St. Barnabas Hospital

All Charges

Charge

Type

Price

BOOT SUSPENSION HEELLIFT

Facility OP

$64.80

Hospital Charge Code	64903162
Hospital Revenue Code	270
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$51.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.40
Rate for Payer: Aetna Government	$32.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$51.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.06
Rate for Payer: Group Health Inc Commercial	$32.40
Rate for Payer: Group Health Inc Medicare	$22.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.40
Rate for Payer: Hamaspik Choice Inc Medicare	$32.40

BOOT TCC-EZ LG

Facility OP

$200.48

Hospital Charge Code	64903736
Hospital Revenue Code	270
Min. Negotiated Rate	$70.17
Max. Negotiated Rate	$160.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$100.24
Rate for Payer: Aetna Government	$100.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$160.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.33
Rate for Payer: Group Health Inc Commercial	$100.24
Rate for Payer: Group Health Inc Medicare	$70.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.24
Rate for Payer: Hamaspik Choice Inc Medicare	$100.24

BOOT TCC-EZ XLG

Facility OP

$210.38

Hospital Charge Code	64903734
Hospital Revenue Code	270
Min. Negotiated Rate	$73.63
Max. Negotiated Rate	$168.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$115.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$105.19
Rate for Payer: Aetna Government	$105.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$168.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$143.06
Rate for Payer: Group Health Inc Commercial	$105.19
Rate for Payer: Group Health Inc Medicare	$73.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.19
Rate for Payer: Hamaspik Choice Inc Medicare	$105.19

BOOT TRACTION BUCKS UNIVERSAL

Facility OP

$48.70

Hospital Charge Code	64901738
Hospital Revenue Code	270
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$38.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.35
Rate for Payer: Aetna Government	$24.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.12
Rate for Payer: Group Health Inc Commercial	$24.35
Rate for Payer: Group Health Inc Medicare	$17.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.35
Rate for Payer: Hamaspik Choice Inc Medicare	$24.35

BORTEZOMIB 3.5 MG INJ

Facility IP

$152.00

Service Code	HCPCS J9041
Hospital Charge Code	41643013
Hospital Revenue Code	636
Min. Negotiated Rate	$76.00
Max. Negotiated Rate	$76.00
Rate for Payer: Cash Price	$1.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.00
Rate for Payer: Hamaspik Choice Inc Medicare	$76.00

BORTEZOMIB 3.5 MG INJ

Facility OP

$152.00

Service Code	HCPCS J9041
Hospital Charge Code	41653013
Hospital Revenue Code	636
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$4,722.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$83.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.96
Rate for Payer: Aetna Government	$1.96
Rate for Payer: Amida Care Medicaid	$47.22
Rate for Payer: Cash Price	$1.96
Rate for Payer: Cash Price	$1.96
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$76.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$87.40
Rate for Payer: Elderplan Medicare Advantage	$1.96
Rate for Payer: EmblemHealth Commercial	$1.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4,722.00
Rate for Payer: Fidelis Essential Plan Aliesa	$47.22
Rate for Payer: Fidelis Essential Plan QHP	$47.22
Rate for Payer: Fidelis Medicare Advantage	$1.96
Rate for Payer: Fidelis Qualified Health Plan	$49.58
Rate for Payer: Group Health Inc Commercial	$1.96
Rate for Payer: Group Health Inc Medicare	$1.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.22
Rate for Payer: Hamaspik Choice Inc Medicare	$76.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$47.22
Rate for Payer: Healthfirst Essential Plan	$47.22
Rate for Payer: Healthfirst Medicare Advantage	$1.67
Rate for Payer: Healthfirst QHP	$47.22
Rate for Payer: Senior Whole Health Medicare Advantage	$1.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$47.22
Rate for Payer: SOMOS Essential	$47.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$98.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1.57
Rate for Payer: Wellcare Medicare	$1.86

