St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ NEPHROURET STENT 10/22

Facility OP

$391.23

Hospital Charge Code	41567228
Hospital Revenue Code	270
Min. Negotiated Rate	$136.93
Max. Negotiated Rate	$312.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$215.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$195.62
Rate for Payer: Aetna Government	$195.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$312.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$266.04
Rate for Payer: Group Health Inc Commercial	$195.62
Rate for Payer: Group Health Inc Medicare	$136.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$195.62
Rate for Payer: Hamaspik Choice Inc Medicare	$195.62

ZZ NEPHROURET STENT 10/24

Facility OP

$391.23

Hospital Charge Code	41567229
Hospital Revenue Code	270
Min. Negotiated Rate	$136.93
Max. Negotiated Rate	$312.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$215.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$195.62
Rate for Payer: Aetna Government	$195.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$312.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$266.04
Rate for Payer: Group Health Inc Commercial	$195.62
Rate for Payer: Group Health Inc Medicare	$136.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$195.62
Rate for Payer: Hamaspik Choice Inc Medicare	$195.62

ZZ NEPHROURET STENT 8/22

Facility OP

$391.23

Hospital Charge Code	41567226
Hospital Revenue Code	270
Min. Negotiated Rate	$136.93
Max. Negotiated Rate	$312.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$215.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$195.62
Rate for Payer: Aetna Government	$195.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$312.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$266.04
Rate for Payer: Group Health Inc Commercial	$195.62
Rate for Payer: Group Health Inc Medicare	$136.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$195.62
Rate for Payer: Hamaspik Choice Inc Medicare	$195.62

ZZ NEPHROURET STENT 8/24

Facility OP

$391.23

Hospital Charge Code	41567227
Hospital Revenue Code	270
Min. Negotiated Rate	$136.93
Max. Negotiated Rate	$312.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$215.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$195.62
Rate for Payer: Aetna Government	$195.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$312.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$266.04
Rate for Payer: Group Health Inc Commercial	$195.62
Rate for Payer: Group Health Inc Medicare	$136.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$195.62
Rate for Payer: Hamaspik Choice Inc Medicare	$195.62

ZZ NESTOR EMBOLI COILS 38-14-12MM

Facility OP

$177.56

Hospital Charge Code	41569885
Hospital Revenue Code	279
Min. Negotiated Rate	$62.15
Max. Negotiated Rate	$142.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$97.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$88.78
Rate for Payer: Aetna Government	$88.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$142.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$120.74
Rate for Payer: Group Health Inc Commercial	$88.78
Rate for Payer: Group Health Inc Medicare	$62.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$88.78
Rate for Payer: Hamaspik Choice Inc Medicare	$88.78

ZZ NEST TM PLAT35-14-10

Facility OP

$226.10

Hospital Charge Code	41569792
Hospital Revenue Code	270
Min. Negotiated Rate	$79.14
Max. Negotiated Rate	$180.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$124.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$113.05
Rate for Payer: Aetna Government	$113.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$180.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.75
Rate for Payer: Group Health Inc Commercial	$113.05
Rate for Payer: Group Health Inc Medicare	$79.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.05
Rate for Payer: Hamaspik Choice Inc Medicare	$113.05

ZZ NEST TM PLAT35-14-12

Facility OP

$226.10

Hospital Charge Code	41569793
Hospital Revenue Code	270
Min. Negotiated Rate	$79.14
Max. Negotiated Rate	$180.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$124.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$113.05
Rate for Payer: Aetna Government	$113.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$180.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.75
Rate for Payer: Group Health Inc Commercial	$113.05
Rate for Payer: Group Health Inc Medicare	$79.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.05
Rate for Payer: Hamaspik Choice Inc Medicare	$113.05

ZZ NEST TM PLAT35-14-4

Facility OP

$226.10

Hospital Charge Code	41569794
Hospital Revenue Code	270
Min. Negotiated Rate	$79.14
Max. Negotiated Rate	$180.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$124.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$113.05
Rate for Payer: Aetna Government	$113.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$180.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.75
Rate for Payer: Group Health Inc Commercial	$113.05
Rate for Payer: Group Health Inc Medicare	$79.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.05
Rate for Payer: Hamaspik Choice Inc Medicare	$113.05

ZZ NEST TM PLAT35-14-6

Facility OP

$226.10

Hospital Charge Code	41569795
Hospital Revenue Code	270
Min. Negotiated Rate	$79.14
Max. Negotiated Rate	$180.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$124.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$113.05
Rate for Payer: Aetna Government	$113.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$180.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.75
Rate for Payer: Group Health Inc Commercial	$113.05
Rate for Payer: Group Health Inc Medicare	$79.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.05
Rate for Payer: Hamaspik Choice Inc Medicare	$113.05

ZZ NEST TM PLAT35-14-8

Facility OP

$226.10

Hospital Charge Code	41569796
Hospital Revenue Code	270
Min. Negotiated Rate	$79.14
Max. Negotiated Rate	$180.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$124.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$113.05
Rate for Payer: Aetna Government	$113.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$180.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.75
Rate for Payer: Group Health Inc Commercial	$113.05
Rate for Payer: Group Health Inc Medicare	$79.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.05
Rate for Payer: Hamaspik Choice Inc Medicare	$113.05

ZZ NEST TM PLAT38-14-10

Facility OP

$226.10

Hospital Charge Code	41569797
Hospital Revenue Code	270
Min. Negotiated Rate	$79.14
Max. Negotiated Rate	$180.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$124.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$113.05
Rate for Payer: Aetna Government	$113.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$180.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.75
Rate for Payer: Group Health Inc Commercial	$113.05
Rate for Payer: Group Health Inc Medicare	$79.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.05
Rate for Payer: Hamaspik Choice Inc Medicare	$113.05

