St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ LUMINEX STENT 6X30 6F

Facility OP

$4,110.75

Service Code	HCPCS C1874
Hospital Charge Code	41569751
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,316.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,260.91
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	$2,055.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,363.68
Rate for Payer: Fidelis Medicare Advantage	$4,316.29
Rate for Payer: Group Health Inc Commercial	$2,055.38
Rate for Payer: Group Health Inc Medicare	$1,438.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,055.38
Rate for Payer: Hamaspik Choice Inc Medicare	$2,055.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,671.99

ZZ LUMINEX STENT 6X50

Facility IP

$4,252.50

Service Code	HCPCS C1876
Hospital Charge Code	41569655
Hospital Revenue Code	278
Min. Negotiated Rate	$2,126.25
Max. Negotiated Rate	$2,126.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,126.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,126.25

ZZ LUMINEX STENT 6X50

Facility OP

$4,252.50

Service Code	HCPCS C1876
Hospital Charge Code	41569655
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$4,465.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,338.88
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	$2,126.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,445.19
Rate for Payer: Fidelis Medicare Advantage	$4,465.12
Rate for Payer: Group Health Inc Commercial	$2,126.25
Rate for Payer: Group Health Inc Medicare	$1,488.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,126.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,126.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,764.12

ZZ LUMINEX STENT 6X50 6F

Facility IP

$4,394.25

Service Code	HCPCS C1874
Hospital Charge Code	41569752
Hospital Revenue Code	278
Min. Negotiated Rate	$2,197.12
Max. Negotiated Rate	$2,197.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,197.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2,197.12

ZZ LUMINEX STENT 6X50 6F

Facility OP

$4,394.25

Service Code	HCPCS C1874
Hospital Charge Code	41569752
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,613.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,416.84
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	$2,197.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,526.69
Rate for Payer: Fidelis Medicare Advantage	$4,613.96
Rate for Payer: Group Health Inc Commercial	$2,197.12
Rate for Payer: Group Health Inc Medicare	$1,537.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,197.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2,197.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,856.26

ZZ LUMINEX STENT 7X30 6F

Facility OP

$4,110.75

Service Code	HCPCS C1874
Hospital Charge Code	41569756
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,316.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,260.91
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	$2,055.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,363.68
Rate for Payer: Fidelis Medicare Advantage	$4,316.29
Rate for Payer: Group Health Inc Commercial	$2,055.38
Rate for Payer: Group Health Inc Medicare	$1,438.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,055.38
Rate for Payer: Hamaspik Choice Inc Medicare	$2,055.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,671.99

ZZ LUMINEX STENT 7X30 6F

Facility IP

$4,110.75

Service Code	HCPCS C1874
Hospital Charge Code	41569756
Hospital Revenue Code	278
Min. Negotiated Rate	$2,055.38
Max. Negotiated Rate	$2,055.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,055.38
Rate for Payer: Hamaspik Choice Inc Medicare	$2,055.38

ZZ LUMINEX STENT 7X40

Facility OP

$3,969.00

Service Code	HCPCS C1876
Hospital Charge Code	41569654
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$4,167.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,182.95
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	$1,984.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,282.18
Rate for Payer: Fidelis Medicare Advantage	$4,167.45
Rate for Payer: Group Health Inc Commercial	$1,984.50
Rate for Payer: Group Health Inc Medicare	$1,389.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,984.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,984.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,579.85

ZZ LUMINEX STENT 7X40

Facility IP

$3,969.00

Service Code	HCPCS C1876
Hospital Charge Code	41569654
Hospital Revenue Code	278
Min. Negotiated Rate	$1,984.50
Max. Negotiated Rate	$1,984.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,984.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,984.50

ZZ LUMINEX STENT 7X40 6F

Facility IP

$4,394.25

Service Code	HCPCS C1876
Hospital Charge Code	41569753
Hospital Revenue Code	278
Min. Negotiated Rate	$2,197.12
Max. Negotiated Rate	$2,197.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,197.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2,197.12

ZZ LUMINEX STENT 7X40 6F

Facility OP

$4,394.25

Service Code	HCPCS C1876
Hospital Charge Code	41569753
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$4,613.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,416.84
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	$2,197.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,526.69
Rate for Payer: Fidelis Medicare Advantage	$4,613.96
Rate for Payer: Group Health Inc Commercial	$2,197.12
Rate for Payer: Group Health Inc Medicare	$1,537.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,197.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2,197.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,856.26

ZZ LUMINEX STENT 7X50

Facility OP

$4,252.50

Service Code	HCPCS C1876
Hospital Charge Code	41569656
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$4,465.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,338.88
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	$2,126.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,445.19
Rate for Payer: Fidelis Medicare Advantage	$4,465.12
Rate for Payer: Group Health Inc Commercial	$2,126.25
Rate for Payer: Group Health Inc Medicare	$1,488.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,126.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,126.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,764.12

