St. Barnabas Hospital

All Charges

Charge

Type

Price

CC SET INTRO 4FR MICROPUNCT

Facility OP

$72.20

Hospital Charge Code	66520127
Hospital Revenue Code	270
Min. Negotiated Rate	$25.27
Max. Negotiated Rate	$57.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.10
Rate for Payer: Aetna Government	$36.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.10
Rate for Payer: Group Health Inc Commercial	$36.10
Rate for Payer: Group Health Inc Medicare	$25.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.10
Rate for Payer: Hamaspik Choice Inc Medicare	$36.10

CC SHEATH COOK 4FR MICPUCTUR KIT

Facility OP

$72.20

Hospital Charge Code	66520279
Hospital Revenue Code	480
Min. Negotiated Rate	$25.27
Max. Negotiated Rate	$57.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.10
Rate for Payer: Aetna Government	$36.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.10
Rate for Payer: Group Health Inc Commercial	$36.10
Rate for Payer: Group Health Inc Medicare	$25.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.10
Rate for Payer: Hamaspik Choice Inc Medicare	$36.10

CC SHEATH COOK 5FR MICROPUNT KIT

Facility OP

$60.80

Hospital Charge Code	66520301
Hospital Revenue Code	270
Min. Negotiated Rate	$21.28
Max. Negotiated Rate	$48.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.40
Rate for Payer: Aetna Government	$30.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$41.34
Rate for Payer: Group Health Inc Commercial	$30.40
Rate for Payer: Group Health Inc Medicare	$21.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.40
Rate for Payer: Hamaspik Choice Inc Medicare	$30.40

CC SHEATH INTR 5F 074 10CM

Facility IP

$792.50

Service Code	HCPCS C1894
Hospital Charge Code	66520239
Hospital Revenue Code	278
Min. Negotiated Rate	$396.25
Max. Negotiated Rate	$396.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.25
Rate for Payer: Hamaspik Choice Inc Medicare	$396.25

CC SHEATH INTR 5F 074 10CM

Facility OP

$792.50

Service Code	HCPCS C1894
Hospital Charge Code	66520239
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$832.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$435.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$396.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$455.69
Rate for Payer: Fidelis Medicare Advantage	$832.12
Rate for Payer: Group Health Inc Commercial	$396.25
Rate for Payer: Group Health Inc Medicare	$277.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.25
Rate for Payer: Hamaspik Choice Inc Medicare	$396.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$515.12

CC SHEATH INTR 5F 074 16CM

Facility OP

$365.00

Service Code	HCPCS C1894
Hospital Charge Code	66520200
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$383.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$200.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$182.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$209.88
Rate for Payer: Fidelis Medicare Advantage	$383.25
Rate for Payer: Group Health Inc Commercial	$182.50
Rate for Payer: Group Health Inc Medicare	$127.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.50
Rate for Payer: Hamaspik Choice Inc Medicare	$182.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$237.25

CC SHEATH INTR 5F 074 16CM

Facility IP

$365.00

Service Code	HCPCS C1894
Hospital Charge Code	66520200
Hospital Revenue Code	278
Min. Negotiated Rate	$182.50
Max. Negotiated Rate	$182.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.50
Rate for Payer: Hamaspik Choice Inc Medicare	$182.50

CC SHEATHS 4F 10CM

Facility IP

$792.50

Service Code	HCPCS C1894
Hospital Charge Code	66528796
Hospital Revenue Code	278
Min. Negotiated Rate	$396.25
Max. Negotiated Rate	$396.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.25
Rate for Payer: Hamaspik Choice Inc Medicare	$396.25

CC SHEATHS 4F 10CM

Facility OP

$792.50

Service Code	HCPCS C1894
Hospital Charge Code	66528796
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$832.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$435.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$396.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$455.69
Rate for Payer: Fidelis Medicare Advantage	$832.12
Rate for Payer: Group Health Inc Commercial	$396.25
Rate for Payer: Group Health Inc Medicare	$277.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.25
Rate for Payer: Hamaspik Choice Inc Medicare	$396.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$515.12

