St. Barnabas Hospital

All Charges

Charge

Type

Price

CC 5F JCL 3.5 SH

Facility OP

$260.00

Hospital Charge Code	66528777
Hospital Revenue Code	480
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$208.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$143.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$130.00
Rate for Payer: Aetna Government	$130.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$208.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$176.80
Rate for Payer: Group Health Inc Commercial	$130.00
Rate for Payer: Group Health Inc Medicare	$91.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.00
Rate for Payer: Hamaspik Choice Inc Medicare	$130.00

CC 5F JL 4.0

Facility OP

$260.00

Hospital Charge Code	66528774
Hospital Revenue Code	480
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$208.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$143.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$130.00
Rate for Payer: Aetna Government	$130.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$208.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$176.80
Rate for Payer: Group Health Inc Commercial	$130.00
Rate for Payer: Group Health Inc Medicare	$91.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.00
Rate for Payer: Hamaspik Choice Inc Medicare	$130.00

CC 5F JR3.5

Facility OP

$160.00

Hospital Charge Code	66528775
Hospital Revenue Code	480
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$128.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$88.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$80.00
Rate for Payer: Aetna Government	$80.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$128.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$108.80
Rate for Payer: Group Health Inc Commercial	$80.00
Rate for Payer: Group Health Inc Medicare	$56.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.00
Rate for Payer: Hamaspik Choice Inc Medicare	$80.00

CC 5F JR4.0 .058

Facility OP

$260.00

Hospital Charge Code	66528776
Hospital Revenue Code	480
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$208.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$143.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$130.00
Rate for Payer: Aetna Government	$130.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$208.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$176.80
Rate for Payer: Group Health Inc Commercial	$130.00
Rate for Payer: Group Health Inc Medicare	$91.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.00
Rate for Payer: Hamaspik Choice Inc Medicare	$130.00

CC 5F MBI .058

Facility OP

$260.00

Hospital Charge Code	66528771
Hospital Revenue Code	480
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$208.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$143.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$130.00
Rate for Payer: Aetna Government	$130.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$208.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$176.80
Rate for Payer: Group Health Inc Commercial	$130.00
Rate for Payer: Group Health Inc Medicare	$91.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.00
Rate for Payer: Hamaspik Choice Inc Medicare	$130.00

CC 5F PACEL FLOW DIR PACING CATH

Facility IP

$220.00

Service Code	HCPCS C1756
Hospital Charge Code	66526870
Hospital Revenue Code	278
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$110.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00

CC 5F PACEL FLOW DIR PACING CATH

Facility OP

$220.00

Service Code	HCPCS C1756
Hospital Charge Code	66526870
Hospital Revenue Code	278
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$231.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$121.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$172.46
Rate for Payer: Aetna Government	$172.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$110.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$126.50
Rate for Payer: Fidelis Medicare Advantage	$231.00
Rate for Payer: Group Health Inc Commercial	$110.00
Rate for Payer: Group Health Inc Medicare	$77.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$143.00

CC 5 FR AL II (100CM)

Facility OP

$217.50

Hospital Charge Code	66528820
Hospital Revenue Code	480
Min. Negotiated Rate	$76.12
Max. Negotiated Rate	$174.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$119.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$108.75
Rate for Payer: Aetna Government	$108.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$174.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$147.90
Rate for Payer: Group Health Inc Commercial	$108.75
Rate for Payer: Group Health Inc Medicare	$76.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$108.75
Rate for Payer: Hamaspik Choice Inc Medicare	$108.75

CC 5 FR AR II (100CM)

Facility OP

$217.50

Hospital Charge Code	66528843
Hospital Revenue Code	480
Min. Negotiated Rate	$76.12
Max. Negotiated Rate	$174.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$119.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$108.75
Rate for Payer: Aetna Government	$108.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$174.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$147.90
Rate for Payer: Group Health Inc Commercial	$108.75
Rate for Payer: Group Health Inc Medicare	$76.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$108.75
Rate for Payer: Hamaspik Choice Inc Medicare	$108.75

