St. Barnabas Hospital

All Charges

Charge

Type

Price

COOK TORQUE DEVICE

Facility OP

$25.60

Hospital Charge Code	40205842
Hospital Revenue Code	270
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$20.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.80
Rate for Payer: Aetna Government	$12.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.41
Rate for Payer: Group Health Inc Commercial	$12.80
Rate for Payer: Group Health Inc Medicare	$8.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.80
Rate for Payer: Hamaspik Choice Inc Medicare	$12.80

COOK ZILVER 9MMX40MMX80CM

Facility OP

$2,600.00

Hospital Charge Code	40205603
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 ZILVER STENT 6X40MM

Facility OP

$4,650.00

Service Code	HCPCS C2625
Hospital Charge Code	40205289
Hospital Revenue Code	278
Min. Negotiated Rate	$26.98
Max. Negotiated Rate	$4,882.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,557.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.98
Rate for Payer: Aetna Government	$26.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,325.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,673.75
Rate for Payer: Fidelis Medicare Advantage	$4,882.50
Rate for Payer: Group Health Inc Commercial	$2,325.00
Rate for Payer: Group Health Inc Medicare	$1,627.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,325.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,022.50

COOK ZILVER STENT 6X40MM

Facility IP

$4,650.00

Service Code	HCPCS C2625
Hospital Charge Code	40205289
Hospital Revenue Code	278
Min. Negotiated Rate	$2,325.00
Max. Negotiated Rate	$2,325.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,325.00

COOK ZLIVER STENT 6X60MM

Facility IP

$2,600.00

Service Code	HCPCS C2625
Hospital Charge Code	40205293
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 ZLIVER STENT 6X60MM

Facility OP

$2,600.00

Service Code	HCPCS C2625
Hospital Charge Code	40205293
Hospital Revenue Code	278
Min. Negotiated Rate	$26.98
Max. Negotiated Rate	$2,730.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,430.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.98
Rate for Payer: Aetna Government	$26.98
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

COPE MANDRIL WIRE GUIDE

Facility IP

$111.00

Service Code	HCPCS C1769
Hospital Charge Code	66524673
Hospital Revenue Code	278
Min. Negotiated Rate	$55.50
Max. Negotiated Rate	$55.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.50
Rate for Payer: Hamaspik Choice Inc Medicare	$55.50

COPE MANDRIL WIRE GUIDE

Facility OP

$111.00

Service Code	HCPCS C1769
Hospital Charge Code	66524673
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$116.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.05
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	$55.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$63.82
Rate for Payer: Fidelis Medicare Advantage	$116.55
Rate for Payer: Group Health Inc Commercial	$55.50
Rate for Payer: Group Health Inc Medicare	$38.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.50
Rate for Payer: Hamaspik Choice Inc Medicare	$55.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$72.15

COPPERCAP COMPRESSED AIR SUPPLY

Facility OP

$10.40

Hospital Charge Code	40209539
Hospital Revenue Code	270
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$8.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.20
Rate for Payer: Aetna Government	$5.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.07
Rate for Payer: Group Health Inc Commercial	$5.20
Rate for Payer: Group Health Inc Medicare	$3.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.20
Rate for Payer: Hamaspik Choice Inc Medicare	$5.20

COPPER IUD

Facility OP

$1,709.60

Service Code	HCPCS J7300
Hospital Charge Code	41657893
Hospital Revenue Code	636
Min. Negotiated Rate	$598.36
Max. Negotiated Rate	$1,111.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$940.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$937.00
Rate for Payer: Aetna Government	$937.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$854.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$983.02
Rate for Payer: Group Health Inc Commercial	$854.80
Rate for Payer: Group Health Inc Medicare	$598.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$854.80
Rate for Payer: Hamaspik Choice Inc Medicare	$854.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,111.24

