St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CC C/WIRE ABBOTT BAL HT .014

Facility

$200.00

Service Code	HCPCS C1769
Hospital Charge Code	66522105
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$210.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$120.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$115.00
Rate for Payer: EmblemHealth Commercial	$100.00
Rate for Payer: Fidelis Medicare Advantage	$210.00
Rate for Payer: Group Health Inc Commercial	$100.00
Rate for Payer: Group Health Inc Medicare	$70.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$130.00

CC C/WIRE AB MIRACLEB3 .014190CM

Facility

$370.00

Service Code	HCPCS C1769
Hospital Charge Code	66529121
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$388.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$203.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$222.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$185.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$212.75
Rate for Payer: EmblemHealth Commercial	$185.00
Rate for Payer: Fidelis Medicare Advantage	$388.50
Rate for Payer: Group Health Inc Commercial	$185.00
Rate for Payer: Group Health Inc Medicare	$129.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.00
Rate for Payer: Hamaspik Choice Inc Medicare	$185.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$240.50

CC C/WIRE AB MIRACLEB3 .014190CM

Facility

$370.00

Service Code	HCPCS C1769
Hospital Charge Code	66529121
Hospital Revenue Code	278
Min. Negotiated Rate	$185.00
Max. Negotiated Rate	$185.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.00
Rate for Payer: Hamaspik Choice Inc Medicare	$185.00

CC C/WIRE AB MIRACLEB3 .014 300CM

Facility

$370.00

Service Code	HCPCS C1769
Hospital Charge Code	66529122
Hospital Revenue Code	278
Min. Negotiated Rate	$185.00
Max. Negotiated Rate	$185.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.00
Rate for Payer: Hamaspik Choice Inc Medicare	$185.00

CC C/WIRE AB MIRACLEB3 .014 300CM

Facility

$370.00

Service Code	HCPCS C1769
Hospital Charge Code	66529122
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$388.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$203.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$222.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$185.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$212.75
Rate for Payer: EmblemHealth Commercial	$185.00
Rate for Payer: Fidelis Medicare Advantage	$388.50
Rate for Payer: Group Health Inc Commercial	$185.00
Rate for Payer: Group Health Inc Medicare	$129.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.00
Rate for Payer: Hamaspik Choice Inc Medicare	$185.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$240.50

CC C/WIRE AB PROWATER .014 180CM

Facility

$200.00

Service Code	HCPCS C1769
Hospital Charge Code	66529123
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$210.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$120.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$115.00
Rate for Payer: EmblemHealth Commercial	$100.00
Rate for Payer: Fidelis Medicare Advantage	$210.00
Rate for Payer: Group Health Inc Commercial	$100.00
Rate for Payer: Group Health Inc Medicare	$70.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$130.00

CC C/WIRE AB PROWATER .014 180CM

Facility

$200.00

Service Code	HCPCS C1769
Hospital Charge Code	66529123
Hospital Revenue Code	278
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$100.00

CC C/WIRE AB PROWATER .014 300CM

Facility

$200.00

Service Code	HCPCS C1769
Hospital Charge Code	66529124
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$210.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$120.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$115.00
Rate for Payer: EmblemHealth Commercial	$100.00
Rate for Payer: Fidelis Medicare Advantage	$210.00
Rate for Payer: Group Health Inc Commercial	$100.00
Rate for Payer: Group Health Inc Medicare	$70.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$130.00

CC C/WIRE AB PROWATER .014 300CM

Facility

$200.00

Service Code	HCPCS C1769
Hospital Charge Code	66529124
Hospital Revenue Code	278
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$100.00

CC D/CATH 5F BOSTON AR 1

Facility

$34.00

Service Code	HCPCS C1725
Hospital Charge Code	66520100
Hospital Revenue Code	278
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$17.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17.00

CC D/CATH 5F BOSTON AR 1

Facility

$34.00

Service Code	HCPCS C1725
Hospital Charge Code	66520100
Hospital Revenue Code	278
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$20.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.55
Rate for Payer: EmblemHealth Commercial	$17.00
Rate for Payer: Fidelis Medicare Advantage	$35.70
Rate for Payer: Group Health Inc Commercial	$17.00
Rate for Payer: Group Health Inc Medicare	$11.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.10

CC D/ CATH 5F BOSTON AR 2

Facility

$44.80

Service Code	HCPCS C1725
Hospital Charge Code	66520102
Hospital Revenue Code	278
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$22.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.40
Rate for Payer: Hamaspik Choice Inc Medicare	$22.40

CC D/ CATH 5F BOSTON AR 2

Facility

$44.80

Service Code	HCPCS C1725
Hospital Charge Code	66520102
Hospital Revenue Code	278
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$47.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$26.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.76
Rate for Payer: EmblemHealth Commercial	$22.40
Rate for Payer: Fidelis Medicare Advantage	$47.04
Rate for Payer: Group Health Inc Commercial	$22.40
Rate for Payer: Group Health Inc Medicare	$15.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.40
Rate for Payer: Hamaspik Choice Inc Medicare	$22.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.12

