St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ ULTRACLIP COAXIAL NDLE 18X10

Facility OP

$28.00

Hospital Charge Code	41568501
Hospital Revenue Code	270
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$22.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.00
Rate for Payer: Aetna Government	$14.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.04
Rate for Payer: Group Health Inc Commercial	$14.00
Rate for Payer: Group Health Inc Medicare	$9.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14.00

ZZ ULTRACLIP II US TISSUE MARKER

Facility OP

$150.00

Hospital Charge Code	41568500
Hospital Revenue Code	270
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$120.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75.00
Rate for Payer: Aetna Government	$75.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$120.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.00
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

ZZ ULTRA SEL NITNL GDE WR

Facility OP

$277.13

Hospital Charge Code	41567128
Hospital Revenue Code	270
Min. Negotiated Rate	$97.00
Max. Negotiated Rate	$221.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$152.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$138.56
Rate for Payer: Aetna Government	$138.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$221.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$188.45
Rate for Payer: Group Health Inc Commercial	$138.56
Rate for Payer: Group Health Inc Medicare	$97.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.56
Rate for Payer: Hamaspik Choice Inc Medicare	$138.56

ZZ ULTRAVIST 300 100ML

Facility OP

$34.18

Hospital Charge Code	41568414
Hospital Revenue Code	270
Min. Negotiated Rate	$11.96
Max. Negotiated Rate	$27.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.09
Rate for Payer: Aetna Government	$17.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.24
Rate for Payer: Group Health Inc Commercial	$17.09
Rate for Payer: Group Health Inc Medicare	$11.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.09
Rate for Payer: Hamaspik Choice Inc Medicare	$17.09

ZZ ULTRAVIST 300 150ML

Facility OP

$51.26

Hospital Charge Code	41568413
Hospital Revenue Code	270
Min. Negotiated Rate	$17.94
Max. Negotiated Rate	$41.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.63
Rate for Payer: Aetna Government	$25.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.86
Rate for Payer: Group Health Inc Commercial	$25.63
Rate for Payer: Group Health Inc Medicare	$17.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.63
Rate for Payer: Hamaspik Choice Inc Medicare	$25.63

ZZ ULTR HVY DUT WR 36-260

Facility OP

$68.40

Hospital Charge Code	41567130
Hospital Revenue Code	270
Min. Negotiated Rate	$23.94
Max. Negotiated Rate	$54.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$34.20
Rate for Payer: Aetna Government	$34.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$54.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.51
Rate for Payer: Group Health Inc Commercial	$34.20
Rate for Payer: Group Health Inc Medicare	$23.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.20
Rate for Payer: Hamaspik Choice Inc Medicare	$34.20

ZZ UNIVERSAL PROC TRAYS

Facility OP

$58.83

Hospital Charge Code	41567002
Hospital Revenue Code	270
Min. Negotiated Rate	$20.59
Max. Negotiated Rate	$47.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.42
Rate for Payer: Aetna Government	$29.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.00
Rate for Payer: Group Health Inc Commercial	$29.42
Rate for Payer: Group Health Inc Medicare	$20.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.42
Rate for Payer: Hamaspik Choice Inc Medicare	$29.42

ZZ URELSIL TVP TRAY 13FR

Facility OP

$235.00

Hospital Charge Code	41540606
Hospital Revenue Code	272
Min. Negotiated Rate	$82.25
Max. Negotiated Rate	$188.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$129.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$117.50
Rate for Payer: Aetna Government	$117.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$188.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$159.80
Rate for Payer: Group Health Inc Commercial	$117.50
Rate for Payer: Group Health Inc Medicare	$82.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$117.50
Rate for Payer: Hamaspik Choice Inc Medicare	$117.50

ZZ URESIL GEN PURPOSE DRAIN CATH

Facility OP

$50.00

Hospital Charge Code	41541155
Hospital Revenue Code	272
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$40.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.00
Rate for Payer: Aetna Government	$25.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.00
Rate for Payer: Group Health Inc Commercial	$25.00
Rate for Payer: Group Health Inc Medicare	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00

ZZ URESIL GEN PURPOSE DRAIN CATH

Facility OP

$50.00

Hospital Charge Code	41540611
Hospital Revenue Code	272
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$40.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.00
Rate for Payer: Aetna Government	$25.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.00
Rate for Payer: Group Health Inc Commercial	$25.00
Rate for Payer: Group Health Inc Medicare	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00

ZZ URESIL TVP TRAY 11FR

Facility OP

$235.00

Hospital Charge Code	41540605
Hospital Revenue Code	272
Min. Negotiated Rate	$82.25
Max. Negotiated Rate	$188.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$129.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$117.50
Rate for Payer: Aetna Government	$117.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$188.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$159.80
Rate for Payer: Group Health Inc Commercial	$117.50
Rate for Payer: Group Health Inc Medicare	$82.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$117.50
Rate for Payer: Hamaspik Choice Inc Medicare	$117.50

ZZ URETERAL STENT 8/22

Facility OP

$365.01

Hospital Charge Code	41567225
Hospital Revenue Code	270
Min. Negotiated Rate	$127.75
Max. Negotiated Rate	$292.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$200.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$182.50
Rate for Payer: Aetna Government	$182.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$292.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$248.21
Rate for Payer: Group Health Inc Commercial	$182.50
Rate for Payer: Group Health Inc Medicare	$127.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.50
Rate for Payer: Hamaspik Choice Inc Medicare	$182.50

ZZ URETR STNT W/GLIX 8/22

Facility OP

$391.23

Hospital Charge Code	41567236
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 URETR STNT W/GLIX 8/24

Facility OP

$391.23

Hospital Charge Code	41567237
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 VACUUM PACKAGE W/TUB W/CAN

