St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZZ STANDARD COILS 35 5 5

Facility

$117.30

Service Code	HCPCS C1884
Hospital Charge Code	41567139
Hospital Revenue Code	278
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$58.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.65
Rate for Payer: Hamaspik Choice Inc Medicare	$58.65

ZZ STANDARD COILS 35 5 5

Facility

$117.30

Service Code	HCPCS C1884
Hospital Charge Code	41567139
Hospital Revenue Code	278
Min. Negotiated Rate	$41.06
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$70.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$67.45
Rate for Payer: EmblemHealth Commercial	$58.65
Rate for Payer: Fidelis Medicare Advantage	$123.16
Rate for Payer: Group Health Inc Commercial	$58.65
Rate for Payer: Group Health Inc Medicare	$41.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.65
Rate for Payer: Hamaspik Choice Inc Medicare	$58.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$76.24

ZZ STANDARD COILS 35 5 8

Facility

$117.30

Service Code	HCPCS C1884
Hospital Charge Code	41567140
Hospital Revenue Code	278
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$58.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.65
Rate for Payer: Hamaspik Choice Inc Medicare	$58.65

ZZ STANDARD COILS 35 5 8

Facility

$117.30

Service Code	HCPCS C1884
Hospital Charge Code	41567140
Hospital Revenue Code	278
Min. Negotiated Rate	$41.06
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$70.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$67.45
Rate for Payer: EmblemHealth Commercial	$58.65
Rate for Payer: Fidelis Medicare Advantage	$123.16
Rate for Payer: Group Health Inc Commercial	$58.65
Rate for Payer: Group Health Inc Medicare	$41.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.65
Rate for Payer: Hamaspik Choice Inc Medicare	$58.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$76.24

ZZ STANDARD CONN. TUBING

Facility

$33.82

Hospital Charge Code	41567501
Hospital Revenue Code	270
Min. Negotiated Rate	$11.84
Max. Negotiated Rate	$27.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.91
Rate for Payer: Aetna Government	$16.91
Rate for Payer: Brighton Health Commercial	$25.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.00
Rate for Payer: Group Health Inc Commercial	$16.91
Rate for Payer: Group Health Inc Medicare	$11.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.91
Rate for Payer: Hamaspik Choice Inc Medicare	$16.91

ZZ STAT LOCK UNIV PLUS

Facility

$28.35

Hospital Charge Code	41569566
Hospital Revenue Code	270
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$22.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.18
Rate for Payer: Aetna Government	$14.18
Rate for Payer: Brighton Health Commercial	$21.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.28
Rate for Payer: Group Health Inc Commercial	$14.18
Rate for Payer: Group Health Inc Medicare	$9.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.18
Rate for Payer: Hamaspik Choice Inc Medicare	$14.18

ZZ STAY FIX

Facility

$19.50

Hospital Charge Code	41561916
Hospital Revenue Code	270
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$15.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.75
Rate for Payer: Aetna Government	$9.75
Rate for Payer: Brighton Health Commercial	$14.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.26
Rate for Payer: Group Health Inc Commercial	$9.75
Rate for Payer: Group Health Inc Medicare	$6.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.75
Rate for Payer: Hamaspik Choice Inc Medicare	$9.75

ZZ ST CATH W/NO SIDE PT 100

Facility

$48.91

Service Code	HCPCS C1725
Hospital Charge Code	41567188
Hospital Revenue Code	278
Min. Negotiated Rate	$24.46
Max. Negotiated Rate	$24.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.46
Rate for Payer: Hamaspik Choice Inc Medicare	$24.46

ZZ ST CATH W/NO SIDE PT 100

Facility

$48.91

Service Code	HCPCS C1725
Hospital Charge Code	41567188
Hospital Revenue Code	278
Min. Negotiated Rate	$17.12
Max. Negotiated Rate	$51.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$29.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.12
Rate for Payer: EmblemHealth Commercial	$24.46
Rate for Payer: Fidelis Medicare Advantage	$51.36
Rate for Payer: Group Health Inc Commercial	$24.46
Rate for Payer: Group Health Inc Medicare	$17.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.46
Rate for Payer: Hamaspik Choice Inc Medicare	$24.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.79

ZZ ST CATH W/NO SIDE PT 80

Facility

$48.91

Service Code	HCPCS C1725
Hospital Charge Code	41567189
Hospital Revenue Code	278
Min. Negotiated Rate	$17.12
Max. Negotiated Rate	$51.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$29.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.12
Rate for Payer: EmblemHealth Commercial	$24.46
Rate for Payer: Fidelis Medicare Advantage	$51.36
Rate for Payer: Group Health Inc Commercial	$24.46
Rate for Payer: Group Health Inc Medicare	$17.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.46
Rate for Payer: Hamaspik Choice Inc Medicare	$24.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.79

ZZ ST CATH W/NO SIDE PT 80

Facility

$48.91

Service Code	HCPCS C1725
Hospital Charge Code	41567189
Hospital Revenue Code	278
Min. Negotiated Rate	$24.46
Max. Negotiated Rate	$24.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.46
Rate for Payer: Hamaspik Choice Inc Medicare	$24.46

ZZ STENT/PALMAZ/NONMOUNT/P154

Facility

$1,743.53

Service Code	HCPCS C1876
Hospital Charge Code	41569227
Hospital Revenue Code	278
Min. Negotiated Rate	$871.76
Max. Negotiated Rate	$871.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$871.76
Rate for Payer: Hamaspik Choice Inc Medicare	$871.76

