St. Barnabas Hospital

All Charges

Charge

Type

Price

CC MED DES ENDEAVR 2.5MMX8MM

Facility IP

$3,450.00

Service Code	HCPCS C1725
Hospital Charge Code	66528988
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 MED DES ENDEAVR 3.5MM X 18MM

Facility OP

$3,450.00

Service Code	HCPCS C1874
Hospital Charge Code	66528994
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 MED DES ENDEAVR 3.5MM X 18MM

Facility IP

$3,450.00

Service Code	HCPCS C1874
Hospital Charge Code	66528994
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 MED DES ENDEAVR 3.5MMX 24MM

Facility IP

$3,450.00

Service Code	HCPCS C1874
Hospital Charge Code	66528995
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 MED DES ENDEAVR 3.5MMX 24MM

Facility OP

$3,450.00

Service Code	HCPCS C1874
Hospital Charge Code	66528995
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 MED DES ENDEAVR 3.5MM X 9MM

Facility IP

$3,450.00

Service Code	HCPCS C1874
Hospital Charge Code	66528996
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 MED DES ENDEAVR 3.5MM X 9MM

Facility OP

$3,450.00

Service Code	HCPCS C1874
Hospital Charge Code	66528996
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 MED DES MED ENDEAVR 2.5MMX18MM

Facility OP

$3,450.00

Service Code	HCPCS C1874
Hospital Charge Code	66528986
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 MED DES MED ENDEAVR 2.5MMX18MM

Facility IP

$3,450.00

Service Code	HCPCS C1874
Hospital Charge Code	66528986
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 MED PACING CABLE58335L/4677401

Facility IP

$339.45

Hospital Charge Code	66528875
Hospital Revenue Code	278
Min. Negotiated Rate	$169.72
Max. Negotiated Rate	$169.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72

CC MED PACING CABLE58335L/4677401

Facility OP

$339.45

Hospital Charge Code	66528875
Hospital Revenue Code	278
Min. Negotiated Rate	$118.81
Max. Negotiated Rate	$356.42
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: Cigna HMO/Network Benefit Plan/Open Access	$169.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$195.18
Rate for Payer: Fidelis Medicare Advantage	$356.42
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$220.64

CC MED PACING CBL 58335L/4677401

Facility IP

$150.00

Service Code	HCPCS C1725
Hospital Charge Code	66528880
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

CC MED PACING CBL 58335L/4677401

Facility OP

$150.00

Service Code	HCPCS C1725
Hospital Charge Code	66528880
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$157.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
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	$75.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.25
Rate for Payer: Fidelis Medicare Advantage	$157.50
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$97.50

CC MEDRAD SYRINGE 150 ML MEDRAD

Facility OP

$8.70

Hospital Charge Code	66528231
Hospital Revenue Code	270
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$6.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.35
Rate for Payer: Aetna Government	$4.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.92
Rate for Payer: Group Health Inc Commercial	$4.35
Rate for Payer: Group Health Inc Medicare	$3.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.35
Rate for Payer: Hamaspik Choice Inc Medicare	$4.35

CC MED SPRINT QUAT 6947-65CM

Facility IP

$13,520.00

Service Code	HCPCS C1895
Hospital Charge Code	66528881
Hospital Revenue Code	278
Min. Negotiated Rate	$6,760.00
Max. Negotiated Rate	$6,760.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,760.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,760.00

CC MED SPRINT QUAT 6947-65CM

Facility OP

$13,520.00

Service Code	HCPCS C1895
Hospital Charge Code	66528881
Hospital Revenue Code	278
Min. Negotiated Rate	$1,297.97
Max. Negotiated Rate	$14,196.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7,436.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,297.97
Rate for Payer: Aetna Government	$1,297.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,760.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,774.00
Rate for Payer: Fidelis Medicare Advantage	$14,196.00
Rate for Payer: Group Health Inc Commercial	$6,760.00
Rate for Payer: Group Health Inc Medicare	$4,732.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,760.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,760.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,788.00

CC MEDTRONIC 6F EBU 3.5 0.071

Facility OP

$136.00

Hospital Charge Code	66528376
Hospital Revenue Code	480
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$108.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$68.00
Rate for Payer: Aetna Government	$68.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$108.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$92.48
Rate for Payer: Group Health Inc Commercial	$68.00
Rate for Payer: Group Health Inc Medicare	$47.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.00
Rate for Payer: Hamaspik Choice Inc Medicare	$68.00

CC MEDTRONIC CABLE 5833SL

Facility OP

$150.00

Hospital Charge Code	66528992
Hospital Revenue Code	270
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$120.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75.00
Rate for Payer: Aetna Government	$75.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$120.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.00
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

CC MEDTRONIC ICD D224VRC SECURA

Facility IP

$34,000.00

Service Code	HCPCS C1725
Hospital Charge Code	66528990
Hospital Revenue Code	278
Min. Negotiated Rate	$17,000.00
Max. Negotiated Rate	$17,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17,000.00

CC MEDTRONIC ICD D224VRC SECURA

Facility OP

$34,000.00

Service Code	HCPCS C1725
Hospital Charge Code	66528990
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$35,700.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18,700.00
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	$17,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$19,550.00
Rate for Payer: Fidelis Medicare Advantage	$35,700.00
Rate for Payer: Group Health Inc Commercial	$17,000.00
Rate for Payer: Group Health Inc Medicare	$11,900.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22,100.00

CC MEDTRONIC RESOLUTE D.E.S.

Facility IP

$3,180.00

Service Code	HCPCS C1874
Hospital Charge Code	66521928
Hospital Revenue Code	278
Min. Negotiated Rate	$1,590.00
Max. Negotiated Rate	$1,590.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,590.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,590.00

CC MEDTRONIC RESOLUTE D.E.S.

Facility OP

$3,180.00

Service Code	HCPCS C1874
Hospital Charge Code	66521928
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,339.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,749.00
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	$1,590.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,828.50
Rate for Payer: Fidelis Medicare Advantage	$3,339.00
Rate for Payer: Group Health Inc Commercial	$1,590.00
Rate for Payer: Group Health Inc Medicare	$1,113.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,590.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,590.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,067.00

CC MEDTRONIC S.L. BALLOON 1.25X

Facility IP

$380.00

Service Code	HCPCS C1725
Hospital Charge Code	66520209
Hospital Revenue Code	278
Min. Negotiated Rate	$190.00
Max. Negotiated Rate	$190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.00
Rate for Payer: Hamaspik Choice Inc Medicare	$190.00

CC MEDTRONIC S.L. BALLOON 1.25X

Facility OP

$380.00

Service Code	HCPCS C1725
Hospital Charge Code	66520209
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$399.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$209.00
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	$190.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$218.50
Rate for Payer: Fidelis Medicare Advantage	$399.00
Rate for Payer: Group Health Inc Commercial	$190.00
Rate for Payer: Group Health Inc Medicare	$133.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.00
Rate for Payer: Hamaspik Choice Inc Medicare	$190.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$247.00

CC MEDTRONIC STEERABLE .014

Facility OP

$710.00

Service Code	HCPCS C1769
Hospital Charge Code	66522013
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$745.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$390.50
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	$355.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$408.25
Rate for Payer: Fidelis Medicare Advantage	$745.50
Rate for Payer: Group Health Inc Commercial	$355.00
Rate for Payer: Group Health Inc Medicare	$248.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$355.00
Rate for Payer: Hamaspik Choice Inc Medicare	$355.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$461.50

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