St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CATH,LUTONIX,4X150X130CM

Facility

$4,750.00

Hospital Charge Code	64906144
Hospital Revenue Code	279
Min. Negotiated Rate	$1,662.50
Max. Negotiated Rate	$3,800.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,612.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,375.00
Rate for Payer: Aetna Government	$2,375.00
Rate for Payer: Brighton Health Commercial	$3,562.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,800.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,230.00
Rate for Payer: Group Health Inc Commercial	$2,375.00
Rate for Payer: Group Health Inc Medicare	$1,662.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,375.00

CATH,LUTONIX,4X80X130CM

Facility

$4,000.00

Hospital Charge Code	64906141
Hospital Revenue Code	279
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$3,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,200.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,000.00
Rate for Payer: Aetna Government	$2,000.00
Rate for Payer: Brighton Health Commercial	$3,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,720.00
Rate for Payer: Group Health Inc Commercial	$2,000.00
Rate for Payer: Group Health Inc Medicare	$1,400.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,000.00

CATH,LUTONIX,5X100X130CM

Facility

$4,000.00

Hospital Charge Code	64906148
Hospital Revenue Code	279
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$3,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,200.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,000.00
Rate for Payer: Aetna Government	$2,000.00
Rate for Payer: Brighton Health Commercial	$3,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,720.00
Rate for Payer: Group Health Inc Commercial	$2,000.00
Rate for Payer: Group Health Inc Medicare	$1,400.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,000.00

CATH,LUTONIX,5X120X130CM

Facility

$4,375.00

Hospital Charge Code	64906149
Hospital Revenue Code	279
Min. Negotiated Rate	$1,531.25
Max. Negotiated Rate	$3,500.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,406.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,187.50
Rate for Payer: Aetna Government	$2,187.50
Rate for Payer: Brighton Health Commercial	$3,281.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,975.00
Rate for Payer: Group Health Inc Commercial	$2,187.50
Rate for Payer: Group Health Inc Medicare	$1,531.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,187.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,187.50

CATH,LUTONIX,5X150X130CM

Facility

$4,750.00

Hospital Charge Code	64906150
Hospital Revenue Code	279
Min. Negotiated Rate	$1,662.50
Max. Negotiated Rate	$3,800.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,612.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,375.00
Rate for Payer: Aetna Government	$2,375.00
Rate for Payer: Brighton Health Commercial	$3,562.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,800.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,230.00
Rate for Payer: Group Health Inc Commercial	$2,375.00
Rate for Payer: Group Health Inc Medicare	$1,662.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,375.00

CATH,LUTONIX,5X40X130CM

Facility

$4,000.00

Hospital Charge Code	64906145
Hospital Revenue Code	279
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$3,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,200.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,000.00
Rate for Payer: Aetna Government	$2,000.00
Rate for Payer: Brighton Health Commercial	$3,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,720.00
Rate for Payer: Group Health Inc Commercial	$2,000.00
Rate for Payer: Group Health Inc Medicare	$1,400.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,000.00

CATH,LUTONIX,5X60X130CM

Facility

$4,000.00

Hospital Charge Code	64906146
Hospital Revenue Code	279
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$3,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,200.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,000.00
Rate for Payer: Aetna Government	$2,000.00
Rate for Payer: Brighton Health Commercial	$3,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,720.00
Rate for Payer: Group Health Inc Commercial	$2,000.00
Rate for Payer: Group Health Inc Medicare	$1,400.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,000.00

CATH,LUTONIX,5X80X130CM

Facility

$4,000.00

Hospital Charge Code	64906147
Hospital Revenue Code	279
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$3,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,200.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,000.00
Rate for Payer: Aetna Government	$2,000.00
Rate for Payer: Brighton Health Commercial	$3,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,720.00
Rate for Payer: Group Health Inc Commercial	$2,000.00
Rate for Payer: Group Health Inc Medicare	$1,400.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,000.00

CATH,LUTONIX,6MM80X130CM

Facility

$4,000.00

Hospital Charge Code	64906153
Hospital Revenue Code	279
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$3,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,200.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,000.00
Rate for Payer: Aetna Government	$2,000.00
Rate for Payer: Brighton Health Commercial	$3,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,720.00
Rate for Payer: Group Health Inc Commercial	$2,000.00
Rate for Payer: Group Health Inc Medicare	$1,400.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,000.00

