St. Barnabas Hospital

All Charges

Charge

Type

Price

BOSTON POL ULTRA 6F 2.0MMX26CM

Facility OP

$324.52

Service Code	HCPCS C1758
Hospital Charge Code	40008273
Hospital Revenue Code	272
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$259.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$178.49
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	$259.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$220.67
Rate for Payer: Group Health Inc Commercial	$162.26
Rate for Payer: Group Health Inc Medicare	$113.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.26
Rate for Payer: Hamaspik Choice Inc Medicare	$162.26

BOSTON SCI ACCOLADE DR MODEL L301

Facility OP

$12,900.00

Service Code	HCPCS C1785
Hospital Charge Code	66572893
Hospital Revenue Code	275
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$13,545.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7,095.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.42
Rate for Payer: Aetna Government	$275.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,450.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,417.50
Rate for Payer: Fidelis Medicare Advantage	$13,545.00
Rate for Payer: Group Health Inc Commercial	$6,450.00
Rate for Payer: Group Health Inc Medicare	$4,515.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,450.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,385.00

BOSTON SCI ACCOLADE PACEMAKE L331

Facility OP

$12,000.00

Service Code	HCPCS C1785
Hospital Charge Code	66576694
Hospital Revenue Code	275
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$12,600.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,600.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.42
Rate for Payer: Aetna Government	$275.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,900.00
Rate for Payer: Fidelis Medicare Advantage	$12,600.00
Rate for Payer: Group Health Inc Commercial	$6,000.00
Rate for Payer: Group Health Inc Medicare	$4,200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,800.00

BOSTON SCI ACCOLAD MRI EL DR L331

Facility OP

$10,250.00

Service Code	HCPCS C1785
Hospital Charge Code	66573168
Hospital Revenue Code	275
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$10,762.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,637.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.42
Rate for Payer: Aetna Government	$275.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,893.75
Rate for Payer: Fidelis Medicare Advantage	$10,762.50
Rate for Payer: Group Health Inc Commercial	$5,125.00
Rate for Payer: Group Health Inc Medicare	$3,587.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,662.50

BOSTON SCI. AUTOTOME CAN. DEVICE

Facility OP

$554.00

Hospital Charge Code	40203361
Hospital Revenue Code	272
Min. Negotiated Rate	$193.90
Max. Negotiated Rate	$443.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$304.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$277.00
Rate for Payer: Aetna Government	$277.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$443.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$376.72
Rate for Payer: Group Health Inc Commercial	$277.00
Rate for Payer: Group Health Inc Medicare	$193.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$277.00
Rate for Payer: Hamaspik Choice Inc Medicare	$277.00

BOSTON SCI. AUTOTOME CAN. DEVICE

Facility OP

$554.00

Hospital Charge Code	40009344
Hospital Revenue Code	272
Min. Negotiated Rate	$193.90
Max. Negotiated Rate	$443.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$304.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$277.00
Rate for Payer: Aetna Government	$277.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$443.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$376.72
Rate for Payer: Group Health Inc Commercial	$277.00
Rate for Payer: Group Health Inc Medicare	$193.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$277.00
Rate for Payer: Hamaspik Choice Inc Medicare	$277.00

BOSTON SCI. CATH. BALLOON 18FR

Facility OP

$463.32

Hospital Charge Code	40009359
Hospital Revenue Code	272
Min. Negotiated Rate	$162.16
Max. Negotiated Rate	$370.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$254.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$231.66
Rate for Payer: Aetna Government	$231.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$370.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$315.06
Rate for Payer: Group Health Inc Commercial	$231.66
Rate for Payer: Group Health Inc Medicare	$162.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$231.66
Rate for Payer: Hamaspik Choice Inc Medicare	$231.66

BOSTON SCI. CATH. BALLOON 18FR

Facility OP

$463.32

Service Code	HCPCS C1725
Hospital Charge Code	40203375
Hospital Revenue Code	272
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$370.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$254.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$370.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$315.06
Rate for Payer: Group Health Inc Commercial	$231.66
Rate for Payer: Group Health Inc Medicare	$162.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$231.66
Rate for Payer: Hamaspik Choice Inc Medicare	$231.66

