St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

STENT VIABHN W/HPRN 6MMX5CM

Facility

$7,046.00

Service Code	HCPCS C1874
Hospital Charge Code	64906541
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$7,398.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,875.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$4,227.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,523.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,051.45
Rate for Payer: EmblemHealth Commercial	$3,523.00
Rate for Payer: Fidelis Medicare Advantage	$7,398.30
Rate for Payer: Group Health Inc Commercial	$3,523.00
Rate for Payer: Group Health Inc Medicare	$2,466.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,523.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,523.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,579.90

STENT VIABHN W/HPRN 8MMX5CM

Facility

$7,046.00

Service Code	HCPCS C1874
Hospital Charge Code	64906542
Hospital Revenue Code	278
Min. Negotiated Rate	$3,523.00
Max. Negotiated Rate	$3,523.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,523.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,523.00

STENT VIABHN W/HPRN 8MMX5CM

Facility

$7,046.00

Service Code	HCPCS C1874
Hospital Charge Code	64906542
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$7,398.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,875.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$4,227.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,523.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,051.45
Rate for Payer: EmblemHealth Commercial	$3,523.00
Rate for Payer: Fidelis Medicare Advantage	$7,398.30
Rate for Payer: Group Health Inc Commercial	$3,523.00
Rate for Payer: Group Health Inc Medicare	$2,466.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,523.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,523.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,579.90

STENT WALL 10X60 PERMALUME

Facility

$3,190.00

Service Code	HCPCS C1713
Hospital Charge Code	40202001
Hospital Revenue Code	278
Min. Negotiated Rate	$1,595.00
Max. Negotiated Rate	$1,595.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,595.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,595.00

STENT WALL 10X60 PERMALUME

Facility

$3,190.00

Service Code	HCPCS C1713
Hospital Charge Code	40202001
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,349.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,754.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,914.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,595.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,834.25
Rate for Payer: EmblemHealth Commercial	$1,595.00
Rate for Payer: Fidelis Medicare Advantage	$3,349.50
Rate for Payer: Group Health Inc Commercial	$1,595.00
Rate for Payer: Group Health Inc Medicare	$1,116.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,595.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,595.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,073.50

STENT XACT COROTID 40MM X 8.0

Facility

$6,375.00

Service Code	HCPCS C1876
Hospital Charge Code	64905907
Hospital Revenue Code	278
Min. Negotiated Rate	$3,187.50
Max. Negotiated Rate	$3,187.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,187.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,187.50

STENT XACT COROTID 40MM X 8.0

Facility

$6,375.00

Service Code	HCPCS C1876
Hospital Charge Code	64905907
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$6,693.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,506.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$3,825.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,187.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,665.62
Rate for Payer: EmblemHealth Commercial	$3,187.50
Rate for Payer: Fidelis Medicare Advantage	$6,693.75
Rate for Payer: Group Health Inc Commercial	$3,187.50
Rate for Payer: Group Health Inc Medicare	$2,231.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,187.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,187.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,143.75

STENT XACT COROTID 40MM X 9.0

Facility

$6,375.00

Service Code	HCPCS C1876
Hospital Charge Code	64905905
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$6,693.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,506.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$3,825.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,187.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,665.62
Rate for Payer: EmblemHealth Commercial	$3,187.50
Rate for Payer: Fidelis Medicare Advantage	$6,693.75
Rate for Payer: Group Health Inc Commercial	$3,187.50
Rate for Payer: Group Health Inc Medicare	$2,231.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,187.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,187.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,143.75

STENT XACT COROTID 40MM X 9.0

Facility

$6,375.00

Service Code	HCPCS C1876
Hospital Charge Code	64905905
Hospital Revenue Code	278
Min. Negotiated Rate	$3,187.50
Max. Negotiated Rate	$3,187.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,187.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,187.50

STENT ZILVER PTX 35/125/6/80

Facility

$4,487.50

Service Code	HCPCS C1874
Hospital Charge Code	64905832
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 ZILVER PTX 35/125/6/80

Facility

$4,487.50

Service Code	HCPCS C1874
Hospital Charge Code	64905832
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

STENT ZILVER PTX 35 35/125/6/60

Facility

$3,737.50

Service Code	HCPCS C1874
Hospital Charge Code	64905830
Hospital Revenue Code	278
Min. Negotiated Rate	$1,868.75
Max. Negotiated Rate	$1,868.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,868.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,868.75

STENT ZILVER PTX 35 35/125/6/60

Facility

$3,737.50

Service Code	HCPCS C1874
Hospital Charge Code	64905830
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,924.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,055.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$2,242.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,868.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,149.06
Rate for Payer: EmblemHealth Commercial	$1,868.75
Rate for Payer: Fidelis Medicare Advantage	$3,924.38
Rate for Payer: Group Health Inc Commercial	$1,868.75
Rate for Payer: Group Health Inc Medicare	$1,308.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,868.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,868.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,429.38

