St. Barnabas Hospital

All Charges

Charge

Type

Price

CC DES AB X RX 4.0MMX12MM

Facility IP

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528974
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00

CC DES AB X RX 4.0MMX12MM

Facility OP

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528974
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,095.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,145.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,950.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,242.50
Rate for Payer: Fidelis Medicare Advantage	$4,095.00
Rate for Payer: Group Health Inc Commercial	$1,950.00
Rate for Payer: Group Health Inc Medicare	$1,365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,535.00

CC DES AB X RX 4.0MMX15MM

Facility IP

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528975
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00

CC DES AB X RX 4.0MMX15MM

Facility OP

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528975
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,095.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,145.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,950.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,242.50
Rate for Payer: Fidelis Medicare Advantage	$4,095.00
Rate for Payer: Group Health Inc Commercial	$1,950.00
Rate for Payer: Group Health Inc Medicare	$1,365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,535.00

CC DES AB X RX 4.0MMX18MM

Facility IP

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528976
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00

CC DES AB X RX 4.0MMX18MM

Facility OP

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528976
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,095.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,145.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,950.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,242.50
Rate for Payer: Fidelis Medicare Advantage	$4,095.00
Rate for Payer: Group Health Inc Commercial	$1,950.00
Rate for Payer: Group Health Inc Medicare	$1,365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,535.00

CC DES AB X RX 4.0MMX23MM

Facility OP

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528977
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,095.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,145.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,950.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,242.50
Rate for Payer: Fidelis Medicare Advantage	$4,095.00
Rate for Payer: Group Health Inc Commercial	$1,950.00
Rate for Payer: Group Health Inc Medicare	$1,365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,535.00

CC DES AB X RX 4.0MMX23MM

Facility IP

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528977
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00

CC DES AB X RX 4.0MMX28MM

Facility IP

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528978
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00

CC DES AB X RX 4.0MMX28MM

Facility OP

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528978
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,095.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,145.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,950.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,242.50
Rate for Payer: Fidelis Medicare Advantage	$4,095.00
Rate for Payer: Group Health Inc Commercial	$1,950.00
Rate for Payer: Group Health Inc Medicare	$1,365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,535.00

CC DES AB X RX 4.0MMX8MM

Facility IP

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528979
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00

CC DES AB X RX 4.0MMX8MM

Facility OP

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528979
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,095.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,145.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,950.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,242.50
Rate for Payer: Fidelis Medicare Advantage	$4,095.00
Rate for Payer: Group Health Inc Commercial	$1,950.00
Rate for Payer: Group Health Inc Medicare	$1,365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,535.00

CC DES MED END 3.5X9-30MM

Facility IP

$3,450.00

Service Code	HCPCS C1874
Hospital Charge Code	66528993
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$1,725.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,725.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,725.00

CC DES MED END 3.5X9-30MM

Facility OP

$3,450.00

Service Code	HCPCS C1874
Hospital Charge Code	66528993
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,622.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,897.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,725.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,983.75
Rate for Payer: Fidelis Medicare Advantage	$3,622.50
Rate for Payer: Group Health Inc Commercial	$1,725.00
Rate for Payer: Group Health Inc Medicare	$1,207.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,725.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,725.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,242.50

CC DES MED ENDEAVOR3.0MMX9-30MM

Facility OP

$3,450.00

Service Code	HCPCS C1874
Hospital Charge Code	66528989
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,622.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,897.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,725.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,983.75
Rate for Payer: Fidelis Medicare Advantage	$3,622.50
Rate for Payer: Group Health Inc Commercial	$1,725.00
Rate for Payer: Group Health Inc Medicare	$1,207.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,725.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,725.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,242.50

CC DES MED ENDEAVOR3.0MMX9-30MM

Facility IP

$3,450.00

Service Code	HCPCS C1874
Hospital Charge Code	66528989
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$1,725.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,725.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,725.00