BOSTON SCI. CATH HEMASTASIS GOLD

Facility OP

$363.12

Hospital Charge Code	40203364
Hospital Revenue Code	272
Min. Negotiated Rate	$127.09
Max. Negotiated Rate	$290.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$199.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$181.56
Rate for Payer: Aetna Government	$181.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$290.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$246.92
Rate for Payer: Group Health Inc Commercial	$181.56
Rate for Payer: Group Health Inc Medicare	$127.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$181.56
Rate for Payer: Hamaspik Choice Inc Medicare	$181.56

BOSTON SCI.CATH HEMASTASIS GOLD

Facility OP

$363.12

Hospital Charge Code	40009347
Hospital Revenue Code	272
Min. Negotiated Rate	$127.09
Max. Negotiated Rate	$290.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$199.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$181.56
Rate for Payer: Aetna Government	$181.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$290.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$246.92
Rate for Payer: Group Health Inc Commercial	$181.56
Rate for Payer: Group Health Inc Medicare	$127.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$181.56
Rate for Payer: Hamaspik Choice Inc Medicare	$181.56

BOSTON SCI DYNAGEN EL VR ICD D150

Facility OP

$40,500.00

Service Code	HCPCS C1722
Hospital Charge Code	66572894
Hospital Revenue Code	275
Min. Negotiated Rate	$3,988.80
Max. Negotiated Rate	$42,525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22,275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,988.80
Rate for Payer: Aetna Government	$3,988.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$23,287.50
Rate for Payer: Fidelis Medicare Advantage	$42,525.00
Rate for Payer: Group Health Inc Commercial	$20,250.00
Rate for Payer: Group Health Inc Medicare	$14,175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$20,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26,325.00

BOSTON SCI EMBLEM MRI S-ICD A219

Facility OP

$45,400.00

Service Code	HCPCS C1722
Hospital Charge Code	66573276
Hospital Revenue Code	275
Min. Negotiated Rate	$3,988.80
Max. Negotiated Rate	$47,670.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24,970.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,988.80
Rate for Payer: Aetna Government	$3,988.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22,700.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$26,105.00
Rate for Payer: Fidelis Medicare Advantage	$47,670.00
Rate for Payer: Group Health Inc Commercial	$22,700.00
Rate for Payer: Group Health Inc Medicare	$15,890.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$22,700.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29,510.00

BOSTON SCI EMBLEM SICD LEAD 3501

Facility IP

$10,000.00

Service Code	HCPCS C1896
Hospital Charge Code	66573277
Hospital Revenue Code	278
Min. Negotiated Rate	$5,000.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,000.00

BOSTON SCI EMBLEM SICD LEAD 3501

Facility OP

$10,000.00

Service Code	HCPCS C1896
Hospital Charge Code	66573277
Hospital Revenue Code	278
Min. Negotiated Rate	$3,139.11
Max. Negotiated Rate	$10,500.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,500.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,139.11
Rate for Payer: Aetna Government	$3,139.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,750.00
Rate for Payer: Fidelis Medicare Advantage	$10,500.00
Rate for Payer: Group Health Inc Commercial	$5,000.00
Rate for Payer: Group Health Inc Medicare	$3,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,500.00

BOSTON SCI ENERGEN ICD- E142

Facility OP

$39,000.00

Service Code	HCPCS C1721
Hospital Charge Code	66573505
Hospital Revenue Code	275
Min. Negotiated Rate	$5,000.00
Max. Negotiated Rate	$40,950.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21,450.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,000.00
Rate for Payer: Aetna Government	$5,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$22,425.00
Rate for Payer: Fidelis Medicare Advantage	$40,950.00
Rate for Payer: Group Health Inc Commercial	$19,500.00
Rate for Payer: Group Health Inc Medicare	$13,650.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$19,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25,350.00

BOSTON SCIENTIFIC DIAL WIRE BLLN

Facility OP

$598.00

Hospital Charge Code	40205612
Hospital Revenue Code	270
Min. Negotiated Rate	$209.30
Max. Negotiated Rate	$478.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$328.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$299.00
Rate for Payer: Aetna Government	$299.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$478.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$406.64
Rate for Payer: Group Health Inc Commercial	$299.00
Rate for Payer: Group Health Inc Medicare	$209.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$299.00
Rate for Payer: Hamaspik Choice Inc Medicare	$299.00

