St. Barnabas Hospital

All Charges

Charge

Type

Price

CC CATH CONTAMINATION SHIELD ARRO

Facility OP

$22.00

Hospital Charge Code	66528267
Hospital Revenue Code	270
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$17.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.00
Rate for Payer: Aetna Government	$11.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.96
Rate for Payer: Group Health Inc Commercial	$11.00
Rate for Payer: Group Health Inc Medicare	$7.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.00
Rate for Payer: Hamaspik Choice Inc Medicare	$11.00

CC CATH CORON DIAG RAD CRV 4.0 6

Facility OP

$220.00

Service Code	HCPCS C1887
Hospital Charge Code	66520204
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$231.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$121.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
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 CATH CORON DIAG RAD CRV 4.0 6

Facility IP

$220.00

Service Code	HCPCS C1887
Hospital Charge Code	66520204
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 CATH CORON DIAG RAD TIG 4.5 5

Facility IP

$220.00

Service Code	HCPCS C1887
Hospital Charge Code	66520202
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 CATH CORON DIAG RAD TIG 4.5 5

Facility OP

$220.00

Service Code	HCPCS C1887
Hospital Charge Code	66520202
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$231.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$121.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
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 CATH CORON DIA RAD CRV 3.5 5F

Facility IP

$220.00

Service Code	HCPCS C1887
Hospital Charge Code	66520203
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 CATH CORON DIA RAD CRV 3.5 5F

Facility OP

$220.00

Hospital Charge Code	66520126
Hospital Revenue Code	480
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 CATH CORON DIA RAD CRV 3.5 5F

Facility OP

$220.00

Service Code	HCPCS C1887
Hospital Charge Code	66520203
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$231.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$121.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
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 CATHERS JL 4.0 5F

Facility OP

$400.00

Hospital Charge Code	66528807
Hospital Revenue Code	480
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$320.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$200.00
Rate for Payer: Aetna Government	$200.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$320.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$272.00
Rate for Payer: Group Health Inc Commercial	$200.00
Rate for Payer: Group Health Inc Medicare	$140.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$200.00

CC CATHETER 5FR AR2 100CM

Facility OP

$224.00

Hospital Charge Code	66520208
Hospital Revenue Code	481
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$123.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$112.00
Rate for Payer: Aetna Government	$112.00
Rate for Payer: Brighton Health Commercial	$6,937.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,959.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,215.78
Rate for Payer: Group Health Inc Commercial	$112.00
Rate for Payer: Group Health Inc Medicare	$78.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.00
Rate for Payer: Hamaspik Choice Inc Medicare	$112.00

CC CATHETERS JR 4 5F

Facility OP

$44.80

Hospital Charge Code	66528812
Hospital Revenue Code	480
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$35.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.40
Rate for Payer: Aetna Government	$22.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.46
Rate for Payer: Group Health Inc Commercial	$22.40
Rate for Payer: Group Health Inc Medicare	$15.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.40
Rate for Payer: Hamaspik Choice Inc Medicare	$22.40

CC CATH JL 4 5F

Facility OP

$160.00

Hospital Charge Code	66528865
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 CATH LAB LINEAR 7.5FR 25CC

Facility IP

$2,238.00

Service Code	HCPCS C1725
Hospital Charge Code	66528980
Hospital Revenue Code	278
Min. Negotiated Rate	$1,119.00
Max. Negotiated Rate	$1,119.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,119.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,119.00

CC CATH LAB LINEAR 7.5FR 25CC

Facility OP

$2,238.00

Service Code	HCPCS C1725
Hospital Charge Code	66528980
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$2,349.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,230.90
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	$1,119.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,286.85
Rate for Payer: Fidelis Medicare Advantage	$2,349.90
Rate for Payer: Group Health Inc Commercial	$1,119.00
Rate for Payer: Group Health Inc Medicare	$783.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,119.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,119.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,454.70

CC CATH LAB LINEAR 7.5FR 34CC

Facility OP

$2,238.00

Service Code	HCPCS C1725
Hospital Charge Code	66528981
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$2,349.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,230.90
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	$1,119.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,286.85
Rate for Payer: Fidelis Medicare Advantage	$2,349.90
Rate for Payer: Group Health Inc Commercial	$1,119.00
Rate for Payer: Group Health Inc Medicare	$783.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,119.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,119.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,454.70

CC CATH LAB LINEAR 7.5FR 34CC

Facility IP

$2,238.00

Service Code	HCPCS C1725
Hospital Charge Code	66528981
Hospital Revenue Code	278
Min. Negotiated Rate	$1,119.00
Max. Negotiated Rate	$1,119.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,119.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,119.00

CC CATH LAB LINEAR 7.5FR 40CC

Facility IP

$2,238.00

Service Code	HCPCS C1725
Hospital Charge Code	66528982
Hospital Revenue Code	278
Min. Negotiated Rate	$1,119.00
Max. Negotiated Rate	$1,119.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,119.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,119.00

CC CATH LAB LINEAR 7.5FR 40CC

Facility OP

$2,238.00

Service Code	HCPCS C1725
Hospital Charge Code	66528982
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$2,349.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,230.90
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	$1,119.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,286.85
Rate for Payer: Fidelis Medicare Advantage	$2,349.90
Rate for Payer: Group Health Inc Commercial	$1,119.00
Rate for Payer: Group Health Inc Medicare	$783.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,119.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,119.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,454.70

CC CATH MAVR BALL 4.0X9MM

Facility IP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520224
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 CATH MAVR BALL 4.0X9MM

Facility OP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520224
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 CATH MAVRK MONO BALL 2.0X12MM

Facility IP

$1,546.00

Service Code	HCPCS C1725
Hospital Charge Code	66520221
Hospital Revenue Code	278
Min. Negotiated Rate	$773.00
Max. Negotiated Rate	$773.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$773.00
Rate for Payer: Hamaspik Choice Inc Medicare	$773.00

CC CATH MAVRK MONO BALL 2.0X12MM

Facility OP

$1,546.00

Service Code	HCPCS C1725
Hospital Charge Code	66520221
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$1,623.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$850.30
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	$773.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$888.95
Rate for Payer: Fidelis Medicare Advantage	$1,623.30
Rate for Payer: Group Health Inc Commercial	$773.00
Rate for Payer: Group Health Inc Medicare	$541.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$773.00
Rate for Payer: Hamaspik Choice Inc Medicare	$773.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,004.90

CC CATH MAVRK MONO BALL 2.0X9MM

Facility OP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520218
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 CATH MAVRK MONO BALL 2.0X9MM

Facility IP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520218
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 CATH MAVRK MONO BALL 2.5X9MM

Facility OP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520219
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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