St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ INTRACOIL STENT 5X60

Facility OP

$3,402.00

Service Code	HCPCS C1876
Hospital Charge Code	41569661
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,572.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,871.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,701.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,956.15
Rate for Payer: Fidelis Medicare Advantage	$3,572.10
Rate for Payer: Group Health Inc Commercial	$1,701.00
Rate for Payer: Group Health Inc Medicare	$1,190.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,701.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,701.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,211.30

ZZ INTRACOIL STENT 6X40

Facility IP

$3,402.00

Service Code	HCPCS C1876
Hospital Charge Code	41569662
Hospital Revenue Code	278
Min. Negotiated Rate	$1,701.00
Max. Negotiated Rate	$1,701.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,701.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,701.00

ZZ INTRACOIL STENT 6X40

Facility OP

$3,402.00

Service Code	HCPCS C1876
Hospital Charge Code	41569662
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,572.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,871.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,701.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,956.15
Rate for Payer: Fidelis Medicare Advantage	$3,572.10
Rate for Payer: Group Health Inc Commercial	$1,701.00
Rate for Payer: Group Health Inc Medicare	$1,190.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,701.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,701.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,211.30

ZZ INTRACOIL STENT 6X60

Facility IP

$3,402.00

Service Code	HCPCS C1876
Hospital Charge Code	41569659
Hospital Revenue Code	278
Min. Negotiated Rate	$1,701.00
Max. Negotiated Rate	$1,701.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,701.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,701.00

ZZ INTRACOIL STENT 6X60

Facility OP

$3,402.00

Service Code	HCPCS C1876
Hospital Charge Code	41569659
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,572.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,871.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,701.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,956.15
Rate for Payer: Fidelis Medicare Advantage	$3,572.10
Rate for Payer: Group Health Inc Commercial	$1,701.00
Rate for Payer: Group Health Inc Medicare	$1,190.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,701.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,701.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,211.30

ZZ INTRASTENT DOUBLE STENT

Facility IP

$3,827.25

Service Code	HCPCS C1876
Hospital Charge Code	41569543
Hospital Revenue Code	278
Min. Negotiated Rate	$1,913.62
Max. Negotiated Rate	$1,913.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,913.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,913.62

ZZ INTRASTENT DOUBLE STENT

Facility OP

$3,827.25

Service Code	HCPCS C1876
Hospital Charge Code	41569543
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$4,018.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,104.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,913.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,200.67
Rate for Payer: Fidelis Medicare Advantage	$4,018.61
Rate for Payer: Group Health Inc Commercial	$1,913.62
Rate for Payer: Group Health Inc Medicare	$1,339.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,913.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,913.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,487.71

ZZ INTRA STENT #S10 26 26MM

Facility OP

$1,828.58

Service Code	HCPCS C1876
Hospital Charge Code	41569014
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$1,920.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,005.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$914.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,051.43
Rate for Payer: Fidelis Medicare Advantage	$1,920.01
Rate for Payer: Group Health Inc Commercial	$914.29
Rate for Payer: Group Health Inc Medicare	$640.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$914.29
Rate for Payer: Hamaspik Choice Inc Medicare	$914.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,188.58

ZZ INTRA STENT #S10 26 26MM

Facility IP

$1,828.58

Service Code	HCPCS C1876
Hospital Charge Code	41569014
Hospital Revenue Code	278
Min. Negotiated Rate	$914.29
Max. Negotiated Rate	$914.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$914.29
Rate for Payer: Hamaspik Choice Inc Medicare	$914.29

ZZ INTRA STENT #S10 36 36MM

Facility IP

$1,828.58

Service Code	HCPCS C1876
Hospital Charge Code	41569013
Hospital Revenue Code	278
Min. Negotiated Rate	$914.29
Max. Negotiated Rate	$914.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$914.29
Rate for Payer: Hamaspik Choice Inc Medicare	$914.29

ZZ INTRA STENT #S10 36 36MM

Facility OP

$1,828.58

Service Code	HCPCS C1876
Hospital Charge Code	41569013
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$1,920.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,005.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$914.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,051.43
Rate for Payer: Fidelis Medicare Advantage	$1,920.01
Rate for Payer: Group Health Inc Commercial	$914.29
Rate for Payer: Group Health Inc Medicare	$640.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$914.29
Rate for Payer: Hamaspik Choice Inc Medicare	$914.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,188.58

ZZ INTRATERINE ACESS BALLOON CATH

Facility IP

$102.78

Service Code	HCPCS C1726
Hospital Charge Code	41567756
Hospital Revenue Code	278
Min. Negotiated Rate	$51.39
Max. Negotiated Rate	$51.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.39
Rate for Payer: Hamaspik Choice Inc Medicare	$51.39

ZZ INTRATERINE ACESS BALLOON CATH

Facility OP

$102.78

Service Code	HCPCS C1726
Hospital Charge Code	41567756
Hospital Revenue Code	278
Min. Negotiated Rate	$17.43
Max. Negotiated Rate	$107.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.43
Rate for Payer: Aetna Government	$17.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$51.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.10
Rate for Payer: Fidelis Medicare Advantage	$107.92
Rate for Payer: Group Health Inc Commercial	$51.39
Rate for Payer: Group Health Inc Medicare	$35.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.39
Rate for Payer: Hamaspik Choice Inc Medicare	$51.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.81

