St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ FLEXII FEM DL LUM KIT

Facility IP

$204.83

Service Code	HCPCS C1725
Hospital Charge Code	41567179
Hospital Revenue Code	278
Min. Negotiated Rate	$102.42
Max. Negotiated Rate	$102.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$102.42
Rate for Payer: Hamaspik Choice Inc Medicare	$102.42

ZZ FLEXIMA 10F 3.3MM APDL

Facility IP

$155.04

Service Code	HCPCS C1725
Hospital Charge Code	41569904
Hospital Revenue Code	278
Min. Negotiated Rate	$77.52
Max. Negotiated Rate	$77.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.52
Rate for Payer: Hamaspik Choice Inc Medicare	$77.52

ZZ FLEXIMA 10F 3.3MM APDL

Facility OP

$155.04

Service Code	HCPCS C1725
Hospital Charge Code	41569904
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$162.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.27
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	$77.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$89.15
Rate for Payer: Fidelis Medicare Advantage	$162.79
Rate for Payer: Group Health Inc Commercial	$77.52
Rate for Payer: Group Health Inc Medicare	$54.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.52
Rate for Payer: Hamaspik Choice Inc Medicare	$77.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$100.78

ZZ FLEXIMA 12F 4.0MM APDL

Facility OP

$155.04

Service Code	HCPCS C1725
Hospital Charge Code	41569905
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$162.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.27
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	$77.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$89.15
Rate for Payer: Fidelis Medicare Advantage	$162.79
Rate for Payer: Group Health Inc Commercial	$77.52
Rate for Payer: Group Health Inc Medicare	$54.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.52
Rate for Payer: Hamaspik Choice Inc Medicare	$77.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$100.78

ZZ FLEXIMA 12F 4.0MM APDL

Facility IP

$155.04

Service Code	HCPCS C1725
Hospital Charge Code	41569905
Hospital Revenue Code	278
Min. Negotiated Rate	$77.52
Max. Negotiated Rate	$77.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.52
Rate for Payer: Hamaspik Choice Inc Medicare	$77.52

ZZ FLEXIMA 14F 4.7MM APDL

Facility IP

$155.04

Service Code	HCPCS C1725
Hospital Charge Code	41569902
Hospital Revenue Code	278
Min. Negotiated Rate	$77.52
Max. Negotiated Rate	$77.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.52
Rate for Payer: Hamaspik Choice Inc Medicare	$77.52

ZZ FLEXIMA 14F 4.7MM APDL

Facility OP

$155.04

Service Code	HCPCS C1725
Hospital Charge Code	41569902
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$162.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.27
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	$77.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$89.15
Rate for Payer: Fidelis Medicare Advantage	$162.79
Rate for Payer: Group Health Inc Commercial	$77.52
Rate for Payer: Group Health Inc Medicare	$54.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.52
Rate for Payer: Hamaspik Choice Inc Medicare	$77.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$100.78

ZZ FLEXIMA 8F 2.7MM APD

Facility IP

$155.04

Service Code	HCPCS C1725
Hospital Charge Code	41569903
Hospital Revenue Code	278
Min. Negotiated Rate	$77.52
Max. Negotiated Rate	$77.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.52
Rate for Payer: Hamaspik Choice Inc Medicare	$77.52

ZZ FLEXIMA 8F 2.7MM APD

Facility OP

$155.04

Service Code	HCPCS C1725
Hospital Charge Code	41569903
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$162.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.27
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	$77.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$89.15
Rate for Payer: Fidelis Medicare Advantage	$162.79
Rate for Payer: Group Health Inc Commercial	$77.52
Rate for Payer: Group Health Inc Medicare	$54.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.52
Rate for Payer: Hamaspik Choice Inc Medicare	$77.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$100.78

ZZ FLEXOR CHECK-FLO PERF INT SET

Facility OP

$129.68

Hospital Charge Code	41569861
Hospital Revenue Code	270
Min. Negotiated Rate	$45.39
Max. Negotiated Rate	$103.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.84
Rate for Payer: Aetna Government	$64.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$103.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$88.18
Rate for Payer: Group Health Inc Commercial	$64.84
Rate for Payer: Group Health Inc Medicare	$45.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.84
Rate for Payer: Hamaspik Choice Inc Medicare	$64.84

ZZ FLEX TRANSDUCER COVER

Facility OP

$20.20

Hospital Charge Code	41567292
Hospital Revenue Code	270
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$16.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.10
Rate for Payer: Aetna Government	$10.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.74
Rate for Payer: Group Health Inc Commercial	$10.10
Rate for Payer: Group Health Inc Medicare	$7.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.10
Rate for Payer: Hamaspik Choice Inc Medicare	$10.10

ZZ FLOW DIRECTED BALLOON CATHETER

Facility OP

$298.30

Service Code	HCPCS C1725
Hospital Charge Code	41548040
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$313.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$164.06
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	$149.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$171.52
Rate for Payer: Fidelis Medicare Advantage	$313.22
Rate for Payer: Group Health Inc Commercial	$149.15
Rate for Payer: Group Health Inc Medicare	$104.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$149.15
Rate for Payer: Hamaspik Choice Inc Medicare	$149.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$193.90

ZZ FLOW DIRECTED BALLOON CATHETER

Facility IP

$298.30

Service Code	HCPCS C1725
Hospital Charge Code	41548040
Hospital Revenue Code	278
Min. Negotiated Rate	$149.15
Max. Negotiated Rate	$149.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$149.15
Rate for Payer: Hamaspik Choice Inc Medicare	$149.15

