St. Barnabas Hospital

All Charges

Charge

Type

Price

B.S. FILTER WIRE LG/SM X190

Facility IP

$3,188.00

Service Code	HCPCS C1887
Hospital Charge Code	66522109
Hospital Revenue Code	278
Min. Negotiated Rate	$1,594.00
Max. Negotiated Rate	$1,594.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,594.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,594.00

B.S. FILTER WIRE LG/SM X190

Facility OP

$3,188.00

Service Code	HCPCS C1887
Hospital Charge Code	66522109
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$3,347.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,753.40
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	$1,594.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,833.10
Rate for Payer: Fidelis Medicare Advantage	$3,347.40
Rate for Payer: Group Health Inc Commercial	$1,594.00
Rate for Payer: Group Health Inc Medicare	$1,115.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,594.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,594.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,072.20

B.S. G DEXTRUS A LEAD 4136 53CM

Facility OP

$1,200.00

Service Code	HCPCS C1785
Hospital Charge Code	40205675
Hospital Revenue Code	278
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$1,260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
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	$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

B.S. G DEXTRUS A LEAD 4136 53CM

Facility IP

$1,200.00

Service Code	HCPCS C1785
Hospital Charge Code	40205675
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

B.S. G DEXTRUS V LEAD 4136 60CM

Facility OP

$1,200.00

Service Code	HCPCS C1785
Hospital Charge Code	40205676
Hospital Revenue Code	278
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$1,260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
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	$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

B.S. G DEXTRUS V LEAD 4136 60CM

Facility IP

$1,200.00

Service Code	HCPCS C1785
Hospital Charge Code	40205676
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

BSKET TRAPZID LITHO COMPT

Facility OP

$698.00

Hospital Charge Code	40200271
Hospital Revenue Code	270
Min. Negotiated Rate	$244.30
Max. Negotiated Rate	$558.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$383.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$349.00
Rate for Payer: Aetna Government	$349.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$558.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$474.64
Rate for Payer: Group Health Inc Commercial	$349.00
Rate for Payer: Group Health Inc Medicare	$244.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$349.00
Rate for Payer: Hamaspik Choice Inc Medicare	$349.00

B.S. PED BX NEEDLE 2.0X160CM

Facility OP

$804.00

Hospital Charge Code	40205150
Hospital Revenue Code	270
Min. Negotiated Rate	$281.40
Max. Negotiated Rate	$643.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$442.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.00
Rate for Payer: Aetna Government	$402.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$643.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$546.72
Rate for Payer: Group Health Inc Commercial	$402.00
Rate for Payer: Group Health Inc Medicare	$281.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$402.00
Rate for Payer: Hamaspik Choice Inc Medicare	$402.00

BSPLT TIB TRI BDD

Facility IP

$3,875.00

Service Code	HCPCS C1776
Hospital Charge Code	64907213
Hospital Revenue Code	278
Min. Negotiated Rate	$1,937.50
Max. Negotiated Rate	$1,937.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,937.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,937.50

BSPLT TIB TRI BDD

Facility OP

$3,875.00

Service Code	HCPCS C1776
Hospital Charge Code	64907213
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,068.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,131.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,937.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,228.12
Rate for Payer: Fidelis Medicare Advantage	$4,068.75
Rate for Payer: Group Health Inc Commercial	$1,937.50
Rate for Payer: Group Health Inc Medicare	$1,356.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,937.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,937.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,518.75

BSPLT TRI 5520

Facility OP

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64907210
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,462.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,337.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,443.75
Rate for Payer: Fidelis Medicare Advantage	$4,462.50
Rate for Payer: Group Health Inc Commercial	$2,125.00
Rate for Payer: Group Health Inc Medicare	$1,487.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,762.50

BSPLT TRI 5520

Facility IP

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64907210
Hospital Revenue Code	278
Min. Negotiated Rate	$2,125.00
Max. Negotiated Rate	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00

BSPLT TRI TS 5521

Facility OP

$3,625.00

Service Code	HCPCS C1776
Hospital Charge Code	64907211
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,806.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,993.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,812.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,084.38
Rate for Payer: Fidelis Medicare Advantage	$3,806.25
Rate for Payer: Group Health Inc Commercial	$1,812.50
Rate for Payer: Group Health Inc Medicare	$1,268.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,812.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,812.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,356.25

