St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZZ FOGAR ART EMBOL 5 180

Facility

$107.03

Service Code	HCPCS C1757
Hospital Charge Code	41567184
Hospital Revenue Code	278
Min. Negotiated Rate	$53.52
Max. Negotiated Rate	$53.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.52
Rate for Payer: Hamaspik Choice Inc Medicare	$53.52

ZZ FOGAR ART EMBOL 5 180

Facility

$107.03

Service Code	HCPCS C1757
Hospital Charge Code	41567184
Hospital Revenue Code	278
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$112.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.33
Rate for Payer: Aetna Government	$16.33
Rate for Payer: Brighton Health Commercial	$64.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$53.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$61.54
Rate for Payer: EmblemHealth Commercial	$53.52
Rate for Payer: Fidelis Medicare Advantage	$112.38
Rate for Payer: Group Health Inc Commercial	$53.52
Rate for Payer: Group Health Inc Medicare	$37.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.52
Rate for Payer: Hamaspik Choice Inc Medicare	$53.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$69.57

ZZ FOGARTY THRULUMEN/3F/40CM

Facility

$162.66

Service Code	HCPCS C1757
Hospital Charge Code	41569505
Hospital Revenue Code	278
Min. Negotiated Rate	$81.33
Max. Negotiated Rate	$81.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.33
Rate for Payer: Hamaspik Choice Inc Medicare	$81.33

ZZ FOGARTY THRULUMEN/3F/40CM

Facility

$162.66

Service Code	HCPCS C1757
Hospital Charge Code	41569505
Hospital Revenue Code	278
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$170.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.33
Rate for Payer: Aetna Government	$16.33
Rate for Payer: Brighton Health Commercial	$97.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.53
Rate for Payer: EmblemHealth Commercial	$81.33
Rate for Payer: Fidelis Medicare Advantage	$170.79
Rate for Payer: Group Health Inc Commercial	$81.33
Rate for Payer: Group Health Inc Medicare	$56.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.33
Rate for Payer: Hamaspik Choice Inc Medicare	$81.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.73

ZZ FOGARTY THRULUMEN/3F/80CM

Facility

$162.66

Service Code	HCPCS C1757
Hospital Charge Code	41569506
Hospital Revenue Code	278
Min. Negotiated Rate	$81.33
Max. Negotiated Rate	$81.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.33
Rate for Payer: Hamaspik Choice Inc Medicare	$81.33

ZZ FOGARTY THRULUMEN/3F/80CM

Facility

$162.66

Service Code	HCPCS C1757
Hospital Charge Code	41569506
Hospital Revenue Code	278
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$170.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.33
Rate for Payer: Aetna Government	$16.33
Rate for Payer: Brighton Health Commercial	$97.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.53
Rate for Payer: EmblemHealth Commercial	$81.33
Rate for Payer: Fidelis Medicare Advantage	$170.79
Rate for Payer: Group Health Inc Commercial	$81.33
Rate for Payer: Group Health Inc Medicare	$56.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.33
Rate for Payer: Hamaspik Choice Inc Medicare	$81.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.73

ZZ FOGARTY THRULUMEN/4F/80CM

Facility

$162.66

Service Code	HCPCS C1757
Hospital Charge Code	41569507
Hospital Revenue Code	278
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$170.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.33
Rate for Payer: Aetna Government	$16.33
Rate for Payer: Brighton Health Commercial	$97.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.53
Rate for Payer: EmblemHealth Commercial	$81.33
Rate for Payer: Fidelis Medicare Advantage	$170.79
Rate for Payer: Group Health Inc Commercial	$81.33
Rate for Payer: Group Health Inc Medicare	$56.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.33
Rate for Payer: Hamaspik Choice Inc Medicare	$81.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.73

ZZ FOGARTY THRULUMEN/4F/80CM

Facility

$162.66

Service Code	HCPCS C1757
Hospital Charge Code	41569507
Hospital Revenue Code	278
Min. Negotiated Rate	$81.33
Max. Negotiated Rate	$81.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.33
Rate for Payer: Hamaspik Choice Inc Medicare	$81.33

