St. Barnabas Hospital

All Charges

Charge

Type

Price

CC G/CATH JR 5.0 6F MED LAUNCHER

Facility OP

$102.00

Service Code	HCPCS C1887
Hospital Charge Code	66521071
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$107.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
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	$51.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.65
Rate for Payer: Fidelis Medicare Advantage	$107.10
Rate for Payer: Group Health Inc Commercial	$51.00
Rate for Payer: Group Health Inc Medicare	$35.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.30

CC G/CATH JR 5.0 6F MED LAUNCHER

Facility IP

$102.00

Service Code	HCPCS C1887
Hospital Charge Code	66521071
Hospital Revenue Code	278
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00

CC G/CATH JR 5.0 7F MED LAUNCHER

Facility IP

$102.00

Service Code	HCPCS C1887
Hospital Charge Code	66521073
Hospital Revenue Code	278
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00

CC G/CATH JR 5.0 7F MED LAUNCHER

Facility OP

$102.00

Service Code	HCPCS C1887
Hospital Charge Code	66521073
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$107.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
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	$51.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.65
Rate for Payer: Fidelis Medicare Advantage	$107.10
Rate for Payer: Group Health Inc Commercial	$51.00
Rate for Payer: Group Health Inc Medicare	$35.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.30

CC G/CATH MB 16F MED LAUNCHER

Facility IP

$102.00

Service Code	HCPCS C1887
Hospital Charge Code	66521075
Hospital Revenue Code	278
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00

CC G/CATH MB 16F MED LAUNCHER

Facility OP

$102.00

Service Code	HCPCS C1887
Hospital Charge Code	66521075
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$107.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
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	$51.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.65
Rate for Payer: Fidelis Medicare Advantage	$107.10
Rate for Payer: Group Health Inc Commercial	$51.00
Rate for Payer: Group Health Inc Medicare	$35.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.30

CC G/CATH MB I 7F MED LAUNCHER

Facility IP

$102.00

Service Code	HCPCS C1887
Hospital Charge Code	66521077
Hospital Revenue Code	278
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00

CC G/CATH MB I 7F MED LAUNCHER

Facility OP

$102.00

Service Code	HCPCS C1887
Hospital Charge Code	66521077
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$107.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
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	$51.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.65
Rate for Payer: Fidelis Medicare Advantage	$107.10
Rate for Payer: Group Health Inc Commercial	$51.00
Rate for Payer: Group Health Inc Medicare	$35.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.30

CC G/CATH MEDTRONIC Z 2 5FR

Facility OP

$102.00

Service Code	HCPCS C1725
Hospital Charge Code	66522009
Hospital Revenue Code	278
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$107.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
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	$51.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.65
Rate for Payer: Fidelis Medicare Advantage	$107.10
Rate for Payer: Group Health Inc Commercial	$51.00
Rate for Payer: Group Health Inc Medicare	$35.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.30

CC G/CATH MEDTRONIC Z 2 5FR

Facility IP

$102.00

Service Code	HCPCS C1725
Hospital Charge Code	66522009
Hospital Revenue Code	278
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00

CC G/CATH SH 6FR MEDTRONIC LAUNCH

Facility OP

$102.00

Service Code	HCPCS C1725
Hospital Charge Code	66525005
Hospital Revenue Code	278
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$107.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
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	$51.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.65
Rate for Payer: Fidelis Medicare Advantage	$107.10
Rate for Payer: Group Health Inc Commercial	$51.00
Rate for Payer: Group Health Inc Medicare	$35.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.30

CC G/CATH SH 6FR MEDTRONIC LAUNCH

Facility IP

$102.00

Service Code	HCPCS C1725
Hospital Charge Code	66525005
Hospital Revenue Code	278
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00

CC G/C IMA 5F MEDTRONIC Z(2)

Facility IP

$102.00

Service Code	HCPCS C1769
Hospital Charge Code	66522101
Hospital Revenue Code	278
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00

CC G/C IMA 5F MEDTRONIC Z(2)

