St. Barnabas Hospital

All Charges

Charge

Type

Price

CC CATH MAVRK MONO BALL 2.5X9MM

Facility IP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520219
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 3.0X9MM

Facility IP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520220
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 3.0X9MM

Facility OP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520220
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 OTW BALL 3.0X12MM

Facility OP

$1,514.00

Service Code	HCPCS C1725
Hospital Charge Code	66520215
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$1,589.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$832.70
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	$757.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$870.55
Rate for Payer: Fidelis Medicare Advantage	$1,589.70
Rate for Payer: Group Health Inc Commercial	$757.00
Rate for Payer: Group Health Inc Medicare	$529.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$757.00
Rate for Payer: Hamaspik Choice Inc Medicare	$757.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$984.10

CC CATH MAVRK OTW BALL 3.0X12MM

Facility IP

$1,514.00

Service Code	HCPCS C1725
Hospital Charge Code	66520215
Hospital Revenue Code	278
Min. Negotiated Rate	$757.00
Max. Negotiated Rate	$757.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$757.00
Rate for Payer: Hamaspik Choice Inc Medicare	$757.00

CC CATH MAVRK OTW BALL 3.0X9MM

Facility OP

$1,514.00

Service Code	HCPCS C1725
Hospital Charge Code	66520212
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$1,589.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$832.70
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	$757.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$870.55
Rate for Payer: Fidelis Medicare Advantage	$1,589.70
Rate for Payer: Group Health Inc Commercial	$757.00
Rate for Payer: Group Health Inc Medicare	$529.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$757.00
Rate for Payer: Hamaspik Choice Inc Medicare	$757.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$984.10

CC CATH MAVRK OTW BALL 3.0X9MM

Facility IP

$1,514.00

Service Code	HCPCS C1725
Hospital Charge Code	66520212
Hospital Revenue Code	278
Min. Negotiated Rate	$757.00
Max. Negotiated Rate	$757.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$757.00
Rate for Payer: Hamaspik Choice Inc Medicare	$757.00

CC CATH MAVRK OTW BALL 3.5X12MM

Facility OP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520216
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 OTW BALL 3.5X12MM

Facility IP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520216
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 CATHMAVRK OTW BALL 3.5X9MM

Facility OP

$1,514.00

Service Code	HCPCS C1725
Hospital Charge Code	66520213
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$1,589.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$832.70
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	$757.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$870.55
Rate for Payer: Fidelis Medicare Advantage	$1,589.70
Rate for Payer: Group Health Inc Commercial	$757.00
Rate for Payer: Group Health Inc Medicare	$529.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$757.00
Rate for Payer: Hamaspik Choice Inc Medicare	$757.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$984.10

CC CATHMAVRK OTW BALL 3.5X9MM

Facility IP

$1,514.00

Service Code	HCPCS C1725
Hospital Charge Code	66520213
Hospital Revenue Code	278
Min. Negotiated Rate	$757.00
Max. Negotiated Rate	$757.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$757.00
Rate for Payer: Hamaspik Choice Inc Medicare	$757.00

CC CATH MAVRK OTW BALL 4.0X12MM

Facility OP

$1,514.00

Service Code	HCPCS C1725
Hospital Charge Code	66520217
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$1,589.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$832.70
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	$757.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$870.55
Rate for Payer: Fidelis Medicare Advantage	$1,589.70
Rate for Payer: Group Health Inc Commercial	$757.00
Rate for Payer: Group Health Inc Medicare	$529.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$757.00
Rate for Payer: Hamaspik Choice Inc Medicare	$757.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$984.10

CC CATH MAVRK OTW BALL 4.0X12MM

Facility IP

$1,514.00

Service Code	HCPCS C1725
Hospital Charge Code	66520217
Hospital Revenue Code	278
Min. Negotiated Rate	$757.00
Max. Negotiated Rate	$757.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$757.00
Rate for Payer: Hamaspik Choice Inc Medicare	$757.00

CC CATH MAVRK OTW BALL 4.0X9MM

Facility IP

$1,514.00

Service Code	HCPCS C1725
Hospital Charge Code	66520214
Hospital Revenue Code	278
Min. Negotiated Rate	$757.00
Max. Negotiated Rate	$757.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$757.00
Rate for Payer: Hamaspik Choice Inc Medicare	$757.00

CC CATH MAVRK OTW BALL 4.0X9MM

Facility OP

$1,514.00

Service Code	HCPCS C1725
Hospital Charge Code	66520214
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$1,589.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$832.70
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	$757.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$870.55
Rate for Payer: Fidelis Medicare Advantage	$1,589.70
Rate for Payer: Group Health Inc Commercial	$757.00
Rate for Payer: Group Health Inc Medicare	$529.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$757.00
Rate for Payer: Hamaspik Choice Inc Medicare	$757.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$984.10

CC CATH MAVR MONO BALL 2.0X25MM

Facility OP

$1,546.00

Service Code	HCPCS C1725
Hospital Charge Code	66520225
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 MAVR MONO BALL 2.0X25MM

Facility IP

$1,546.00

Service Code	HCPCS C1725
Hospital Charge Code	66520225
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 MAVR MONO BALL 2.5X12MM

Facility IP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520222
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 MONO BALL 2.5X12MM

Facility OP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520222
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 QUANTM BALLOON 2.0X12MM

Facility IP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520227
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 QUANTM BALLOON 2.0X12MM

Facility OP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520227
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 QUANTM BALLOON 2.5X12MM

Facility IP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520228
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 QUANTM BALLOON 2.5X12MM

Facility OP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520228
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 QUANTM BALLOON 3.0X12MM

Facility OP

$1,586.00

Service Code	HCPCS C1725
Hospital Charge Code	66520229
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$1,665.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$872.30
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	$793.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$911.95
Rate for Payer: Fidelis Medicare Advantage	$1,665.30
Rate for Payer: Group Health Inc Commercial	$793.00
Rate for Payer: Group Health Inc Medicare	$555.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$793.00
Rate for Payer: Hamaspik Choice Inc Medicare	$793.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,030.90

CC CATH QUANTM BALLOON 3.0X12MM

Facility IP

$1,586.00

Service Code	HCPCS C1725
Hospital Charge Code	66520229
Hospital Revenue Code	278
Min. Negotiated Rate	$793.00
Max. Negotiated Rate	$793.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$793.00
Rate for Payer: Hamaspik Choice Inc Medicare	$793.00

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