CC 5 FR AR MOD (100CM)

Facility OP

$160.00

Hospital Charge Code	66528769
Hospital Revenue Code	480
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$128.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$88.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$80.00
Rate for Payer: Aetna Government	$80.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$128.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$108.80
Rate for Payer: Group Health Inc Commercial	$80.00
Rate for Payer: Group Health Inc Medicare	$56.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.00
Rate for Payer: Hamaspik Choice Inc Medicare	$80.00

CC 5 FR FL 3.5 (100CM)

Facility OP

$217.50

Hospital Charge Code	66528819
Hospital Revenue Code	480
Min. Negotiated Rate	$76.12
Max. Negotiated Rate	$174.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$119.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$108.75
Rate for Payer: Aetna Government	$108.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$174.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$147.90
Rate for Payer: Group Health Inc Commercial	$108.75
Rate for Payer: Group Health Inc Medicare	$76.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$108.75
Rate for Payer: Hamaspik Choice Inc Medicare	$108.75

CC 5 FR LCB (100CM)

Facility OP

$217.50

Hospital Charge Code	66528822
Hospital Revenue Code	480
Min. Negotiated Rate	$76.12
Max. Negotiated Rate	$174.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$119.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$108.75
Rate for Payer: Aetna Government	$108.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$174.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$147.90
Rate for Payer: Group Health Inc Commercial	$108.75
Rate for Payer: Group Health Inc Medicare	$76.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$108.75
Rate for Payer: Hamaspik Choice Inc Medicare	$108.75

CC 5 FR MPA 1-(100CM)

Facility OP

$43.50

Hospital Charge Code	66528817
Hospital Revenue Code	480
Min. Negotiated Rate	$15.22
Max. Negotiated Rate	$34.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.75
Rate for Payer: Aetna Government	$21.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.58
Rate for Payer: Group Health Inc Commercial	$21.75
Rate for Payer: Group Health Inc Medicare	$15.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.75
Rate for Payer: Hamaspik Choice Inc Medicare	$21.75

CC 5FR PIG 145 ANG 100CM 6SH

Facility OP

$46.00

Hospital Charge Code	66528246
Hospital Revenue Code	270
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$36.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.00
Rate for Payer: Aetna Government	$23.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.28
Rate for Payer: Group Health Inc Commercial	$23.00
Rate for Payer: Group Health Inc Medicare	$16.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.00
Rate for Payer: Hamaspik Choice Inc Medicare	$23.00

CC 5 FR SUPER ARROW FLEX 24CM

Facility OP

$96.00

Hospital Charge Code	66528278
Hospital Revenue Code	480
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$76.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$48.00
Rate for Payer: Aetna Government	$48.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$76.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.28
Rate for Payer: Group Health Inc Commercial	$48.00
Rate for Payer: Group Health Inc Medicare	$33.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.00
Rate for Payer: Hamaspik Choice Inc Medicare	$48.00

CC 6 FR AR II MOD (100CM)

Facility OP

$46.50

Hospital Charge Code	66528850
Hospital Revenue Code	480
Min. Negotiated Rate	$16.28
Max. Negotiated Rate	$37.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.25
Rate for Payer: Aetna Government	$23.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.62
Rate for Payer: Group Health Inc Commercial	$23.25
Rate for Payer: Group Health Inc Medicare	$16.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.25
Rate for Payer: Hamaspik Choice Inc Medicare	$23.25

CC 6 FR AR I MOD (100CM)

Facility OP

$17.44

Hospital Charge Code	66528851
Hospital Revenue Code	480
Min. Negotiated Rate	$6.10
Max. Negotiated Rate	$13.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.72
Rate for Payer: Aetna Government	$8.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.86
Rate for Payer: Group Health Inc Commercial	$8.72
Rate for Payer: Group Health Inc Medicare	$6.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.72
Rate for Payer: Hamaspik Choice Inc Medicare	$8.72

