St. Barnabas Hospital

All Charges

Charge

Type

Price

ABBOTT STENT 3.25MM X 28MM

Facility IP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523387
Hospital Revenue Code	278
Min. Negotiated Rate	$1,100.00
Max. Negotiated Rate	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00

ABBOTT STENT 3.25MM X 28MM

Facility OP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523387
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,265.00
Rate for Payer: Fidelis Medicare Advantage	$2,310.00
Rate for Payer: Group Health Inc Commercial	$1,100.00
Rate for Payer: Group Health Inc Medicare	$770.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,430.00

ABBOTT STENT 3.25MM X 33MM

Facility IP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523388
Hospital Revenue Code	278
Min. Negotiated Rate	$1,100.00
Max. Negotiated Rate	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00

ABBOTT STENT 3.25MM X 33MM

Facility OP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523388
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,265.00
Rate for Payer: Fidelis Medicare Advantage	$2,310.00
Rate for Payer: Group Health Inc Commercial	$1,100.00
Rate for Payer: Group Health Inc Medicare	$770.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,430.00

ABBOTT STENT 3.25MM X 38MM

Facility OP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523389
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,265.00
Rate for Payer: Fidelis Medicare Advantage	$2,310.00
Rate for Payer: Group Health Inc Commercial	$1,100.00
Rate for Payer: Group Health Inc Medicare	$770.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,430.00

ABBOTT STENT 3.25MM X 38MM

Facility IP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523389
Hospital Revenue Code	278
Min. Negotiated Rate	$1,100.00
Max. Negotiated Rate	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00

ABBOTT STENT 3.50MM X 08MM

Facility IP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523390
Hospital Revenue Code	278
Min. Negotiated Rate	$1,100.00
Max. Negotiated Rate	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00

ABBOTT STENT 3.50MM X 08MM

Facility OP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523390
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,265.00
Rate for Payer: Fidelis Medicare Advantage	$2,310.00
Rate for Payer: Group Health Inc Commercial	$1,100.00
Rate for Payer: Group Health Inc Medicare	$770.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,430.00

ABBOTT STENT 3.50MM X 12MM

Facility OP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523391
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,265.00
Rate for Payer: Fidelis Medicare Advantage	$2,310.00
Rate for Payer: Group Health Inc Commercial	$1,100.00
Rate for Payer: Group Health Inc Medicare	$770.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,430.00

ABBOTT STENT 3.50MM X 12MM

Facility IP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523391
Hospital Revenue Code	278
Min. Negotiated Rate	$1,100.00
Max. Negotiated Rate	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00

ABBOTT STENT 3.50MM X 15MM

Facility IP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523392
Hospital Revenue Code	278
Min. Negotiated Rate	$1,100.00
Max. Negotiated Rate	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00

ABBOTT STENT 3.50MM X 15MM

Facility OP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523392
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,265.00
Rate for Payer: Fidelis Medicare Advantage	$2,310.00
Rate for Payer: Group Health Inc Commercial	$1,100.00
Rate for Payer: Group Health Inc Medicare	$770.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,430.00

ABBOTT STENT 3.50MM X 18MM

Facility IP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523393
Hospital Revenue Code	278
Min. Negotiated Rate	$1,100.00
Max. Negotiated Rate	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00

ABBOTT STENT 3.50MM X 18MM

Facility OP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523393
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,265.00
Rate for Payer: Fidelis Medicare Advantage	$2,310.00
Rate for Payer: Group Health Inc Commercial	$1,100.00
Rate for Payer: Group Health Inc Medicare	$770.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,430.00

ABBOTT STENT 3.50MM X 23MM

Facility OP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523394
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,265.00
Rate for Payer: Fidelis Medicare Advantage	$2,310.00
Rate for Payer: Group Health Inc Commercial	$1,100.00
Rate for Payer: Group Health Inc Medicare	$770.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,430.00

ABBOTT STENT 3.50MM X 23MM

Facility IP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523394
Hospital Revenue Code	278
Min. Negotiated Rate	$1,100.00
Max. Negotiated Rate	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00

ABBOTT STENT 3.50MM X 28MM

Facility IP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523395
Hospital Revenue Code	278
Min. Negotiated Rate	$1,100.00
Max. Negotiated Rate	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00

ABBOTT STENT 3.50MM X 28MM

Facility OP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523395
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,265.00
Rate for Payer: Fidelis Medicare Advantage	$2,310.00
Rate for Payer: Group Health Inc Commercial	$1,100.00
Rate for Payer: Group Health Inc Medicare	$770.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,430.00

ABBOTT STENT 3.50MM X 33MM

Facility IP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523396
Hospital Revenue Code	278
Min. Negotiated Rate	$1,100.00
Max. Negotiated Rate	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00

ABBOTT STENT 3.50MM X 33MM

Facility OP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523396
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,265.00
Rate for Payer: Fidelis Medicare Advantage	$2,310.00
Rate for Payer: Group Health Inc Commercial	$1,100.00
Rate for Payer: Group Health Inc Medicare	$770.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,430.00

ABBOTT STENT 3.50MM X 38MM

Facility IP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523397
Hospital Revenue Code	278
Min. Negotiated Rate	$1,100.00
Max. Negotiated Rate	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00

ABBOTT STENT 3.50MM X 38MM

Facility OP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523397
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,265.00
Rate for Payer: Fidelis Medicare Advantage	$2,310.00
Rate for Payer: Group Health Inc Commercial	$1,100.00
Rate for Payer: Group Health Inc Medicare	$770.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,430.00

ABBOTT STENT 4.00MM X 08MM

Facility IP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523398
Hospital Revenue Code	278
Min. Negotiated Rate	$1,100.00
Max. Negotiated Rate	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00

ABBOTT STENT 4.00MM X 08MM

Facility OP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523398
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,265.00
Rate for Payer: Fidelis Medicare Advantage	$2,310.00
Rate for Payer: Group Health Inc Commercial	$1,100.00
Rate for Payer: Group Health Inc Medicare	$770.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,430.00

ABBOTT STENT 4.00MM X 12MM

Facility OP

$2,200.00

Service Code	HCPCS C1874
Hospital Charge Code	66523399
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,265.00
Rate for Payer: Fidelis Medicare Advantage	$2,310.00
Rate for Payer: Group Health Inc Commercial	$1,100.00
Rate for Payer: Group Health Inc Medicare	$770.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,430.00

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