St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

STENT FLUENCY 9 X 60 (FEM09060)

Facility

$2,095.00

Service Code	HCPCS C1768
Hospital Charge Code	64906422
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$2,199.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,152.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$1,257.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,047.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,204.62
Rate for Payer: EmblemHealth Commercial	$1,047.50
Rate for Payer: Fidelis Medicare Advantage	$2,199.75
Rate for Payer: Group Health Inc Commercial	$1,047.50
Rate for Payer: Group Health Inc Medicare	$733.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,047.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,047.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,361.75

STENT FLUENCY 9 X 60 (FEM09060)

Facility

$2,095.00

Service Code	HCPCS C1768
Hospital Charge Code	64906422
Hospital Revenue Code	278
Min. Negotiated Rate	$1,047.50
Max. Negotiated Rate	$1,047.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,047.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,047.50

STENT GLIDESHEATH

Facility

$183.75

Service Code	HCPCS C1874
Hospital Charge Code	64907350
Hospital Revenue Code	278
Min. Negotiated Rate	$91.88
Max. Negotiated Rate	$91.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.88
Rate for Payer: Hamaspik Choice Inc Medicare	$91.88

STENT GLIDESHEATH

Facility

$183.75

Service Code	HCPCS C1874
Hospital Charge Code	64907350
Hospital Revenue Code	278
Min. Negotiated Rate	$64.31
Max. Negotiated Rate	$265.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$101.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$110.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$91.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.66
Rate for Payer: EmblemHealth Commercial	$91.88
Rate for Payer: Fidelis Medicare Advantage	$192.94
Rate for Payer: Group Health Inc Commercial	$91.88
Rate for Payer: Group Health Inc Medicare	$64.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.88
Rate for Payer: Hamaspik Choice Inc Medicare	$91.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$119.44

STENT GRAFT THRC TAG

Facility

$50,362.50

Service Code	HCPCS C1877
Hospital Charge Code	64907416
Hospital Revenue Code	278
Min. Negotiated Rate	$25,181.25
Max. Negotiated Rate	$25,181.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,181.25
Rate for Payer: Hamaspik Choice Inc Medicare	$25,181.25

STENT GRAFT THRC TAG

Facility

$50,362.50

Service Code	HCPCS C1877
Hospital Charge Code	64907416
Hospital Revenue Code	278
Min. Negotiated Rate	$127.45
Max. Negotiated Rate	$52,880.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27,699.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Brighton Health Commercial	$30,217.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25,181.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$28,958.44
Rate for Payer: EmblemHealth Commercial	$25,181.25
Rate for Payer: Fidelis Medicare Advantage	$52,880.62
Rate for Payer: Group Health Inc Commercial	$25,181.25
Rate for Payer: Group Health Inc Medicare	$17,626.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,181.25
Rate for Payer: Hamaspik Choice Inc Medicare	$25,181.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$32,735.62

STENT LIBERTE MONO 12MM 2.75

Facility

$1,800.00

Hospital Charge Code	65520110
Hospital Revenue Code	480
Min. Negotiated Rate	$630.00
Max. Negotiated Rate	$1,440.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$990.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$900.00
Rate for Payer: Aetna Government	$900.00
Rate for Payer: Brighton Health Commercial	$1,350.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,440.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,224.00
Rate for Payer: Group Health Inc Commercial	$900.00
Rate for Payer: Group Health Inc Medicare	$630.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$900.00

STENT PERC 4.8X24 W/O WIRE

Facility

$337.13

Service Code	HCPCS C1877
Hospital Charge Code	64901167
Hospital Revenue Code	278
Min. Negotiated Rate	$168.56
Max. Negotiated Rate	$168.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.56
Rate for Payer: Hamaspik Choice Inc Medicare	$168.56