Facility OP

$102.00

Service Code	HCPCS C1769
Hospital Charge Code	66522101
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$107.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$51.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.65
Rate for Payer: Fidelis Medicare Advantage	$107.10
Rate for Payer: Group Health Inc Commercial	$51.00
Rate for Payer: Group Health Inc Medicare	$35.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.30

CC GUIDE CATH 6FR B.S. RUNWAY

Facility OP

$120.00

Service Code	HCPCS C1887
Hospital Charge Code	66520308
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$126.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.00
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	$60.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.00
Rate for Payer: Fidelis Medicare Advantage	$126.00
Rate for Payer: Group Health Inc Commercial	$60.00
Rate for Payer: Group Health Inc Medicare	$42.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$78.00

CC GUIDE CATH 6FR B.S. RUNWAY

Facility IP

$120.00

Service Code	HCPCS C1887
Hospital Charge Code	66520308
Hospital Revenue Code	278
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00

CC GUIDE/ CATH 6F TERUMO HEARTIII

Facility IP

$102.00

Service Code	HCPCS C1887
Hospital Charge Code	66522119
Hospital Revenue Code	278
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00

CC GUIDE/ CATH 6F TERUMO HEARTIII

Facility OP

$102.00

Service Code	HCPCS C1887
Hospital Charge Code	66522119
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$107.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
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	$51.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.65
Rate for Payer: Fidelis Medicare Advantage	$107.10
Rate for Payer: Group Health Inc Commercial	$51.00
Rate for Payer: Group Health Inc Medicare	$35.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.30

CC GUIDE CATH AL 6F .75-3.0

Facility OP

$102.00

Service Code	HCPCS C1887
Hospital Charge Code	66522007
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$107.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
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	$51.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.65
Rate for Payer: Fidelis Medicare Advantage	$107.10
Rate for Payer: Group Health Inc Commercial	$51.00
Rate for Payer: Group Health Inc Medicare	$35.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.30

CC GUIDE CATH AL 6F .75-3.0

Facility IP

$102.00

Service Code	HCPCS C1887
Hospital Charge Code	66522007
Hospital Revenue Code	278
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00

CC GUIDEWIRE .035X180 AMPLATZ SUP

Facility OP

$420.00

Service Code	HCPCS C1769
Hospital Charge Code	66520207
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$441.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$231.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$210.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$241.50
Rate for Payer: Fidelis Medicare Advantage	$441.00
Rate for Payer: Group Health Inc Commercial	$210.00
Rate for Payer: Group Health Inc Medicare	$147.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.00
Rate for Payer: Hamaspik Choice Inc Medicare	$210.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$273.00

CC GUIDEWIRE .035X180 AMPLATZ SUP

Facility IP

$420.00

Service Code	HCPCS C1769
Hospital Charge Code	66520207
Hospital Revenue Code	278
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$210.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.00
Rate for Payer: Hamaspik Choice Inc Medicare	$210.00

CC GUIDEWIRE 40CM STRAIGHT TIP

Facility OP

$420.00

Service Code	HCPCS C1769
Hospital Charge Code	66520235
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$441.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$231.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$210.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$241.50
Rate for Payer: Fidelis Medicare Advantage	$441.00
Rate for Payer: Group Health Inc Commercial	$210.00
Rate for Payer: Group Health Inc Medicare	$147.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.00
Rate for Payer: Hamaspik Choice Inc Medicare	$210.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$273.00

CC GUIDEWIRE 40CM STRAIGHT TIP

Facility IP

$420.00

Service Code	HCPCS C1769
Hospital Charge Code	66520235
Hospital Revenue Code	278
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$210.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.00
Rate for Payer: Hamaspik Choice Inc Medicare	$210.00

CC GUIDEWIRE MAILMAN 182CM STR

Facility IP

$1,340.00

Service Code	HCPCS C1769
Hospital Charge Code	66520123
Hospital Revenue Code	278
Min. Negotiated Rate	$670.00
Max. Negotiated Rate	$670.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$670.00
Rate for Payer: Hamaspik Choice Inc Medicare	$670.00

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