St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CC BS.038ZIP HYDR G STD STR180CM

Facility

$85.88

Hospital Charge Code	66528831
Hospital Revenue Code	480
Min. Negotiated Rate	$30.06
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.94
Rate for Payer: Aetna Government	$42.94
Rate for Payer: Brighton Health Commercial	$64.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$68.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.40
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: United Healthcare Commercial	$316.00

CC BS .038 ZIP HYDRO GUIDE 150STF

Facility

$429.44

Service Code	HCPCS C1769
Hospital Charge Code	66520259
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$450.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$236.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$257.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$214.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$246.93
Rate for Payer: EmblemHealth Commercial	$214.72
Rate for Payer: Fidelis Medicare Advantage	$450.91
Rate for Payer: Group Health Inc Commercial	$214.72
Rate for Payer: Group Health Inc Medicare	$150.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$214.72
Rate for Payer: Hamaspik Choice Inc Medicare	$214.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$279.14

CC BS .038 ZIP HYDRO GUIDE 150STF

Facility

$429.44

Service Code	HCPCS C1769
Hospital Charge Code	66520259
Hospital Revenue Code	278
Min. Negotiated Rate	$214.72
Max. Negotiated Rate	$214.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$214.72
Rate for Payer: Hamaspik Choice Inc Medicare	$214.72

CC BS.38ZIPWIRE HYDRO GW 150STR

Facility

$493.10

Service Code	HCPCS C1769
Hospital Charge Code	66520260
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$517.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$271.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$295.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$246.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$283.53
Rate for Payer: EmblemHealth Commercial	$246.55
Rate for Payer: Fidelis Medicare Advantage	$517.76
Rate for Payer: Group Health Inc Commercial	$246.55
Rate for Payer: Group Health Inc Medicare	$172.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$246.55
Rate for Payer: Hamaspik Choice Inc Medicare	$246.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$320.52

CC BS.38ZIPWIRE HYDRO GW 150STR

Facility

$493.10

Service Code	HCPCS C1769
Hospital Charge Code	66520260
Hospital Revenue Code	278
Min. Negotiated Rate	$246.55
Max. Negotiated Rate	$246.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$246.55
Rate for Payer: Hamaspik Choice Inc Medicare	$246.55

CC B.S 6FR EXPO MULTI PACK

Facility

$102.00

Hospital Charge Code	66520307
Hospital Revenue Code	279
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$81.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.00
Rate for Payer: Aetna Government	$51.00
Rate for Payer: Brighton Health Commercial	$76.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.36
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

CC B.S. ADDWIRE EXTENSION .014

Facility

$185.60

Service Code	HCPCS C1769
Hospital Charge Code	66522121
Hospital Revenue Code	278
Min. Negotiated Rate	$92.80
Max. Negotiated Rate	$92.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.80
Rate for Payer: Hamaspik Choice Inc Medicare	$92.80

CC B.S. ADDWIRE EXTENSION .014

Facility

$185.60

Service Code	HCPCS C1769
Hospital Charge Code	66522121
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$194.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$102.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$111.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$92.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$106.72
Rate for Payer: EmblemHealth Commercial	$92.80
Rate for Payer: Fidelis Medicare Advantage	$194.88
Rate for Payer: Group Health Inc Commercial	$92.80
Rate for Payer: Group Health Inc Medicare	$64.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.80
Rate for Payer: Hamaspik Choice Inc Medicare	$92.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$120.64

CC B.S. APEX 2.0MM-4.0X12MM

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66521085
Hospital Revenue Code	278
Min. Negotiated Rate	$235.00
Max. Negotiated Rate	$235.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00

CC B.S. APEX 2.0MM-4.0X12MM

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66521085
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$493.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$258.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$282.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$270.25
Rate for Payer: EmblemHealth Commercial	$235.00
Rate for Payer: Fidelis Medicare Advantage	$493.50
Rate for Payer: Group Health Inc Commercial	$235.00
Rate for Payer: Group Health Inc Medicare	$164.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$305.50

CC B.S. APEX FLEX 1.5MM-8-12-15M

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66521087
Hospital Revenue Code	278
Min. Negotiated Rate	$235.00
Max. Negotiated Rate	$235.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00

CC B.S. APEX FLEX 1.5MM-8-12-15M

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66521087
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$493.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$258.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$282.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$270.25
Rate for Payer: EmblemHealth Commercial	$235.00
Rate for Payer: Fidelis Medicare Advantage	$493.50
Rate for Payer: Group Health Inc Commercial	$235.00
Rate for Payer: Group Health Inc Medicare	$164.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$305.50

