St. Barnabas Hospital

All Charges

Charge

Type

Price

CONVEX REAMER - 014

Facility OP

$2,315.00

Hospital Charge Code	64903267
Hospital Revenue Code	270
Min. Negotiated Rate	$810.25
Max. Negotiated Rate	$1,852.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,273.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,157.50
Rate for Payer: Aetna Government	$1,157.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,852.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,574.20
Rate for Payer: Group Health Inc Commercial	$1,157.50
Rate for Payer: Group Health Inc Medicare	$810.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,157.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,157.50

CONVEX REAMER -016

Facility OP

$1,852.00

Hospital Charge Code	40005915
Hospital Revenue Code	272
Min. Negotiated Rate	$648.20
Max. Negotiated Rate	$1,481.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,018.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$926.00
Rate for Payer: Aetna Government	$926.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,481.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,259.36
Rate for Payer: Group Health Inc Commercial	$926.00
Rate for Payer: Group Health Inc Medicare	$648.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$926.00
Rate for Payer: Hamaspik Choice Inc Medicare	$926.00

CONVEX REAMER -018

Facility OP

$2,315.00

Hospital Charge Code	64904653
Hospital Revenue Code	270
Min. Negotiated Rate	$810.25
Max. Negotiated Rate	$1,852.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,273.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,157.50
Rate for Payer: Aetna Government	$1,157.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,852.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,574.20
Rate for Payer: Group Health Inc Commercial	$1,157.50
Rate for Payer: Group Health Inc Medicare	$810.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,157.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,157.50

COOK 10MMX40MMX80CM

Facility OP

$2,600.00

Hospital Charge Code	40205600
Hospital Revenue Code	270
Min. Negotiated Rate	$910.00
Max. Negotiated Rate	$2,080.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,430.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,300.00
Rate for Payer: Aetna Government	$1,300.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,080.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,768.00
Rate for Payer: Group Health Inc Commercial	$1,300.00
Rate for Payer: Group Health Inc Medicare	$910.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,300.00

COOK 10MMX60MMX60CM

Facility OP

$2,600.00

Hospital Charge Code	40205601
Hospital Revenue Code	270
Min. Negotiated Rate	$910.00
Max. Negotiated Rate	$2,080.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,430.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,300.00
Rate for Payer: Aetna Government	$1,300.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,080.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,768.00
Rate for Payer: Group Health Inc Commercial	$1,300.00
Rate for Payer: Group Health Inc Medicare	$910.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,300.00

COOK 10MMX80MMX80CM

Facility OP

$2,600.00

Hospital Charge Code	40205602
Hospital Revenue Code	270
Min. Negotiated Rate	$910.00
Max. Negotiated Rate	$2,080.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,430.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,300.00
Rate for Payer: Aetna Government	$1,300.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,080.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,768.00
Rate for Payer: Group Health Inc Commercial	$1,300.00
Rate for Payer: Group Health Inc Medicare	$910.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,300.00

COOK 4FR INTRDUCER SHEATH

Facility IP

$249.00

Service Code	HCPCS C1894
Hospital Charge Code	40205843
Hospital Revenue Code	278
Min. Negotiated Rate	$124.50
Max. Negotiated Rate	$124.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$124.50
Rate for Payer: Hamaspik Choice Inc Medicare	$124.50

COOK 4FR INTRDUCER SHEATH

Facility OP

$249.00

Service Code	HCPCS C1894
Hospital Charge Code	40205843
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$261.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$136.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$124.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$143.18
Rate for Payer: Fidelis Medicare Advantage	$261.45
Rate for Payer: Group Health Inc Commercial	$124.50
Rate for Payer: Group Health Inc Medicare	$87.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$124.50
Rate for Payer: Hamaspik Choice Inc Medicare	$124.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$161.85

COOK 6FR INTRODUCER SHEATH

Facility IP

$132.50

Service Code	HCPCS C1894
Hospital Charge Code	40205844
Hospital Revenue Code	278
Min. Negotiated Rate	$66.25
Max. Negotiated Rate	$66.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.25
Rate for Payer: Hamaspik Choice Inc Medicare	$66.25

COOK 6FR INTRODUCER SHEATH

Facility OP

$132.50

Service Code	HCPCS C1894
Hospital Charge Code	40205844
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$139.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$72.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$66.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.19
Rate for Payer: Fidelis Medicare Advantage	$139.12
Rate for Payer: Group Health Inc Commercial	$66.25
Rate for Payer: Group Health Inc Medicare	$46.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.25
Rate for Payer: Hamaspik Choice Inc Medicare	$66.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$86.12

COOK 9MMX60MMX80CM

Facility OP

$2,600.00

Hospital Charge Code	40205599
Hospital Revenue Code	270
Min. Negotiated Rate	$910.00
Max. Negotiated Rate	$2,080.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,430.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,300.00
Rate for Payer: Aetna Government	$1,300.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,080.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,768.00
Rate for Payer: Group Health Inc Commercial	$1,300.00
Rate for Payer: Group Health Inc Medicare	$910.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,300.00

COOK BALLON CATHETER 35LP

Facility OP

$420.00

Service Code	HCPCS C1725
Hospital Charge Code	40205841
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$441.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$231.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$210.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$241.50
Rate for Payer: Fidelis Medicare Advantage	$441.00
Rate for Payer: Group Health Inc Commercial	$210.00
Rate for Payer: Group Health Inc Medicare	$147.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.00
Rate for Payer: Hamaspik Choice Inc Medicare	$210.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$273.00