BORTEZOMIB 3.5 MG INJ

Facility OP

$152.00

Service Code	HCPCS J9041
Hospital Charge Code	41643013
Hospital Revenue Code	636
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$4,722.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$83.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.96
Rate for Payer: Aetna Government	$1.96
Rate for Payer: Amida Care Medicaid	$47.22
Rate for Payer: Cash Price	$1.96
Rate for Payer: Cash Price	$1.96
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$76.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$87.40
Rate for Payer: Elderplan Medicare Advantage	$1.96
Rate for Payer: EmblemHealth Commercial	$1.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4,722.00
Rate for Payer: Fidelis Essential Plan Aliesa	$47.22
Rate for Payer: Fidelis Essential Plan QHP	$47.22
Rate for Payer: Fidelis Medicare Advantage	$1.96
Rate for Payer: Fidelis Qualified Health Plan	$49.58
Rate for Payer: Group Health Inc Commercial	$1.96
Rate for Payer: Group Health Inc Medicare	$1.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.22
Rate for Payer: Hamaspik Choice Inc Medicare	$76.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$47.22
Rate for Payer: Healthfirst Essential Plan	$47.22
Rate for Payer: Healthfirst Medicare Advantage	$1.67
Rate for Payer: Healthfirst QHP	$47.22
Rate for Payer: Senior Whole Health Medicare Advantage	$1.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$47.22
Rate for Payer: SOMOS Essential	$47.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$98.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1.57
Rate for Payer: Wellcare Medicare	$1.86

BORTEZOMIB 3.5 MG INJ

Facility IP

$152.00

Service Code	HCPCS J9041
Hospital Charge Code	41653013
Hospital Revenue Code	636
Min. Negotiated Rate	$76.00
Max. Negotiated Rate	$76.00
Rate for Payer: Cash Price	$1.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.00
Rate for Payer: Hamaspik Choice Inc Medicare	$76.00

BOS POLARIS UL 6F 2MM X 26CM

Facility IP

$405.65

Service Code	HCPCS C1758
Hospital Charge Code	40008267
Hospital Revenue Code	278
Min. Negotiated Rate	$202.82
Max. Negotiated Rate	$202.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$202.82
Rate for Payer: Hamaspik Choice Inc Medicare	$202.82

BOS POLARIS UL 6F 2MM X 26CM

Facility OP

$405.65

Service Code	HCPCS C1758
Hospital Charge Code	40008267
Hospital Revenue Code	278
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$425.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$223.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.97
Rate for Payer: Aetna Government	$2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$202.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$233.25
Rate for Payer: Fidelis Medicare Advantage	$425.93
Rate for Payer: Group Health Inc Commercial	$202.82
Rate for Payer: Group Health Inc Medicare	$141.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$202.82
Rate for Payer: Hamaspik Choice Inc Medicare	$202.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$263.67

BOS.SCI. 5FR IMAGER

Facility IP

$126.00

Service Code	HCPCS C1887
Hospital Charge Code	40208128
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$63.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.00
Rate for Payer: Hamaspik Choice Inc Medicare	$63.00

BOS.SCI. 5FR IMAGER

Facility OP

$126.00

Service Code	HCPCS C1887
Hospital Charge Code	40208128
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$132.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$69.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$63.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$72.45
Rate for Payer: Fidelis Medicare Advantage	$132.30
Rate for Payer: Group Health Inc Commercial	$63.00
Rate for Payer: Group Health Inc Medicare	$44.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.00
Rate for Payer: Hamaspik Choice Inc Medicare	$63.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$81.90

BOSTN SCIENTFC SENSR .035INX150CM

Facility OP

$895.00

Service Code	HCPCS C1769
Hospital Charge Code	40201551
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$939.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$492.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$447.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$514.62
Rate for Payer: Fidelis Medicare Advantage	$939.75
Rate for Payer: Group Health Inc Commercial	$447.50
Rate for Payer: Group Health Inc Medicare	$313.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$447.50
Rate for Payer: Hamaspik Choice Inc Medicare	$447.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$581.75

BOSTN SCIENTFC SENSR .035INX150CM

Facility IP

$895.00

Service Code	HCPCS C1769
Hospital Charge Code	40201551
Hospital Revenue Code	278
Min. Negotiated Rate	$447.50
Max. Negotiated Rate	$447.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$447.50
Rate for Payer: Hamaspik Choice Inc Medicare	$447.50

BOSTN SCI FLEX 365 YAGX100W X2.6M

Facility OP

$356.39

Service Code	HCPCS C1713
Hospital Charge Code	40201536
Hospital Revenue Code	278
Min. Negotiated Rate	$124.74
Max. Negotiated Rate	$374.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$196.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$178.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$204.92
Rate for Payer: Fidelis Medicare Advantage	$374.21
Rate for Payer: Group Health Inc Commercial	$178.20
Rate for Payer: Group Health Inc Medicare	$124.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$178.20
Rate for Payer: Hamaspik Choice Inc Medicare	$178.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$231.65