STENT PERC 4.8X24 W/O WIRE

Facility

$337.13

Service Code	HCPCS C1877
Hospital Charge Code	64901167
Hospital Revenue Code	278
Min. Negotiated Rate	$118.00
Max. Negotiated Rate	$353.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$185.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Brighton Health Commercial	$202.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$168.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$193.85
Rate for Payer: EmblemHealth Commercial	$168.56
Rate for Payer: Fidelis Medicare Advantage	$353.99
Rate for Payer: Group Health Inc Commercial	$168.56
Rate for Payer: Group Health Inc Medicare	$118.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.56
Rate for Payer: Hamaspik Choice Inc Medicare	$168.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$219.13

STENT PERC PLUS 6X22 W/O WIRE

Facility

$303.75

Service Code	HCPCS C1877
Hospital Charge Code	64901169
Hospital Revenue Code	278
Min. Negotiated Rate	$106.31
Max. Negotiated Rate	$318.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$167.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Brighton Health Commercial	$182.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$151.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$174.66
Rate for Payer: EmblemHealth Commercial	$151.88
Rate for Payer: Fidelis Medicare Advantage	$318.94
Rate for Payer: Group Health Inc Commercial	$151.88
Rate for Payer: Group Health Inc Medicare	$106.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$151.88
Rate for Payer: Hamaspik Choice Inc Medicare	$151.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$197.44

STENT PERC PLUS 6X22 W/O WIRE

Facility

$303.75

Service Code	HCPCS C1877
Hospital Charge Code	64901169
Hospital Revenue Code	278
Min. Negotiated Rate	$151.88
Max. Negotiated Rate	$151.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$151.88
Rate for Payer: Hamaspik Choice Inc Medicare	$151.88

STENT PERCUFLEX 4.8FR24CM

Facility

$350.00

Service Code	HCPCS C2617
Hospital Charge Code	40209390
Hospital Revenue Code	278
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

STENT PERCUFLEX 4.8FR24CM

Facility

$350.00

Service Code	HCPCS C2617
Hospital Charge Code	40209390
Hospital Revenue Code	278
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$367.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.14
Rate for Payer: Aetna Government	$10.14
Rate for Payer: Brighton Health Commercial	$210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$175.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.25
Rate for Payer: EmblemHealth Commercial	$175.00
Rate for Payer: Fidelis Medicare Advantage	$367.50
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$227.50

STENT PERCUFLEX 4.8FRX22CM

Facility

$350.00

Service Code	HCPCS C2617
Hospital Charge Code	40209387
Hospital Revenue Code	278
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$367.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.14
Rate for Payer: Aetna Government	$10.14
Rate for Payer: Brighton Health Commercial	$210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$175.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.25
Rate for Payer: EmblemHealth Commercial	$175.00
Rate for Payer: Fidelis Medicare Advantage	$367.50
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$227.50

STENT PERCUFLEX 4.8FRX22CM

Facility

$350.00

Service Code	HCPCS C2617
Hospital Charge Code	40209387
Hospital Revenue Code	278
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

STENT PERCUFLEX 6.0X26

Facility

$238.00

Service Code	HCPCS C2617
Hospital Charge Code	40205344
Hospital Revenue Code	278
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$119.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.00
Rate for Payer: Hamaspik Choice Inc Medicare	$119.00

STENT PERCUFLEX 6.0X26

Facility

$238.00

Service Code	HCPCS C2617
Hospital Charge Code	40205344
Hospital Revenue Code	278
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$249.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.14
Rate for Payer: Aetna Government	$10.14
Rate for Payer: Brighton Health Commercial	$142.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$119.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.85
Rate for Payer: EmblemHealth Commercial	$119.00
Rate for Payer: Fidelis Medicare Advantage	$249.90
Rate for Payer: Group Health Inc Commercial	$119.00
Rate for Payer: Group Health Inc Medicare	$83.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.00
Rate for Payer: Hamaspik Choice Inc Medicare	$119.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.70

