St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CC BMS MED INTEGRITY 4.0X9-30MM

Facility

$1,650.00

Service Code	HCPCS C1876
Hospital Charge Code	66529386
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$1,732.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$907.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$990.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$825.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$948.75
Rate for Payer: EmblemHealth Commercial	$825.00
Rate for Payer: Fidelis Medicare Advantage	$1,732.50
Rate for Payer: Group Health Inc Commercial	$825.00
Rate for Payer: Group Health Inc Medicare	$577.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$825.00
Rate for Payer: Hamaspik Choice Inc Medicare	$825.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,072.50

CC BOOMERANG CLOSURE WIRE

Facility

$3,000.00

Hospital Charge Code	66529215
Hospital Revenue Code	270
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$2,400.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,500.00
Rate for Payer: Aetna Government	$1,500.00
Rate for Payer: Brighton Health Commercial	$2,250.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,040.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

CC BOS. SCI. .035 TERUMO ANG 150

Facility

$63.36

Service Code	HCPCS C1769
Hospital Charge Code	66528319
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$66.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$38.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$36.43
Rate for Payer: EmblemHealth Commercial	$31.68
Rate for Payer: Fidelis Medicare Advantage	$66.53
Rate for Payer: Group Health Inc Commercial	$31.68
Rate for Payer: Group Health Inc Medicare	$22.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.68
Rate for Payer: Hamaspik Choice Inc Medicare	$31.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$41.18

CC BOS. SCI. .035 TERUMO ANG 150

Facility

$63.36

Service Code	HCPCS C1769
Hospital Charge Code	66528319
Hospital Revenue Code	278
Min. Negotiated Rate	$31.68
Max. Negotiated Rate	$31.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.68
Rate for Payer: Hamaspik Choice Inc Medicare	$31.68

CC BOS. SCI. .035 TERUMO ANG 180C

Facility

$85.89

Service Code	HCPCS C1769
Hospital Charge Code	66528320
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$90.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$51.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$42.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.39
Rate for Payer: EmblemHealth Commercial	$42.94
Rate for Payer: Fidelis Medicare Advantage	$90.18
Rate for Payer: Group Health Inc Commercial	$42.94
Rate for Payer: Group Health Inc Medicare	$30.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.94
Rate for Payer: Hamaspik Choice Inc Medicare	$42.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$55.83

CC BOS. SCI. .035 TERUMO ANG 180C

Facility

$85.89

Service Code	HCPCS C1769
Hospital Charge Code	66528320
Hospital Revenue Code	278
Min. Negotiated Rate	$42.94
Max. Negotiated Rate	$42.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.94
Rate for Payer: Hamaspik Choice Inc Medicare	$42.94

CC BOS. SCI. .035 TERUMO ANG 260

Facility

$95.04

Service Code	HCPCS C1769
Hospital Charge Code	66528321
Hospital Revenue Code	278
Min. Negotiated Rate	$47.52
Max. Negotiated Rate	$47.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.52
Rate for Payer: Hamaspik Choice Inc Medicare	$47.52

CC BOS. SCI. .035 TERUMO ANG 260

Facility

$95.04

Service Code	HCPCS C1769
Hospital Charge Code	66528321
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$99.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$57.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$54.65
Rate for Payer: EmblemHealth Commercial	$47.52
Rate for Payer: Fidelis Medicare Advantage	$99.79
Rate for Payer: Group Health Inc Commercial	$47.52
Rate for Payer: Group Health Inc Medicare	$33.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.52
Rate for Payer: Hamaspik Choice Inc Medicare	$47.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$61.78

CC BOS. SCI. .035 TERUMO ANG STIF

Facility

$101.03

Service Code	HCPCS C1769
Hospital Charge Code	66528322
Hospital Revenue Code	278
Min. Negotiated Rate	$50.52
Max. Negotiated Rate	$50.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.52
Rate for Payer: Hamaspik Choice Inc Medicare	$50.52

CC BOS. SCI. .035 TERUMO ANG STIF

Facility

$101.03

Service Code	HCPCS C1769
Hospital Charge Code	66528322
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$106.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$60.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.09
Rate for Payer: EmblemHealth Commercial	$50.52
Rate for Payer: Fidelis Medicare Advantage	$106.08
Rate for Payer: Group Health Inc Commercial	$50.52
Rate for Payer: Group Health Inc Medicare	$35.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.52
Rate for Payer: Hamaspik Choice Inc Medicare	$50.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.67

CC BOS. SCI. 035 TERUMO STR 150C

Facility

$63.36

Hospital Charge Code	66528323
Hospital Revenue Code	270
Min. Negotiated Rate	$22.18
Max. Negotiated Rate	$50.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.68
Rate for Payer: Aetna Government	$31.68
Rate for Payer: Brighton Health Commercial	$47.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.08
Rate for Payer: Group Health Inc Commercial	$31.68
Rate for Payer: Group Health Inc Medicare	$22.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.68
Rate for Payer: Hamaspik Choice Inc Medicare	$31.68

CC BOS. SCI. 5 FR FL 4 100CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528282
Hospital Revenue Code	278
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

CC BOS. SCI. 5 FR FL 4 100CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528282
Hospital Revenue Code	278
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$10.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: EmblemHealth Commercial	$8.50
Rate for Payer: Fidelis Medicare Advantage	$17.85
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

CC BOS. SCI. 5 FR FL 4 125CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528283
Hospital Revenue Code	278
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$10.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: EmblemHealth Commercial	$8.50
Rate for Payer: Fidelis Medicare Advantage	$17.85
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

CC BOS. SCI. 5 FR FL 4 125CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528283
Hospital Revenue Code	278
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

CC BOS. SCI. 5FR FL 4.5 100CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528284
Hospital Revenue Code	278
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$10.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: EmblemHealth Commercial	$8.50
Rate for Payer: Fidelis Medicare Advantage	$17.85
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

CC BOS. SCI. 5FR FL 4.5 100CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528284
Hospital Revenue Code	278
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

CC BOS. SCI. 5 FR FR 4 125CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528285
Hospital Revenue Code	278
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$10.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: EmblemHealth Commercial	$8.50
Rate for Payer: Fidelis Medicare Advantage	$17.85
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

CC BOS. SCI. 5 FR FR 4 125CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528285
Hospital Revenue Code	278
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

CC BOS. SCI. 5 FR FR 5 125CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528286
Hospital Revenue Code	278
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

CC BOS. SCI. 5 FR FR 5 125CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528286
Hospital Revenue Code	278
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$10.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: EmblemHealth Commercial	$8.50
Rate for Payer: Fidelis Medicare Advantage	$17.85
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

CC BOS. SCI. 5 FR IM 100CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528287
Hospital Revenue Code	278
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$10.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: EmblemHealth Commercial	$8.50
Rate for Payer: Fidelis Medicare Advantage	$17.85
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

CC BOS. SCI. 5 FR IM 100CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528287
Hospital Revenue Code	278
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

CC BOS. SCI. 5 FR IM 125CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528288
Hospital Revenue Code	278
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

CC BOS. SCI. 5 FR IM 125CM

Facility

$17.00

Service Code	HCPCS C1725
Hospital Charge Code	66528288
Hospital Revenue Code	278
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$10.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: EmblemHealth Commercial	$8.50
Rate for Payer: Fidelis Medicare Advantage	$17.85
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

Know your out-of-pocket cost for care.

All Charges