St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BOS.SCI. 5FR IMAGER

Facility

$126.00

Service Code	HCPCS C1887
Hospital Charge Code	40208128
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$132.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$69.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Brighton Health Commercial	$75.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$63.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$72.45
Rate for Payer: EmblemHealth Commercial	$63.00
Rate for Payer: Fidelis Medicare Advantage	$132.30
Rate for Payer: Group Health Inc Commercial	$63.00
Rate for Payer: Group Health Inc Medicare	$44.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.00
Rate for Payer: Hamaspik Choice Inc Medicare	$63.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$81.90

BOSTN SCIENTFC SENSR .035INX150CM

Facility

$895.00

Service Code	HCPCS C1769
Hospital Charge Code	40201551
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$939.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$492.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$537.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$447.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$514.62
Rate for Payer: EmblemHealth Commercial	$447.50
Rate for Payer: Fidelis Medicare Advantage	$939.75
Rate for Payer: Group Health Inc Commercial	$447.50
Rate for Payer: Group Health Inc Medicare	$313.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$447.50
Rate for Payer: Hamaspik Choice Inc Medicare	$447.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$581.75

BOSTN SCIENTFC SENSR .035INX150CM

Facility

$895.00

Service Code	HCPCS C1769
Hospital Charge Code	40201551
Hospital Revenue Code	278
Min. Negotiated Rate	$447.50
Max. Negotiated Rate	$447.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$447.50
Rate for Payer: Hamaspik Choice Inc Medicare	$447.50

BOSTN SCI FLEX 365 YAGX100W X2.6M

Facility

$356.39

Service Code	HCPCS C1713
Hospital Charge Code	40201536
Hospital Revenue Code	278
Min. Negotiated Rate	$178.20
Max. Negotiated Rate	$178.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$178.20
Rate for Payer: Hamaspik Choice Inc Medicare	$178.20

BOSTN SCI FLEX 365 YAGX100W X2.6M

Facility

$356.39

Service Code	HCPCS C1713
Hospital Charge Code	40201536
Hospital Revenue Code	278
Min. Negotiated Rate	$124.74
Max. Negotiated Rate	$374.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$196.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$213.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$178.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$204.92
Rate for Payer: EmblemHealth Commercial	$178.20
Rate for Payer: Fidelis Medicare Advantage	$374.21
Rate for Payer: Group Health Inc Commercial	$178.20
Rate for Payer: Group Health Inc Medicare	$124.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$178.20
Rate for Payer: Hamaspik Choice Inc Medicare	$178.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$231.65

BOSTN SCI SENOR 1.67MMX26CM POLAS

Facility

$152.25

Service Code	HCPCS C2617
Hospital Charge Code	40206329
Hospital Revenue Code	278
Min. Negotiated Rate	$76.12
Max. Negotiated Rate	$76.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.12
Rate for Payer: Hamaspik Choice Inc Medicare	$76.12

BOSTN SCI SENOR 1.67MMX26CM POLAS

Facility

$152.25

Service Code	HCPCS C2617
Hospital Charge Code	40206329
Hospital Revenue Code	278
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$159.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$83.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.14
Rate for Payer: Aetna Government	$10.14
Rate for Payer: Brighton Health Commercial	$91.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$76.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$87.54
Rate for Payer: EmblemHealth Commercial	$76.12
Rate for Payer: Fidelis Medicare Advantage	$159.86
Rate for Payer: Group Health Inc Commercial	$76.12
Rate for Payer: Group Health Inc Medicare	$53.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.12
Rate for Payer: Hamaspik Choice Inc Medicare	$76.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$98.96

BOSTN SCI SENSOR .038IN X 150CM

Facility

$48.78

Service Code	HCPCS C1769
Hospital Charge Code	40201539
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$51.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$29.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.05
Rate for Payer: EmblemHealth Commercial	$24.39
Rate for Payer: Fidelis Medicare Advantage	$51.22
Rate for Payer: Group Health Inc Commercial	$24.39
Rate for Payer: Group Health Inc Medicare	$17.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.39
Rate for Payer: Hamaspik Choice Inc Medicare	$24.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.71

BOSTN SCI SENSOR .038IN X 150CM

Facility

$48.78

Service Code	HCPCS C1769
Hospital Charge Code	40201539
Hospital Revenue Code	278
Min. Negotiated Rate	$24.39
Max. Negotiated Rate	$24.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.39
Rate for Payer: Hamaspik Choice Inc Medicare	$24.39

