St. Barnabas Hospital

All Charges

Charge

Type

Price

WIRE GUIDE EXTRA ST

Facility OP

$278.00

Service Code	HCPCS C1769
Hospital Charge Code	64906027
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$291.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$152.90
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	$139.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$159.85
Rate for Payer: Fidelis Medicare Advantage	$291.90
Rate for Payer: Group Health Inc Commercial	$139.00
Rate for Payer: Group Health Inc Medicare	$97.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.00
Rate for Payer: Hamaspik Choice Inc Medicare	$139.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$180.70

WIRE, GUIDE IT 3.0X100CM

Facility OP

$352.00

Service Code	HCPCS C1769
Hospital Charge Code	40003333
Hospital Revenue Code	272
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$281.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$193.60
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	$281.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$239.36
Rate for Payer: Group Health Inc Commercial	$176.00
Rate for Payer: Group Health Inc Medicare	$123.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$176.00
Rate for Payer: Hamaspik Choice Inc Medicare	$176.00

WIRE GUIDE JAGWIRE .035X260CM STR

Facility IP

$368.75

Service Code	HCPCS C1769
Hospital Charge Code	64904005
Hospital Revenue Code	278
Min. Negotiated Rate	$184.38
Max. Negotiated Rate	$184.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$184.38
Rate for Payer: Hamaspik Choice Inc Medicare	$184.38

WIRE GUIDE JAGWIRE .035X260CM STR

Facility OP

$368.75

Service Code	HCPCS C1769
Hospital Charge Code	64904005
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$387.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$202.81
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	$184.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$212.03
Rate for Payer: Fidelis Medicare Advantage	$387.19
Rate for Payer: Group Health Inc Commercial	$184.38
Rate for Payer: Group Health Inc Medicare	$129.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$184.38
Rate for Payer: Hamaspik Choice Inc Medicare	$184.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$239.69

WIRE, GUIDE NCB-PH 1.6X190MM

Facility OP

$55.63

Service Code	HCPCS C1769
Hospital Charge Code	64906104
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$58.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.60
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	$27.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.99
Rate for Payer: Fidelis Medicare Advantage	$58.41
Rate for Payer: Group Health Inc Commercial	$27.82
Rate for Payer: Group Health Inc Medicare	$19.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.82
Rate for Payer: Hamaspik Choice Inc Medicare	$27.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.16

WIRE, GUIDE NCB-PH 1.6X190MM

Facility IP

$55.63

Service Code	HCPCS C1769
Hospital Charge Code	64906104
Hospital Revenue Code	278
Min. Negotiated Rate	$27.82
Max. Negotiated Rate	$27.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.82
Rate for Payer: Hamaspik Choice Inc Medicare	$27.82

WIRE GUIDE TROCAR TIP 1.35MM

Facility OP

$20.00

Service Code	HCPCS C1769
Hospital Charge Code	64906361
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$21.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.00
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	$10.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.50
Rate for Payer: Fidelis Medicare Advantage	$21.00
Rate for Payer: Group Health Inc Commercial	$10.00
Rate for Payer: Group Health Inc Medicare	$7.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.00

WIRE GUIDE TROCAR TIP 1.35MM

Facility IP

$20.00

Service Code	HCPCS C1769
Hospital Charge Code	64906361
Hospital Revenue Code	278
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$10.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10.00

WIRE HYDRO

Facility OP

$97.50

Hospital Charge Code	64905072
Hospital Revenue Code	270
Min. Negotiated Rate	$34.12
Max. Negotiated Rate	$78.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$48.75
Rate for Payer: Aetna Government	$48.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$66.30
Rate for Payer: Group Health Inc Commercial	$48.75
Rate for Payer: Group Health Inc Medicare	$34.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.75
Rate for Payer: Hamaspik Choice Inc Medicare	$48.75

WIRE K

Facility IP

$185.00

Service Code	HCPCS C1713
Hospital Charge Code	64906982
Hospital Revenue Code	278
Min. Negotiated Rate	$92.50
Max. Negotiated Rate	$92.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.50
Rate for Payer: Hamaspik Choice Inc Medicare	$92.50

WIRE K

Facility OP

$185.00

Service Code	HCPCS C1713
Hospital Charge Code	64906982
Hospital Revenue Code	278
Min. Negotiated Rate	$64.75
Max. Negotiated Rate	$194.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$101.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$92.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$106.38
Rate for Payer: Fidelis Medicare Advantage	$194.25
Rate for Payer: Group Health Inc Commercial	$92.50
Rate for Payer: Group Health Inc Medicare	$64.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.50
Rate for Payer: Hamaspik Choice Inc Medicare	$92.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$120.25

WIRE K .035 X 9 2PT DM TRAUMA

Facility OP

$42.08

Hospital Charge Code	64902703
Hospital Revenue Code	270
Min. Negotiated Rate	$14.73
Max. Negotiated Rate	$33.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.04
Rate for Payer: Aetna Government	$21.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.61
Rate for Payer: Group Health Inc Commercial	$21.04
Rate for Payer: Group Health Inc Medicare	$14.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.04
Rate for Payer: Hamaspik Choice Inc Medicare	$21.04

