St. Barnabas Hospital

All Charges

Charge

Type

Price

CC CORD EM .035 STD JTIP 150CM MO

Facility IP

$3.44

Service Code	HCPCS C1725
Hospital Charge Code	66528365
Hospital Revenue Code	278
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$1.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.72
Rate for Payer: Hamaspik Choice Inc Medicare	$1.72

CC CORD EM .035 STD STR TIP 150CM

Facility IP

$8.84

Service Code	HCPCS C1725
Hospital Charge Code	66528366
Hospital Revenue Code	278
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$4.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.42
Rate for Payer: Hamaspik Choice Inc Medicare	$4.42

CC CORD EM .035 STD STR TIP 150CM

Facility OP

$8.84

Service Code	HCPCS C1725
Hospital Charge Code	66528366
Hospital Revenue Code	278
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.86
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	$4.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.08
Rate for Payer: Fidelis Medicare Advantage	$9.28
Rate for Payer: Group Health Inc Commercial	$4.42
Rate for Payer: Group Health Inc Medicare	$3.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.42
Rate for Payer: Hamaspik Choice Inc Medicare	$4.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.75

CC CORD EM .035 STD STR TIP 260CM

Facility IP

$8.84

Service Code	HCPCS C1725
Hospital Charge Code	66528367
Hospital Revenue Code	278
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$4.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.42
Rate for Payer: Hamaspik Choice Inc Medicare	$4.42

CC CORD EM .035 STD STR TIP 260CM

Facility OP

$8.84

Service Code	HCPCS C1725
Hospital Charge Code	66528367
Hospital Revenue Code	278
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.86
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	$4.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.08
Rate for Payer: Fidelis Medicare Advantage	$9.28
Rate for Payer: Group Health Inc Commercial	$4.42
Rate for Payer: Group Health Inc Medicare	$3.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.42
Rate for Payer: Hamaspik Choice Inc Medicare	$4.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.75

CC CORD EM .065 STD JTIP 150CM

Facility IP

$15.66

Service Code	HCPCS C1725
Hospital Charge Code	66528369
Hospital Revenue Code	278
Min. Negotiated Rate	$7.83
Max. Negotiated Rate	$7.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.83
Rate for Payer: Hamaspik Choice Inc Medicare	$7.83

CC CORD EM .065 STD JTIP 150CM

Facility OP

$15.66

Service Code	HCPCS C1725
Hospital Charge Code	66528369
Hospital Revenue Code	278
Min. Negotiated Rate	$5.48
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.61
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	$7.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.00
Rate for Payer: Fidelis Medicare Advantage	$16.44
Rate for Payer: Group Health Inc Commercial	$7.83
Rate for Payer: Group Health Inc Medicare	$5.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.83
Rate for Payer: Hamaspik Choice Inc Medicare	$7.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.18

CC CORD. INF. 5 FR PIG STR 110CM

Facility OP

$9.20

Hospital Charge Code	66528271
Hospital Revenue Code	270
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$7.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.60
Rate for Payer: Aetna Government	$4.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.26
Rate for Payer: Group Health Inc Commercial	$4.60
Rate for Payer: Group Health Inc Medicare	$3.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.60
Rate for Payer: Hamaspik Choice Inc Medicare	$4.60

CC CORD INF 5 FR PIG STR 110CM 6S

Facility OP

$9.20

Hospital Charge Code	66528355
Hospital Revenue Code	270
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$7.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.60
Rate for Payer: Aetna Government	$4.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.26
Rate for Payer: Group Health Inc Commercial	$4.60
Rate for Payer: Group Health Inc Medicare	$3.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.60
Rate for Payer: Hamaspik Choice Inc Medicare	$4.60

CC CORDIS 4FR 3DRC CATHETER

Facility OP

$50.00

Service Code	HCPCS C1725
Hospital Charge Code	66520313
Hospital Revenue Code	278
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$52.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.50
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	$25.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.75
Rate for Payer: Fidelis Medicare Advantage	$52.50
Rate for Payer: Group Health Inc Commercial	$25.00
Rate for Payer: Group Health Inc Medicare	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$32.50

CC CORDIS 4FR 3DRC CATHETER

Facility IP

$50.00

Service Code	HCPCS C1725
Hospital Charge Code	66520313
Hospital Revenue Code	278
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$25.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00

CC CORDIS 4 FR AV+STD L S 11CM

Facility OP

$7.20

Service Code	HCPCS C1725
Hospital Charge Code	66528358
Hospital Revenue Code	278
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.96
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	$3.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.14
Rate for Payer: Fidelis Medicare Advantage	$7.56
Rate for Payer: Group Health Inc Commercial	$3.60
Rate for Payer: Group Health Inc Medicare	$2.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.60
Rate for Payer: Hamaspik Choice Inc Medicare	$3.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.68

CC CORDIS 4 FR AV+STD L S 11CM

Facility IP

$7.20

Service Code	HCPCS C1725
Hospital Charge Code	66528358
Hospital Revenue Code	278
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.60
Rate for Payer: Hamaspik Choice Inc Medicare	$3.60