ZZ STENT/PALMAZ/NONMOUNT/P154

Facility

$1,743.53

Service Code	HCPCS C1876
Hospital Charge Code	41569227
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$1,830.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$958.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,046.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$871.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,002.53
Rate for Payer: EmblemHealth Commercial	$871.76
Rate for Payer: Fidelis Medicare Advantage	$1,830.71
Rate for Payer: Group Health Inc Commercial	$871.76
Rate for Payer: Group Health Inc Medicare	$610.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$871.76
Rate for Payer: Hamaspik Choice Inc Medicare	$871.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,133.29

ZZ STENT/PALMAZ/NONMOUNT/P294M

Facility

$1,743.53

Service Code	HCPCS C1876
Hospital Charge Code	41569229
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$1,830.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$958.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,046.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$871.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,002.53
Rate for Payer: EmblemHealth Commercial	$871.76
Rate for Payer: Fidelis Medicare Advantage	$1,830.71
Rate for Payer: Group Health Inc Commercial	$871.76
Rate for Payer: Group Health Inc Medicare	$610.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$871.76
Rate for Payer: Hamaspik Choice Inc Medicare	$871.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,133.29

ZZ STENT/PALMAZ/NONMOUNT/P294M

Facility

$1,743.53

Service Code	HCPCS C1876
Hospital Charge Code	41569229
Hospital Revenue Code	278
Min. Negotiated Rate	$871.76
Max. Negotiated Rate	$871.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$871.76
Rate for Payer: Hamaspik Choice Inc Medicare	$871.76

ZZ STENT/PALMAZ/NONMOUNT/P308M

Facility

$1,743.53

Service Code	HCPCS C1876
Hospital Charge Code	41569230
Hospital Revenue Code	278
Min. Negotiated Rate	$871.76
Max. Negotiated Rate	$871.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$871.76
Rate for Payer: Hamaspik Choice Inc Medicare	$871.76

ZZ STENT/PALMAZ/NONMOUNT/P308M

Facility

$1,743.53

Service Code	HCPCS C1876
Hospital Charge Code	41569230
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$1,830.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$958.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,046.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$871.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,002.53
Rate for Payer: EmblemHealth Commercial	$871.76
Rate for Payer: Fidelis Medicare Advantage	$1,830.71
Rate for Payer: Group Health Inc Commercial	$871.76
Rate for Payer: Group Health Inc Medicare	$610.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$871.76
Rate for Payer: Hamaspik Choice Inc Medicare	$871.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,133.29

ZZ STENT/PALMAZ/NONMOUNT/P394M

Facility

$1,743.53

Service Code	HCPCS C1876
Hospital Charge Code	41569231
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$1,830.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$958.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,046.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$871.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,002.53
Rate for Payer: EmblemHealth Commercial	$871.76
Rate for Payer: Fidelis Medicare Advantage	$1,830.71
Rate for Payer: Group Health Inc Commercial	$871.76
Rate for Payer: Group Health Inc Medicare	$610.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$871.76
Rate for Payer: Hamaspik Choice Inc Medicare	$871.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,133.29

ZZ STENT/PALMAZ/NONMOUNT/P394M

Facility

$1,743.53

Service Code	HCPCS C1876
Hospital Charge Code	41569231
Hospital Revenue Code	278
Min. Negotiated Rate	$871.76
Max. Negotiated Rate	$871.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$871.76
Rate for Payer: Hamaspik Choice Inc Medicare	$871.76

ZZ STENT/PALMAZ/PREMOUNT/P1505

Facility

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569233
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,266.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,186.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,294.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,079.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,240.94
Rate for Payer: EmblemHealth Commercial	$1,079.08
Rate for Payer: Fidelis Medicare Advantage	$2,266.06
Rate for Payer: Group Health Inc Commercial	$1,079.08
Rate for Payer: Group Health Inc Medicare	$755.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,402.80

ZZ STENT/PALMAZ/PREMOUNT/P1505

Facility

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569233
Hospital Revenue Code	278
Min. Negotiated Rate	$1,079.08
Max. Negotiated Rate	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.08

ZZ STENT/PALMAZ/PREMOUNT/P1506

Facility

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569234
Hospital Revenue Code	278
Min. Negotiated Rate	$1,079.08
Max. Negotiated Rate	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.08

ZZ STENT/PALMAZ/PREMOUNT/P1506

Facility

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569234
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,266.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,186.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,294.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,079.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,240.94
Rate for Payer: EmblemHealth Commercial	$1,079.08
Rate for Payer: Fidelis Medicare Advantage	$2,266.06
Rate for Payer: Group Health Inc Commercial	$1,079.08
Rate for Payer: Group Health Inc Medicare	$755.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,402.80

ZZ STENT/PALMAZ/PREMOUNT/P2006

Facility

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569235
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,266.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,186.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,294.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,079.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,240.94
Rate for Payer: EmblemHealth Commercial	$1,079.08
Rate for Payer: Fidelis Medicare Advantage	$2,266.06
Rate for Payer: Group Health Inc Commercial	$1,079.08
Rate for Payer: Group Health Inc Medicare	$755.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,402.80

ZZ STENT/PALMAZ/PREMOUNT/P2006

Facility

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569235
Hospital Revenue Code	278
Min. Negotiated Rate	$1,079.08
Max. Negotiated Rate	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1,079.08

Know your out-of-pocket cost for care.

All Charges