CC SHEATHS 5F 10CM

Facility OP

$792.50

Service Code	HCPCS C1894
Hospital Charge Code	66528795
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$832.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$435.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$396.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$455.69
Rate for Payer: Fidelis Medicare Advantage	$832.12
Rate for Payer: Group Health Inc Commercial	$396.25
Rate for Payer: Group Health Inc Medicare	$277.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.25
Rate for Payer: Hamaspik Choice Inc Medicare	$396.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$515.12

CC SHEATHS 5F 10CM

Facility IP

$792.50

Service Code	HCPCS C1894
Hospital Charge Code	66528795
Hospital Revenue Code	278
Min. Negotiated Rate	$396.25
Max. Negotiated Rate	$396.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.25
Rate for Payer: Hamaspik Choice Inc Medicare	$396.25

CC SHEATH TERUMO 4FR PINNACLE10CM

Facility OP

$19.40

Service Code	HCPCS C1766
Hospital Charge Code	66520256
Hospital Revenue Code	278
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$20.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.80
Rate for Payer: Aetna Government	$6.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.16
Rate for Payer: Fidelis Medicare Advantage	$20.37
Rate for Payer: Group Health Inc Commercial	$9.70
Rate for Payer: Group Health Inc Medicare	$6.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.70
Rate for Payer: Hamaspik Choice Inc Medicare	$9.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.61

CC SHEATH TERUMO 4FR PINNACLE10CM

Facility IP

$19.40

Service Code	HCPCS C1766
Hospital Charge Code	66520256
Hospital Revenue Code	278
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$9.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.70
Rate for Payer: Hamaspik Choice Inc Medicare	$9.70

CC SHEATH TERUMO 5FRPINNACLE 10CM

Facility OP

$190.00

Hospital Charge Code	66520257
Hospital Revenue Code	480
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$152.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$104.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$95.00
Rate for Payer: Aetna Government	$95.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$152.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$129.20
Rate for Payer: Group Health Inc Commercial	$95.00
Rate for Payer: Group Health Inc Medicare	$66.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.00
Rate for Payer: Hamaspik Choice Inc Medicare	$95.00

CC SHEATH TERUMO 5FR PINNACLE25CM

Facility OP

$37.90

Hospital Charge Code	66520258
Hospital Revenue Code	480
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$30.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.95
Rate for Payer: Aetna Government	$18.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.77
Rate for Payer: Group Health Inc Commercial	$18.95
Rate for Payer: Group Health Inc Medicare	$13.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.95
Rate for Payer: Hamaspik Choice Inc Medicare	$18.95

CC SHIELD CONTAMINATION CATH-GAR

Facility OP

$614.00

Hospital Charge Code	66520238
Hospital Revenue Code	481
Min. Negotiated Rate	$214.90
Max. Negotiated Rate	$6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$337.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$307.00
Rate for Payer: Aetna Government	$307.00
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	$307.00
Rate for Payer: Group Health Inc Medicare	$214.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$307.00
Rate for Payer: Hamaspik Choice Inc Medicare	$307.00

CC SINGLE PATIENT DISPOSABLE SET

Facility OP

$55.50

Hospital Charge Code	66520253
Hospital Revenue Code	270
Min. Negotiated Rate	$19.42
Max. Negotiated Rate	$44.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.75
Rate for Payer: Aetna Government	$27.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$44.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.74
Rate for Payer: Group Health Inc Commercial	$27.75
Rate for Payer: Group Health Inc Medicare	$19.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.75
Rate for Payer: Hamaspik Choice Inc Medicare	$27.75