ZZ LUMINEX STENT 7X50

Facility IP

$4,252.50

Service Code	HCPCS C1876
Hospital Charge Code	41569656
Hospital Revenue Code	278
Min. Negotiated Rate	$2,126.25
Max. Negotiated Rate	$2,126.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,126.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,126.25

ZZ LUMINEX STENT 7X50 6F

Facility OP

$4,394.25

Service Code	HCPCS C1876
Hospital Charge Code	41569754
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$4,613.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,416.84
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	$2,197.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,526.69
Rate for Payer: Fidelis Medicare Advantage	$4,613.96
Rate for Payer: Group Health Inc Commercial	$2,197.12
Rate for Payer: Group Health Inc Medicare	$1,537.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,197.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2,197.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,856.26

ZZ LUMINEX STENT 7X50 6F

Facility IP

$4,394.25

Service Code	HCPCS C1876
Hospital Charge Code	41569754
Hospital Revenue Code	278
Min. Negotiated Rate	$2,197.12
Max. Negotiated Rate	$2,197.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,197.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2,197.12

ZZ LUMINEX STENT 7X60

Facility IP

$5,103.00

Service Code	HCPCS C1876
Hospital Charge Code	41569653
Hospital Revenue Code	278
Min. Negotiated Rate	$2,551.50
Max. Negotiated Rate	$2,551.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,551.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,551.50

ZZ LUMINEX STENT 7X60

Facility OP

$5,103.00

Service Code	HCPCS C1876
Hospital Charge Code	41569653
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$5,358.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,806.65
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	$2,551.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,934.22
Rate for Payer: Fidelis Medicare Advantage	$5,358.15
Rate for Payer: Group Health Inc Commercial	$2,551.50
Rate for Payer: Group Health Inc Medicare	$1,786.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,551.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,551.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,316.95

ZZ LUMINEX STENT 7X60 6F

Facility IP

$4,521.83

Service Code	HCPCS C1876
Hospital Charge Code	41569755
Hospital Revenue Code	278
Min. Negotiated Rate	$2,260.92
Max. Negotiated Rate	$2,260.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,260.92
Rate for Payer: Hamaspik Choice Inc Medicare	$2,260.92

ZZ LUMINEX STENT 7X60 6F

Facility OP

$4,521.83

Service Code	HCPCS C1876
Hospital Charge Code	41569755
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$4,747.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,487.01
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	$2,260.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,600.05
Rate for Payer: Fidelis Medicare Advantage	$4,747.92
Rate for Payer: Group Health Inc Commercial	$2,260.92
Rate for Payer: Group Health Inc Medicare	$1,582.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,260.92
Rate for Payer: Hamaspik Choice Inc Medicare	$2,260.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,939.19

ZZ LUMINEX STENT 8X50

Facility OP

$4,252.50

Service Code	HCPCS C1876
Hospital Charge Code	41569657
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$4,465.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,338.88
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	$2,126.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,445.19
Rate for Payer: Fidelis Medicare Advantage	$4,465.12
Rate for Payer: Group Health Inc Commercial	$2,126.25
Rate for Payer: Group Health Inc Medicare	$1,488.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,126.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,126.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,764.12

ZZ LUMINEX STENT 8X50

Facility IP

$4,252.50

Service Code	HCPCS C1876
Hospital Charge Code	41569657
Hospital Revenue Code	278
Min. Negotiated Rate	$2,126.25
Max. Negotiated Rate	$2,126.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,126.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,126.25

ZZ LUMINEX STENT 8X50 6F

Facility OP

$4,394.25

Service Code	HCPCS C1876
Hospital Charge Code	41569759
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$4,613.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,416.84
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	$2,197.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,526.69
Rate for Payer: Fidelis Medicare Advantage	$4,613.96
Rate for Payer: Group Health Inc Commercial	$2,197.12
Rate for Payer: Group Health Inc Medicare	$1,537.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,197.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2,197.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,856.26

ZZ LUMINEX STENT 8X50 6F

Facility IP

$4,394.25

Service Code	HCPCS C1876
Hospital Charge Code	41569759
Hospital Revenue Code	278
Min. Negotiated Rate	$2,197.12
Max. Negotiated Rate	$2,197.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,197.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2,197.12

ZZ LUMINEX STENT 8X60 6F

Facility OP

$4,521.83

Service Code	HCPCS C1876
Hospital Charge Code	41569758
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$4,747.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,487.01
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	$2,260.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,600.05
Rate for Payer: Fidelis Medicare Advantage	$4,747.92
Rate for Payer: Group Health Inc Commercial	$2,260.92
Rate for Payer: Group Health Inc Medicare	$1,582.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,260.92
Rate for Payer: Hamaspik Choice Inc Medicare	$2,260.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,939.19

ZZ LUMINEX STENT 8X60 6F

Facility IP

$4,521.83

Service Code	HCPCS C1876
Hospital Charge Code	41569758
Hospital Revenue Code	278
Min. Negotiated Rate	$2,260.92
Max. Negotiated Rate	$2,260.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,260.92
Rate for Payer: Hamaspik Choice Inc Medicare	$2,260.92

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