WIRE K .045 X 9 DIAMOND PT

Facility OP

$290.00

Hospital Charge Code	64902924
Hospital Revenue Code	270
Min. Negotiated Rate	$101.50
Max. Negotiated Rate	$232.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$159.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$145.00
Rate for Payer: Aetna Government	$145.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$232.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$197.20
Rate for Payer: Group Health Inc Commercial	$145.00
Rate for Payer: Group Health Inc Medicare	$101.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$145.00
Rate for Payer: Hamaspik Choice Inc Medicare	$145.00

WIRE K .062X9

Facility OP

$362.50

Hospital Charge Code	64903047
Hospital Revenue Code	270
Min. Negotiated Rate	$126.88
Max. Negotiated Rate	$290.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$199.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$181.25
Rate for Payer: Aetna Government	$181.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$290.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$246.50
Rate for Payer: Group Health Inc Commercial	$181.25
Rate for Payer: Group Health Inc Medicare	$126.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$181.25
Rate for Payer: Hamaspik Choice Inc Medicare	$181.25

WIRE K 1.14 X 160MM

Facility OP

$43.75

Hospital Charge Code	64904426
Hospital Revenue Code	270
Min. Negotiated Rate	$15.31
Max. Negotiated Rate	$35.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.88
Rate for Payer: Aetna Government	$21.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.75
Rate for Payer: Group Health Inc Commercial	$21.88
Rate for Payer: Group Health Inc Medicare	$15.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.88
Rate for Payer: Hamaspik Choice Inc Medicare	$21.88

WIRE K 1.4 5-7/8 THR TROC

Facility IP

$137.00

Service Code	HCPCS C1769
Hospital Charge Code	40202403
Hospital Revenue Code	278
Min. Negotiated Rate	$68.50
Max. Negotiated Rate	$68.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.50
Rate for Payer: Hamaspik Choice Inc Medicare	$68.50

WIRE K 1.4 5-7/8 THR TROC

Facility OP

$137.00

Service Code	HCPCS C1769
Hospital Charge Code	40202403
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$143.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$75.35
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	$68.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$78.78
Rate for Payer: Fidelis Medicare Advantage	$143.85
Rate for Payer: Group Health Inc Commercial	$68.50
Rate for Payer: Group Health Inc Medicare	$47.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.50
Rate for Payer: Hamaspik Choice Inc Medicare	$68.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$89.05

WIRE, K 1.6MM 6

Facility OP

$65.00

Hospital Charge Code	40007561
Hospital Revenue Code	272
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$52.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.50
Rate for Payer: Aetna Government	$32.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.20
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

WIRE, K 1.6MM 6

Facility OP

$65.00

Hospital Charge Code	40204642
Hospital Revenue Code	272
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$52.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.50
Rate for Payer: Aetna Government	$32.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.20
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

WIRE, K 1.6MM 6

Facility OP

$81.25

Hospital Charge Code	64906134
Hospital Revenue Code	270
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$65.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.62
Rate for Payer: Aetna Government	$40.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.25
Rate for Payer: Group Health Inc Commercial	$40.62
Rate for Payer: Group Health Inc Medicare	$28.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.62
Rate for Payer: Hamaspik Choice Inc Medicare	$40.62

WIRE K 1.6MM TROCAR P 150MM

Facility IP

$160.00

Service Code	HCPCS C1713
Hospital Charge Code	40205104
Hospital Revenue Code	278
Min. Negotiated Rate	$80.00
Max. Negotiated Rate	$80.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.00
Rate for Payer: Hamaspik Choice Inc Medicare	$80.00

WIRE K 1.6MM TROCAR P 150MM

Facility OP

$160.00

Service Code	HCPCS C1713
Hospital Charge Code	40205104
Hospital Revenue Code	278
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$168.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$88.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$92.00
Rate for Payer: Fidelis Medicare Advantage	$168.00
Rate for Payer: Group Health Inc Commercial	$80.00
Rate for Payer: Group Health Inc Medicare	$56.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.00
Rate for Payer: Hamaspik Choice Inc Medicare	$80.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$104.00

WIRE K 1.6MM W/STOP

Facility IP

$462.50

Service Code	HCPCS C1713
Hospital Charge Code	64906981
Hospital Revenue Code	278
Min. Negotiated Rate	$231.25
Max. Negotiated Rate	$231.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$231.25
Rate for Payer: Hamaspik Choice Inc Medicare	$231.25

WIRE K 1.6MM W/STOP

Facility OP

$462.50

Service Code	HCPCS C1713
Hospital Charge Code	64906981
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$485.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$254.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$231.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$265.94
Rate for Payer: Fidelis Medicare Advantage	$485.62
Rate for Payer: Group Health Inc Commercial	$231.25
Rate for Payer: Group Health Inc Medicare	$161.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$231.25
Rate for Payer: Hamaspik Choice Inc Medicare	$231.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$300.62

WIRE K 1.6X200

Facility OP

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	64906247
Hospital Revenue Code	278
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$262.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$143.75
Rate for Payer: Fidelis Medicare Advantage	$262.50
Rate for Payer: Group Health Inc Commercial	$125.00
Rate for Payer: Group Health Inc Medicare	$87.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$162.50

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