CC SINGLE PT DISPOSABLE SET LONG

Facility OP

$65.16

Hospital Charge Code	66529920
Hospital Revenue Code	270
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$52.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.58
Rate for Payer: Aetna Government	$32.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.31
Rate for Payer: Group Health Inc Commercial	$32.58
Rate for Payer: Group Health Inc Medicare	$22.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.58
Rate for Payer: Hamaspik Choice Inc Medicare	$32.58

CC SINUS OR JUGL CATH VENOGRAM

Facility OP

$8,393.53

Service Code	HCPCS 75860 26
Hospital Charge Code	66528654
Hospital Revenue Code	320
Min. Negotiated Rate	$56.69
Max. Negotiated Rate	$6,714.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,616.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,196.76
Rate for Payer: Aetna Government	$4,196.76
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,714.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,707.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$56.69
Rate for Payer: Group Health Inc Commercial	$4,196.76
Rate for Payer: Group Health Inc Medicare	$2,937.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.76
Rate for Payer: Hamaspik Choice Inc Medicare	$4,196.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$62.99

CC SKIN PREP TRAY

Facility OP

$5.69

Hospital Charge Code	66528232
Hospital Revenue Code	270
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$4.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.87
Rate for Payer: Group Health Inc Commercial	$2.84
Rate for Payer: Group Health Inc Medicare	$1.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.84
Rate for Payer: Hamaspik Choice Inc Medicare	$2.84

CC SQ REM SC/DC ICD GENERATOR

Facility OP

$9,037.83

Service Code	HCPCS 33241
Hospital Charge Code	66528646
Hospital Revenue Code	360
Min. Negotiated Rate	$243.37
Max. Negotiated Rate	$4,541.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,541.28
Rate for Payer: Aetna Government	$4,541.28
Rate for Payer: Cash Price	$4,541.28
Rate for Payer: Cash Price	$4,541.28
Rate for Payer: Cash Price	$4,541.28
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4,541.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$4,541.28
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$243.37
Rate for Payer: Fidelis Essential Plan Aliesa	$3,860.09
Rate for Payer: Fidelis Essential Plan QHP	$4,041.74
Rate for Payer: Fidelis Medicare Advantage	$4,541.28
Rate for Payer: Fidelis Qualified Health Plan	$4,041.74
Rate for Payer: Group Health Inc Commercial	$4,541.28
Rate for Payer: Group Health Inc Medicare	$4,541.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,518.92
Rate for Payer: Hamaspik Choice Inc Medicare	$4,541.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$270.41
Rate for Payer: Healthfirst Medicare Advantage	$3,860.09
Rate for Payer: Healthfirst QHP	$4,541.28
Rate for Payer: Senior Whole Health Medicare Advantage	$4,541.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,541.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,633.02
Rate for Payer: Wellcare Medicare	$4,314.22

CC STAT LOCK

Facility OP

$36.50

Hospital Charge Code	66528374
Hospital Revenue Code	480
Min. Negotiated Rate	$12.78
Max. Negotiated Rate	$29.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.25
Rate for Payer: Aetna Government	$18.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.82
Rate for Payer: Group Health Inc Commercial	$18.25
Rate for Payer: Group Health Inc Medicare	$12.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.25
Rate for Payer: Hamaspik Choice Inc Medicare	$18.25

CC STENT LIB MONO 12MM 2.75

Facility OP

$1,800.00

Service Code	HCPCS C1876
Hospital Charge Code	66520111
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$1,890.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$990.00
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	$900.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,035.00
Rate for Payer: Fidelis Medicare Advantage	$1,890.00
Rate for Payer: Group Health Inc Commercial	$900.00
Rate for Payer: Group Health Inc Medicare	$630.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$900.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,170.00

CC STENT LIB MONO 12MM 2.75

Facility IP

$1,800.00

Service Code	HCPCS C1876
Hospital Charge Code	66520111
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$900.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$900.00

CC STENT LIB MONO 12MM 3.0

Facility IP

$1,800.00

Service Code	HCPCS C1876
Hospital Charge Code	66520110
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$900.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$900.00

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