CATH,LUTONIX,6X100X130CM

Facility

$4,000.00

Hospital Charge Code	64906154
Hospital Revenue Code	279
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$3,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,200.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,000.00
Rate for Payer: Aetna Government	$2,000.00
Rate for Payer: Brighton Health Commercial	$3,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,720.00
Rate for Payer: Group Health Inc Commercial	$2,000.00
Rate for Payer: Group Health Inc Medicare	$1,400.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,000.00

CATH,LUTONIX,6X120X130CM

Facility

$4,375.00

Hospital Charge Code	64906155
Hospital Revenue Code	279
Min. Negotiated Rate	$1,531.25
Max. Negotiated Rate	$3,500.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,406.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,187.50
Rate for Payer: Aetna Government	$2,187.50
Rate for Payer: Brighton Health Commercial	$3,281.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,975.00
Rate for Payer: Group Health Inc Commercial	$2,187.50
Rate for Payer: Group Health Inc Medicare	$1,531.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,187.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,187.50

CATH,LUTONIX,6X150X130CM

Facility

$4,750.00

Hospital Charge Code	64906156
Hospital Revenue Code	279
Min. Negotiated Rate	$1,662.50
Max. Negotiated Rate	$3,800.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,612.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,375.00
Rate for Payer: Aetna Government	$2,375.00
Rate for Payer: Brighton Health Commercial	$3,562.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,800.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,230.00
Rate for Payer: Group Health Inc Commercial	$2,375.00
Rate for Payer: Group Health Inc Medicare	$1,662.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,375.00

CATH,LUTONIX,6X4X130CM

Facility

$4,000.00

Hospital Charge Code	64906151
Hospital Revenue Code	279
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$3,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,200.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,000.00
Rate for Payer: Aetna Government	$2,000.00
Rate for Payer: Brighton Health Commercial	$3,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,720.00
Rate for Payer: Group Health Inc Commercial	$2,000.00
Rate for Payer: Group Health Inc Medicare	$1,400.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,000.00

CATH,LUTONIX,6X60X130CM

Facility

$4,000.00

Hospital Charge Code	64906152
Hospital Revenue Code	279
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$3,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,200.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,000.00
Rate for Payer: Aetna Government	$2,000.00
Rate for Payer: Brighton Health Commercial	$3,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,720.00
Rate for Payer: Group Health Inc Commercial	$2,000.00
Rate for Payer: Group Health Inc Medicare	$1,400.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,000.00

CATH MALECOT NEPHROSTOM 20F

Facility

$239.25

Hospital Charge Code	64905388
Hospital Revenue Code	279
Min. Negotiated Rate	$83.74
Max. Negotiated Rate	$191.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$131.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$119.62
Rate for Payer: Aetna Government	$119.62
Rate for Payer: Brighton Health Commercial	$179.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$191.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$162.69
Rate for Payer: Group Health Inc Commercial	$119.62
Rate for Payer: Group Health Inc Medicare	$83.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.62
Rate for Payer: Hamaspik Choice Inc Medicare	$119.62

CATH,NC TREK 2.0MMX6 RX

Facility

$375.00

Hospital Charge Code	64902602
Hospital Revenue Code	279
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$300.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$206.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$187.50
Rate for Payer: Aetna Government	$187.50
Rate for Payer: Brighton Health Commercial	$281.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$255.00
Rate for Payer: Group Health Inc Commercial	$187.50
Rate for Payer: Group Health Inc Medicare	$131.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.50
Rate for Payer: Hamaspik Choice Inc Medicare	$187.50

CATH PAC XTREME 4.0X250MM

Facility

$512.50

Service Code	HCPCS C1725
Hospital Charge Code	64906977
Hospital Revenue Code	278
Min. Negotiated Rate	$256.25
Max. Negotiated Rate	$256.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$256.25
Rate for Payer: Hamaspik Choice Inc Medicare	$256.25

CATH PAC XTREME 4.0X250MM

Facility

$512.50

Service Code	HCPCS C1725
Hospital Charge Code	64906977
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$538.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$281.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$307.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$256.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$294.69
Rate for Payer: EmblemHealth Commercial	$256.25
Rate for Payer: Fidelis Medicare Advantage	$538.12
Rate for Payer: Group Health Inc Commercial	$256.25
Rate for Payer: Group Health Inc Medicare	$179.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$256.25
Rate for Payer: Hamaspik Choice Inc Medicare	$256.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$333.12