BOSTN SCI FLEX 365 YAGX100W X2.6M

Facility IP

$356.39

Service Code	HCPCS C1713
Hospital Charge Code	40201536
Hospital Revenue Code	278
Min. Negotiated Rate	$178.20
Max. Negotiated Rate	$178.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$178.20
Rate for Payer: Hamaspik Choice Inc Medicare	$178.20

BOSTN SCI SENOR 1.67MMX26CM POLAS

Facility IP

$152.25

Service Code	HCPCS C2617
Hospital Charge Code	40206329
Hospital Revenue Code	278
Min. Negotiated Rate	$76.12
Max. Negotiated Rate	$76.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.12
Rate for Payer: Hamaspik Choice Inc Medicare	$76.12

BOSTN SCI SENOR 1.67MMX26CM POLAS

Facility OP

$152.25

Service Code	HCPCS C2617
Hospital Charge Code	40206329
Hospital Revenue Code	278
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$159.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$83.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.14
Rate for Payer: Aetna Government	$10.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$76.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$87.54
Rate for Payer: Fidelis Medicare Advantage	$159.86
Rate for Payer: Group Health Inc Commercial	$76.12
Rate for Payer: Group Health Inc Medicare	$53.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.12
Rate for Payer: Hamaspik Choice Inc Medicare	$76.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$98.96

BOSTN SCI SENSOR .038IN X 150CM

Facility IP

$48.78

Service Code	HCPCS C1769
Hospital Charge Code	40201539
Hospital Revenue Code	278
Min. Negotiated Rate	$24.39
Max. Negotiated Rate	$24.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.39
Rate for Payer: Hamaspik Choice Inc Medicare	$24.39

BOSTN SCI SENSOR .038IN X 150CM

Facility OP

$48.78

Service Code	HCPCS C1769
Hospital Charge Code	40201539
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$51.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.05
Rate for Payer: Fidelis Medicare Advantage	$51.22
Rate for Payer: Group Health Inc Commercial	$24.39
Rate for Payer: Group Health Inc Medicare	$17.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.39
Rate for Payer: Hamaspik Choice Inc Medicare	$24.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.71

BOSTN SCI WALLFLX DUODEL STENT

Facility IP

$6,066.30

Service Code	HCPCS C1874
Hospital Charge Code	40002156
Hospital Revenue Code	278
Min. Negotiated Rate	$3,033.15
Max. Negotiated Rate	$3,033.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,033.15
Rate for Payer: Hamaspik Choice Inc Medicare	$3,033.15

BOSTN SCI WALLFLX DUODEL STENT

Facility OP

$6,066.30

Service Code	HCPCS C1874
Hospital Charge Code	40002156
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$6,369.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,336.46
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	$3,033.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,488.12
Rate for Payer: Fidelis Medicare Advantage	$6,369.62
Rate for Payer: Group Health Inc Commercial	$3,033.15
Rate for Payer: Group Health Inc Medicare	$2,123.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,033.15
Rate for Payer: Hamaspik Choice Inc Medicare	$3,033.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,943.10

BOSTN SCI WALLFLX ESOPHE STENT

Facility IP

$2,863.16

Service Code	HCPCS C1874
Hospital Charge Code	40001459
Hospital Revenue Code	278
Min. Negotiated Rate	$1,431.58
Max. Negotiated Rate	$1,431.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,431.58
Rate for Payer: Hamaspik Choice Inc Medicare	$1,431.58

BOSTN SCI WALLFLX ESOPHE STENT

Facility OP

$2,863.16

Service Code	HCPCS C1874
Hospital Charge Code	40001459
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,006.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,574.74
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	$1,431.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,646.32
Rate for Payer: Fidelis Medicare Advantage	$3,006.32
Rate for Payer: Group Health Inc Commercial	$1,431.58
Rate for Payer: Group Health Inc Medicare	$1,002.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,431.58
Rate for Payer: Hamaspik Choice Inc Medicare	$1,431.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,861.05

BOSTON 10X54 DUAL LUMEN CATH

Facility OP

$157.62

Service Code	HCPCS C1758
Hospital Charge Code	40008292
Hospital Revenue Code	272
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$126.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.97
Rate for Payer: Aetna Government	$2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$126.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$107.18
Rate for Payer: Group Health Inc Commercial	$78.81
Rate for Payer: Group Health Inc Medicare	$55.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.81
Rate for Payer: Hamaspik Choice Inc Medicare	$78.81

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