St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ STENT/PALMAZ/NONMOUNT/P154

Facility OP

$1,743.53

Service Code	HCPCS C1876
Hospital Charge Code	41569227
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$1,830.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$958.94
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	$871.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,002.53
Rate for Payer: Fidelis Medicare Advantage	$1,830.71
Rate for Payer: Group Health Inc Commercial	$871.76
Rate for Payer: Group Health Inc Medicare	$610.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$871.76
Rate for Payer: Hamaspik Choice Inc Medicare	$871.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,133.29

ZZ STENT/PALMAZ/NONMOUNT/P154

Facility IP

$1,743.53

Service Code	HCPCS C1876
Hospital Charge Code	41569227
Hospital Revenue Code	278
Min. Negotiated Rate	$871.76
Max. Negotiated Rate	$871.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$871.76
Rate for Payer: Hamaspik Choice Inc Medicare	$871.76

ZZ STENT/PALMAZ/NONMOUNT/P294M

Facility OP

$1,743.53

Service Code	HCPCS C1876
Hospital Charge Code	41569229
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$1,830.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$958.94
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	$871.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,002.53
Rate for Payer: Fidelis Medicare Advantage	$1,830.71
Rate for Payer: Group Health Inc Commercial	$871.76
Rate for Payer: Group Health Inc Medicare	$610.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$871.76
Rate for Payer: Hamaspik Choice Inc Medicare	$871.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,133.29

ZZ STENT/PALMAZ/NONMOUNT/P294M

Facility IP

$1,743.53

Service Code	HCPCS C1876
Hospital Charge Code	41569229
Hospital Revenue Code	278
Min. Negotiated Rate	$871.76
Max. Negotiated Rate	$871.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$871.76
Rate for Payer: Hamaspik Choice Inc Medicare	$871.76

ZZ STENT/PALMAZ/NONMOUNT/P308M

Facility OP

$1,743.53

Service Code	HCPCS C1876
Hospital Charge Code	41569230
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$1,830.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$958.94
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	$871.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,002.53
Rate for Payer: Fidelis Medicare Advantage	$1,830.71
Rate for Payer: Group Health Inc Commercial	$871.76
Rate for Payer: Group Health Inc Medicare	$610.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$871.76
Rate for Payer: Hamaspik Choice Inc Medicare	$871.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,133.29

ZZ STENT/PALMAZ/NONMOUNT/P308M

Facility IP

$1,743.53

Service Code	HCPCS C1876
Hospital Charge Code	41569230
Hospital Revenue Code	278
Min. Negotiated Rate	$871.76
Max. Negotiated Rate	$871.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$871.76
Rate for Payer: Hamaspik Choice Inc Medicare	$871.76

ZZ STENT/PALMAZ/NONMOUNT/P394M

Facility IP

$1,743.53

Service Code	HCPCS C1876
Hospital Charge Code	41569231
Hospital Revenue Code	278
Min. Negotiated Rate	$871.76
Max. Negotiated Rate	$871.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$871.76
Rate for Payer: Hamaspik Choice Inc Medicare	$871.76

ZZ STENT/PALMAZ/NONMOUNT/P394M

Facility OP

$1,743.53

Service Code	HCPCS C1876
Hospital Charge Code	41569231
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$1,830.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$958.94
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	$871.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,002.53
Rate for Payer: Fidelis Medicare Advantage	$1,830.71
Rate for Payer: Group Health Inc Commercial	$871.76
Rate for Payer: Group Health Inc Medicare	$610.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$871.76
Rate for Payer: Hamaspik Choice Inc Medicare	$871.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,133.29

ZZ STENT/PALMAZ/PREMOUNT/P1505

Facility OP

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569233
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,266.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,186.98
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	$1,079.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,240.94
Rate for Payer: Fidelis Medicare Advantage	$2,266.06
Rate for Payer: Group Health Inc Commercial	$1,079.08
Rate for Payer: Group Health Inc Medicare	$755.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,402.80

ZZ STENT/PALMAZ/PREMOUNT/P1505

Facility IP

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569233
Hospital Revenue Code	278
Min. Negotiated Rate	$1,079.08
Max. Negotiated Rate	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.08