BOSTON SCIENTIFIC INCEPTA ICDE160

Facility OP

$36,220.00

Service Code	HCPCS C1722
Hospital Charge Code	66573201
Hospital Revenue Code	275
Min. Negotiated Rate	$3,988.80
Max. Negotiated Rate	$38,031.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19,921.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,988.80
Rate for Payer: Aetna Government	$3,988.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18,110.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$20,826.50
Rate for Payer: Fidelis Medicare Advantage	$38,031.00
Rate for Payer: Group Health Inc Commercial	$18,110.00
Rate for Payer: Group Health Inc Medicare	$12,677.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$18,110.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23,543.00

BOSTON SCIENTIFIC PERIVAC- 4305

Facility OP

$300.00

Hospital Charge Code	66526607
Hospital Revenue Code	272
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$240.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$150.00
Rate for Payer: Aetna Government	$150.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$240.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$204.00
Rate for Payer: Group Health Inc Commercial	$150.00
Rate for Payer: Group Health Inc Medicare	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00

BOSTON SCIENTIFIC UROMAX 20

Facility OP

$473.62

Hospital Charge Code	40203338
Hospital Revenue Code	272
Min. Negotiated Rate	$165.77
Max. Negotiated Rate	$378.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$260.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$236.81
Rate for Payer: Aetna Government	$236.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$378.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$322.06
Rate for Payer: Group Health Inc Commercial	$236.81
Rate for Payer: Group Health Inc Medicare	$165.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$236.81
Rate for Payer: Hamaspik Choice Inc Medicare	$236.81

BOSTON SCIENTIFIC UROMAX 20

Facility OP

$473.62

Hospital Charge Code	40009320
Hospital Revenue Code	272
Min. Negotiated Rate	$165.77
Max. Negotiated Rate	$378.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$260.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$236.81
Rate for Payer: Aetna Government	$236.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$378.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$322.06
Rate for Payer: Group Health Inc Commercial	$236.81
Rate for Payer: Group Health Inc Medicare	$165.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$236.81
Rate for Payer: Hamaspik Choice Inc Medicare	$236.81

BOSTON SCI ESSENT PACEMAKER L100

Facility OP

$11,600.00

Service Code	HCPCS C1786
Hospital Charge Code	66573210
Hospital Revenue Code	275
Min. Negotiated Rate	$1,116.69
Max. Negotiated Rate	$12,180.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,380.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,116.69
Rate for Payer: Aetna Government	$1,116.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,800.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,670.00
Rate for Payer: Fidelis Medicare Advantage	$12,180.00
Rate for Payer: Group Health Inc Commercial	$5,800.00
Rate for Payer: Group Health Inc Medicare	$4,060.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,800.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,800.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,540.00

BOSTON SCI INGEVITY 7741-52

Facility OP

$1,200.00

Service Code	HCPCS C1898
Hospital Charge Code	66576696
Hospital Revenue Code	278
Min. Negotiated Rate	$98.92
Max. Negotiated Rate	$1,260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$98.92
Rate for Payer: Aetna Government	$98.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.00
Rate for Payer: Fidelis Medicare Advantage	$1,260.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$780.00

BOSTON SCI INGEVITY 7741-52

Facility IP

$1,200.00

Service Code	HCPCS C1898
Hospital Charge Code	66576696
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00

BOSTON SCI INGEVITY MODEL 7742-59

Facility OP

$1,200.00

Service Code	HCPCS C1898
Hospital Charge Code	66576693
Hospital Revenue Code	278
Min. Negotiated Rate	$98.92
Max. Negotiated Rate	$1,260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$98.92
Rate for Payer: Aetna Government	$98.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.00
Rate for Payer: Fidelis Medicare Advantage	$1,260.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$780.00

BOSTON SCI INGEVITY MODEL 7742-59

Facility IP

$1,200.00

Service Code	HCPCS C1898
Hospital Charge Code	66576693
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00

Price Transparency.

All Charges