St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ ORTHOVITA DELIVERY KIT

Facility OP

$1,100.00

Hospital Charge Code	41563100
Hospital Revenue Code	272
Min. Negotiated Rate	$385.00
Max. Negotiated Rate	$880.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$605.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$550.00
Rate for Payer: Aetna Government	$550.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$880.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$748.00
Rate for Payer: Group Health Inc Commercial	$550.00
Rate for Payer: Group Health Inc Medicare	$385.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$550.00

ZZ PALMAZ STENT-ILIAC 30

Facility OP

$2,445.19

Service Code	HCPCS C1876
Hospital Charge Code	41567144
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,567.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,344.85
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	$1,222.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,405.98
Rate for Payer: Fidelis Medicare Advantage	$2,567.45
Rate for Payer: Group Health Inc Commercial	$1,222.60
Rate for Payer: Group Health Inc Medicare	$855.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,222.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,222.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,589.37

ZZ PALMAZ STENT-ILIAC 30

Facility IP

$2,445.19

Service Code	HCPCS C1876
Hospital Charge Code	41567144
Hospital Revenue Code	278
Min. Negotiated Rate	$1,222.60
Max. Negotiated Rate	$1,222.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,222.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,222.60

ZZ PALMAZ STENT ILIAC 39

Facility OP

$2,445.19

Service Code	HCPCS C1876
Hospital Charge Code	41567145
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,567.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,344.85
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	$1,222.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,405.98
Rate for Payer: Fidelis Medicare Advantage	$2,567.45
Rate for Payer: Group Health Inc Commercial	$1,222.60
Rate for Payer: Group Health Inc Medicare	$855.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,222.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,222.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,589.37

ZZ PALMAZ STENT ILIAC 39

Facility IP

$2,445.19

Service Code	HCPCS C1876
Hospital Charge Code	41567145
Hospital Revenue Code	278
Min. Negotiated Rate	$1,222.60
Max. Negotiated Rate	$1,222.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,222.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,222.60

ZZ PALMAZ STENT-RENAL 15

Facility OP

$2,445.19

Service Code	HCPCS C1876
Hospital Charge Code	41567146
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,567.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,344.85
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	$1,222.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,405.98
Rate for Payer: Fidelis Medicare Advantage	$2,567.45
Rate for Payer: Group Health Inc Commercial	$1,222.60
Rate for Payer: Group Health Inc Medicare	$855.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,222.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,222.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,589.37

ZZ PALMAZ STENT-RENAL 15

Facility IP

$2,445.19

Service Code	HCPCS C1876
Hospital Charge Code	41567146
Hospital Revenue Code	278
Min. Negotiated Rate	$1,222.60
Max. Negotiated Rate	$1,222.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,222.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,222.60

ZZ PARALLAX ACRYLIC RESIN

Facility OP

$365.72

Hospital Charge Code	41569568
Hospital Revenue Code	270
Min. Negotiated Rate	$128.00
Max. Negotiated Rate	$292.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$201.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$182.86
Rate for Payer: Aetna Government	$182.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$292.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$248.69
Rate for Payer: Group Health Inc Commercial	$182.86
Rate for Payer: Group Health Inc Medicare	$128.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.86
Rate for Payer: Hamaspik Choice Inc Medicare	$182.86

ZZ PARALLAX TRACER BONE

Facility OP

$211.21

Hospital Charge Code	41569567
Hospital Revenue Code	270
Min. Negotiated Rate	$73.92
Max. Negotiated Rate	$168.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$116.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$105.60
Rate for Payer: Aetna Government	$105.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$168.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$143.62
Rate for Payer: Group Health Inc Commercial	$105.60
Rate for Payer: Group Health Inc Medicare	$73.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.60
Rate for Payer: Hamaspik Choice Inc Medicare	$105.60

ZZ PEEL-AWAY/10F/12CM

Facility OP

$76.55

Service Code	HCPCS C1892
Hospital Charge Code	41569274
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$80.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.02
Rate for Payer: Fidelis Medicare Advantage	$80.38
Rate for Payer: Group Health Inc Commercial	$38.28
Rate for Payer: Group Health Inc Medicare	$26.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.28
Rate for Payer: Hamaspik Choice Inc Medicare	$38.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$49.76

ZZ PEEL-AWAY/10F/12CM

Facility IP

$76.55

Service Code	HCPCS C1892
Hospital Charge Code	41569274
Hospital Revenue Code	278
Min. Negotiated Rate	$38.28
Max. Negotiated Rate	$38.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.28
Rate for Payer: Hamaspik Choice Inc Medicare	$38.28

ZZ PEEL-AWAY/10F/32

Facility OP

$80.80

Service Code	HCPCS C1892
Hospital Charge Code	41569275
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$84.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.46
Rate for Payer: Fidelis Medicare Advantage	$84.84
Rate for Payer: Group Health Inc Commercial	$40.40
Rate for Payer: Group Health Inc Medicare	$28.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.40
Rate for Payer: Hamaspik Choice Inc Medicare	$40.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.52