STENT PERC UURETERAL 4.8X26

Facility

$500.00

Service Code	HCPCS C1877
Hospital Charge Code	64901174
Hospital Revenue Code	278
Min. Negotiated Rate	$250.00
Max. Negotiated Rate	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

STENT PERC UURETERAL 4.8X26

Facility

$500.00

Service Code	HCPCS C1877
Hospital Charge Code	64901174
Hospital Revenue Code	278
Min. Negotiated Rate	$127.45
Max. Negotiated Rate	$525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Brighton Health Commercial	$300.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$287.50
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis Medicare Advantage	$525.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$325.00

STENT PERIPH DIALYSIS SEGMENT

Facility

$30,010.30

Service Code	HCPCS 36903
Hospital Charge Code	40034505
Hospital Revenue Code	361
Min. Negotiated Rate	$342.00
Max. Negotiated Rate	$22,507.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12,721.98
Rate for Payer: Aetna Government	$12,721.98
Rate for Payer: Brighton Health Commercial	$22,507.72
Rate for Payer: Cash Price	$12,721.98
Rate for Payer: Cash Price	$12,721.98
Rate for Payer: Cash Price	$12,721.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12,721.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$12,721.98
Rate for Payer: EmblemHealth Commercial	$12,721.98
Rate for Payer: Fidelis Essential Plan Aliesa	$10,813.68
Rate for Payer: Fidelis Essential Plan QHP	$11,322.56
Rate for Payer: Fidelis Medicare Advantage	$12,721.98
Rate for Payer: Fidelis Qualified Health Plan	$11,322.56
Rate for Payer: Group Health Inc Commercial	$12,721.98
Rate for Payer: Group Health Inc Medicare	$12,721.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,005.15
Rate for Payer: Hamaspik Choice Inc Medicare	$12,721.98
Rate for Payer: Healthfirst Medicare Advantage	$10,813.68
Rate for Payer: Healthfirst QHP	$12,721.98
Rate for Payer: Senior Whole Health Medicare Advantage	$12,721.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12,721.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10,177.58
Rate for Payer: Wellcare Medicare	$12,085.88

STENT PERIPH DIALYSIS SEGMENT

Facility

$30,010.30

Service Code	HCPCS 36903
Hospital Charge Code	40034505
Hospital Revenue Code	361
Rate for Payer: Cash Price	$12,721.98

STENT PERIPH DRG EL A

Facility

$2,937.50

Service Code	HCPCS C1874
Hospital Charge Code	64904139
Hospital Revenue Code	278
Min. Negotiated Rate	$1,468.75
Max. Negotiated Rate	$1,468.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,468.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,468.75

STENT PERIPH DRG EL A

Facility

$2,937.50

Service Code	HCPCS C1874
Hospital Charge Code	64904139
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,084.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,615.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$1,762.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,468.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,689.06
Rate for Payer: EmblemHealth Commercial	$1,468.75
Rate for Payer: Fidelis Medicare Advantage	$3,084.38
Rate for Payer: Group Health Inc Commercial	$1,468.75
Rate for Payer: Group Health Inc Medicare	$1,028.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,468.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,468.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,909.38

STENT PERIPH DRG EL B

Facility

$4,487.50

Service Code	HCPCS C1874
Hospital Charge Code	64904141
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,711.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,468.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$2,692.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,243.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,580.31
Rate for Payer: EmblemHealth Commercial	$2,243.75
Rate for Payer: Fidelis Medicare Advantage	$4,711.88
Rate for Payer: Group Health Inc Commercial	$2,243.75
Rate for Payer: Group Health Inc Medicare	$1,570.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$2,243.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,916.88

STENT PERIPH DRG EL B

Facility

$4,487.50

Service Code	HCPCS C1874
Hospital Charge Code	64904141
Hospital Revenue Code	278
Min. Negotiated Rate	$2,243.75
Max. Negotiated Rate	$2,243.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$2,243.75

Know your out-of-pocket cost for care.

All Charges