St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ BILIAR CTH AMPLA 12/30

Facility IP

$231.41

Service Code	HCPCS C1725
Hospital Charge Code	41567224
Hospital Revenue Code	278
Min. Negotiated Rate	$115.70
Max. Negotiated Rate	$115.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.70
Rate for Payer: Hamaspik Choice Inc Medicare	$115.70

ZZ BILIAR CTH AMPLA 12/30

Facility OP

$231.41

Service Code	HCPCS C1725
Hospital Charge Code	41567224
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$242.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$127.28
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	$115.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$133.06
Rate for Payer: Fidelis Medicare Advantage	$242.98
Rate for Payer: Group Health Inc Commercial	$115.70
Rate for Payer: Group Health Inc Medicare	$80.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.70
Rate for Payer: Hamaspik Choice Inc Medicare	$115.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$150.42

ZZ BILIAR CTH AMPLA 8/30

Facility IP

$231.41

Service Code	HCPCS C1725
Hospital Charge Code	41567222
Hospital Revenue Code	278
Min. Negotiated Rate	$115.70
Max. Negotiated Rate	$115.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.70
Rate for Payer: Hamaspik Choice Inc Medicare	$115.70

ZZ BILIAR CTH AMPLA 8/30

Facility OP

$231.41

Service Code	HCPCS C1725
Hospital Charge Code	41567222
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$242.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$127.28
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	$115.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$133.06
Rate for Payer: Fidelis Medicare Advantage	$242.98
Rate for Payer: Group Health Inc Commercial	$115.70
Rate for Payer: Group Health Inc Medicare	$80.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.70
Rate for Payer: Hamaspik Choice Inc Medicare	$115.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$150.42

ZZ BILIAR DRAIN CATH 8/35

Facility OP

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41567220
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$250.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.98
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	$119.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.93
Rate for Payer: Fidelis Medicare Advantage	$250.05
Rate for Payer: Group Health Inc Commercial	$119.07
Rate for Payer: Group Health Inc Medicare	$83.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.79

ZZ BILIAR DRAIN CATH 8/35

Facility IP

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41567220
Hospital Revenue Code	278
Min. Negotiated Rate	$119.07
Max. Negotiated Rate	$119.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07

ZZ BILIAR DRN CATH 10/35

Facility OP

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41567221
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$250.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.98
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	$119.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.93
Rate for Payer: Fidelis Medicare Advantage	$250.05
Rate for Payer: Group Health Inc Commercial	$119.07
Rate for Payer: Group Health Inc Medicare	$83.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.79

ZZ BILIAR DRN CATH 10/35

Facility IP

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41567221
Hospital Revenue Code	278
Min. Negotiated Rate	$119.07
Max. Negotiated Rate	$119.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07

ZZ BIO NDK QK CR 10 5 10

Facility OP

$87.89

Hospital Charge Code	41567065
Hospital Revenue Code	270
Min. Negotiated Rate	$30.76
Max. Negotiated Rate	$70.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.94
Rate for Payer: Aetna Government	$43.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.77
Rate for Payer: Group Health Inc Commercial	$43.94
Rate for Payer: Group Health Inc Medicare	$30.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.94
Rate for Payer: Hamaspik Choice Inc Medicare	$43.94

ZZ BIO NDL QK CR 18 15 10

Facility OP

$87.89

Hospital Charge Code	41567066
Hospital Revenue Code	270
Min. Negotiated Rate	$30.76
Max. Negotiated Rate	$70.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.94
Rate for Payer: Aetna Government	$43.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.77
Rate for Payer: Group Health Inc Commercial	$43.94
Rate for Payer: Group Health Inc Medicare	$30.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.94
Rate for Payer: Hamaspik Choice Inc Medicare	$43.94

ZZ BIO NDL QK CR 18 15 20

Facility OP

$87.89

Hospital Charge Code	41567067
Hospital Revenue Code	270
Min. Negotiated Rate	$30.76
Max. Negotiated Rate	$70.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.94
Rate for Payer: Aetna Government	$43.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.77
Rate for Payer: Group Health Inc Commercial	$43.94
Rate for Payer: Group Health Inc Medicare	$30.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.94
Rate for Payer: Hamaspik Choice Inc Medicare	$43.94

ZZ BIO NDL QK CR 18 20 20

Facility OP

$87.89

Hospital Charge Code	41567068
Hospital Revenue Code	270
Min. Negotiated Rate	$30.76
Max. Negotiated Rate	$70.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.94
Rate for Payer: Aetna Government	$43.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.77
Rate for Payer: Group Health Inc Commercial	$43.94
Rate for Payer: Group Health Inc Medicare	$30.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.94
Rate for Payer: Hamaspik Choice Inc Medicare	$43.94

ZZ BIO NDL QK CR 18 6 10

Facility OP

$87.89

Hospital Charge Code	41567069
Hospital Revenue Code	270
Min. Negotiated Rate	$30.76
Max. Negotiated Rate	$70.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.94
Rate for Payer: Aetna Government	$43.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.77
Rate for Payer: Group Health Inc Commercial	$43.94
Rate for Payer: Group Health Inc Medicare	$30.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.94
Rate for Payer: Hamaspik Choice Inc Medicare	$43.94

ZZ BIO NDL QK CR 18 9 10

Facility OP

$87.89

Hospital Charge Code	41567070
Hospital Revenue Code	270
Min. Negotiated Rate	$30.76
Max. Negotiated Rate	$70.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.94
Rate for Payer: Aetna Government	$43.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.77
Rate for Payer: Group Health Inc Commercial	$43.94
Rate for Payer: Group Health Inc Medicare	$30.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.94
Rate for Payer: Hamaspik Choice Inc Medicare	$43.94

