St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZZ STENT/PALMAZ/PREMOUNT/P2007

Facility

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569236
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/P2007

Facility

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569236
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/P2905

Facility

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569237
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/P2905

Facility

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569237
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/P2906

Facility

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569238
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/P2906

Facility

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569238
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/P2907

Facility

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569239
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/P2907

Facility

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569239
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/P2908

Facility

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569240
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/P2908

Facility

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569240
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/P3008

Facility

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569232
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/P3008

Facility

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569232
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/P3907

Facility

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569241
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/P3907

Facility

$2,158.15

Service Code	HCPCS C1876
Hospital Charge Code	41569241
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/PALMEZ/NONMOUNT/P204M

Facility

$1,743.53

Service Code	HCPCS C1876
Hospital Charge Code	41569228
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/PALMEZ/NONMOUNT/P204M

Facility

$1,743.53

Service Code	HCPCS C1876
Hospital Charge Code	41569228
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/SYMPHOMY/10MM*40MM

Facility

$2,479.21

Service Code	HCPCS C1876
Hospital Charge Code	41569243
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,603.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,363.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,487.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,239.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,425.55
Rate for Payer: EmblemHealth Commercial	$1,239.60
Rate for Payer: Fidelis Medicare Advantage	$2,603.17
Rate for Payer: Group Health Inc Commercial	$1,239.60
Rate for Payer: Group Health Inc Medicare	$867.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,239.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,239.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,611.49

ZZ STENT/SYMPHOMY/10MM*40MM

Facility

$2,479.21

Service Code	HCPCS C1876
Hospital Charge Code	41569243
Hospital Revenue Code	278
Min. Negotiated Rate	$1,239.60
Max. Negotiated Rate	$1,239.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,239.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,239.60

ZZ STENT/SYMPHOMY/6MM*40MM

Facility

$2,479.21

Service Code	HCPCS C1876
Hospital Charge Code	41569245
Hospital Revenue Code	278
Min. Negotiated Rate	$1,239.60
Max. Negotiated Rate	$1,239.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,239.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,239.60

ZZ STENT/SYMPHOMY/6MM*40MM

Facility

$2,479.21

Service Code	HCPCS C1876
Hospital Charge Code	41569245
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,603.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,363.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,487.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,239.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,425.55
Rate for Payer: EmblemHealth Commercial	$1,239.60
Rate for Payer: Fidelis Medicare Advantage	$2,603.17
Rate for Payer: Group Health Inc Commercial	$1,239.60
Rate for Payer: Group Health Inc Medicare	$867.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,239.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,239.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,611.49

ZZ STENT/SYMPHOMY/7MM*40MM

Facility

$2,479.21

Service Code	HCPCS C1876
Hospital Charge Code	41569246
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,603.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,363.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,487.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,239.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,425.55
Rate for Payer: EmblemHealth Commercial	$1,239.60
Rate for Payer: Fidelis Medicare Advantage	$2,603.17
Rate for Payer: Group Health Inc Commercial	$1,239.60
Rate for Payer: Group Health Inc Medicare	$867.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,239.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,239.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,611.49

ZZ STENT/SYMPHOMY/7MM*40MM

Facility

$2,479.21

Service Code	HCPCS C1876
Hospital Charge Code	41569246
Hospital Revenue Code	278
Min. Negotiated Rate	$1,239.60
Max. Negotiated Rate	$1,239.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,239.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,239.60

ZZ STENT/SYMPHOMY/8*23/7F/75CM

Facility

$2,479.21

Service Code	HCPCS C1876
Hospital Charge Code	41569248
Hospital Revenue Code	278
Min. Negotiated Rate	$1,239.60
Max. Negotiated Rate	$1,239.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,239.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,239.60

ZZ STENT/SYMPHOMY/8*23/7F/75CM

Facility

$2,479.21

Service Code	HCPCS C1876
Hospital Charge Code	41569248
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,603.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,363.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,487.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,239.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,425.55
Rate for Payer: EmblemHealth Commercial	$1,239.60
Rate for Payer: Fidelis Medicare Advantage	$2,603.17
Rate for Payer: Group Health Inc Commercial	$1,239.60
Rate for Payer: Group Health Inc Medicare	$867.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,239.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,239.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,611.49

ZZ STENT/SYMPHOMY/8MM*60MM

Facility

$2,479.21

Service Code	HCPCS C1876
Hospital Charge Code	41569247
Hospital Revenue Code	278
Min. Negotiated Rate	$1,239.60
Max. Negotiated Rate	$1,239.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,239.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,239.60

Know your out-of-pocket cost for care.

All Charges