St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ FOGARTY THRULUMEN/5F/80CM

Facility IP

$162.66

Service Code	HCPCS C1757
Hospital Charge Code	41569504
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 GADOLINIUM 10ML

Facility OP

$87.89

Service Code	HCPCS A9576
Hospital Charge Code	41569599
Hospital Revenue Code	255
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$70.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.47
Rate for Payer: Aetna Government	$1.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.77
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1.31
Rate for Payer: Group Health Inc Commercial	$43.94
Rate for Payer: Group Health Inc Medicare	$30.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.94
Rate for Payer: Hamaspik Choice Inc Medicare	$43.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.45
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.49
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.58
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.58
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$57.13

ZZ GADOLINIUM 15ML

Facility OP

$134.66

Service Code	HCPCS A9576
Hospital Charge Code	41569598
Hospital Revenue Code	255
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$107.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.47
Rate for Payer: Aetna Government	$1.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$107.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$91.57
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1.31
Rate for Payer: Group Health Inc Commercial	$67.33
Rate for Payer: Group Health Inc Medicare	$47.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.33
Rate for Payer: Hamaspik Choice Inc Medicare	$67.33
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.45
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.49
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.58
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.58
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$87.53

ZZ GADOLINIUM 20ML

Facility OP

$175.77

Service Code	HCPCS A9576
Hospital Charge Code	41569597
Hospital Revenue Code	255
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$140.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$96.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.47
Rate for Payer: Aetna Government	$1.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$140.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$119.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1.31
Rate for Payer: Group Health Inc Commercial	$87.88
Rate for Payer: Group Health Inc Medicare	$61.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.88
Rate for Payer: Hamaspik Choice Inc Medicare	$87.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.45
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.49
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.58
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.58
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$114.25

ZZ GASTROJEJ SET/CAC

Facility OP

$565.11

Hospital Charge Code	41569509
Hospital Revenue Code	270
Min. Negotiated Rate	$197.79
Max. Negotiated Rate	$452.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$310.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$282.56
Rate for Payer: Aetna Government	$282.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$452.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$384.27
Rate for Payer: Group Health Inc Commercial	$282.56
Rate for Payer: Group Health Inc Medicare	$197.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$282.56
Rate for Payer: Hamaspik Choice Inc Medicare	$282.56

ZZ GASTROSTOMY PONSKY B.A.S.

Facility OP

$756.00

Hospital Charge Code	41567748
Hospital Revenue Code	270
Min. Negotiated Rate	$264.60
Max. Negotiated Rate	$604.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$415.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$378.00
Rate for Payer: Aetna Government	$378.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$604.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$514.08
Rate for Payer: Group Health Inc Commercial	$378.00
Rate for Payer: Group Health Inc Medicare	$264.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$378.00
Rate for Payer: Hamaspik Choice Inc Medicare	$378.00

ZZ GATEWAY PLUS Y ADAPTOR

Facility OP

$57.75

Hospital Charge Code	41569886
Hospital Revenue Code	270
Min. Negotiated Rate	$20.21
Max. Negotiated Rate	$46.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.88
Rate for Payer: Aetna Government	$28.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.27
Rate for Payer: Group Health Inc Commercial	$28.88
Rate for Payer: Group Health Inc Medicare	$20.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.88
Rate for Payer: Hamaspik Choice Inc Medicare	$28.88

ZZ GEL FOAM 3MM X 12MM

Facility OP

$10.64

Hospital Charge Code	41567331
Hospital Revenue Code	270
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$8.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.32
Rate for Payer: Aetna Government	$5.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.24
Rate for Payer: Group Health Inc Commercial	$5.32
Rate for Payer: Group Health Inc Medicare	$3.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.32
Rate for Payer: Hamaspik Choice Inc Medicare	$5.32

ZZ GENESIS T-STENT 6/80/5.4

Facility IP

$3,472.88

Service Code	HCPCS C1874
Hospital Charge Code	41569809
Hospital Revenue Code	278
Min. Negotiated Rate	$1,736.44
Max. Negotiated Rate	$1,736.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,736.44
Rate for Payer: Hamaspik Choice Inc Medicare	$1,736.44

ZZ GENESIS T-STENT 6/80/5.4

Facility OP

$3,472.88

Service Code	HCPCS C1874
Hospital Charge Code	41569809
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,646.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,910.08
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	$1,736.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,996.91
Rate for Payer: Fidelis Medicare Advantage	$3,646.52
Rate for Payer: Group Health Inc Commercial	$1,736.44
Rate for Payer: Group Health Inc Medicare	$1,215.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,736.44
Rate for Payer: Hamaspik Choice Inc Medicare	$1,736.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,257.37

ZZ GENESIS T-STENT 6/80.6.4

Facility OP

$3,472.88

Service Code	HCPCS C1874
Hospital Charge Code	41569810
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,646.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,910.08
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	$1,736.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,996.91
Rate for Payer: Fidelis Medicare Advantage	$3,646.52
Rate for Payer: Group Health Inc Commercial	$1,736.44
Rate for Payer: Group Health Inc Medicare	$1,215.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,736.44
Rate for Payer: Hamaspik Choice Inc Medicare	$1,736.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,257.37

ZZ GENESIS T-STENT 6/80.6.4

Facility IP

$3,472.88

Service Code	HCPCS C1874
Hospital Charge Code	41569810
Hospital Revenue Code	278
Min. Negotiated Rate	$1,736.44
Max. Negotiated Rate	$1,736.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,736.44
Rate for Payer: Hamaspik Choice Inc Medicare	$1,736.44