CC 6 FR JL 3.5 (100CM)

Facility OP

$310.00

Hospital Charge Code	66528815
Hospital Revenue Code	480
Min. Negotiated Rate	$108.50
Max. Negotiated Rate	$248.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$170.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$155.00
Rate for Payer: Aetna Government	$155.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$248.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$210.80
Rate for Payer: Group Health Inc Commercial	$155.00
Rate for Payer: Group Health Inc Medicare	$108.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$155.00
Rate for Payer: Hamaspik Choice Inc Medicare	$155.00

CC 6 FR JL 4 (100CM)

Facility OP

$310.00

Hospital Charge Code	66528814
Hospital Revenue Code	480
Min. Negotiated Rate	$108.50
Max. Negotiated Rate	$248.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$170.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$155.00
Rate for Payer: Aetna Government	$155.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$248.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$210.80
Rate for Payer: Group Health Inc Commercial	$155.00
Rate for Payer: Group Health Inc Medicare	$108.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$155.00
Rate for Payer: Hamaspik Choice Inc Medicare	$155.00

CC 6FR JL 5.0 071

Facility OP

$220.00

Hospital Charge Code	66520302
Hospital Revenue Code	279
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$176.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$121.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$110.00
Rate for Payer: Aetna Government	$110.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$176.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.60
Rate for Payer: Group Health Inc Commercial	$110.00
Rate for Payer: Group Health Inc Medicare	$77.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00

CC 6 FR JR 6.0 (100CM)

Facility OP

$46.50

Hospital Charge Code	66528845
Hospital Revenue Code	480
Min. Negotiated Rate	$16.28
Max. Negotiated Rate	$37.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.25
Rate for Payer: Aetna Government	$23.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.62
Rate for Payer: Group Health Inc Commercial	$23.25
Rate for Payer: Group Health Inc Medicare	$16.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.25
Rate for Payer: Hamaspik Choice Inc Medicare	$23.25

CC 6 FR MPA 1-(100CM)

Facility OP

$17.44

Hospital Charge Code	66528847
Hospital Revenue Code	480
Min. Negotiated Rate	$6.10
Max. Negotiated Rate	$13.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.72
Rate for Payer: Aetna Government	$8.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.86
Rate for Payer: Group Health Inc Commercial	$8.72
Rate for Payer: Group Health Inc Medicare	$6.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.72
Rate for Payer: Hamaspik Choice Inc Medicare	$8.72

CC 6FR MP A-2 (100CM)

Facility OP

$17.44

Hospital Charge Code	66528848
Hospital Revenue Code	480
Min. Negotiated Rate	$6.10
Max. Negotiated Rate	$13.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.72
Rate for Payer: Aetna Government	$8.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.86
Rate for Payer: Group Health Inc Commercial	$8.72
Rate for Payer: Group Health Inc Medicare	$6.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.72
Rate for Payer: Hamaspik Choice Inc Medicare	$8.72

CC 6 FR MP B-2 (100CM)

Facility OP

$46.50

Hospital Charge Code	66528849
Hospital Revenue Code	480
Min. Negotiated Rate	$16.28
Max. Negotiated Rate	$37.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.25
Rate for Payer: Aetna Government	$23.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.62
Rate for Payer: Group Health Inc Commercial	$23.25
Rate for Payer: Group Health Inc Medicare	$16.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.25
Rate for Payer: Hamaspik Choice Inc Medicare	$23.25

CC 6 FR PIG 145 ANG 110CM 6SH

Facility OP

$18.50

Hospital Charge Code	66528244
Hospital Revenue Code	270
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$14.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.25
Rate for Payer: Aetna Government	$9.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.58
Rate for Payer: Group Health Inc Commercial	$9.25
Rate for Payer: Group Health Inc Medicare	$6.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.25
Rate for Payer: Hamaspik Choice Inc Medicare	$9.25

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