St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ WALL STENT 12MM X 90MM

Facility OP

$5,623.94

Service Code	HCPCS C1874
Hospital Charge Code	41567346
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$5,905.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,093.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,811.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,233.77
Rate for Payer: Fidelis Medicare Advantage	$5,905.14
Rate for Payer: Group Health Inc Commercial	$2,811.97
Rate for Payer: Group Health Inc Medicare	$1,968.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,811.97
Rate for Payer: Hamaspik Choice Inc Medicare	$2,811.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,655.56

ZZ WALL STENT 12X60

Facility OP

$3,015.74

Service Code	HCPCS C1876
Hospital Charge Code	41567151
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 12X60

Facility IP

$3,015.74

Service Code	HCPCS C1876
Hospital Charge Code	41567151
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 14MM X 40MM

Facility IP

$3,504.77

Service Code	HCPCS C1876
Hospital Charge Code	41567344
Hospital Revenue Code	278
Min. Negotiated Rate	$1,752.38
Max. Negotiated Rate	$1,752.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,752.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1,752.38

ZZ WALL STENT 14MM X 40MM

Facility OP

$3,504.77

Service Code	HCPCS C1876
Hospital Charge Code	41567344
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,680.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,927.62
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	$1,752.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,015.24
Rate for Payer: Fidelis Medicare Advantage	$3,680.01
Rate for Payer: Group Health Inc Commercial	$1,752.38
Rate for Payer: Group Health Inc Medicare	$1,226.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,752.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1,752.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,278.10

ZZ WALL STENT 14X55

Facility OP

$3,015.74

Service Code	HCPCS C1876
Hospital Charge Code	41567152
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 14X55

Facility IP

$3,015.74

Service Code	HCPCS C1876
Hospital Charge Code	41567152
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 16X60

Facility IP

$3,015.74

Service Code	HCPCS C1874
Hospital Charge Code	41567153
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 16X60

Facility OP

$3,015.74

Service Code	HCPCS C1874
Hospital Charge Code	41567153
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,166.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,658.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
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 18X60

Facility OP

$3,667.79

Service Code	HCPCS C1876
Hospital Charge Code	41567154
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,851.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,017.28
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	$1,833.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,108.98
Rate for Payer: Fidelis Medicare Advantage	$3,851.18
Rate for Payer: Group Health Inc Commercial	$1,833.90
Rate for Payer: Group Health Inc Medicare	$1,283.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,833.90
Rate for Payer: Hamaspik Choice Inc Medicare	$1,833.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,384.06

ZZ WALL STENT 18X60

Facility IP

$3,667.79

Service Code	HCPCS C1876
Hospital Charge Code	41567154
Hospital Revenue Code	278
Min. Negotiated Rate	$1,833.90
Max. Negotiated Rate	$1,833.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,833.90
Rate for Payer: Hamaspik Choice Inc Medicare	$1,833.90

ZZ WALL STENT 22X45

Facility IP

$3,667.79

Service Code	HCPCS C1876
Hospital Charge Code	41567155
Hospital Revenue Code	278
Min. Negotiated Rate	$1,833.90
Max. Negotiated Rate	$1,833.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,833.90
Rate for Payer: Hamaspik Choice Inc Medicare	$1,833.90

ZZ WALL STENT 22X45

Facility OP

$3,667.79

Service Code	HCPCS C1876
Hospital Charge Code	41567155
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,851.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,017.28
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	$1,833.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,108.98
Rate for Payer: Fidelis Medicare Advantage	$3,851.18
Rate for Payer: Group Health Inc Commercial	$1,833.90
Rate for Payer: Group Health Inc Medicare	$1,283.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,833.90
Rate for Payer: Hamaspik Choice Inc Medicare	$1,833.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,384.06

ZZ WALL STENT 8F 14X60

Facility IP

$2,986.67

Service Code	HCPCS C1876
Hospital Charge Code	41569741
Hospital Revenue Code	278
Min. Negotiated Rate	$1,493.34
Max. Negotiated Rate	$1,493.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,493.34
Rate for Payer: Hamaspik Choice Inc Medicare	$1,493.34

ZZ WALL STENT 8F 14X60

Facility OP

$2,986.67

Service Code	HCPCS C1876
Hospital Charge Code	41569741
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,136.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,642.67
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	$1,493.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,717.34
Rate for Payer: Fidelis Medicare Advantage	$3,136.00
Rate for Payer: Group Health Inc Commercial	$1,493.34
Rate for Payer: Group Health Inc Medicare	$1,045.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,493.34
Rate for Payer: Hamaspik Choice Inc Medicare	$1,493.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,941.34

ZZ WALL STENT 8MM X 40MM

Facility OP

$3,504.77

Service Code	HCPCS C1876
Hospital Charge Code	41567345
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,680.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,927.62
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	$1,752.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,015.24
Rate for Payer: Fidelis Medicare Advantage	$3,680.01
Rate for Payer: Group Health Inc Commercial	$1,752.38
Rate for Payer: Group Health Inc Medicare	$1,226.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,752.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1,752.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,278.10

ZZ WALL STENT 8MM X 40MM

Facility IP

$3,504.77

Service Code	HCPCS C1876
Hospital Charge Code	41567345
Hospital Revenue Code	278
Min. Negotiated Rate	$1,752.38
Max. Negotiated Rate	$1,752.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,752.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1,752.38

ZZ WALL STENT 8X40

Facility IP

$3,015.74

Service Code	HCPCS C1876
Hospital Charge Code	41567156
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 8X40

Facility OP

$3,015.74

Service Code	HCPCS C1876
Hospital Charge Code	41567156
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 8X60

Facility OP

$3,015.74

Service Code	HCPCS C1876
Hospital Charge Code	41567157
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 8X60

Facility IP

$3,015.74

Service Code	HCPCS C1876
Hospital Charge Code	41567157
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 9X52

Facility IP

$3,328.74

Service Code	HCPCS C1876
Hospital Charge Code	41569648
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 9X52

Facility OP

$3,328.74

Service Code	HCPCS C1876
Hospital Charge Code	41569648
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 WILLS OGLES PERC GASTR

Facility OP

$355.44

Hospital Charge Code	41567193
Hospital Revenue Code	270
Min. Negotiated Rate	$124.40
Max. Negotiated Rate	$284.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$195.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$177.72
Rate for Payer: Aetna Government	$177.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$284.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$241.70
Rate for Payer: Group Health Inc Commercial	$177.72
Rate for Payer: Group Health Inc Medicare	$124.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.72
Rate for Payer: Hamaspik Choice Inc Medicare	$177.72

ZZ WIRE/AMPLANTZ SS/.038/75CM

Facility OP

$323.19

Hospital Charge Code	41569220
Hospital Revenue Code	270
Min. Negotiated Rate	$113.12
Max. Negotiated Rate	$258.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$177.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$161.60
Rate for Payer: Aetna Government	$161.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$258.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$219.77
Rate for Payer: Group Health Inc Commercial	$161.60
Rate for Payer: Group Health Inc Medicare	$113.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$161.60
Rate for Payer: Hamaspik Choice Inc Medicare	$161.60

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