St. Barnabas Hospital

All Charges

Charge

Type

Price

CC CATH QUANTM BALLOON 4.0X12MM

Facility OP

$1,586.00

Service Code	HCPCS C1725
Hospital Charge Code	66520230
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 4.0X12MM

Facility IP

$1,586.00

Service Code	HCPCS C1725
Hospital Charge Code	66520230
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

CC CATH QUANTM BALLOON 5.0X12MM

Facility OP

$1,586.00

Service Code	HCPCS C1725
Hospital Charge Code	66520231
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 5.0X12MM

Facility IP

$1,586.00

Service Code	HCPCS C1725
Hospital Charge Code	66520231
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

CC CATH QUANT OTW BALL2.0X12MM

Facility IP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520232
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 QUANT OTW BALL2.0X12MM

Facility OP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520232
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 QUANT OTW BALL 2.5X12MM

Facility IP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520233
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 QUANT OTW BALL 2.5X12MM

Facility OP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520233
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 QUANT OTW BALL 3.5X12MM

Facility OP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520234
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 QUANT OTW BALL 3.5X12MM

Facility IP

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66520234
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 CIERADIOGRAPHY/FLOUROSCOPY

Facility OP

$339.45

Service Code	HCPCS 76120 TC
Hospital Charge Code	66528382
Hospital Revenue Code	329
Min. Negotiated Rate	$109.38
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.72
Rate for Payer: Aetna Government	$169.72
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$109.38
Rate for Payer: Group Health Inc Commercial	$169.72
Rate for Payer: Group Health Inc Medicare	$118.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$121.53

CC CONMED CYTOLOGY BRUSH

Facility OP

$510.00

Hospital Charge Code	66571554
Hospital Revenue Code	270
Min. Negotiated Rate	$178.50
Max. Negotiated Rate	$408.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$280.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$255.00
Rate for Payer: Aetna Government	$255.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$408.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$346.80
Rate for Payer: Group Health Inc Commercial	$255.00
Rate for Payer: Group Health Inc Medicare	$178.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$255.00
Rate for Payer: Hamaspik Choice Inc Medicare	$255.00

CC COOK 5FR RCFW-5.0-25-45-RB-CHB

Facility OP

$135.80

Hospital Charge Code	66528428
Hospital Revenue Code	480
Min. Negotiated Rate	$47.53
Max. Negotiated Rate	$108.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$67.90
Rate for Payer: Aetna Government	$67.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$108.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$92.34
Rate for Payer: Group Health Inc Commercial	$67.90
Rate for Payer: Group Health Inc Medicare	$47.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.90
Rate for Payer: Hamaspik Choice Inc Medicare	$67.90

CC COOKS 6 FR KCFW-6.0-38-55-RB

Facility OP

$126.10

Hospital Charge Code	66529918
Hospital Revenue Code	480
Min. Negotiated Rate	$44.14
Max. Negotiated Rate	$100.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$69.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.05
Rate for Payer: Aetna Government	$63.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$100.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$85.75
Rate for Payer: Group Health Inc Commercial	$63.05
Rate for Payer: Group Health Inc Medicare	$44.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.05
Rate for Payer: Hamaspik Choice Inc Medicare	$63.05

CC COOK THREE WAY STOPCOCK

Facility OP

$16.00

Hospital Charge Code	66522201
Hospital Revenue Code	270
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$12.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.00
Rate for Payer: Aetna Government	$8.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.88
Rate for Payer: Group Health Inc Commercial	$8.00
Rate for Payer: Group Health Inc Medicare	$5.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00

CC CORD EM .025 STD JTIP 150CM

Facility OP

$4.12

Hospital Charge Code	66528360
Hospital Revenue Code	270
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$3.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.06
Rate for Payer: Aetna Government	$2.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.80
Rate for Payer: Group Health Inc Commercial	$2.06
Rate for Payer: Group Health Inc Medicare	$1.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.06
Rate for Payer: Hamaspik Choice Inc Medicare	$2.06

CC CORD EM .025 STD JTIP 260CM

Facility IP

$3.20

Service Code	HCPCS C1725
Hospital Charge Code	66528361
Hospital Revenue Code	278
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$1.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1.60

CC CORD EM .025 STD JTIP 260CM

Facility OP

$3.20

Service Code	HCPCS C1725
Hospital Charge Code	66528361
Hospital Revenue Code	278
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.76
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	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.84
Rate for Payer: Fidelis Medicare Advantage	$3.36
Rate for Payer: Group Health Inc Commercial	$1.60
Rate for Payer: Group Health Inc Medicare	$1.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.08

CC CORD EM .025 STD STR TIP 150CM

Facility IP

$3.20

Service Code	HCPCS C1725
Hospital Charge Code	66528362
Hospital Revenue Code	278
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$1.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1.60

CC CORD EM .025 STD STR TIP 150CM

Facility OP

$3.20

Service Code	HCPCS C1725
Hospital Charge Code	66528362
Hospital Revenue Code	278
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.76
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	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.84
Rate for Payer: Fidelis Medicare Advantage	$3.36
Rate for Payer: Group Health Inc Commercial	$1.60
Rate for Payer: Group Health Inc Medicare	$1.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.08

CC CORD EM .032 STD JTIP 150CM

Facility IP

$4.12

Service Code	HCPCS C1725
Hospital Charge Code	66528363
Hospital Revenue Code	278
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$2.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.06
Rate for Payer: Hamaspik Choice Inc Medicare	$2.06

CC CORD EM .032 STD JTIP 150CM

Facility OP

$4.12

Service Code	HCPCS C1725
Hospital Charge Code	66528363
Hospital Revenue Code	278
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.27
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	$2.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.37
Rate for Payer: Fidelis Medicare Advantage	$4.33
Rate for Payer: Group Health Inc Commercial	$2.06
Rate for Payer: Group Health Inc Medicare	$1.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.06
Rate for Payer: Hamaspik Choice Inc Medicare	$2.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.68

CC CORD EM .032 STD STR TIP 150CM

Facility IP

$3.20

Service Code	HCPCS C1725
Hospital Charge Code	66528364
Hospital Revenue Code	278
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$1.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1.60

CC CORD EM .032 STD STR TIP 150CM

Facility OP

$3.20

Service Code	HCPCS C1725
Hospital Charge Code	66528364
Hospital Revenue Code	278
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.76
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	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.84
Rate for Payer: Fidelis Medicare Advantage	$3.36
Rate for Payer: Group Health Inc Commercial	$1.60
Rate for Payer: Group Health Inc Medicare	$1.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.08

CC CORD EM .035 STD JTIP 150CM MO

Facility OP

$3.44

Service Code	HCPCS C1725
Hospital Charge Code	66528365
Hospital Revenue Code	278
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.89
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	$1.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.98
Rate for Payer: Fidelis Medicare Advantage	$3.61
Rate for Payer: Group Health Inc Commercial	$1.72
Rate for Payer: Group Health Inc Medicare	$1.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.72
Rate for Payer: Hamaspik Choice Inc Medicare	$1.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.24

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