St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ VORTEX PORT SYSTEM

Facility OP

$790.00

Hospital Charge Code	41568616
Hospital Revenue Code	279
Min. Negotiated Rate	$276.50
Max. Negotiated Rate	$632.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$434.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$395.00
Rate for Payer: Aetna Government	$395.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$632.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$537.20
Rate for Payer: Group Health Inc Commercial	$395.00
Rate for Payer: Group Health Inc Medicare	$276.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$395.00
Rate for Payer: Hamaspik Choice Inc Medicare	$395.00

ZZ VTC-NEPH W/GLIX 10/25

Facility OP

$264.01

Hospital Charge Code	41567234
Hospital Revenue Code	270
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$211.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$145.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$132.00
Rate for Payer: Aetna Government	$132.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$211.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$179.53
Rate for Payer: Group Health Inc Commercial	$132.00
Rate for Payer: Group Health Inc Medicare	$92.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$132.00
Rate for Payer: Hamaspik Choice Inc Medicare	$132.00

ZZ VTC-NEPH W/GLIX 12/25

Facility OP

$264.01

Hospital Charge Code	41567235
Hospital Revenue Code	270
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$211.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$145.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$132.00
Rate for Payer: Aetna Government	$132.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$211.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$179.53
Rate for Payer: Group Health Inc Commercial	$132.00
Rate for Payer: Group Health Inc Medicare	$92.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$132.00
Rate for Payer: Hamaspik Choice Inc Medicare	$132.00

ZZ VTC-NEPH W/GLIX 8/25

Facility OP

$264.01

Hospital Charge Code	41567233
Hospital Revenue Code	270
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$211.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$145.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$132.00
Rate for Payer: Aetna Government	$132.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$211.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$179.53
Rate for Payer: Group Health Inc Commercial	$132.00
Rate for Payer: Group Health Inc Medicare	$92.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$132.00
Rate for Payer: Hamaspik Choice Inc Medicare	$132.00

ZZ VXCL TUNNLD CENTRL VEN.CATH 5F

Facility OP

$510.30

Hospital Charge Code	41569747
Hospital Revenue Code	270
Min. Negotiated Rate	$178.60
Max. Negotiated Rate	$408.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$280.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$255.15
Rate for Payer: Aetna Government	$255.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$408.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$347.00
Rate for Payer: Group Health Inc Commercial	$255.15
Rate for Payer: Group Health Inc Medicare	$178.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$255.15
Rate for Payer: Hamaspik Choice Inc Medicare	$255.15

ZZ VXCL TUNNLD CENTRL VEN.CATH 6F

Facility OP

$652.05

Hospital Charge Code	41569748
Hospital Revenue Code	270
Min. Negotiated Rate	$228.22
Max. Negotiated Rate	$521.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$358.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$326.02
Rate for Payer: Aetna Government	$326.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$521.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$443.39
Rate for Payer: Group Health Inc Commercial	$326.02
Rate for Payer: Group Health Inc Medicare	$228.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$326.02
Rate for Payer: Hamaspik Choice Inc Medicare	$326.02

ZZ WALLGRAFT CATHETER 10X30

Facility IP

$5,528.25

Service Code	HCPCS C1876
Hospital Charge Code	41569678
Hospital Revenue Code	278
Min. Negotiated Rate	$2,764.12
Max. Negotiated Rate	$2,764.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,764.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2,764.12

ZZ WALLGRAFT CATHETER 10X30

Facility OP

$5,528.25

Service Code	HCPCS C1876
Hospital Charge Code	41569678
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$5,804.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,040.54
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	$2,764.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,178.74
Rate for Payer: Fidelis Medicare Advantage	$5,804.66
Rate for Payer: Group Health Inc Commercial	$2,764.12
Rate for Payer: Group Health Inc Medicare	$1,934.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,764.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2,764.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,593.36

ZZ WALLGRAFT CATHETER 10X70

Facility IP

$6,378.75

Service Code	HCPCS C1876
Hospital Charge Code	41569680
Hospital Revenue Code	278
Min. Negotiated Rate	$3,189.38
Max. Negotiated Rate	$3,189.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,189.38
Rate for Payer: Hamaspik Choice Inc Medicare	$3,189.38

ZZ WALLGRAFT CATHETER 10X70

Facility OP

$6,378.75

Service Code	HCPCS C1876
Hospital Charge Code	41569680
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$6,697.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,508.31
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	$3,189.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,667.78
Rate for Payer: Fidelis Medicare Advantage	$6,697.69
Rate for Payer: Group Health Inc Commercial	$3,189.38
Rate for Payer: Group Health Inc Medicare	$2,232.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,189.38
Rate for Payer: Hamaspik Choice Inc Medicare	$3,189.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,146.19

ZZ WALLGRAFT CATHETER 7X5

Facility OP

$5,528.25

Service Code	HCPCS C1876
Hospital Charge Code	41569679
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$5,804.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,040.54
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	$2,764.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,178.74
Rate for Payer: Fidelis Medicare Advantage	$5,804.66
Rate for Payer: Group Health Inc Commercial	$2,764.12
Rate for Payer: Group Health Inc Medicare	$1,934.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,764.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2,764.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,593.36

ZZ WALLGRAFT CATHETER 7X5

Facility IP

$5,528.25

Service Code	HCPCS C1876
Hospital Charge Code	41569679
Hospital Revenue Code	278
Min. Negotiated Rate	$2,764.12
Max. Negotiated Rate	$2,764.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,764.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2,764.12