CC DEVICE MAGNET EXCHANGE

Facility OP

$226.00

Hospital Charge Code	66520125
Hospital Revenue Code	480
Min. Negotiated Rate	$79.10
Max. Negotiated Rate	$180.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$124.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$113.00
Rate for Payer: Aetna Government	$113.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$180.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.68
Rate for Payer: Group Health Inc Commercial	$113.00
Rate for Payer: Group Health Inc Medicare	$79.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.00
Rate for Payer: Hamaspik Choice Inc Medicare	$113.00

CC DEVICE VASCULAR CLOSURE MYNX

Facility OP

$460.00

Hospital Charge Code	66520226
Hospital Revenue Code	481
Min. Negotiated Rate	$161.00
Max. Negotiated Rate	$6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$253.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$230.00
Rate for Payer: Aetna Government	$230.00
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	$230.00
Rate for Payer: Group Health Inc Medicare	$161.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$230.00
Rate for Payer: Hamaspik Choice Inc Medicare	$230.00

CC DEXTRUS IS-1 BI POS FIX 53CM

Facility IP

$1,350.00

Service Code	HCPCS C1898
Hospital Charge Code	66526872
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$675.00
Rate for Payer: Hamaspik Choice Inc Medicare	$675.00

CC DEXTRUS IS-1 BI POS FIX 53CM

Facility OP

$1,350.00

Service Code	HCPCS C1898
Hospital Charge Code	66526872
Hospital Revenue Code	278
Min. Negotiated Rate	$98.92
Max. Negotiated Rate	$1,417.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$742.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$98.92
Rate for Payer: Aetna Government	$98.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$675.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$776.25
Rate for Payer: Fidelis Medicare Advantage	$1,417.50
Rate for Payer: Group Health Inc Commercial	$675.00
Rate for Payer: Group Health Inc Medicare	$472.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$675.00
Rate for Payer: Hamaspik Choice Inc Medicare	$675.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$877.50

CC DEXTRUS IS-1 BI POS FIX 60CM

Facility OP

$1,350.00

Service Code	HCPCS C1898
Hospital Charge Code	66526873
Hospital Revenue Code	278
Min. Negotiated Rate	$98.92
Max. Negotiated Rate	$1,417.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$742.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$98.92
Rate for Payer: Aetna Government	$98.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$675.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$776.25
Rate for Payer: Fidelis Medicare Advantage	$1,417.50
Rate for Payer: Group Health Inc Commercial	$675.00
Rate for Payer: Group Health Inc Medicare	$472.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$675.00
Rate for Payer: Hamaspik Choice Inc Medicare	$675.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$877.50

CC DEXTRUS IS-1 BI POS FIX 60CM

Facility IP

$1,350.00

Service Code	HCPCS C1898
Hospital Charge Code	66526873
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$675.00
Rate for Payer: Hamaspik Choice Inc Medicare	$675.00

CC DEXTRUS IS-1 BI POS FIX RA/RV

Facility IP

$1,350.00

Service Code	HCPCS C1898
Hospital Charge Code	66526901
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$675.00
Rate for Payer: Hamaspik Choice Inc Medicare	$675.00

CC DEXTRUS IS-1 BI POS FIX RA/RV

Facility OP

$1,350.00

Service Code	HCPCS C1898
Hospital Charge Code	66526901
Hospital Revenue Code	278
Min. Negotiated Rate	$98.92
Max. Negotiated Rate	$1,417.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$742.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$98.92
Rate for Payer: Aetna Government	$98.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$675.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$776.25
Rate for Payer: Fidelis Medicare Advantage	$1,417.50
Rate for Payer: Group Health Inc Commercial	$675.00
Rate for Payer: Group Health Inc Medicare	$472.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$675.00
Rate for Payer: Hamaspik Choice Inc Medicare	$675.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$877.50

CC D/G/WIRE CORDIS EMERALD .025

Facility OP

$52.00

Service Code	HCPCS C1725
Hospital Charge Code	66520106
Hospital Revenue Code	278
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$54.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.60
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	$26.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.90
Rate for Payer: Fidelis Medicare Advantage	$54.60
Rate for Payer: Group Health Inc Commercial	$26.00
Rate for Payer: Group Health Inc Medicare	$18.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.00
Rate for Payer: Hamaspik Choice Inc Medicare	$26.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$33.80

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