BOSTN SCI WALLFLX DUODEL STENT

Facility

$6,066.30

Service Code	HCPCS C1874
Hospital Charge Code	40002156
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$6,369.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,336.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$3,639.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,033.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,488.12
Rate for Payer: EmblemHealth Commercial	$3,033.15
Rate for Payer: Fidelis Medicare Advantage	$6,369.62
Rate for Payer: Group Health Inc Commercial	$3,033.15
Rate for Payer: Group Health Inc Medicare	$2,123.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,033.15
Rate for Payer: Hamaspik Choice Inc Medicare	$3,033.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,943.10

BOSTN SCI WALLFLX DUODEL STENT

Facility

$6,066.30

Service Code	HCPCS C1874
Hospital Charge Code	40002156
Hospital Revenue Code	278
Min. Negotiated Rate	$3,033.15
Max. Negotiated Rate	$3,033.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,033.15
Rate for Payer: Hamaspik Choice Inc Medicare	$3,033.15

BOSTN SCI WALLFLX ESOPHE STENT

Facility

$2,863.16

Service Code	HCPCS C1874
Hospital Charge Code	40001459
Hospital Revenue Code	278
Min. Negotiated Rate	$1,431.58
Max. Negotiated Rate	$1,431.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,431.58
Rate for Payer: Hamaspik Choice Inc Medicare	$1,431.58

BOSTN SCI WALLFLX ESOPHE STENT

Facility

$2,863.16

Service Code	HCPCS C1874
Hospital Charge Code	40001459
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,006.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,574.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$1,717.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,431.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,646.32
Rate for Payer: EmblemHealth Commercial	$1,431.58
Rate for Payer: Fidelis Medicare Advantage	$3,006.32
Rate for Payer: Group Health Inc Commercial	$1,431.58
Rate for Payer: Group Health Inc Medicare	$1,002.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,431.58
Rate for Payer: Hamaspik Choice Inc Medicare	$1,431.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,861.05

BOSTON 10X54 DUAL LUMEN CATH

Facility

$157.62

Service Code	HCPCS C1758
Hospital Charge Code	40008292
Hospital Revenue Code	272
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$126.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.97
Rate for Payer: Aetna Government	$2.97
Rate for Payer: Brighton Health Commercial	$118.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$126.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$107.18
Rate for Payer: Group Health Inc Commercial	$78.81
Rate for Payer: Group Health Inc Medicare	$55.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.81
Rate for Payer: Hamaspik Choice Inc Medicare	$78.81

BOSTON POL ULTRA 6F 2.0MMX26CM

Facility

$324.52

Service Code	HCPCS C1758
Hospital Charge Code	40008273
Hospital Revenue Code	272
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$259.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$178.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.97
Rate for Payer: Aetna Government	$2.97
Rate for Payer: Brighton Health Commercial	$243.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$259.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$220.67
Rate for Payer: Group Health Inc Commercial	$162.26
Rate for Payer: Group Health Inc Medicare	$113.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.26
Rate for Payer: Hamaspik Choice Inc Medicare	$162.26

BOSTON SCI ACCOLADE DR MODEL L301

Facility

$12,900.00

Service Code	HCPCS C1785
Hospital Charge Code	66572893
Hospital Revenue Code	275
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$13,545.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7,095.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.42
Rate for Payer: Aetna Government	$275.42
Rate for Payer: Brighton Health Commercial	$7,740.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,450.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,417.50
Rate for Payer: EmblemHealth Commercial	$6,450.00
Rate for Payer: Fidelis Medicare Advantage	$13,545.00
Rate for Payer: Group Health Inc Commercial	$6,450.00
Rate for Payer: Group Health Inc Medicare	$4,515.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,450.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,385.00

BOSTON SCI ACCOLADE PACEMAKE L331

Facility

$12,000.00

Service Code	HCPCS C1785
Hospital Charge Code	66576694
Hospital Revenue Code	275
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$12,600.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,600.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.42
Rate for Payer: Aetna Government	$275.42
Rate for Payer: Brighton Health Commercial	$7,200.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,900.00
Rate for Payer: EmblemHealth Commercial	$6,000.00
Rate for Payer: Fidelis Medicare Advantage	$12,600.00
Rate for Payer: Group Health Inc Commercial	$6,000.00
Rate for Payer: Group Health Inc Medicare	$4,200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,800.00

BOSTON SCI ACCOLAD MRI EL DR L331

Facility

$10,250.00

Service Code	HCPCS C1785
Hospital Charge Code	66573168
Hospital Revenue Code	275
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$10,762.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,637.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.42
Rate for Payer: Aetna Government	$275.42
Rate for Payer: Brighton Health Commercial	$6,150.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,893.75
Rate for Payer: EmblemHealth Commercial	$5,125.00
Rate for Payer: Fidelis Medicare Advantage	$10,762.50
Rate for Payer: Group Health Inc Commercial	$5,125.00
Rate for Payer: Group Health Inc Medicare	$3,587.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,662.50