ZZ WALL STENT 10X20 6F

Facility OP

$3,699.68

Service Code	HCPCS C1876
Hospital Charge Code	41569647
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,884.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,034.82
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	$1,849.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,127.32
Rate for Payer: Fidelis Medicare Advantage	$3,884.66
Rate for Payer: Group Health Inc Commercial	$1,849.84
Rate for Payer: Group Health Inc Medicare	$1,294.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,849.84
Rate for Payer: Hamaspik Choice Inc Medicare	$1,849.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,404.79

ZZ WALL STENT 10X20 6F

Facility IP

$3,699.68

Service Code	HCPCS C1876
Hospital Charge Code	41569647
Hospital Revenue Code	278
Min. Negotiated Rate	$1,849.84
Max. Negotiated Rate	$1,849.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,849.84
Rate for Payer: Hamaspik Choice Inc Medicare	$1,849.84

ZZ WALL STENT 10X39

Facility IP

$3,328.74

Service Code	HCPCS C1876
Hospital Charge Code	41569651
Hospital Revenue Code	278
Min. Negotiated Rate	$1,664.37
Max. Negotiated Rate	$1,664.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,664.37
Rate for Payer: Hamaspik Choice Inc Medicare	$1,664.37

ZZ WALL STENT 10X39

Facility OP

$3,328.74

Service Code	HCPCS C1876
Hospital Charge Code	41569651
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,495.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,830.81
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	$1,664.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,914.03
Rate for Payer: Fidelis Medicare Advantage	$3,495.18
Rate for Payer: Group Health Inc Commercial	$1,664.37
Rate for Payer: Group Health Inc Medicare	$1,165.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,664.37
Rate for Payer: Hamaspik Choice Inc Medicare	$1,664.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,163.68

ZZ WALL STENT 10X42

Facility OP

$3,243.95

Service Code	HCPCS C1876
Hospital Charge Code	41567149
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,406.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,784.17
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	$1,621.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,865.27
Rate for Payer: Fidelis Medicare Advantage	$3,406.15
Rate for Payer: Group Health Inc Commercial	$1,621.98
Rate for Payer: Group Health Inc Medicare	$1,135.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,621.98
Rate for Payer: Hamaspik Choice Inc Medicare	$1,621.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,108.57

ZZ WALL STENT 10X42

Facility IP

$3,243.95

Service Code	HCPCS C1876
Hospital Charge Code	41567149
Hospital Revenue Code	278
Min. Negotiated Rate	$1,621.98
Max. Negotiated Rate	$1,621.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,621.98
Rate for Payer: Hamaspik Choice Inc Medicare	$1,621.98

ZZ WALL STENT 10X49

Facility OP

$3,328.74

Service Code	HCPCS C1876
Hospital Charge Code	41569649
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,495.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,830.81
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	$1,664.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,914.03
Rate for Payer: Fidelis Medicare Advantage	$3,495.18
Rate for Payer: Group Health Inc Commercial	$1,664.37
Rate for Payer: Group Health Inc Medicare	$1,165.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,664.37
Rate for Payer: Hamaspik Choice Inc Medicare	$1,664.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,163.68

ZZ WALL STENT 10X49

Facility IP

$3,328.74

Service Code	HCPCS C1876
Hospital Charge Code	41569649
Hospital Revenue Code	278
Min. Negotiated Rate	$1,664.37
Max. Negotiated Rate	$1,664.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,664.37
Rate for Payer: Hamaspik Choice Inc Medicare	$1,664.37

ZZ WALL STENT 10X68

Facility OP

$3,015.74

Service Code	HCPCS C1876
Hospital Charge Code	41567150
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,166.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,658.66
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	$1,507.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,734.05
Rate for Payer: Fidelis Medicare Advantage	$3,166.53
Rate for Payer: Group Health Inc Commercial	$1,507.87
Rate for Payer: Group Health Inc Medicare	$1,055.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,507.87
Rate for Payer: Hamaspik Choice Inc Medicare	$1,507.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,960.23

ZZ WALL STENT 10X68

Facility IP

$3,015.74

Service Code	HCPCS C1876
Hospital Charge Code	41567150
Hospital Revenue Code	278
Min. Negotiated Rate	$1,507.87
Max. Negotiated Rate	$1,507.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,507.87
Rate for Payer: Hamaspik Choice Inc Medicare	$1,507.87

ZZ WALL STENT 10X69

Facility OP

$5,339.55

Service Code	HCPCS C1876
Hospital Charge Code	41569650
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$5,606.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,936.75
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	$2,669.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,070.24
Rate for Payer: Fidelis Medicare Advantage	$5,606.53
Rate for Payer: Group Health Inc Commercial	$2,669.78
Rate for Payer: Group Health Inc Medicare	$1,868.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,669.78
Rate for Payer: Hamaspik Choice Inc Medicare	$2,669.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,470.71

ZZ WALL STENT 10X69

Facility IP

$5,339.55

Service Code	HCPCS C1876
Hospital Charge Code	41569650
Hospital Revenue Code	278
Min. Negotiated Rate	$2,669.78
Max. Negotiated Rate	$2,669.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,669.78
Rate for Payer: Hamaspik Choice Inc Medicare	$2,669.78

ZZ WALL STENT 12MM X 90MM

Facility IP

$5,623.94

Service Code	HCPCS C1874
Hospital Charge Code	41567346
Hospital Revenue Code	278
Min. Negotiated Rate	$2,811.97
Max. Negotiated Rate	$2,811.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,811.97
Rate for Payer: Hamaspik Choice Inc Medicare	$2,811.97

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