CC B.S. APEX PUSH 1.5MMX12MM BALL

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66521079
Hospital Revenue Code	278
Min. Negotiated Rate	$235.00
Max. Negotiated Rate	$235.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00

CC B.S. APEX PUSH 1.5MMX12MM BALL

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66521079
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$493.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$258.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$282.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$270.25
Rate for Payer: EmblemHealth Commercial	$235.00
Rate for Payer: Fidelis Medicare Advantage	$493.50
Rate for Payer: Group Health Inc Commercial	$235.00
Rate for Payer: Group Health Inc Medicare	$164.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$305.50

CC B.S. APEX PUSH 1.5MMX8-12-15MM

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66521089
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$493.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$258.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$282.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$270.25
Rate for Payer: EmblemHealth Commercial	$235.00
Rate for Payer: Fidelis Medicare Advantage	$493.50
Rate for Payer: Group Health Inc Commercial	$235.00
Rate for Payer: Group Health Inc Medicare	$164.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$305.50

CC B.S. APEX PUSH 1.5MMX8-12-15MM

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66521089
Hospital Revenue Code	278
Min. Negotiated Rate	$235.00
Max. Negotiated Rate	$235.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00

CC BS APEX PUSH 1.5MMX 8MM BALL

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66521083
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$493.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$258.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$282.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$270.25
Rate for Payer: EmblemHealth Commercial	$235.00
Rate for Payer: Fidelis Medicare Advantage	$493.50
Rate for Payer: Group Health Inc Commercial	$235.00
Rate for Payer: Group Health Inc Medicare	$164.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$305.50

CC BS APEX PUSH 1.5MMX 8MM BALL

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66521083
Hospital Revenue Code	278
Min. Negotiated Rate	$235.00
Max. Negotiated Rate	$235.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00

CC BS APEX PUSH 1.5X15MM BALL

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66521081
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$493.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$258.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$282.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$270.25
Rate for Payer: EmblemHealth Commercial	$235.00
Rate for Payer: Fidelis Medicare Advantage	$493.50
Rate for Payer: Group Health Inc Commercial	$235.00
Rate for Payer: Group Health Inc Medicare	$164.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$305.50

CC BS APEX PUSH 1.5X15MM BALL

Facility

$470.00

Service Code	HCPCS C1725
Hospital Charge Code	66521081
Hospital Revenue Code	278
Min. Negotiated Rate	$235.00
Max. Negotiated Rate	$235.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00

CC B SCI 2MM BIOSPY FORCEPS

Facility

$950.00

Service Code	HCPCS C1713
Hospital Charge Code	66571555
Hospital Revenue Code	278
Min. Negotiated Rate	$475.00
Max. Negotiated Rate	$475.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$475.00
Rate for Payer: Hamaspik Choice Inc Medicare	$475.00

CC B SCI 2MM BIOSPY FORCEPS

Facility

$950.00

Service Code	HCPCS C1713
Hospital Charge Code	66571555
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$997.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$522.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$570.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$475.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$546.25
Rate for Payer: EmblemHealth Commercial	$475.00
Rate for Payer: Fidelis Medicare Advantage	$997.50
Rate for Payer: Group Health Inc Commercial	$475.00
Rate for Payer: Group Health Inc Medicare	$332.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$475.00
Rate for Payer: Hamaspik Choice Inc Medicare	$475.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$617.50

CC B SCI COMPLIANCE ENDOKIT

Facility

$390.00

Hospital Charge Code	66571556
Hospital Revenue Code	270
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$312.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$214.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$195.00
Rate for Payer: Aetna Government	$195.00
Rate for Payer: Brighton Health Commercial	$292.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$312.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$265.20
Rate for Payer: Group Health Inc Commercial	$195.00
Rate for Payer: Group Health Inc Medicare	$136.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$195.00
Rate for Payer: Hamaspik Choice Inc Medicare	$195.00

CC B.S. C/WIRE .014

Facility

$190.00

Service Code	HCPCS C1769
Hospital Charge Code	66522111
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$199.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$104.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$114.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$95.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$109.25
Rate for Payer: EmblemHealth Commercial	$95.00
Rate for Payer: Fidelis Medicare Advantage	$199.50
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
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$123.50

CC B.S. C/WIRE .014

Facility

$190.00

Service Code	HCPCS C1769
Hospital Charge Code	66522111
Hospital Revenue Code	278
Min. Negotiated Rate	$95.00
Max. Negotiated Rate	$95.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.00
Rate for Payer: Hamaspik Choice Inc Medicare	$95.00

Know your out-of-pocket cost for care.

All Charges