ZZ INTRODUCER FLEXOR 5FR X 4

Facility OP

$165.30

Hospital Charge Code	41564478
Hospital Revenue Code	270
Min. Negotiated Rate	$57.86
Max. Negotiated Rate	$132.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$90.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$82.65
Rate for Payer: Aetna Government	$82.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$132.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$112.40
Rate for Payer: Group Health Inc Commercial	$82.65
Rate for Payer: Group Health Inc Medicare	$57.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.65
Rate for Payer: Hamaspik Choice Inc Medicare	$82.65

ZZ INTRODUCER SET ANSEL 6FR 55CM

Facility OP

$197.03

Hospital Charge Code	41569676
Hospital Revenue Code	270
Min. Negotiated Rate	$68.96
Max. Negotiated Rate	$157.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$108.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$98.52
Rate for Payer: Aetna Government	$98.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$157.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$133.98
Rate for Payer: Group Health Inc Commercial	$98.52
Rate for Payer: Group Health Inc Medicare	$68.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$98.52
Rate for Payer: Hamaspik Choice Inc Medicare	$98.52

ZZ INTRO SET 10.0/30CM G08686

Facility IP

$136.62

Service Code	HCPCS C1894
Hospital Charge Code	41569944
Hospital Revenue Code	278
Min. Negotiated Rate	$68.31
Max. Negotiated Rate	$68.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.31
Rate for Payer: Hamaspik Choice Inc Medicare	$68.31

ZZ INTRO SET 10.0/30CM G08686

Facility OP

$136.62

Service Code	HCPCS C1894
Hospital Charge Code	41569944
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$143.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$75.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$68.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$78.56
Rate for Payer: Fidelis Medicare Advantage	$143.45
Rate for Payer: Group Health Inc Commercial	$68.31
Rate for Payer: Group Health Inc Medicare	$47.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.31
Rate for Payer: Hamaspik Choice Inc Medicare	$68.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$88.80

ZZ INTRO SET 10.0/40CM G32233

Facility IP

$156.28

Service Code	HCPCS C1894
Hospital Charge Code	41569940
Hospital Revenue Code	278
Min. Negotiated Rate	$78.14
Max. Negotiated Rate	$78.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.14
Rate for Payer: Hamaspik Choice Inc Medicare	$78.14

ZZ INTRO SET 10.0/40CM G32233

Facility OP

$156.28

Service Code	HCPCS C1894
Hospital Charge Code	41569940
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$164.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$89.86
Rate for Payer: Fidelis Medicare Advantage	$164.09
Rate for Payer: Group Health Inc Commercial	$78.14
Rate for Payer: Group Health Inc Medicare	$54.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.14
Rate for Payer: Hamaspik Choice Inc Medicare	$78.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$101.58

ZZ INTRO SET 10.0/60CM G10836

Facility IP

$157.80

Service Code	HCPCS C1894
Hospital Charge Code	41569945
Hospital Revenue Code	278
Min. Negotiated Rate	$78.90
Max. Negotiated Rate	$78.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.90
Rate for Payer: Hamaspik Choice Inc Medicare	$78.90

ZZ INTRO SET 10.0/60CM G10836

Facility OP

$157.80

Service Code	HCPCS C1894
Hospital Charge Code	41569945
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$165.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$90.74
Rate for Payer: Fidelis Medicare Advantage	$165.69
Rate for Payer: Group Health Inc Commercial	$78.90
Rate for Payer: Group Health Inc Medicare	$55.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.90
Rate for Payer: Hamaspik Choice Inc Medicare	$78.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$102.57

ZZ INTRO SET 11.0/70CM G11240

Facility OP

$140.30

Hospital Charge Code	41569946
Hospital Revenue Code	279
Min. Negotiated Rate	$49.10
Max. Negotiated Rate	$112.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$77.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.15
Rate for Payer: Aetna Government	$70.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$112.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.40
Rate for Payer: Group Health Inc Commercial	$70.15
Rate for Payer: Group Health Inc Medicare	$49.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.15
Rate for Payer: Hamaspik Choice Inc Medicare	$70.15

ZZ INTRO SET 12.0/30CM G08956

Facility OP

$140.30

Hospital Charge Code	41569947
Hospital Revenue Code	279
Min. Negotiated Rate	$49.10
Max. Negotiated Rate	$112.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$77.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.15
Rate for Payer: Aetna Government	$70.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$112.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.40
Rate for Payer: Group Health Inc Commercial	$70.15
Rate for Payer: Group Health Inc Medicare	$49.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.15
Rate for Payer: Hamaspik Choice Inc Medicare	$70.15

ZZ INTRO SET 14.0/30CM G08957

Facility OP

$140.30

Hospital Charge Code	41569948
Hospital Revenue Code	279
Min. Negotiated Rate	$49.10
Max. Negotiated Rate	$112.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$77.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.15
Rate for Payer: Aetna Government	$70.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$112.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.40
Rate for Payer: Group Health Inc Commercial	$70.15
Rate for Payer: Group Health Inc Medicare	$49.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.15
Rate for Payer: Hamaspik Choice Inc Medicare	$70.15

ZZ INTRO SET 6.0/48CM G10346

Facility OP

$111.78

Hospital Charge Code	41569941
Hospital Revenue Code	279
Min. Negotiated Rate	$39.12
Max. Negotiated Rate	$89.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$55.89
Rate for Payer: Aetna Government	$55.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$89.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.01
Rate for Payer: Group Health Inc Commercial	$55.89
Rate for Payer: Group Health Inc Medicare	$39.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.89
Rate for Payer: Hamaspik Choice Inc Medicare	$55.89

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