St. Barnabas Hospital

All Charges

Charge

Type

Price

CC B.S. 035 TER STR STIFF 150CM

Facility OP

$97.15

Service Code	HCPCS C1769
Hospital Charge Code	66528324
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$102.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.86
Rate for Payer: Fidelis Medicare Advantage	$102.01
Rate for Payer: Group Health Inc Commercial	$48.58
Rate for Payer: Group Health Inc Medicare	$34.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.58
Rate for Payer: Hamaspik Choice Inc Medicare	$48.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$63.15

CC B.S. .035 TER STR STIFF 260CM

Facility IP

$106.66

Service Code	HCPCS C1769
Hospital Charge Code	66528325
Hospital Revenue Code	278
Min. Negotiated Rate	$53.33
Max. Negotiated Rate	$53.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.33
Rate for Payer: Hamaspik Choice Inc Medicare	$53.33

CC B.S. .035 TER STR STIFF 260CM

Facility OP

$106.66

Service Code	HCPCS C1769
Hospital Charge Code	66528325
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$111.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$53.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$61.33
Rate for Payer: Fidelis Medicare Advantage	$111.99
Rate for Payer: Group Health Inc Commercial	$53.33
Rate for Payer: Group Health Inc Medicare	$37.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.33
Rate for Payer: Hamaspik Choice Inc Medicare	$53.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$69.33

CC B.S. .038 TER STR STIFF 150CM

Facility OP

$97.16

Service Code	HCPCS C1769
Hospital Charge Code	66528429
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$102.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.87
Rate for Payer: Fidelis Medicare Advantage	$102.02
Rate for Payer: Group Health Inc Commercial	$48.58
Rate for Payer: Group Health Inc Medicare	$34.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.58
Rate for Payer: Hamaspik Choice Inc Medicare	$48.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$63.15

CC B.S. .038 TER STR STIFF 150CM

Facility IP

$97.16

Service Code	HCPCS C1769
Hospital Charge Code	66528429
Hospital Revenue Code	278
Min. Negotiated Rate	$48.58
Max. Negotiated Rate	$48.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.58
Rate for Payer: Hamaspik Choice Inc Medicare	$48.58

CC B.S. .038 TERUMO ANG 150CM

Facility OP

$63.36

Service Code	HCPCS C1769
Hospital Charge Code	66528326
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$66.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$36.43
Rate for Payer: Fidelis Medicare Advantage	$66.53
Rate for Payer: Group Health Inc Commercial	$31.68
Rate for Payer: Group Health Inc Medicare	$22.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.68
Rate for Payer: Hamaspik Choice Inc Medicare	$31.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$41.18

CC B.S. .038 TERUMO ANG 150CM

Facility IP

$63.36

Service Code	HCPCS C1769
Hospital Charge Code	66528326
Hospital Revenue Code	278
Min. Negotiated Rate	$31.68
Max. Negotiated Rate	$31.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.68
Rate for Payer: Hamaspik Choice Inc Medicare	$31.68

CC B.S. .038 TERUMO ANG STIFF 180

Facility OP

$101.03

Hospital Charge Code	66528327
Hospital Revenue Code	480
Min. Negotiated Rate	$35.36
Max. Negotiated Rate	$80.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.52
Rate for Payer: Aetna Government	$50.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.70
Rate for Payer: Group Health Inc Commercial	$50.52
Rate for Payer: Group Health Inc Medicare	$35.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.52
Rate for Payer: Hamaspik Choice Inc Medicare	$50.52

CC B.S. .038 TERUMO STR 150CM

Facility IP

$86.94

Service Code	HCPCS C1769
Hospital Charge Code	66528328
Hospital Revenue Code	278
Min. Negotiated Rate	$43.47
Max. Negotiated Rate	$43.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.47
Rate for Payer: Hamaspik Choice Inc Medicare	$43.47

CC B.S. .038 TERUMO STR 150CM

Facility OP

$86.94

Service Code	HCPCS C1769
Hospital Charge Code	66528328
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$91.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$43.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.99
Rate for Payer: Fidelis Medicare Advantage	$91.29
Rate for Payer: Group Health Inc Commercial	$43.47
Rate for Payer: Group Health Inc Medicare	$30.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.47
Rate for Payer: Hamaspik Choice Inc Medicare	$43.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$56.51

CC B.S. .038 TERUMO STR 180CM

Facility IP

$85.89

Service Code	HCPCS C1769
Hospital Charge Code	66528329
Hospital Revenue Code	278
Min. Negotiated Rate	$42.94
Max. Negotiated Rate	$42.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.94
Rate for Payer: Hamaspik Choice Inc Medicare	$42.94

CC B.S. .038 TERUMO STR 180CM

Facility OP

$85.89

Service Code	HCPCS C1769
Hospital Charge Code	66528329
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$90.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$42.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.39
Rate for Payer: Fidelis Medicare Advantage	$90.18
Rate for Payer: Group Health Inc Commercial	$42.94
Rate for Payer: Group Health Inc Medicare	$30.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.94
Rate for Payer: Hamaspik Choice Inc Medicare	$42.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$55.83