ZZ BIO NDL QK CR 19 15 10

Facility OP

$87.89

Hospital Charge Code	41567072
Hospital Revenue Code	270
Min. Negotiated Rate	$30.76
Max. Negotiated Rate	$70.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.94
Rate for Payer: Aetna Government	$43.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.77
Rate for Payer: Group Health Inc Commercial	$43.94
Rate for Payer: Group Health Inc Medicare	$30.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.94
Rate for Payer: Hamaspik Choice Inc Medicare	$43.94

ZZ BIO NDL QK CR 19 15 20

Facility OP

$87.89

Hospital Charge Code	41567073
Hospital Revenue Code	270
Min. Negotiated Rate	$30.76
Max. Negotiated Rate	$70.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.94
Rate for Payer: Aetna Government	$43.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.77
Rate for Payer: Group Health Inc Commercial	$43.94
Rate for Payer: Group Health Inc Medicare	$30.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.94
Rate for Payer: Hamaspik Choice Inc Medicare	$43.94

ZZ BIO NDL QK CR 19 20 20

Facility OP

$87.89

Hospital Charge Code	41567074
Hospital Revenue Code	270
Min. Negotiated Rate	$30.76
Max. Negotiated Rate	$70.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.94
Rate for Payer: Aetna Government	$43.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.77
Rate for Payer: Group Health Inc Commercial	$43.94
Rate for Payer: Group Health Inc Medicare	$30.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.94
Rate for Payer: Hamaspik Choice Inc Medicare	$43.94

ZZ BIO NDL QK CR 19 6 10

Facility OP

$87.89

Hospital Charge Code	41567071
Hospital Revenue Code	270
Min. Negotiated Rate	$30.76
Max. Negotiated Rate	$70.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.94
Rate for Payer: Aetna Government	$43.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.77
Rate for Payer: Group Health Inc Commercial	$43.94
Rate for Payer: Group Health Inc Medicare	$30.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.94
Rate for Payer: Hamaspik Choice Inc Medicare	$43.94

ZZ BIO NDL QK CR 20 15 20

Facility OP

$87.89

Hospital Charge Code	41567078
Hospital Revenue Code	270
Min. Negotiated Rate	$30.76
Max. Negotiated Rate	$70.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.94
Rate for Payer: Aetna Government	$43.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.77
Rate for Payer: Group Health Inc Commercial	$43.94
Rate for Payer: Group Health Inc Medicare	$30.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.94
Rate for Payer: Hamaspik Choice Inc Medicare	$43.94

ZZ BIO NDL QK CR 20 20 20

Facility OP

$87.89

Hospital Charge Code	41567079
Hospital Revenue Code	270
Min. Negotiated Rate	$30.76
Max. Negotiated Rate	$70.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.94
Rate for Payer: Aetna Government	$43.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.77
Rate for Payer: Group Health Inc Commercial	$43.94
Rate for Payer: Group Health Inc Medicare	$30.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.94
Rate for Payer: Hamaspik Choice Inc Medicare	$43.94

ZZ BIO NDL QK CR 20 6 20

Facility OP

$87.89

Hospital Charge Code	41567080
Hospital Revenue Code	270
Min. Negotiated Rate	$30.76
Max. Negotiated Rate	$70.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.94
Rate for Payer: Aetna Government	$43.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.77
Rate for Payer: Group Health Inc Commercial	$43.94
Rate for Payer: Group Health Inc Medicare	$30.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.94
Rate for Payer: Hamaspik Choice Inc Medicare	$43.94

ZZ BIO NDL QK CR 20 9 10

Facility OP

$87.89

Hospital Charge Code	41567081
Hospital Revenue Code	270
Min. Negotiated Rate	$30.76
Max. Negotiated Rate	$70.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.94
Rate for Payer: Aetna Government	$43.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.77
Rate for Payer: Group Health Inc Commercial	$43.94
Rate for Payer: Group Health Inc Medicare	$30.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.94
Rate for Payer: Hamaspik Choice Inc Medicare	$43.94

ZZ BIO NDL QK R 20 9 20

Facility OP

$87.89

Hospital Charge Code	41567082
Hospital Revenue Code	270
Min. Negotiated Rate	$30.76
Max. Negotiated Rate	$70.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.94
Rate for Payer: Aetna Government	$43.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.77
Rate for Payer: Group Health Inc Commercial	$43.94
Rate for Payer: Group Health Inc Medicare	$30.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.94
Rate for Payer: Hamaspik Choice Inc Medicare	$43.94

ZZ BIOP NDL QK CR 19 6 10

Facility OP

$87.89

Hospital Charge Code	41567075
Hospital Revenue Code	270
Min. Negotiated Rate	$30.76
Max. Negotiated Rate	$70.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.94
Rate for Payer: Aetna Government	$43.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.77
Rate for Payer: Group Health Inc Commercial	$43.94
Rate for Payer: Group Health Inc Medicare	$30.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.94
Rate for Payer: Hamaspik Choice Inc Medicare	$43.94

ZZ BIOP NDL QK CR 19 9 10

Facility OP

$87.89

Hospital Charge Code	41567076
Hospital Revenue Code	270
Min. Negotiated Rate	$30.76
Max. Negotiated Rate	$70.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.94
Rate for Payer: Aetna Government	$43.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.77
Rate for Payer: Group Health Inc Commercial	$43.94
Rate for Payer: Group Health Inc Medicare	$30.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.94
Rate for Payer: Hamaspik Choice Inc Medicare	$43.94

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