CATH,PIGTAIL,5FR,100CM,.038

Facility

$32.75

Hospital Charge Code	64906169
Hospital Revenue Code	279
Min. Negotiated Rate	$11.46
Max. Negotiated Rate	$26.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.38
Rate for Payer: Aetna Government	$16.38
Rate for Payer: Brighton Health Commercial	$24.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.27
Rate for Payer: Group Health Inc Commercial	$16.38
Rate for Payer: Group Health Inc Medicare	$11.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.38
Rate for Payer: Hamaspik Choice Inc Medicare	$16.38

CATH,PIGTAIL,5FR,65CM,.038

Facility

$32.75

Hospital Charge Code	64906168
Hospital Revenue Code	279
Min. Negotiated Rate	$11.46
Max. Negotiated Rate	$26.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.38
Rate for Payer: Aetna Government	$16.38
Rate for Payer: Brighton Health Commercial	$24.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.27
Rate for Payer: Group Health Inc Commercial	$16.38
Rate for Payer: Group Health Inc Medicare	$11.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.38
Rate for Payer: Hamaspik Choice Inc Medicare	$16.38

CATH PREMI 27GA VYGON

Facility

$127.57

Hospital Charge Code	64902853
Hospital Revenue Code	279
Min. Negotiated Rate	$44.65
Max. Negotiated Rate	$102.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.78
Rate for Payer: Aetna Government	$63.78
Rate for Payer: Brighton Health Commercial	$95.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$102.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.75
Rate for Payer: Group Health Inc Commercial	$63.78
Rate for Payer: Group Health Inc Medicare	$44.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.78
Rate for Payer: Hamaspik Choice Inc Medicare	$63.78

CATH PROBE GOLD 10 FR

Facility

$440.00

Hospital Charge Code	64902803
Hospital Revenue Code	279
Min. Negotiated Rate	$154.00
Max. Negotiated Rate	$352.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$242.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$220.00
Rate for Payer: Aetna Government	$220.00
Rate for Payer: Brighton Health Commercial	$330.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$352.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$299.20
Rate for Payer: Group Health Inc Commercial	$220.00
Rate for Payer: Group Health Inc Medicare	$154.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.00
Rate for Payer: Hamaspik Choice Inc Medicare	$220.00

CATH, PTA BAL 2.5/10CM/130 4F

Facility

$1,280.00

Service Code	HCPCS C1726
Hospital Charge Code	64906139
Hospital Revenue Code	278
Min. Negotiated Rate	$640.00
Max. Negotiated Rate	$640.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$640.00
Rate for Payer: Hamaspik Choice Inc Medicare	$640.00

CATH, PTA BAL 2.5/10CM/130 4F

Facility

$1,280.00

Service Code	HCPCS C1726
Hospital Charge Code	64906139
Hospital Revenue Code	278
Min. Negotiated Rate	$17.43
Max. Negotiated Rate	$1,344.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$704.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.43
Rate for Payer: Aetna Government	$17.43
Rate for Payer: Brighton Health Commercial	$768.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$640.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$736.00
Rate for Payer: EmblemHealth Commercial	$640.00
Rate for Payer: Fidelis Medicare Advantage	$1,344.00
Rate for Payer: Group Health Inc Commercial	$640.00
Rate for Payer: Group Health Inc Medicare	$448.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$640.00
Rate for Payer: Hamaspik Choice Inc Medicare	$640.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$832.00

CATH, PTA BAL 2.5/22CM/130 4F

Facility

$1,345.00

Service Code	HCPCS C1726
Hospital Charge Code	64906140
Hospital Revenue Code	278
Min. Negotiated Rate	$17.43
Max. Negotiated Rate	$1,412.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$739.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.43
Rate for Payer: Aetna Government	$17.43
Rate for Payer: Brighton Health Commercial	$807.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$672.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$773.38
Rate for Payer: EmblemHealth Commercial	$672.50
Rate for Payer: Fidelis Medicare Advantage	$1,412.25
Rate for Payer: Group Health Inc Commercial	$672.50
Rate for Payer: Group Health Inc Medicare	$470.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$672.50
Rate for Payer: Hamaspik Choice Inc Medicare	$672.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$874.25

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