CC B.S. 038 X 260CM AMP SUPER STF

Facility IP

$86.94

Service Code	HCPCS C1769
Hospital Charge Code	66528330
Hospital Revenue Code	278
Min. Negotiated Rate	$43.47
Max. Negotiated Rate	$43.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.47
Rate for Payer: Hamaspik Choice Inc Medicare	$43.47

CC B.S. 038 X 260CM AMP SUPER STF

Facility OP

$86.94

Service Code	HCPCS C1769
Hospital Charge Code	66528330
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$91.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$43.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.99
Rate for Payer: Fidelis Medicare Advantage	$91.29
Rate for Payer: Group Health Inc Commercial	$43.47
Rate for Payer: Group Health Inc Medicare	$30.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.47
Rate for Payer: Hamaspik Choice Inc Medicare	$43.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$56.51

CC BS.038ZIP HYDR G STD STR180CM

Facility OP

$85.88

Hospital Charge Code	66528831
Hospital Revenue Code	480
Min. Negotiated Rate	$30.06
Max. Negotiated Rate	$68.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.94
Rate for Payer: Aetna Government	$42.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$68.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.40
Rate for Payer: Group Health Inc Commercial	$42.94
Rate for Payer: Group Health Inc Medicare	$30.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.94
Rate for Payer: Hamaspik Choice Inc Medicare	$42.94

CC BS .038 ZIP HYDRO GUIDE 150STF

Facility IP

$429.44

Service Code	HCPCS C1769
Hospital Charge Code	66520259
Hospital Revenue Code	278
Min. Negotiated Rate	$214.72
Max. Negotiated Rate	$214.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$214.72
Rate for Payer: Hamaspik Choice Inc Medicare	$214.72

CC BS .038 ZIP HYDRO GUIDE 150STF

Facility OP

$429.44

Service Code	HCPCS C1769
Hospital Charge Code	66520259
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$450.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$236.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$214.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$246.93
Rate for Payer: Fidelis Medicare Advantage	$450.91
Rate for Payer: Group Health Inc Commercial	$214.72
Rate for Payer: Group Health Inc Medicare	$150.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$214.72
Rate for Payer: Hamaspik Choice Inc Medicare	$214.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$279.14

CC BS.38ZIPWIRE HYDRO GW 150STR

Facility IP

$493.10

Service Code	HCPCS C1769
Hospital Charge Code	66520260
Hospital Revenue Code	278
Min. Negotiated Rate	$246.55
Max. Negotiated Rate	$246.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$246.55
Rate for Payer: Hamaspik Choice Inc Medicare	$246.55

CC BS.38ZIPWIRE HYDRO GW 150STR

Facility OP

$493.10

Service Code	HCPCS C1769
Hospital Charge Code	66520260
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$517.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$271.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$246.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$283.53
Rate for Payer: Fidelis Medicare Advantage	$517.76
Rate for Payer: Group Health Inc Commercial	$246.55
Rate for Payer: Group Health Inc Medicare	$172.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$246.55
Rate for Payer: Hamaspik Choice Inc Medicare	$246.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$320.52

CC B.S 6FR EXPO MULTI PACK

Facility OP

$102.00

Hospital Charge Code	66520307
Hospital Revenue Code	279
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$81.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.00
Rate for Payer: Aetna Government	$51.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.36
Rate for Payer: Group Health Inc Commercial	$51.00
Rate for Payer: Group Health Inc Medicare	$35.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00

CC B.S. ADDWIRE EXTENSION .014

Facility OP

$185.60

Service Code	HCPCS C1769
Hospital Charge Code	66522121
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$194.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$102.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$92.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$106.72
Rate for Payer: Fidelis Medicare Advantage	$194.88
Rate for Payer: Group Health Inc Commercial	$92.80
Rate for Payer: Group Health Inc Medicare	$64.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.80
Rate for Payer: Hamaspik Choice Inc Medicare	$92.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$120.64

CC B.S. ADDWIRE EXTENSION .014

Facility IP

$185.60

Service Code	HCPCS C1769
Hospital Charge Code	66522121
Hospital Revenue Code	278
Min. Negotiated Rate	$92.80
Max. Negotiated Rate	$92.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.80
Rate for Payer: Hamaspik Choice Inc Medicare	$92.80

CC B.S. APEX 2.0MM-4.0X12MM

Facility IP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66521085
Hospital Revenue Code	278
Min. Negotiated Rate	$235.00
Max. Negotiated Rate	$235.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00

CC B.S. APEX 2.0MM-4.0X12MM

Facility OP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66521085
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$493.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$258.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$270.25
Rate for Payer: Fidelis Medicare Advantage	$493.50
Rate for Payer: Group Health Inc Commercial	$235.00
Rate for Payer: Group Health Inc Medicare	$164.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$305.50

CC B.S. APEX FLEX 1.5MM-8-12-15M

Facility OP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66521087
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$493.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$258.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$270.25
Rate for Payer: Fidelis Medicare Advantage	$493.50
Rate for Payer: Group Health Inc Commercial	$235.00
Rate for Payer: Group Health Inc Medicare	$164.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$305.50

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