ZZ NEST TM PLAT38-14-12

Facility OP

$226.10

Hospital Charge Code	41569798
Hospital Revenue Code	270
Min. Negotiated Rate	$79.14
Max. Negotiated Rate	$180.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$124.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$113.05
Rate for Payer: Aetna Government	$113.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$180.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.75
Rate for Payer: Group Health Inc Commercial	$113.05
Rate for Payer: Group Health Inc Medicare	$79.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.05
Rate for Payer: Hamaspik Choice Inc Medicare	$113.05

ZZ NEST TM PLAT38-14-4

Facility OP

$226.10

Hospital Charge Code	41569799
Hospital Revenue Code	270
Min. Negotiated Rate	$79.14
Max. Negotiated Rate	$180.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$124.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$113.05
Rate for Payer: Aetna Government	$113.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$180.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.75
Rate for Payer: Group Health Inc Commercial	$113.05
Rate for Payer: Group Health Inc Medicare	$79.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.05
Rate for Payer: Hamaspik Choice Inc Medicare	$113.05

ZZ NEST TM PLAT38-14-6

Facility OP

$226.10

Hospital Charge Code	41569800
Hospital Revenue Code	270
Min. Negotiated Rate	$79.14
Max. Negotiated Rate	$180.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$124.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$113.05
Rate for Payer: Aetna Government	$113.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$180.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.75
Rate for Payer: Group Health Inc Commercial	$113.05
Rate for Payer: Group Health Inc Medicare	$79.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.05
Rate for Payer: Hamaspik Choice Inc Medicare	$113.05

ZZ NEST TM PLAT38-14-8

Facility OP

$226.10

Hospital Charge Code	41569801
Hospital Revenue Code	270
Min. Negotiated Rate	$79.14
Max. Negotiated Rate	$180.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$124.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$113.05
Rate for Payer: Aetna Government	$113.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$180.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.75
Rate for Payer: Group Health Inc Commercial	$113.05
Rate for Payer: Group Health Inc Medicare	$79.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.05
Rate for Payer: Hamaspik Choice Inc Medicare	$113.05

ZZ NITINOL BILIARY STENT

Facility IP

$5,103.00

Service Code	HCPCS C1876
Hospital Charge Code	41569273
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 NITINOL BILIARY STENT

Facility OP

$5,103.00

Service Code	HCPCS C1876
Hospital Charge Code	41569273
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 NM ADENOSINE 30MG

Facility OP

$551.20

Hospital Charge Code	41568759
Hospital Revenue Code	250
Min. Negotiated Rate	$192.92
Max. Negotiated Rate	$440.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.60
Rate for Payer: Aetna Government	$275.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$440.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$374.82
Rate for Payer: Group Health Inc Commercial	$275.60
Rate for Payer: Group Health Inc Medicare	$192.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.60
Rate for Payer: Hamaspik Choice Inc Medicare	$275.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$358.28

ZZ NM CCK VIAL

Facility IP

$184.80

Service Code	HCPCS J2805
Hospital Charge Code	41568598
Hospital Revenue Code	636
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$92.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.40
Rate for Payer: Hamaspik Choice Inc Medicare	$92.40

ZZ NM CCK VIAL

Facility OP

$184.80

Service Code	HCPCS J2805
Hospital Charge Code	41568598
Hospital Revenue Code	636
Min. Negotiated Rate	$64.68
Max. Negotiated Rate	$137.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$101.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$121.08
Rate for Payer: Aetna Government	$121.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$92.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$106.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$120.19
Rate for Payer: Group Health Inc Commercial	$92.40
Rate for Payer: Group Health Inc Medicare	$64.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.40
Rate for Payer: Hamaspik Choice Inc Medicare	$92.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$133.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$137.53
Rate for Payer: SOMOS Essential	$137.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$120.12

ZZ NM DIPYRIDAMOLE, PER 10MG

Facility IP

$271.88

Service Code	HCPCS J1245
Hospital Charge Code	41569588
Hospital Revenue Code	636
Min. Negotiated Rate	$135.94
Max. Negotiated Rate	$135.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$135.94
Rate for Payer: Hamaspik Choice Inc Medicare	$135.94

ZZ NM DIPYRIDAMOLE, PER 10MG

Facility OP

$271.88

Service Code	HCPCS J1245
Hospital Charge Code	41569588
Hospital Revenue Code	636
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$176.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$149.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.65
Rate for Payer: Aetna Government	$3.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$135.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$156.33
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.40
Rate for Payer: Group Health Inc Commercial	$135.94
Rate for Payer: Group Health Inc Medicare	$95.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$135.94
Rate for Payer: Hamaspik Choice Inc Medicare	$135.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.96
Rate for Payer: SOMOS Essential	$3.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$176.72

ZZ NM FUROSEMIDE/LASIX

Facility IP

$0.26

Service Code	HCPCS J1940
Hospital Charge Code	41568605
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13

ZZ NM FUROSEMIDE/LASIX

Facility OP

$0.26

Service Code	HCPCS J1940
Hospital Charge Code	41568605
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.45
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.64
Rate for Payer: SOMOS Essential	$0.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

ZZ NM GA-67, PER MCI

Facility OP

$25.28

Service Code	HCPCS A9556
Hospital Charge Code	41569585
Hospital Revenue Code	343
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$99.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$99.50
Rate for Payer: Aetna Government	$99.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.19
Rate for Payer: Group Health Inc Commercial	$12.64
Rate for Payer: Group Health Inc Medicare	$8.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.64
Rate for Payer: Hamaspik Choice Inc Medicare	$12.64

Price Transparency.

All Charges