospital Revenue Code	272
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$280.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.00
Rate for Payer: Aetna Government	$175.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$280.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$238.00
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

ZZ EOVIST 10ML

Facility OP

$129.00

Service Code	HCPCS A9581
Hospital Charge Code	41561801
Hospital Revenue Code	255
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$103.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.73
Rate for Payer: Aetna Government	$14.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$103.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$87.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$13.26
Rate for Payer: Group Health Inc Commercial	$64.50
Rate for Payer: Group Health Inc Medicare	$45.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.50
Rate for Payer: Hamaspik Choice Inc Medicare	$64.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$14.73
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$14.76
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$15.65
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$15.65
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$15.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$83.85

ZZ EV3 AVIGO HYGRO GUIDEWIRE

Facility OP

$920.00

Service Code	HCPCS C1769
Hospital Charge Code	41564625
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$966.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$506.00
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	$460.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$529.00
Rate for Payer: Fidelis Medicare Advantage	$966.00
Rate for Payer: Group Health Inc Commercial	$460.00
Rate for Payer: Group Health Inc Medicare	$322.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$460.00
Rate for Payer: Hamaspik Choice Inc Medicare	$460.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$598.00

ZZ EV3 AVIGO HYGRO GUIDEWIRE

Facility IP

$920.00

Service Code	HCPCS C1769
Hospital Charge Code	41564625
Hospital Revenue Code	278
Min. Negotiated Rate	$460.00
Max. Negotiated Rate	$460.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$460.00
Rate for Payer: Hamaspik Choice Inc Medicare	$460.00

ZZ EV3 CONCERTO 2MM/6CM

Facility OP

$1,400.00

Hospital Charge Code	41564615
Hospital Revenue Code	272
Min. Negotiated Rate	$490.00
Max. Negotiated Rate	$1,120.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$770.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$700.00
Rate for Payer: Aetna Government	$700.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,120.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$952.00
Rate for Payer: Group Health Inc Commercial	$700.00
Rate for Payer: Group Health Inc Medicare	$490.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$700.00

ZZ EV3 CONCERTO 3MM/8CM

Facility OP

$1,500.00

Hospital Charge Code	41563150
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$825.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$750.00
Rate for Payer: Aetna Government	$750.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,020.00
Rate for Payer: Group Health Inc Commercial	$750.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$750.00

ZZ EV3 CONCERTO 4MM/10CM

Facility OP

$1,500.00

Hospital Charge Code	41563151
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$825.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$750.00
Rate for Payer: Aetna Government	$750.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,020.00
Rate for Payer: Group Health Inc Commercial	$750.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$750.00

ZZ EV3 CONCERTO 5MM/15CM

Facility OP

$1,500.00

Hospital Charge Code	41563152
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$825.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$750.00
Rate for Payer: Aetna Government	$750.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,020.00
Rate for Payer: Group Health Inc Commercial	$750.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$750.00

ZZ EV3 CPNCERTO 7MM 30CM

Facility OP

$1,400.00

Hospital Charge Code	41564617
Hospital Revenue Code	272
Min. Negotiated Rate	$490.00
Max. Negotiated Rate	$1,120.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$770.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$700.00
Rate for Payer: Aetna Government	$700.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,120.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$952.00
Rate for Payer: Group Health Inc Commercial	$700.00
Rate for Payer: Group Health Inc Medicare	$490.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$700.00

ZZ EV3 INFUSION CATHETER

Facility OP

$230.00

Service Code	HCPCS C1725
Hospital Charge Code	41561930
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$241.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.50
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	$115.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.25
Rate for Payer: Fidelis Medicare Advantage	$241.50
Rate for Payer: Group Health Inc Commercial	$115.00
Rate for Payer: Group Health Inc Medicare	$80.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$149.50

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