ZZ PEEL-AWAY/10F/32

Facility IP

$80.80

Service Code	HCPCS C1892
Hospital Charge Code	41569275
Hospital Revenue Code	278
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$40.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.40
Rate for Payer: Hamaspik Choice Inc Medicare	$40.40

ZZ PEEL-AWAY/12F/15CM

Facility OP

$80.80

Service Code	HCPCS C1892
Hospital Charge Code	41569276
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$84.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.46
Rate for Payer: Fidelis Medicare Advantage	$84.84
Rate for Payer: Group Health Inc Commercial	$40.40
Rate for Payer: Group Health Inc Medicare	$28.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.40
Rate for Payer: Hamaspik Choice Inc Medicare	$40.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.52

ZZ PEEL-AWAY/12F/15CM

Facility IP

$80.80

Service Code	HCPCS C1892
Hospital Charge Code	41569276
Hospital Revenue Code	278
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$40.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.40
Rate for Payer: Hamaspik Choice Inc Medicare	$40.40

ZZ PEEL-AWAY/12F/32CM

Facility OP

$80.80

Service Code	HCPCS C1892
Hospital Charge Code	41569277
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$84.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.46
Rate for Payer: Fidelis Medicare Advantage	$84.84
Rate for Payer: Group Health Inc Commercial	$40.40
Rate for Payer: Group Health Inc Medicare	$28.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.40
Rate for Payer: Hamaspik Choice Inc Medicare	$40.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.52

ZZ PEEL-AWAY/12F/32CM

Facility IP

$80.80

Service Code	HCPCS C1892
Hospital Charge Code	41569277
Hospital Revenue Code	278
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$40.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.40
Rate for Payer: Hamaspik Choice Inc Medicare	$40.40

ZZ PEEL-AWAY/12F/60CM

Facility OP

$80.80

Service Code	HCPCS C1892
Hospital Charge Code	41569278
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$84.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.46
Rate for Payer: Fidelis Medicare Advantage	$84.84
Rate for Payer: Group Health Inc Commercial	$40.40
Rate for Payer: Group Health Inc Medicare	$28.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.40
Rate for Payer: Hamaspik Choice Inc Medicare	$40.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.52

ZZ PEEL-AWAY/12F/60CM

Facility IP

$80.80

Service Code	HCPCS C1892
Hospital Charge Code	41569278
Hospital Revenue Code	278
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$40.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.40
Rate for Payer: Hamaspik Choice Inc Medicare	$40.40

ZZ PEEL-AWAY/6F/15CM

Facility OP

$76.55

Service Code	HCPCS C1892
Hospital Charge Code	41569279
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$80.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.02
Rate for Payer: Fidelis Medicare Advantage	$80.38
Rate for Payer: Group Health Inc Commercial	$38.28
Rate for Payer: Group Health Inc Medicare	$26.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.28
Rate for Payer: Hamaspik Choice Inc Medicare	$38.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$49.76

ZZ PEEL-AWAY/6F/15CM

Facility IP

$76.55

Service Code	HCPCS C1892
Hospital Charge Code	41569279
Hospital Revenue Code	278
Min. Negotiated Rate	$38.28
Max. Negotiated Rate	$38.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.28
Rate for Payer: Hamaspik Choice Inc Medicare	$38.28

ZZ PEEL-AWAY/6F/32CM

Facility IP

$76.55

Service Code	HCPCS C1892
Hospital Charge Code	41569280
Hospital Revenue Code	278
Min. Negotiated Rate	$38.28
Max. Negotiated Rate	$38.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.28
Rate for Payer: Hamaspik Choice Inc Medicare	$38.28

ZZ PEEL-AWAY/6F/32CM

Facility OP

$76.55

Service Code	HCPCS C1892
Hospital Charge Code	41569280
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$80.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.02
Rate for Payer: Fidelis Medicare Advantage	$80.38
Rate for Payer: Group Health Inc Commercial	$38.28
Rate for Payer: Group Health Inc Medicare	$26.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.28
Rate for Payer: Hamaspik Choice Inc Medicare	$38.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$49.76

ZZ PEEL-AWAY/6F/60CM

Facility IP

$131.55

Service Code	HCPCS C1892
Hospital Charge Code	41569281
Hospital Revenue Code	278
Min. Negotiated Rate	$65.78
Max. Negotiated Rate	$65.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.78
Rate for Payer: Hamaspik Choice Inc Medicare	$65.78

ZZ PEEL-AWAY/6F/60CM

Facility OP

$131.55

Service Code	HCPCS C1892
Hospital Charge Code	41569281
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$138.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$72.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$75.64
Rate for Payer: Fidelis Medicare Advantage	$138.13
Rate for Payer: Group Health Inc Commercial	$65.78
Rate for Payer: Group Health Inc Medicare	$46.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.78
Rate for Payer: Hamaspik Choice Inc Medicare	$65.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$85.51

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