St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

STENT PERIPH EVFLX 035

Facility

$1,420.00

Hospital Charge Code	64906370
Hospital Revenue Code	279
Min. Negotiated Rate	$497.00
Max. Negotiated Rate	$1,136.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$781.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$710.00
Rate for Payer: Aetna Government	$710.00
Rate for Payer: Brighton Health Commercial	$1,065.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,136.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$965.60
Rate for Payer: Group Health Inc Commercial	$710.00
Rate for Payer: Group Health Inc Medicare	$497.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$710.00
Rate for Payer: Hamaspik Choice Inc Medicare	$710.00

STENT POLARIS 5FR X 24CM

Facility

$442.50

Service Code	HCPCS C1877
Hospital Charge Code	64901281
Hospital Revenue Code	278
Min. Negotiated Rate	$127.45
Max. Negotiated Rate	$464.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$243.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Brighton Health Commercial	$265.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$221.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$254.44
Rate for Payer: EmblemHealth Commercial	$221.25
Rate for Payer: Fidelis Medicare Advantage	$464.62
Rate for Payer: Group Health Inc Commercial	$221.25
Rate for Payer: Group Health Inc Medicare	$154.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$221.25
Rate for Payer: Hamaspik Choice Inc Medicare	$221.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$287.62

STENT POLARIS 5FR X 24CM

Facility

$442.50

Service Code	HCPCS C1877
Hospital Charge Code	64901281
Hospital Revenue Code	278
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$221.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$221.25
Rate for Payer: Hamaspik Choice Inc Medicare	$221.25

STENT POLARIS 6X26

Facility

$358.75

Service Code	HCPCS C1877
Hospital Charge Code	64903730
Hospital Revenue Code	278
Min. Negotiated Rate	$179.38
Max. Negotiated Rate	$179.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.38
Rate for Payer: Hamaspik Choice Inc Medicare	$179.38

STENT POLARIS 6X26

Facility

$358.75

Service Code	HCPCS C1877
Hospital Charge Code	64903730
Hospital Revenue Code	278
Min. Negotiated Rate	$125.56
Max. Negotiated Rate	$376.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$197.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Brighton Health Commercial	$215.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$179.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$206.28
Rate for Payer: EmblemHealth Commercial	$179.38
Rate for Payer: Fidelis Medicare Advantage	$376.69
Rate for Payer: Group Health Inc Commercial	$179.38
Rate for Payer: Group Health Inc Medicare	$125.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.38
Rate for Payer: Hamaspik Choice Inc Medicare	$179.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$233.19

STENT POLARIS LOOP URET W/O WIRE

Facility

$447.50

Service Code	HCPCS C1877
Hospital Charge Code	64901361
Hospital Revenue Code	278
Min. Negotiated Rate	$223.75
Max. Negotiated Rate	$223.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$223.75
Rate for Payer: Hamaspik Choice Inc Medicare	$223.75

STENT POLARIS LOOP URET W/O WIRE

Facility

$447.50

Service Code	HCPCS C1877
Hospital Charge Code	64901361
Hospital Revenue Code	278
Min. Negotiated Rate	$127.45
Max. Negotiated Rate	$469.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$246.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Brighton Health Commercial	$268.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$223.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$257.31
Rate for Payer: EmblemHealth Commercial	$223.75
Rate for Payer: Fidelis Medicare Advantage	$469.88
Rate for Payer: Group Health Inc Commercial	$223.75
Rate for Payer: Group Health Inc Medicare	$156.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$223.75
Rate for Payer: Hamaspik Choice Inc Medicare	$223.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$290.88

STENT POLARIS ULTRA 5F X 20CM

Facility

$562.50

Service Code	HCPCS C1877
Hospital Charge Code	64901824
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$281.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.25
Rate for Payer: Hamaspik Choice Inc Medicare	$281.25