COPPER IUD

Facility IP

$1,709.60

Service Code	HCPCS J7300
Hospital Charge Code	41657893
Hospital Revenue Code	636
Min. Negotiated Rate	$854.80
Max. Negotiated Rate	$854.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$854.80
Rate for Payer: Hamaspik Choice Inc Medicare	$854.80

COPPER IUD

Facility OP

$1,709.60

Service Code	HCPCS J7300
Hospital Charge Code	41647893
Hospital Revenue Code	636
Min. Negotiated Rate	$598.36
Max. Negotiated Rate	$1,111.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$940.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$937.00
Rate for Payer: Aetna Government	$937.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$854.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$983.02
Rate for Payer: Group Health Inc Commercial	$854.80
Rate for Payer: Group Health Inc Medicare	$598.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$854.80
Rate for Payer: Hamaspik Choice Inc Medicare	$854.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,111.24

COPPER IUD

Facility IP

$1,709.60

Service Code	HCPCS J7300
Hospital Charge Code	41647893
Hospital Revenue Code	636
Min. Negotiated Rate	$854.80
Max. Negotiated Rate	$854.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$854.80
Rate for Payer: Hamaspik Choice Inc Medicare	$854.80

COPPER, SERUM

Facility OP

$31.03

Service Code	HCPCS 82525
Hospital Charge Code	40609054
Hospital Revenue Code	300
Min. Negotiated Rate	$9.93
Max. Negotiated Rate	$19.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.41
Rate for Payer: Aetna Government	$12.41
Rate for Payer: Cash Price	$12.41
Rate for Payer: Cash Price	$12.41
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.69
Rate for Payer: Elderplan Medicare Advantage	$12.41
Rate for Payer: EmblemHealth Commercial	$12.41
Rate for Payer: Fidelis CHP/HARP/Medicaid	$11.17
Rate for Payer: Fidelis Essential Plan Aliesa	$10.55
Rate for Payer: Fidelis Essential Plan QHP	$11.04
Rate for Payer: Fidelis Medicare Advantage	$12.41
Rate for Payer: Fidelis Qualified Health Plan	$11.04
Rate for Payer: Group Health Inc Commercial	$12.41
Rate for Payer: Group Health Inc Medicare	$12.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.52
Rate for Payer: Hamaspik Choice Inc Medicare	$12.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$12.41
Rate for Payer: Healthfirst Medicare Advantage	$12.41
Rate for Payer: Healthfirst QHP	$12.41
Rate for Payer: Senior Whole Health Medicare Advantage	$12.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.41
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.93
Rate for Payer: Wellcare Medicare	$11.17

CORAIL2 STD SZ12

Facility OP

$17,406.00

Service Code	HCPCS C1776
Hospital Charge Code	40005157
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$18,276.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9,573.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,703.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$10,008.45
Rate for Payer: Fidelis Medicare Advantage	$18,276.30
Rate for Payer: Group Health Inc Commercial	$8,703.00
Rate for Payer: Group Health Inc Medicare	$6,092.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,703.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8,703.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11,313.90

CORAIL2 STD SZ12

Facility OP

$21,757.50

Service Code	HCPCS C1776
Hospital Charge Code	64905285
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$22,845.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11,966.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10,878.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$12,510.56
Rate for Payer: Fidelis Medicare Advantage	$22,845.38
Rate for Payer: Group Health Inc Commercial	$10,878.75
Rate for Payer: Group Health Inc Medicare	$7,615.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,878.75
Rate for Payer: Hamaspik Choice Inc Medicare	$10,878.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14,142.38

CORAIL2 STD SZ12

Facility IP

$21,757.50

Service Code	HCPCS C1776
Hospital Charge Code	64905285
Hospital Revenue Code	278
Min. Negotiated Rate	$10,878.75
Max. Negotiated Rate	$10,878.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,878.75
Rate for Payer: Hamaspik Choice Inc Medicare	$10,878.75

CORAIL2 STD SZ12

Facility IP

$17,406.00

Service Code	HCPCS C1776
Hospital Charge Code	40005157
Hospital Revenue Code	278
Min. Negotiated Rate	$8,703.00
Max. Negotiated Rate	$8,703.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,703.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8,703.00