CC D/CATH 5F BOSTON IM

Facility

$44.80

Service Code	HCPCS C1725
Hospital Charge Code	66520103
Hospital Revenue Code	278
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$47.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$26.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.76
Rate for Payer: EmblemHealth Commercial	$22.40
Rate for Payer: Fidelis Medicare Advantage	$47.04
Rate for Payer: Group Health Inc Commercial	$22.40
Rate for Payer: Group Health Inc Medicare	$15.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.40
Rate for Payer: Hamaspik Choice Inc Medicare	$22.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.12

CC D/CATH 5F BOSTON IM

Facility

$44.80

Service Code	HCPCS C1725
Hospital Charge Code	66520103
Hospital Revenue Code	278
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$22.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.40
Rate for Payer: Hamaspik Choice Inc Medicare	$22.40

CC D/CATH 5F BOSTON RCB

Facility

$44.80

Service Code	HCPCS C1725
Hospital Charge Code	66520104
Hospital Revenue Code	278
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$22.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.40
Rate for Payer: Hamaspik Choice Inc Medicare	$22.40

CC D/CATH 5F BOSTON RCB

Facility

$44.80

Service Code	HCPCS C1725
Hospital Charge Code	66520104
Hospital Revenue Code	278
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$47.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$26.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.76
Rate for Payer: EmblemHealth Commercial	$22.40
Rate for Payer: Fidelis Medicare Advantage	$47.04
Rate for Payer: Group Health Inc Commercial	$22.40
Rate for Payer: Group Health Inc Medicare	$15.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.40
Rate for Payer: Hamaspik Choice Inc Medicare	$22.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.12

CC D/CATH 6F CORDIS JL 4.0 100CM

Facility

$44.00

Service Code	HCPCS C1725
Hospital Charge Code	66520105
Hospital Revenue Code	278
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$46.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$26.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.30
Rate for Payer: EmblemHealth Commercial	$22.00
Rate for Payer: Fidelis Medicare Advantage	$46.20
Rate for Payer: Group Health Inc Commercial	$22.00
Rate for Payer: Group Health Inc Medicare	$15.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.00
Rate for Payer: Hamaspik Choice Inc Medicare	$22.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.60

CC D/CATH 6F CORDIS JL 4.0 100CM

Facility

$44.00

Service Code	HCPCS C1725
Hospital Charge Code	66520105
Hospital Revenue Code	278
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$22.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.00
Rate for Payer: Hamaspik Choice Inc Medicare	$22.00

CC DEBRIDE, SKIN TO SQ TISSUE

Facility

$967.73

Service Code	HCPCS 11042
Hospital Charge Code	66528650
Hospital Revenue Code	360
Rate for Payer: Cash Price	$461.12

CC DEBRIDE, SKIN TO SQ TISSUE

Facility

$967.73

Service Code	HCPCS 11042
Hospital Charge Code	66528650
Hospital Revenue Code	360
Min. Negotiated Rate	$322.78
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$461.12
Rate for Payer: Aetna Government	$461.12
Rate for Payer: Affinity Essential Plan 1&2	$322.78
Rate for Payer: Affinity Essential Plan 3&4	$322.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$322.78
Rate for Payer: Brighton Health Commercial	$725.80
Rate for Payer: Cash Price	$461.12
Rate for Payer: Cash Price	$461.12
Rate for Payer: Cash Price	$461.12
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$461.12
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	$461.12
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$391.95
Rate for Payer: Fidelis Essential Plan QHP	$410.40
Rate for Payer: Fidelis Medicare Advantage	$461.12
Rate for Payer: Fidelis Qualified Health Plan	$410.40
Rate for Payer: Group Health Inc Commercial	$461.12
Rate for Payer: Group Health Inc Medicare	$461.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$483.86
Rate for Payer: Hamaspik Choice Inc Medicare	$461.12
Rate for Payer: Healthfirst Medicare Advantage	$391.95
Rate for Payer: Healthfirst QHP	$461.12
Rate for Payer: Humana Medicare	$470.34
Rate for Payer: Senior Whole Health Medicare Advantage	$461.12
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$461.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$461.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$368.90
Rate for Payer: Wellcare Medicare	$438.06

CC DES ABBOTT XIENCE NANO 2.25X

Facility

$3,900.00

Service Code	HCPCS C1725
Hospital Charge Code	66520211
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00

CC DES ABBOTT XIENCE NANO 2.25X

Facility

$3,900.00

Service Code	HCPCS C1725
Hospital Charge Code	66520211
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$4,095.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,145.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$2,340.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,950.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,242.50
Rate for Payer: EmblemHealth Commercial	$1,950.00
Rate for Payer: Fidelis Medicare Advantage	$4,095.00
Rate for Payer: Group Health Inc Commercial	$1,950.00
Rate for Payer: Group Health Inc Medicare	$1,365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,535.00

CC DES AB X RX 2.5MMX12MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528951
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,095.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,145.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$2,340.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,950.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,242.50
Rate for Payer: EmblemHealth Commercial	$1,950.00
Rate for Payer: Fidelis Medicare Advantage	$4,095.00
Rate for Payer: Group Health Inc Commercial	$1,950.00
Rate for Payer: Group Health Inc Medicare	$1,365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,535.00

CC DES AB X RX 2.5MMX12MM

Facility

$3,900.00

Service Code	HCPCS C1874
Hospital Charge Code	66528951
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,950.00

Know your out-of-pocket cost for care.

All Charges