STENT POLARIS ULTRA 5F X 20CM

Facility

$562.50

Service Code	HCPCS C1877
Hospital Charge Code	64901824
Hospital Revenue Code	278
Min. Negotiated Rate	$127.45
Max. Negotiated Rate	$590.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$309.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Brighton Health Commercial	$337.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$281.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$323.44
Rate for Payer: EmblemHealth Commercial	$281.25
Rate for Payer: Fidelis Medicare Advantage	$590.62
Rate for Payer: Group Health Inc Commercial	$281.25
Rate for Payer: Group Health Inc Medicare	$196.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.25
Rate for Payer: Hamaspik Choice Inc Medicare	$281.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$365.62

STENT POLARIS ULTRA 5F X 26CM

Facility

$380.63

Service Code	HCPCS C1877
Hospital Charge Code	64901826
Hospital Revenue Code	278
Min. Negotiated Rate	$127.45
Max. Negotiated Rate	$399.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$209.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Brighton Health Commercial	$228.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$190.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$218.86
Rate for Payer: EmblemHealth Commercial	$190.32
Rate for Payer: Fidelis Medicare Advantage	$399.66
Rate for Payer: Group Health Inc Commercial	$190.32
Rate for Payer: Group Health Inc Medicare	$133.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.32
Rate for Payer: Hamaspik Choice Inc Medicare	$190.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$247.41

STENT POLARIS ULTRA 5F X 26CM

Facility

$380.63

Service Code	HCPCS C1877
Hospital Charge Code	64901826
Hospital Revenue Code	278
Min. Negotiated Rate	$190.32
Max. Negotiated Rate	$190.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.32
Rate for Payer: Hamaspik Choice Inc Medicare	$190.32

STENT POLARIS ULTRA 5F X 28CM

Facility

$562.50

Service Code	HCPCS C1877
Hospital Charge Code	64901827
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$281.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.25
Rate for Payer: Hamaspik Choice Inc Medicare	$281.25

STENT POLARIS ULTRA 5F X 28CM

Facility

$562.50

Service Code	HCPCS C1877
Hospital Charge Code	64901827
Hospital Revenue Code	278
Min. Negotiated Rate	$127.45
Max. Negotiated Rate	$590.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$309.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Brighton Health Commercial	$337.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$281.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$323.44
Rate for Payer: EmblemHealth Commercial	$281.25
Rate for Payer: Fidelis Medicare Advantage	$590.62
Rate for Payer: Group Health Inc Commercial	$281.25
Rate for Payer: Group Health Inc Medicare	$196.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.25
Rate for Payer: Hamaspik Choice Inc Medicare	$281.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$365.62

STENT POLARIS ULTRA 6FR30CM

Facility

$324.52

Hospital Charge Code	64906719
Hospital Revenue Code	279
Min. Negotiated Rate	$113.58
Max. Negotiated Rate	$259.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$178.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$162.26
Rate for Payer: Aetna Government	$162.26
Rate for Payer: Brighton Health Commercial	$243.39
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

STENT POLARIS ULTRA 6F X 20CM

Facility

$358.75

Service Code	HCPCS C1877
Hospital Charge Code	64902700
Hospital Revenue Code	278
Min. Negotiated Rate	$179.38
Max. Negotiated Rate	$179.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.38
Rate for Payer: Hamaspik Choice Inc Medicare	$179.38

STENT POLARIS ULTRA 6F X 20CM

Facility

$358.75

Service Code	HCPCS C1877
Hospital Charge Code	64902700
Hospital Revenue Code	278
Min. Negotiated Rate	$125.56
Max. Negotiated Rate	$376.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$197.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Brighton Health Commercial	$215.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$179.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$206.28
Rate for Payer: EmblemHealth Commercial	$179.38
Rate for Payer: Fidelis Medicare Advantage	$376.69
Rate for Payer: Group Health Inc Commercial	$179.38
Rate for Payer: Group Health Inc Medicare	$125.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.38
Rate for Payer: Hamaspik Choice Inc Medicare	$179.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$233.19

STENT POLARIS ULTRA 6F X 22CM

Facility

$358.75

Service Code	HCPCS C1877
Hospital Charge Code	64902503
Hospital Revenue Code	278
Min. Negotiated Rate	$179.38
Max. Negotiated Rate	$179.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.38
Rate for Payer: Hamaspik Choice Inc Medicare	$179.38