BSPLT TRI TS 5521

Facility IP

$3,625.00

Service Code	HCPCS C1776
Hospital Charge Code	64907211
Hospital Revenue Code	278
Min. Negotiated Rate	$1,812.50
Max. Negotiated Rate	$1,812.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,812.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,812.50

BSPLT TRI UNIV

Facility OP

$1,263.50

Service Code	HCPCS C1776
Hospital Charge Code	64907212
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,326.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$631.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$726.51
Rate for Payer: Fidelis Medicare Advantage	$1,326.68
Rate for Payer: Group Health Inc Commercial	$631.75
Rate for Payer: Group Health Inc Medicare	$442.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$631.75
Rate for Payer: Hamaspik Choice Inc Medicare	$631.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$821.28

BSPLT TRI UNIV

Facility IP

$1,263.50

Service Code	HCPCS C1776
Hospital Charge Code	64907212
Hospital Revenue Code	278
Min. Negotiated Rate	$631.75
Max. Negotiated Rate	$631.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$631.75
Rate for Payer: Hamaspik Choice Inc Medicare	$631.75

B.S. SENSOR W/WIRE 0.038X 150CM

Facility IP

$119.00

Service Code	HCPCS C1713
Hospital Charge Code	40205798
Hospital Revenue Code	278
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$59.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.50
Rate for Payer: Hamaspik Choice Inc Medicare	$59.50

B.S. SENSOR W/WIRE 0.038X 150CM

Facility OP

$119.00

Service Code	HCPCS C1713
Hospital Charge Code	40205798
Hospital Revenue Code	278
Min. Negotiated Rate	$41.65
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$65.45
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	$59.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.42
Rate for Payer: Fidelis Medicare Advantage	$124.95
Rate for Payer: Group Health Inc Commercial	$59.50
Rate for Payer: Group Health Inc Medicare	$41.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.50
Rate for Payer: Hamaspik Choice Inc Medicare	$59.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$77.35

B.S. THE MAGNET EXCHANGE DEVICE

Facility OP

$226.00

Hospital Charge Code	66522097
Hospital Revenue Code	270
Min. Negotiated Rate	$79.10
Max. Negotiated Rate	$180.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$124.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$113.00
Rate for Payer: Aetna Government	$113.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$180.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.68
Rate for Payer: Group Health Inc Commercial	$113.00
Rate for Payer: Group Health Inc Medicare	$79.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.00
Rate for Payer: Hamaspik Choice Inc Medicare	$113.00

BSTN SCI INGEVITY MRI LEAD 774259

Facility OP

$1,200.00

Service Code	HCPCS C1898
Hospital Charge Code	66573173
Hospital Revenue Code	275
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

BS TRIAL LEAD KIT 50CM

Facility IP

$1,500.00

Service Code	HCPCS C1778
Hospital Charge Code	40204562
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$750.00

BS TRIAL LEAD KIT 50CM

Facility OP

$1,500.00

Service Code	HCPCS C1778
Hospital Charge Code	40204562
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,575.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$825.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$550.66
Rate for Payer: Aetna Government	$550.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$750.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$862.50
Rate for Payer: Fidelis Medicare Advantage	$1,575.00
Rate for Payer: Group Health Inc Commercial	$750.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$750.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$975.00

BTB TIGHTROPE

Facility IP

$1,520.00

Service Code	HCPCS C1776
Hospital Charge Code	64903682
Hospital Revenue Code	278
Min. Negotiated Rate	$760.00
Max. Negotiated Rate	$760.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$760.00
Rate for Payer: Hamaspik Choice Inc Medicare	$760.00

BTB TIGHTROPE

Facility OP

$1,520.00

Service Code	HCPCS C1776
Hospital Charge Code	64903682
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,596.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$836.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$760.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$874.00
Rate for Payer: Fidelis Medicare Advantage	$1,596.00
Rate for Payer: Group Health Inc Commercial	$760.00
Rate for Payer: Group Health Inc Medicare	$532.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$760.00
Rate for Payer: Hamaspik Choice Inc Medicare	$760.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$988.00

BUCKS EXTENSION

Facility OP

$69.46

Hospital Charge Code	40200662
Hospital Revenue Code	270
Min. Negotiated Rate	$24.31
Max. Negotiated Rate	$55.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$34.73
Rate for Payer: Aetna Government	$34.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$55.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.23
Rate for Payer: Group Health Inc Commercial	$34.73
Rate for Payer: Group Health Inc Medicare	$24.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.73
Rate for Payer: Hamaspik Choice Inc Medicare	$34.73

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