ZZ GLIDE WIRE 18-150 ANGL

Facility OP

$189.24

Service Code	HCPCS C1769
Hospital Charge Code	41567115
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$198.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$104.08
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	$94.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$108.81
Rate for Payer: Fidelis Medicare Advantage	$198.70
Rate for Payer: Group Health Inc Commercial	$94.62
Rate for Payer: Group Health Inc Medicare	$66.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.62
Rate for Payer: Hamaspik Choice Inc Medicare	$94.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$123.01

ZZ GLIDE WIRE 18-150 ANGL

Facility IP

$189.24

Service Code	HCPCS C1769
Hospital Charge Code	41567115
Hospital Revenue Code	278
Min. Negotiated Rate	$94.62
Max. Negotiated Rate	$94.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.62
Rate for Payer: Hamaspik Choice Inc Medicare	$94.62

ZZ GLIDE WIRE 18-180 ANGL

Facility OP

$189.24

Service Code	HCPCS C1769
Hospital Charge Code	41567116
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$198.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$104.08
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	$94.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$108.81
Rate for Payer: Fidelis Medicare Advantage	$198.70
Rate for Payer: Group Health Inc Commercial	$94.62
Rate for Payer: Group Health Inc Medicare	$66.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.62
Rate for Payer: Hamaspik Choice Inc Medicare	$94.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$123.01

ZZ GLIDE WIRE 18-180 ANGL

Facility IP

$189.24

Service Code	HCPCS C1769
Hospital Charge Code	41567116
Hospital Revenue Code	278
Min. Negotiated Rate	$94.62
Max. Negotiated Rate	$94.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.62
Rate for Payer: Hamaspik Choice Inc Medicare	$94.62

ZZ GLIDE WIRE 25-180 ANGL

Facility OP

$189.24

Service Code	HCPCS C1769
Hospital Charge Code	41567117
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$198.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$104.08
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	$94.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$108.81
Rate for Payer: Fidelis Medicare Advantage	$198.70
Rate for Payer: Group Health Inc Commercial	$94.62
Rate for Payer: Group Health Inc Medicare	$66.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.62
Rate for Payer: Hamaspik Choice Inc Medicare	$94.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$123.01

ZZ GLIDE WIRE 25-180 ANGL

Facility IP

$189.24

Service Code	HCPCS C1769
Hospital Charge Code	41567117
Hospital Revenue Code	278
Min. Negotiated Rate	$94.62
Max. Negotiated Rate	$94.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.62
Rate for Payer: Hamaspik Choice Inc Medicare	$94.62

ZZ GLIDE WIRE 35-150 ANGLED

Facility IP

$157.34

Service Code	HCPCS C1769
Hospital Charge Code	41567120
Hospital Revenue Code	278
Min. Negotiated Rate	$78.67
Max. Negotiated Rate	$78.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.67
Rate for Payer: Hamaspik Choice Inc Medicare	$78.67

ZZ GLIDE WIRE 35-150 ANGLED

Facility OP

$157.34

Service Code	HCPCS C1769
Hospital Charge Code	41567120
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$165.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.54
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	$78.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$90.47
Rate for Payer: Fidelis Medicare Advantage	$165.21
Rate for Payer: Group Health Inc Commercial	$78.67
Rate for Payer: Group Health Inc Medicare	$55.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.67
Rate for Payer: Hamaspik Choice Inc Medicare	$78.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$102.27

ZZ GLIDE WIRE 35-180 ANGL

Facility IP

$137.85

Service Code	HCPCS C1769
Hospital Charge Code	41567112
Hospital Revenue Code	278
Min. Negotiated Rate	$68.92
Max. Negotiated Rate	$68.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.92
Rate for Payer: Hamaspik Choice Inc Medicare	$68.92

ZZ GLIDE WIRE 35-180 ANGL

Facility OP

$137.85

Service Code	HCPCS C1769
Hospital Charge Code	41567112
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$144.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$75.82
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	$68.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$79.26
Rate for Payer: Fidelis Medicare Advantage	$144.74
Rate for Payer: Group Health Inc Commercial	$68.92
Rate for Payer: Group Health Inc Medicare	$48.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.92
Rate for Payer: Hamaspik Choice Inc Medicare	$68.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$89.60

ZZ GLIDE WIRE 35-260 ANGL

Facility IP

$208.73

Service Code	HCPCS C1769
Hospital Charge Code	41567118
Hospital Revenue Code	278
Min. Negotiated Rate	$104.36
Max. Negotiated Rate	$104.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$104.36
Rate for Payer: Hamaspik Choice Inc Medicare	$104.36

ZZ GLIDE WIRE 35-260 ANGL

Facility OP

$208.73

Service Code	HCPCS C1769
Hospital Charge Code	41567118
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$219.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$114.80
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	$104.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$120.02
Rate for Payer: Fidelis Medicare Advantage	$219.17
Rate for Payer: Group Health Inc Commercial	$104.36
Rate for Payer: Group Health Inc Medicare	$73.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$104.36
Rate for Payer: Hamaspik Choice Inc Medicare	$104.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$135.67

ZZ GLIDE WIRE 35-260 ANGLED

Facility IP

$154.15

Service Code	HCPCS C1769
Hospital Charge Code	41567113
Hospital Revenue Code	278
Min. Negotiated Rate	$77.08
Max. Negotiated Rate	$77.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.08
Rate for Payer: Hamaspik Choice Inc Medicare	$77.08

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