CC CORDIS 5 FR AV+STD L S 11CM

Facility OP

$7.20

Service Code	HCPCS C1725
Hospital Charge Code	66528359
Hospital Revenue Code	278
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.96
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	$3.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.14
Rate for Payer: Fidelis Medicare Advantage	$7.56
Rate for Payer: Group Health Inc Commercial	$3.60
Rate for Payer: Group Health Inc Medicare	$2.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.60
Rate for Payer: Hamaspik Choice Inc Medicare	$3.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.68

CC CORDIS 5 FR AV+STD L S 11CM

Facility IP

$7.20

Service Code	HCPCS C1725
Hospital Charge Code	66528359
Hospital Revenue Code	278
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.60
Rate for Payer: Hamaspik Choice Inc Medicare	$3.60

CC CORDIS AVIATOR 4.0MM X 15MM

Facility OP

$354.20

Service Code	HCPCS C1876
Hospital Charge Code	66528562
Hospital Revenue Code	278
Min. Negotiated Rate	$123.97
Max. Negotiated Rate	$398.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$194.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$177.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$203.66
Rate for Payer: Fidelis Medicare Advantage	$371.91
Rate for Payer: Group Health Inc Commercial	$177.10
Rate for Payer: Group Health Inc Medicare	$123.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.10
Rate for Payer: Hamaspik Choice Inc Medicare	$177.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$230.23

CC CORDIS AVIATOR 4.0MM X 15MM

Facility IP

$354.20

Service Code	HCPCS C1876
Hospital Charge Code	66528562
Hospital Revenue Code	278
Min. Negotiated Rate	$177.10
Max. Negotiated Rate	$177.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.10
Rate for Payer: Hamaspik Choice Inc Medicare	$177.10

CC CORDIS AVIATOR 4.0MM X 20MM

Facility IP

$354.20

Service Code	HCPCS C1876
Hospital Charge Code	66528561
Hospital Revenue Code	278
Min. Negotiated Rate	$177.10
Max. Negotiated Rate	$177.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.10
Rate for Payer: Hamaspik Choice Inc Medicare	$177.10

CC CORDIS AVIATOR 4.0MM X 20MM

Facility OP

$354.20

Service Code	HCPCS C1876
Hospital Charge Code	66528561
Hospital Revenue Code	278
Min. Negotiated Rate	$123.97
Max. Negotiated Rate	$398.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$194.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$177.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$203.66
Rate for Payer: Fidelis Medicare Advantage	$371.91
Rate for Payer: Group Health Inc Commercial	$177.10
Rate for Payer: Group Health Inc Medicare	$123.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.10
Rate for Payer: Hamaspik Choice Inc Medicare	$177.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$230.23

CC CORDIS AVIATOR 5.0MM X 15MM

Facility OP

$354.20

Service Code	HCPCS C1876
Hospital Charge Code	66528560
Hospital Revenue Code	278
Min. Negotiated Rate	$123.97
Max. Negotiated Rate	$398.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$194.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$177.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$203.66
Rate for Payer: Fidelis Medicare Advantage	$371.91
Rate for Payer: Group Health Inc Commercial	$177.10
Rate for Payer: Group Health Inc Medicare	$123.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.10
Rate for Payer: Hamaspik Choice Inc Medicare	$177.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$230.23

CC CORDIS AVIATOR 5.0MM X 15MM

Facility IP

$354.20

Service Code	HCPCS C1876
Hospital Charge Code	66528560
Hospital Revenue Code	278
Min. Negotiated Rate	$177.10
Max. Negotiated Rate	$177.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.10
Rate for Payer: Hamaspik Choice Inc Medicare	$177.10

CC CORDIS AVIATOR 5.0MM X 20MM

Facility OP

$354.20

Service Code	HCPCS C1876
Hospital Charge Code	66528559
Hospital Revenue Code	278
Min. Negotiated Rate	$123.97
Max. Negotiated Rate	$398.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$194.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$177.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$203.66
Rate for Payer: Fidelis Medicare Advantage	$371.91
Rate for Payer: Group Health Inc Commercial	$177.10
Rate for Payer: Group Health Inc Medicare	$123.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.10
Rate for Payer: Hamaspik Choice Inc Medicare	$177.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$230.23

CC CORDIS AVIATOR 5.0MM X 20MM

Facility IP

$354.20

Service Code	HCPCS C1876
Hospital Charge Code	66528559
Hospital Revenue Code	278
Min. Negotiated Rate	$177.10
Max. Negotiated Rate	$177.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.10
Rate for Payer: Hamaspik Choice Inc Medicare	$177.10

CC CORDIS AVIATOR 6.0MM X 15MM

Facility IP

$354.20

Service Code	HCPCS C1876
Hospital Charge Code	66528558
Hospital Revenue Code	278
Min. Negotiated Rate	$177.10
Max. Negotiated Rate	$177.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.10
Rate for Payer: Hamaspik Choice Inc Medicare	$177.10

CC CORDIS AVIATOR 6.0MM X 15MM

Facility OP

$354.20

Service Code	HCPCS C1876
Hospital Charge Code	66528558
Hospital Revenue Code	278
Min. Negotiated Rate	$123.97
Max. Negotiated Rate	$398.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$194.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$177.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$203.66
Rate for Payer: Fidelis Medicare Advantage	$371.91
Rate for Payer: Group Health Inc Commercial	$177.10
Rate for Payer: Group Health Inc Medicare	$123.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.10
Rate for Payer: Hamaspik Choice Inc Medicare	$177.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$230.23

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