STENT POLARIS ULTRA 6F X 22CM

Facility

$358.75

Service Code	HCPCS C1877
Hospital Charge Code	64902503
Hospital Revenue Code	278
Min. Negotiated Rate	$125.56
Max. Negotiated Rate	$376.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$197.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Brighton Health Commercial	$215.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$179.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$206.28
Rate for Payer: EmblemHealth Commercial	$179.38
Rate for Payer: Fidelis Medicare Advantage	$376.69
Rate for Payer: Group Health Inc Commercial	$179.38
Rate for Payer: Group Health Inc Medicare	$125.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.38
Rate for Payer: Hamaspik Choice Inc Medicare	$179.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$233.19

STENT POLARIS ULTRA 6F X 24CM

Facility

$358.75

Service Code	HCPCS C1877
Hospital Charge Code	64902054
Hospital Revenue Code	278
Min. Negotiated Rate	$179.38
Max. Negotiated Rate	$179.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.38
Rate for Payer: Hamaspik Choice Inc Medicare	$179.38

STENT POLARIS ULTRA 6F X 24CM

Facility

$358.75

Service Code	HCPCS C1877
Hospital Charge Code	64902054
Hospital Revenue Code	278
Min. Negotiated Rate	$125.56
Max. Negotiated Rate	$376.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$197.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Brighton Health Commercial	$215.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$179.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$206.28
Rate for Payer: EmblemHealth Commercial	$179.38
Rate for Payer: Fidelis Medicare Advantage	$376.69
Rate for Payer: Group Health Inc Commercial	$179.38
Rate for Payer: Group Health Inc Medicare	$125.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.38
Rate for Payer: Hamaspik Choice Inc Medicare	$179.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$233.19

STENT RX 10 X 10CM BOSTON

Facility

$456.03

Service Code	HCPCS C1877
Hospital Charge Code	64901316
Hospital Revenue Code	278
Min. Negotiated Rate	$127.45
Max. Negotiated Rate	$478.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$250.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Brighton Health Commercial	$273.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$228.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$262.22
Rate for Payer: EmblemHealth Commercial	$228.02
Rate for Payer: Fidelis Medicare Advantage	$478.83
Rate for Payer: Group Health Inc Commercial	$228.02
Rate for Payer: Group Health Inc Medicare	$159.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$228.02
Rate for Payer: Hamaspik Choice Inc Medicare	$228.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$296.42

STENT RX 10 X 10CM BOSTON

Facility

$456.03

Service Code	HCPCS C1877
Hospital Charge Code	64901316
Hospital Revenue Code	278
Min. Negotiated Rate	$228.02
Max. Negotiated Rate	$228.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$228.02
Rate for Payer: Hamaspik Choice Inc Medicare	$228.02

STENT RX 10 X 5CM BOSTON

Facility

$372.50

Service Code	HCPCS C1877
Hospital Charge Code	64901315
Hospital Revenue Code	278
Min. Negotiated Rate	$127.45
Max. Negotiated Rate	$391.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$204.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Brighton Health Commercial	$223.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$186.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$214.19
Rate for Payer: EmblemHealth Commercial	$186.25
Rate for Payer: Fidelis Medicare Advantage	$391.12
Rate for Payer: Group Health Inc Commercial	$186.25
Rate for Payer: Group Health Inc Medicare	$130.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$186.25
Rate for Payer: Hamaspik Choice Inc Medicare	$186.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$242.12

STENT RX 10 X 5CM BOSTON

Facility

$372.50

Service Code	HCPCS C1877
Hospital Charge Code	64901315
Hospital Revenue Code	278
Min. Negotiated Rate	$186.25
Max. Negotiated Rate	$186.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$186.25
Rate for Payer: Hamaspik Choice Inc Medicare	$186.25

STENT RX 10X5CM BOSTON

Facility

$300.00

Service Code	HCPCS C1874
Hospital Charge Code	40200997
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00

Know your out-of-pocket cost for care.

All Charges