BOSTON SCI. AUTOTOME CAN. DEVICE

Facility

$554.00

Hospital Charge Code	40009344
Hospital Revenue Code	272
Min. Negotiated Rate	$193.90
Max. Negotiated Rate	$443.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$304.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$277.00
Rate for Payer: Aetna Government	$277.00
Rate for Payer: Brighton Health Commercial	$415.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$443.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$376.72
Rate for Payer: Group Health Inc Commercial	$277.00
Rate for Payer: Group Health Inc Medicare	$193.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$277.00
Rate for Payer: Hamaspik Choice Inc Medicare	$277.00

BOSTON SCI. AUTOTOME CAN. DEVICE

Facility

$554.00

Hospital Charge Code	40203361
Hospital Revenue Code	272
Min. Negotiated Rate	$193.90
Max. Negotiated Rate	$443.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$304.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$277.00
Rate for Payer: Aetna Government	$277.00
Rate for Payer: Brighton Health Commercial	$415.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$443.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$376.72
Rate for Payer: Group Health Inc Commercial	$277.00
Rate for Payer: Group Health Inc Medicare	$193.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$277.00
Rate for Payer: Hamaspik Choice Inc Medicare	$277.00

BOSTON SCI. CATH. BALLOON 18FR

Facility

$463.32

Service Code	HCPCS C1725
Hospital Charge Code	40203375
Hospital Revenue Code	272
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$370.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$254.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$347.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$370.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$315.06
Rate for Payer: Group Health Inc Commercial	$231.66
Rate for Payer: Group Health Inc Medicare	$162.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$231.66
Rate for Payer: Hamaspik Choice Inc Medicare	$231.66

BOSTON SCI. CATH. BALLOON 18FR

Facility

$463.32

Hospital Charge Code	40009359
Hospital Revenue Code	272
Min. Negotiated Rate	$162.16
Max. Negotiated Rate	$370.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$254.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$231.66
Rate for Payer: Aetna Government	$231.66
Rate for Payer: Brighton Health Commercial	$347.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$370.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$315.06
Rate for Payer: Group Health Inc Commercial	$231.66
Rate for Payer: Group Health Inc Medicare	$162.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$231.66
Rate for Payer: Hamaspik Choice Inc Medicare	$231.66

BOSTON SCI. CATH HEMASTASIS GOLD

Facility

$363.12

Hospital Charge Code	40203364
Hospital Revenue Code	272
Min. Negotiated Rate	$127.09
Max. Negotiated Rate	$290.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$199.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$181.56
Rate for Payer: Aetna Government	$181.56
Rate for Payer: Brighton Health Commercial	$272.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$290.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$246.92
Rate for Payer: Group Health Inc Commercial	$181.56
Rate for Payer: Group Health Inc Medicare	$127.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$181.56
Rate for Payer: Hamaspik Choice Inc Medicare	$181.56

BOSTON SCI.CATH HEMASTASIS GOLD

Facility

$363.12

Hospital Charge Code	40009347
Hospital Revenue Code	272
Min. Negotiated Rate	$127.09
Max. Negotiated Rate	$290.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$199.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$181.56
Rate for Payer: Aetna Government	$181.56
Rate for Payer: Brighton Health Commercial	$272.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$290.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$246.92
Rate for Payer: Group Health Inc Commercial	$181.56
Rate for Payer: Group Health Inc Medicare	$127.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$181.56
Rate for Payer: Hamaspik Choice Inc Medicare	$181.56

BOSTON SCI DYNAGEN EL VR ICD D150

Facility

$40,500.00

Service Code	HCPCS C1722
Hospital Charge Code	66572894
Hospital Revenue Code	275
Min. Negotiated Rate	$3,988.80
Max. Negotiated Rate	$42,525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22,275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,988.80
Rate for Payer: Aetna Government	$3,988.80
Rate for Payer: Brighton Health Commercial	$24,300.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$23,287.50
Rate for Payer: EmblemHealth Commercial	$20,250.00
Rate for Payer: Fidelis Medicare Advantage	$42,525.00
Rate for Payer: Group Health Inc Commercial	$20,250.00
Rate for Payer: Group Health Inc Medicare	$14,175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$20,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26,325.00

Know your out-of-pocket cost for care.

All Charges