ZZ FOGARTY THRULUMEN/5F/80CM

Facility

$162.66

Service Code	HCPCS C1757
Hospital Charge Code	41569504
Hospital Revenue Code	278
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$170.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.33
Rate for Payer: Aetna Government	$16.33
Rate for Payer: Brighton Health Commercial	$97.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.53
Rate for Payer: EmblemHealth Commercial	$81.33
Rate for Payer: Fidelis Medicare Advantage	$170.79
Rate for Payer: Group Health Inc Commercial	$81.33
Rate for Payer: Group Health Inc Medicare	$56.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.33
Rate for Payer: Hamaspik Choice Inc Medicare	$81.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.73

ZZ FOGARTY THRULUMEN/5F/80CM

Facility

$162.66

Service Code	HCPCS C1757
Hospital Charge Code	41569504
Hospital Revenue Code	278
Min. Negotiated Rate	$81.33
Max. Negotiated Rate	$81.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.33
Rate for Payer: Hamaspik Choice Inc Medicare	$81.33

ZZ GADOLINIUM 10ML

Facility

$87.89

Service Code	HCPCS A9576
Hospital Charge Code	41569599
Hospital Revenue Code	255
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$70.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.47
Rate for Payer: Aetna Government	$1.47
Rate for Payer: Brighton Health Commercial	$65.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.77
Rate for Payer: Group Health Inc Commercial	$43.94
Rate for Payer: Group Health Inc Medicare	$30.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.94
Rate for Payer: Hamaspik Choice Inc Medicare	$43.94
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.49
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.58
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.58
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$57.13

ZZ GADOLINIUM 15ML

Facility

$134.66

Service Code	HCPCS A9576
Hospital Charge Code	41569598
Hospital Revenue Code	255
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$107.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.47
Rate for Payer: Aetna Government	$1.47
Rate for Payer: Brighton Health Commercial	$101.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$107.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$91.57
Rate for Payer: Group Health Inc Commercial	$67.33
Rate for Payer: Group Health Inc Medicare	$47.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.33
Rate for Payer: Hamaspik Choice Inc Medicare	$67.33
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.49
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.58
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.58
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$87.53

ZZ GADOLINIUM 20ML

Facility

$175.77

Service Code	HCPCS A9576
Hospital Charge Code	41569597
Hospital Revenue Code	255
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$140.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$96.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.47
Rate for Payer: Aetna Government	$1.47
Rate for Payer: Brighton Health Commercial	$131.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$140.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$119.52
Rate for Payer: Group Health Inc Commercial	$87.88
Rate for Payer: Group Health Inc Medicare	$61.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.88
Rate for Payer: Hamaspik Choice Inc Medicare	$87.88
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.49
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.58
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.58
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$114.25

ZZ GASTROJEJ SET/CAC

Facility

$565.11

Hospital Charge Code	41569509
Hospital Revenue Code	270
Min. Negotiated Rate	$197.79
Max. Negotiated Rate	$452.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$310.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$282.56
Rate for Payer: Aetna Government	$282.56
Rate for Payer: Brighton Health Commercial	$423.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$452.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$384.27
Rate for Payer: Group Health Inc Commercial	$282.56
Rate for Payer: Group Health Inc Medicare	$197.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$282.56
Rate for Payer: Hamaspik Choice Inc Medicare	$282.56

ZZ GASTROSTOMY PONSKY B.A.S.

Facility

$756.00

Hospital Charge Code	41567748
Hospital Revenue Code	270
Min. Negotiated Rate	$264.60
Max. Negotiated Rate	$604.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$415.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$378.00
Rate for Payer: Aetna Government	$378.00
Rate for Payer: Brighton Health Commercial	$567.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$604.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$514.08
Rate for Payer: Group Health Inc Commercial	$378.00
Rate for Payer: Group Health Inc Medicare	$264.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$378.00
Rate for Payer: Hamaspik Choice Inc Medicare	$378.00

ZZ GATEWAY PLUS Y ADAPTOR

Facility

$57.75

Hospital Charge Code	41569886
Hospital Revenue Code	270
Min. Negotiated Rate	$20.21
Max. Negotiated Rate	$46.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.88
Rate for Payer: Aetna Government	$28.88
Rate for Payer: Brighton Health Commercial	$43.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.27
Rate for Payer: Group Health Inc Commercial	$28.88
Rate for Payer: Group Health Inc Medicare	$20.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.88
Rate for Payer: Hamaspik Choice Inc Medicare	$28.88