CORAIL2 STD SZ 13

Facility OP

$21,435.00

Service Code	HCPCS C1776
Hospital Charge Code	64903614
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$22,506.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11,789.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10,717.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$12,325.12
Rate for Payer: Fidelis Medicare Advantage	$22,506.75
Rate for Payer: Group Health Inc Commercial	$10,717.50
Rate for Payer: Group Health Inc Medicare	$7,502.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,717.50
Rate for Payer: Hamaspik Choice Inc Medicare	$10,717.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13,932.75

CORAIL2 STD SZ 13

Facility IP

$21,435.00

Service Code	HCPCS C1776
Hospital Charge Code	64903614
Hospital Revenue Code	278
Min. Negotiated Rate	$10,717.50
Max. Negotiated Rate	$10,717.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,717.50
Rate for Payer: Hamaspik Choice Inc Medicare	$10,717.50

CORAIL AMT COLLAR SZ 16

Facility IP

$17,406.00

Service Code	HCPCS C1776
Hospital Charge Code	40005147
Hospital Revenue Code	278
Min. Negotiated Rate	$8,703.00
Max. Negotiated Rate	$8,703.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,703.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8,703.00

CORAIL AMT COLLAR SZ 16

Facility OP

$17,406.00

Service Code	HCPCS C1776
Hospital Charge Code	40005147
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$18,276.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9,573.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,703.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$10,008.45
Rate for Payer: Fidelis Medicare Advantage	$18,276.30
Rate for Payer: Group Health Inc Commercial	$8,703.00
Rate for Payer: Group Health Inc Medicare	$6,092.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,703.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8,703.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11,313.90

CORAIL AMT COLLAR SZ 16

Facility OP

$21,757.50

Service Code	HCPCS C1776
Hospital Charge Code	64905207
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$22,845.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11,966.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10,878.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$12,510.56
Rate for Payer: Fidelis Medicare Advantage	$22,845.38
Rate for Payer: Group Health Inc Commercial	$10,878.75
Rate for Payer: Group Health Inc Medicare	$7,615.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,878.75
Rate for Payer: Hamaspik Choice Inc Medicare	$10,878.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14,142.38

CORAIL AMT COLLAR SZ 16

Facility IP

$21,757.50

Service Code	HCPCS C1776
Hospital Charge Code	64905207
Hospital Revenue Code	278
Min. Negotiated Rate	$10,878.75
Max. Negotiated Rate	$10,878.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,878.75
Rate for Payer: Hamaspik Choice Inc Medicare	$10,878.75

CORD BLOOD

Facility OP

$330.23

Service Code	HCPCS 86900
Hospital Charge Code	40711115
Hospital Revenue Code	300
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$181.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$181.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$147.72
Rate for Payer: Aetna Government	$147.72
Rate for Payer: Cash Price	$147.72
Rate for Payer: Cash Price	$147.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$147.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.02
Rate for Payer: Elderplan Medicare Advantage	$147.72
Rate for Payer: EmblemHealth Commercial	$147.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.69
Rate for Payer: Fidelis Essential Plan Aliesa	$125.56
Rate for Payer: Fidelis Essential Plan QHP	$131.47
Rate for Payer: Fidelis Medicare Advantage	$147.72
Rate for Payer: Fidelis Qualified Health Plan	$131.47
Rate for Payer: Group Health Inc Commercial	$147.72
Rate for Payer: Group Health Inc Medicare	$147.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.12
Rate for Payer: Hamaspik Choice Inc Medicare	$147.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.99
Rate for Payer: Healthfirst Medicare Advantage	$147.72
Rate for Payer: Healthfirst QHP	$147.72
Rate for Payer: Senior Whole Health Medicare Advantage	$147.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$147.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$118.18
Rate for Payer: Wellcare Medicare	$132.95

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