STEREOSCOP X-RAY GUID-TARGET GUID

Facility

$266.72

Service Code	HCPCS G6002 TC
Hospital Charge Code	66542965
Hospital Revenue Code	333
Min. Negotiated Rate	$93.35
Max. Negotiated Rate	$294.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$146.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$133.36
Rate for Payer: Aetna Government	$133.36
Rate for Payer: Brighton Health Commercial	$200.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$213.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$181.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$279.92
Rate for Payer: Fidelis Essential Plan Aliesa	$279.92
Rate for Payer: Fidelis Essential Plan QHP	$294.00
Rate for Payer: Fidelis Qualified Health Plan	$294.00
Rate for Payer: Group Health Inc Commercial	$133.36
Rate for Payer: Group Health Inc Medicare	$93.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.36
Rate for Payer: Hamaspik Choice Inc Medicare	$133.36

STERILANT,NON-GLUT,CIDEX OPA,GAL

Facility

$48.75

Hospital Charge Code	64901028
Hospital Revenue Code	270
Min. Negotiated Rate	$17.06
Max. Negotiated Rate	$39.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.38
Rate for Payer: Aetna Government	$24.38
Rate for Payer: Brighton Health Commercial	$36.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.15
Rate for Payer: Group Health Inc Commercial	$24.38
Rate for Payer: Group Health Inc Medicare	$17.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.38
Rate for Payer: Hamaspik Choice Inc Medicare	$24.38

STERILE COMBINE

Facility

$25.52

Hospital Charge Code	40205735
Hospital Revenue Code	270
Min. Negotiated Rate	$8.93
Max. Negotiated Rate	$20.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.76
Rate for Payer: Aetna Government	$12.76
Rate for Payer: Brighton Health Commercial	$19.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.35
Rate for Payer: Group Health Inc Commercial	$12.76
Rate for Payer: Group Health Inc Medicare	$8.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.76
Rate for Payer: Hamaspik Choice Inc Medicare	$12.76

STERILE INFLATABLE INTRAOP SIZER

Facility

$130.00

Hospital Charge Code	40005329
Hospital Revenue Code	272
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$104.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.00
Rate for Payer: Aetna Government	$65.00
Rate for Payer: Brighton Health Commercial	$97.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$104.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$88.40
Rate for Payer: Group Health Inc Commercial	$65.00
Rate for Payer: Group Health Inc Medicare	$45.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00

STERILE TALC POWDER AEROSOL

Facility

$335.50

Hospital Charge Code	41642744
Hospital Revenue Code	250
Min. Negotiated Rate	$117.42
Max. Negotiated Rate	$268.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$184.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$167.75
Rate for Payer: Aetna Government	$167.75
Rate for Payer: Brighton Health Commercial	$251.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$268.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$228.14
Rate for Payer: Group Health Inc Commercial	$167.75
Rate for Payer: Group Health Inc Medicare	$117.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$167.75
Rate for Payer: Hamaspik Choice Inc Medicare	$167.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$218.08

STERILE TALC POWDER AEROSOL

Facility

$335.50

Hospital Charge Code	41652744
Hospital Revenue Code	250
Min. Negotiated Rate	$117.42
Max. Negotiated Rate	$268.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$184.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$167.75
Rate for Payer: Aetna Government	$167.75
Rate for Payer: Brighton Health Commercial	$251.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$268.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$228.14
Rate for Payer: Group Health Inc Commercial	$167.75
Rate for Payer: Group Health Inc Medicare	$117.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$167.75
Rate for Payer: Hamaspik Choice Inc Medicare	$167.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$218.08

STERILE WATER FOR DILUTION IJ SOLN [40800007]

Facility

$0.12

Service Code	NDC 00409488710
Hospital Charge Code	00409488710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.08
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

STERILE WATER FOR INJECTION 100 ML VIAL

Facility

$5.15

Service Code	HCPCS A4216
Hospital Charge Code	41642608
Hospital Revenue Code	272
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$4.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$3.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.50
Rate for Payer: Group Health Inc Commercial	$2.58
Rate for Payer: Group Health Inc Medicare	$1.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.58
Rate for Payer: Hamaspik Choice Inc Medicare	$2.58

STERILE WATER FOR INJECTION 100 ML VIAL

Facility

$5.15

Service Code	HCPCS A4216
Hospital Charge Code	41652608
Hospital Revenue Code	272
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$4.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$3.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.50
Rate for Payer: Group Health Inc Commercial	$2.58
Rate for Payer: Group Health Inc Medicare	$1.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.58
Rate for Payer: Hamaspik Choice Inc Medicare	$2.58

STERILE WATER FOR INJECTION 20 ML

Facility

$2.20

Service Code	HCPCS A4216
Hospital Charge Code	41654158
Hospital Revenue Code	272
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$1.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$1.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.50
Rate for Payer: Group Health Inc Commercial	$1.10
Rate for Payer: Group Health Inc Medicare	$0.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.10
Rate for Payer: Hamaspik Choice Inc Medicare	$1.10

STERILE WATER FOR INJECTION 20 ML

Facility

$2.20

Service Code	HCPCS A4216
Hospital Charge Code	41644158
Hospital Revenue Code	272
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$1.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$1.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.50
Rate for Payer: Group Health Inc Commercial	$1.10
Rate for Payer: Group Health Inc Medicare	$0.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.10
Rate for Payer: Hamaspik Choice Inc Medicare	$1.10

STERILE WATER FOR INJECTION IJ SOLN [7484]

Facility

$0.12

Service Code	NDC 00409488710
Hospital Charge Code	00409488710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.08
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

Know your out-of-pocket cost for care.

All Charges