ZZ FLOW SWITCH

Facility OP

$13.47

Hospital Charge Code	41567306
Hospital Revenue Code	270
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$10.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.74
Rate for Payer: Aetna Government	$6.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.16
Rate for Payer: Group Health Inc Commercial	$6.74
Rate for Payer: Group Health Inc Medicare	$4.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.74
Rate for Payer: Hamaspik Choice Inc Medicare	$6.74

ZZ FOGAR ART EMBOL 3 180

Facility IP

$107.03

Service Code	HCPCS C1757
Hospital Charge Code	41567183
Hospital Revenue Code	278
Min. Negotiated Rate	$53.52
Max. Negotiated Rate	$53.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.52
Rate for Payer: Hamaspik Choice Inc Medicare	$53.52

ZZ FOGAR ART EMBOL 3 180

Facility OP

$107.03

Service Code	HCPCS C1757
Hospital Charge Code	41567183
Hospital Revenue Code	278
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$112.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.33
Rate for Payer: Aetna Government	$16.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$53.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$61.54
Rate for Payer: Fidelis Medicare Advantage	$112.38
Rate for Payer: Group Health Inc Commercial	$53.52
Rate for Payer: Group Health Inc Medicare	$37.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.52
Rate for Payer: Hamaspik Choice Inc Medicare	$53.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$69.57

ZZ FOGAR ART EMBOL 5 180

Facility OP

$107.03

Service Code	HCPCS C1757
Hospital Charge Code	41567184
Hospital Revenue Code	278
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$112.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.33
Rate for Payer: Aetna Government	$16.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$53.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$61.54
Rate for Payer: Fidelis Medicare Advantage	$112.38
Rate for Payer: Group Health Inc Commercial	$53.52
Rate for Payer: Group Health Inc Medicare	$37.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.52
Rate for Payer: Hamaspik Choice Inc Medicare	$53.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$69.57

ZZ FOGAR ART EMBOL 5 180

Facility IP

$107.03

Service Code	HCPCS C1757
Hospital Charge Code	41567184
Hospital Revenue Code	278
Min. Negotiated Rate	$53.52
Max. Negotiated Rate	$53.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.52
Rate for Payer: Hamaspik Choice Inc Medicare	$53.52

ZZ FOGARTY THRULUMEN/3F/40CM

Facility IP

$162.66

Service Code	HCPCS C1757
Hospital Charge Code	41569505
Hospital Revenue Code	278
Min. Negotiated Rate	$81.33
Max. Negotiated Rate	$81.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.33
Rate for Payer: Hamaspik Choice Inc Medicare	$81.33

ZZ FOGARTY THRULUMEN/3F/40CM

Facility OP

$162.66

Service Code	HCPCS C1757
Hospital Charge Code	41569505
Hospital Revenue Code	278
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$170.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.33
Rate for Payer: Aetna Government	$16.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.53
Rate for Payer: Fidelis Medicare Advantage	$170.79
Rate for Payer: Group Health Inc Commercial	$81.33
Rate for Payer: Group Health Inc Medicare	$56.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.33
Rate for Payer: Hamaspik Choice Inc Medicare	$81.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.73

ZZ FOGARTY THRULUMEN/3F/80CM

Facility IP

$162.66

Service Code	HCPCS C1757
Hospital Charge Code	41569506
Hospital Revenue Code	278
Min. Negotiated Rate	$81.33
Max. Negotiated Rate	$81.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.33
Rate for Payer: Hamaspik Choice Inc Medicare	$81.33

ZZ FOGARTY THRULUMEN/3F/80CM

Facility OP

$162.66

Service Code	HCPCS C1757
Hospital Charge Code	41569506
Hospital Revenue Code	278
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$170.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.33
Rate for Payer: Aetna Government	$16.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.53
Rate for Payer: Fidelis Medicare Advantage	$170.79
Rate for Payer: Group Health Inc Commercial	$81.33
Rate for Payer: Group Health Inc Medicare	$56.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.33
Rate for Payer: Hamaspik Choice Inc Medicare	$81.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.73

ZZ FOGARTY THRULUMEN/4F/80CM

Facility OP

$162.66

Service Code	HCPCS C1757
Hospital Charge Code	41569507
Hospital Revenue Code	278
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$170.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.33
Rate for Payer: Aetna Government	$16.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.53
Rate for Payer: Fidelis Medicare Advantage	$170.79
Rate for Payer: Group Health Inc Commercial	$81.33
Rate for Payer: Group Health Inc Medicare	$56.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.33
Rate for Payer: Hamaspik Choice Inc Medicare	$81.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.73

ZZ FOGARTY THRULUMEN/4F/80CM

Facility IP

$162.66

Service Code	HCPCS C1757
Hospital Charge Code	41569507
Hospital Revenue Code	278
Min. Negotiated Rate	$81.33
Max. Negotiated Rate	$81.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.33
Rate for Payer: Hamaspik Choice Inc Medicare	$81.33

ZZ FOGARTY THRULUMEN/5F/80CM

Facility OP

$162.66

Service Code	HCPCS C1757
Hospital Charge Code	41569504
Hospital Revenue Code	278
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$170.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.33
Rate for Payer: Aetna Government	$16.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.53
Rate for Payer: Fidelis Medicare Advantage	$170.79
Rate for Payer: Group Health Inc Commercial	$81.33
Rate for Payer: Group Health Inc Medicare	$56.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.33
Rate for Payer: Hamaspik Choice Inc Medicare	$81.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.73

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