Facility OP

$42.50

Hospital Charge Code	41568864
Hospital Revenue Code	270
Min. Negotiated Rate	$14.88
Max. Negotiated Rate	$34.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.25
Rate for Payer: Aetna Government	$21.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.90
Rate for Payer: Group Health Inc Commercial	$21.25
Rate for Payer: Group Health Inc Medicare	$14.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.25
Rate for Payer: Hamaspik Choice Inc Medicare	$21.25

ZZ VALLEYLAB MWA ANTENNA 17CM

Facility OP

$3,880.00

Hospital Charge Code	41567761
Hospital Revenue Code	270
Min. Negotiated Rate	$1,358.00
Max. Negotiated Rate	$3,104.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,940.00
Rate for Payer: Aetna Government	$1,940.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,104.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,638.40
Rate for Payer: Group Health Inc Commercial	$1,940.00
Rate for Payer: Group Health Inc Medicare	$1,358.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,940.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,940.00

ZZ VASC ACCES CTH 7-65-20

Facility OP

$270.74

Hospital Charge Code	41567317
Hospital Revenue Code	270
Min. Negotiated Rate	$94.76
Max. Negotiated Rate	$216.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$148.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$135.37
Rate for Payer: Aetna Government	$135.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$216.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.10
Rate for Payer: Group Health Inc Commercial	$135.37
Rate for Payer: Group Health Inc Medicare	$94.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$135.37
Rate for Payer: Hamaspik Choice Inc Medicare	$135.37

ZZ VASC ACCS CTH 6-65-20

Facility OP

$270.74

Hospital Charge Code	41567316
Hospital Revenue Code	270
Min. Negotiated Rate	$94.76
Max. Negotiated Rate	$216.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$148.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$135.37
Rate for Payer: Aetna Government	$135.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$216.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.10
Rate for Payer: Group Health Inc Commercial	$135.37
Rate for Payer: Group Health Inc Medicare	$94.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$135.37
Rate for Payer: Hamaspik Choice Inc Medicare	$135.37

ZZ VASCA-CXK LT SUB 2 LUM

Facility OP

$198.81

Hospital Charge Code	41567178
Hospital Revenue Code	270
Min. Negotiated Rate	$69.58
Max. Negotiated Rate	$159.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$109.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$99.40
Rate for Payer: Aetna Government	$99.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$159.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$135.19
Rate for Payer: Group Health Inc Commercial	$99.40
Rate for Payer: Group Health Inc Medicare	$69.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.40
Rate for Payer: Hamaspik Choice Inc Medicare	$99.40

ZZ VASCATH-CXK RT FEMORAL

Facility OP

$198.81

Hospital Charge Code	41567180
Hospital Revenue Code	270
Min. Negotiated Rate	$69.58
Max. Negotiated Rate	$159.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$109.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$99.40
Rate for Payer: Aetna Government	$99.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$159.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$135.19
Rate for Payer: Group Health Inc Commercial	$99.40
Rate for Payer: Group Health Inc Medicare	$69.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.40
Rate for Payer: Hamaspik Choice Inc Medicare	$99.40

ZZ VASCATH-CXK RT SUBCLAV

Facility OP

$198.81

Hospital Charge Code	41567177
Hospital Revenue Code	270
Min. Negotiated Rate	$69.58
Max. Negotiated Rate	$159.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$109.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$99.40
Rate for Payer: Aetna Government	$99.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$159.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$135.19
Rate for Payer: Group Health Inc Commercial	$99.40
Rate for Payer: Group Health Inc Medicare	$69.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.40
Rate for Payer: Hamaspik Choice Inc Medicare	$99.40

ZZ VASCATH PC-02 19

Facility OP

$358.63

Hospital Charge Code	41567181
Hospital Revenue Code	270
Min. Negotiated Rate	$125.52
Max. Negotiated Rate	$286.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$197.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$179.32
Rate for Payer: Aetna Government	$179.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$286.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$243.87
Rate for Payer: Group Health Inc Commercial	$179.32
Rate for Payer: Group Health Inc Medicare	$125.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.32
Rate for Payer: Hamaspik Choice Inc Medicare	$179.32

ZZ VASCATH PC-02 23

Facility OP

$358.63

Hospital Charge Code	41567182
Hospital Revenue Code	270
Min. Negotiated Rate	$125.52
Max. Negotiated Rate	$286.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$197.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$179.32
Rate for Payer: Aetna Government	$179.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$286.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$243.87
Rate for Payer: Group Health Inc Commercial	$179.32
Rate for Payer: Group Health Inc Medicare	$125.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.32
Rate for Payer: Hamaspik Choice Inc Medicare	$179.32

ZZ VASCULAR DILATOR 4

Facility OP

$15.24

Hospital Charge Code	41567308
Hospital Revenue Code	270
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$12.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.62
Rate for Payer: Aetna Government	$7.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.36
Rate for Payer: Group Health Inc Commercial	$7.62
Rate for Payer: Group Health Inc Medicare	$5.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.62
Rate for Payer: Hamaspik Choice Inc Medicare	$7.62

ZZ VENACAVA FILTER SYSTEM 9FR70CM

Facility OP

$3,331.13

Service Code	HCPCS C1880
Hospital Charge Code	41569663
Hospital Revenue Code	278
Min. Negotiated Rate	$57.08
Max. Negotiated Rate	$3,497.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,832.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$57.08
Rate for Payer: Aetna Government	$57.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,665.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,915.40
Rate for Payer: Fidelis Medicare Advantage	$3,497.69
Rate for Payer: Group Health Inc Commercial	$1,665.56
Rate for Payer: Group Health Inc Medicare	$1,165.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,665.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1,665.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,165.23

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