ZZ STENT/PALMAZ/PREMOUNT/P1506

Facility OP

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569234
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,266.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,186.98
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	$1,079.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,240.94
Rate for Payer: Fidelis Medicare Advantage	$2,266.06
Rate for Payer: Group Health Inc Commercial	$1,079.08
Rate for Payer: Group Health Inc Medicare	$755.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,402.80

ZZ STENT/PALMAZ/PREMOUNT/P1506

Facility IP

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569234
Hospital Revenue Code	278
Min. Negotiated Rate	$1,079.08
Max. Negotiated Rate	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.08

ZZ STENT/PALMAZ/PREMOUNT/P2006

Facility IP

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569235
Hospital Revenue Code	278
Min. Negotiated Rate	$1,079.08
Max. Negotiated Rate	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.08

ZZ STENT/PALMAZ/PREMOUNT/P2006

Facility OP

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569235
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,266.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,186.98
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	$1,079.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,240.94
Rate for Payer: Fidelis Medicare Advantage	$2,266.06
Rate for Payer: Group Health Inc Commercial	$1,079.08
Rate for Payer: Group Health Inc Medicare	$755.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,402.80

ZZ STENT/PALMAZ/PREMOUNT/P2007

Facility OP

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569236
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,266.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,186.98
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	$1,079.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,240.94
Rate for Payer: Fidelis Medicare Advantage	$2,266.06
Rate for Payer: Group Health Inc Commercial	$1,079.08
Rate for Payer: Group Health Inc Medicare	$755.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,402.80

ZZ STENT/PALMAZ/PREMOUNT/P2007

Facility IP

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569236
Hospital Revenue Code	278
Min. Negotiated Rate	$1,079.08
Max. Negotiated Rate	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.08

ZZ STENT/PALMAZ/PREMOUNT/P2905

Facility OP

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569237
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,266.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,186.98
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	$1,079.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,240.94
Rate for Payer: Fidelis Medicare Advantage	$2,266.06
Rate for Payer: Group Health Inc Commercial	$1,079.08
Rate for Payer: Group Health Inc Medicare	$755.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,402.80

ZZ STENT/PALMAZ/PREMOUNT/P2905

Facility IP

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569237
Hospital Revenue Code	278
Min. Negotiated Rate	$1,079.08
Max. Negotiated Rate	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.08

ZZ STENT/PALMAZ/PREMOUNT/P2906

Facility OP

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569238
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,266.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,186.98
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	$1,079.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,240.94
Rate for Payer: Fidelis Medicare Advantage	$2,266.06
Rate for Payer: Group Health Inc Commercial	$1,079.08
Rate for Payer: Group Health Inc Medicare	$755.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,402.80

ZZ STENT/PALMAZ/PREMOUNT/P2906

Facility IP

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569238
Hospital Revenue Code	278
Min. Negotiated Rate	$1,079.08
Max. Negotiated Rate	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.08

ZZ STENT/PALMAZ/PREMOUNT/P2907

Facility OP

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569239
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,266.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,186.98
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	$1,079.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,240.94
Rate for Payer: Fidelis Medicare Advantage	$2,266.06
Rate for Payer: Group Health Inc Commercial	$1,079.08
Rate for Payer: Group Health Inc Medicare	$755.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,402.80

ZZ STENT/PALMAZ/PREMOUNT/P2907

Facility IP

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569239
Hospital Revenue Code	278
Min. Negotiated Rate	$1,079.08
Max. Negotiated Rate	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.08

ZZ STENT/PALMAZ/PREMOUNT/P2908

Facility IP

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569240
Hospital Revenue Code	278
Min. Negotiated Rate	$1,079.08
Max. Negotiated Rate	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.08

ZZ STENT/PALMAZ/PREMOUNT/P2908

Facility OP

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569240
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,266.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,186.98
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	$1,079.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,240.94
Rate for Payer: Fidelis Medicare Advantage	$2,266.06
Rate for Payer: Group Health Inc Commercial	$1,079.08
Rate for Payer: Group Health Inc Medicare	$755.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,402.80

ZZ STENT/PALMAZ/PREMOUNT/P3008

Facility OP

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569232
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,266.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,186.98
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	$1,079.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,240.94
Rate for Payer: Fidelis Medicare Advantage	$2,266.06
Rate for Payer: Group Health Inc Commercial	$1,079.08
Rate for Payer: Group Health Inc Medicare	$755.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,402.80

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