COOK BALLON CATHETER 35LP

Facility IP

$420.00

Service Code	HCPCS C1725
Hospital Charge Code	40205841
Hospital Revenue Code	278
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$210.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.00
Rate for Payer: Hamaspik Choice Inc Medicare	$210.00

COOK CATH 10MMX.035

Facility IP

$224.00

Service Code	HCPCS C1887
Hospital Charge Code	40208129
Hospital Revenue Code	278
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$112.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.00
Rate for Payer: Hamaspik Choice Inc Medicare	$112.00

COOK CATH 10MMX.035

Facility OP

$224.00

Service Code	HCPCS C1887
Hospital Charge Code	40208129
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$235.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$123.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$112.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$128.80
Rate for Payer: Fidelis Medicare Advantage	$235.20
Rate for Payer: Group Health Inc Commercial	$112.00
Rate for Payer: Group Health Inc Medicare	$78.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.00
Rate for Payer: Hamaspik Choice Inc Medicare	$112.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$145.60

COOK CELECT VENA CAVA FILTER SET

Facility OP

$2,600.00

Service Code	HCPCS C1880
Hospital Charge Code	40205799
Hospital Revenue Code	278
Min. Negotiated Rate	$57.08
Max. Negotiated Rate	$2,730.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,430.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$57.08
Rate for Payer: Aetna Government	$57.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,495.00
Rate for Payer: Fidelis Medicare Advantage	$2,730.00
Rate for Payer: Group Health Inc Commercial	$1,300.00
Rate for Payer: Group Health Inc Medicare	$910.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,300.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,690.00

COOK CELECT VENA CAVA FILTER SET

Facility IP

$2,600.00

Service Code	HCPCS C1880
Hospital Charge Code	40205799
Hospital Revenue Code	278
Min. Negotiated Rate	$1,300.00
Max. Negotiated Rate	$1,300.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,300.00

COOK CEREBRAL WIRE GUIDE

Facility OP

$42.00

Hospital Charge Code	40206285
Hospital Revenue Code	270
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$33.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.00
Rate for Payer: Aetna Government	$21.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.56
Rate for Payer: Group Health Inc Commercial	$21.00
Rate for Payer: Group Health Inc Medicare	$14.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.00
Rate for Payer: Hamaspik Choice Inc Medicare	$21.00

COOK G/W 035X180CM

Facility OP

$43.50

Service Code	HCPCS C1769
Hospital Charge Code	40205846
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$45.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.01
Rate for Payer: Fidelis Medicare Advantage	$45.68
Rate for Payer: Group Health Inc Commercial	$21.75
Rate for Payer: Group Health Inc Medicare	$15.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.75
Rate for Payer: Hamaspik Choice Inc Medicare	$21.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.28

COOK G/W 035X180CM

Facility IP

$43.50

Service Code	HCPCS C1769
Hospital Charge Code	40205846
Hospital Revenue Code	278
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$21.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.75
Rate for Payer: Hamaspik Choice Inc Medicare	$21.75

COOK HYDRO ST GUIDE WIRE

Facility IP

$336.00

Service Code	HCPCS C1769
Hospital Charge Code	40205845
Hospital Revenue Code	278
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$168.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.00
Rate for Payer: Hamaspik Choice Inc Medicare	$168.00

COOK HYDRO ST GUIDE WIRE

Facility OP

$336.00

Service Code	HCPCS C1769
Hospital Charge Code	40205845
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$352.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$184.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$168.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$193.20
Rate for Payer: Fidelis Medicare Advantage	$352.80
Rate for Payer: Group Health Inc Commercial	$168.00
Rate for Payer: Group Health Inc Medicare	$117.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.00
Rate for Payer: Hamaspik Choice Inc Medicare	$168.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$218.40

COOK NEFF PERC ACCESS SET- G08564

Facility OP

$169.56

Hospital Charge Code	66526608
Hospital Revenue Code	272
Min. Negotiated Rate	$59.35
Max. Negotiated Rate	$135.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$84.78
Rate for Payer: Aetna Government	$84.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$135.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$115.30
Rate for Payer: Group Health Inc Commercial	$84.78
Rate for Payer: Group Health Inc Medicare	$59.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$84.78
Rate for Payer: Hamaspik Choice Inc Medicare	$84.78

COOK NESTER EMBO COIL P 10MMX.038

Facility OP

$253.00

Hospital Charge Code	40208130
Hospital Revenue Code	270
Min. Negotiated Rate	$88.55
Max. Negotiated Rate	$202.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$139.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$126.50
Rate for Payer: Aetna Government	$126.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$202.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$172.04
Rate for Payer: Group Health Inc Commercial	$126.50
Rate for Payer: Group Health Inc Medicare	$88.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.50
Rate for Payer: Hamaspik Choice Inc Medicare	$126.50

COOKS MICRO PUNCTURE INTRO SET

Facility OP

$61.00

Hospital Charge Code	40205267
Hospital Revenue Code	270
Min. Negotiated Rate	$21.35
Max. Negotiated Rate	$48.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.50
Rate for Payer: Aetna Government	$30.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$41.48
Rate for Payer: Group Health Inc Commercial	$30.50
Rate for Payer: Group Health Inc Medicare	$21.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.50
Rate for Payer: Hamaspik Choice Inc Medicare	$30.50

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