ZZ GEL FOAM 3MM X 12MM

Facility

$10.64

Hospital Charge Code	41567331
Hospital Revenue Code	270
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$8.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.32
Rate for Payer: Aetna Government	$5.32
Rate for Payer: Brighton Health Commercial	$7.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.24
Rate for Payer: Group Health Inc Commercial	$5.32
Rate for Payer: Group Health Inc Medicare	$3.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.32
Rate for Payer: Hamaspik Choice Inc Medicare	$5.32

ZZ GENESIS T-STENT 6/80/5.4

Facility

$3,472.88

Service Code	HCPCS C1874
Hospital Charge Code	41569809
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,646.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,910.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$2,083.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,736.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,996.91
Rate for Payer: EmblemHealth Commercial	$1,736.44
Rate for Payer: Fidelis Medicare Advantage	$3,646.52
Rate for Payer: Group Health Inc Commercial	$1,736.44
Rate for Payer: Group Health Inc Medicare	$1,215.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,736.44
Rate for Payer: Hamaspik Choice Inc Medicare	$1,736.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,257.37

ZZ GENESIS T-STENT 6/80/5.4

Facility

$3,472.88

Service Code	HCPCS C1874
Hospital Charge Code	41569809
Hospital Revenue Code	278
Min. Negotiated Rate	$1,736.44
Max. Negotiated Rate	$1,736.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,736.44
Rate for Payer: Hamaspik Choice Inc Medicare	$1,736.44

ZZ GENESIS T-STENT 6/80.6.4

Facility

$3,472.88

Service Code	HCPCS C1874
Hospital Charge Code	41569810
Hospital Revenue Code	278
Min. Negotiated Rate	$1,736.44
Max. Negotiated Rate	$1,736.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,736.44
Rate for Payer: Hamaspik Choice Inc Medicare	$1,736.44

ZZ GENESIS T-STENT 6/80.6.4

Facility

$3,472.88

Service Code	HCPCS C1874
Hospital Charge Code	41569810
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,646.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,910.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$2,083.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,736.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,996.91
Rate for Payer: EmblemHealth Commercial	$1,736.44
Rate for Payer: Fidelis Medicare Advantage	$3,646.52
Rate for Payer: Group Health Inc Commercial	$1,736.44
Rate for Payer: Group Health Inc Medicare	$1,215.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,736.44
Rate for Payer: Hamaspik Choice Inc Medicare	$1,736.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,257.37

ZZ GLIDE WIRE 18-150 ANGL

Facility

$189.24

Service Code	HCPCS C1769
Hospital Charge Code	41567115
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$198.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$104.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$113.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$94.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$108.81
Rate for Payer: EmblemHealth Commercial	$94.62
Rate for Payer: Fidelis Medicare Advantage	$198.70
Rate for Payer: Group Health Inc Commercial	$94.62
Rate for Payer: Group Health Inc Medicare	$66.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.62
Rate for Payer: Hamaspik Choice Inc Medicare	$94.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$123.01

ZZ GLIDE WIRE 18-150 ANGL

Facility

$189.24

Service Code	HCPCS C1769
Hospital Charge Code	41567115
Hospital Revenue Code	278
Min. Negotiated Rate	$94.62
Max. Negotiated Rate	$94.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.62
Rate for Payer: Hamaspik Choice Inc Medicare	$94.62

ZZ GLIDE WIRE 18-180 ANGL

Facility

$189.24

Service Code	HCPCS C1769
Hospital Charge Code	41567116
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$198.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$104.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$113.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$94.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$108.81
Rate for Payer: EmblemHealth Commercial	$94.62
Rate for Payer: Fidelis Medicare Advantage	$198.70
Rate for Payer: Group Health Inc Commercial	$94.62
Rate for Payer: Group Health Inc Medicare	$66.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.62
Rate for Payer: Hamaspik Choice Inc Medicare	$94.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$123.01

ZZ GLIDE WIRE 18-180 ANGL

Facility

$189.24

Service Code	HCPCS C1769
Hospital Charge Code	41567116
Hospital Revenue Code	278
Min. Negotiated Rate	$94.62
Max. Negotiated Rate	$94.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.62
Rate for Payer: Hamaspik Choice Inc Medicare	$94.62

Know your out-of-pocket cost for care.

All Charges