St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ CATH/COBRA2/5F/.035/100CM

Facility IP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569385
Hospital Revenue Code	278
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$18.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.60
Rate for Payer: Hamaspik Choice Inc Medicare	$18.60

ZZ CATH/COBRA2/5F/.035/100CM

Facility OP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569385
Hospital Revenue Code	278
Min. Negotiated Rate	$13.02
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.47
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	$18.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.40
Rate for Payer: Fidelis Medicare Advantage	$39.07
Rate for Payer: Group Health Inc Commercial	$18.60
Rate for Payer: Group Health Inc Medicare	$13.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.60
Rate for Payer: Hamaspik Choice Inc Medicare	$18.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$24.19

ZZ CATH COBRA 3 5FR 038-90

Facility OP

$226.80

Service Code	HCPCS C1725
Hospital Charge Code	41569706
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$238.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$124.74
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	$113.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$130.41
Rate for Payer: Fidelis Medicare Advantage	$238.14
Rate for Payer: Group Health Inc Commercial	$113.40
Rate for Payer: Group Health Inc Medicare	$79.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.40
Rate for Payer: Hamaspik Choice Inc Medicare	$113.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$147.42

ZZ CATH COBRA 3 5FR 038-90

Facility IP

$226.80

Service Code	HCPCS C1725
Hospital Charge Code	41569706
Hospital Revenue Code	278
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$113.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.40
Rate for Payer: Hamaspik Choice Inc Medicare	$113.40

ZZ CATH/CRAIG INFUSION/4FR

Facility OP

$299.38

Service Code	HCPCS C1725
Hospital Charge Code	41569740
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$314.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$164.66
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	$149.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$172.14
Rate for Payer: Fidelis Medicare Advantage	$314.35
Rate for Payer: Group Health Inc Commercial	$149.69
Rate for Payer: Group Health Inc Medicare	$104.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$149.69
Rate for Payer: Hamaspik Choice Inc Medicare	$149.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$194.60

ZZ CATH/CRAIG INFUSION/4FR

Facility IP

$299.38

Service Code	HCPCS C1725
Hospital Charge Code	41569740
Hospital Revenue Code	278
Min. Negotiated Rate	$149.69
Max. Negotiated Rate	$149.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$149.69
Rate for Payer: Hamaspik Choice Inc Medicare	$149.69

ZZ CATH/CRAIG INFUSION/5FR

Facility OP

$267.91

Service Code	HCPCS C1725
Hospital Charge Code	41569739
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$281.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$147.35
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	$133.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$154.05
Rate for Payer: Fidelis Medicare Advantage	$281.31
Rate for Payer: Group Health Inc Commercial	$133.96
Rate for Payer: Group Health Inc Medicare	$93.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.96
Rate for Payer: Hamaspik Choice Inc Medicare	$133.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$174.14

ZZ CATH/CRAIG INFUSION/5FR

Facility IP

$267.91

Service Code	HCPCS C1725
Hospital Charge Code	41569739
Hospital Revenue Code	278
Min. Negotiated Rate	$133.96
Max. Negotiated Rate	$133.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.96
Rate for Payer: Hamaspik Choice Inc Medicare	$133.96

ZZ CATH/DRAINAGE/BIL/10.2/32

Facility IP

$203.60

Service Code	HCPCS C1725
Hospital Charge Code	41569376
Hospital Revenue Code	278
Min. Negotiated Rate	$101.80
Max. Negotiated Rate	$101.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$101.80
Rate for Payer: Hamaspik Choice Inc Medicare	$101.80

ZZ CATH/DRAINAGE/BIL/10.2/32

Facility OP

$203.60

Service Code	HCPCS C1725
Hospital Charge Code	41569376
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$213.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$111.98
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	$101.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$117.07
Rate for Payer: Fidelis Medicare Advantage	$213.78
Rate for Payer: Group Health Inc Commercial	$101.80
Rate for Payer: Group Health Inc Medicare	$71.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$101.80
Rate for Payer: Hamaspik Choice Inc Medicare	$101.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$132.34

ZZ CATHETER 5 18 5 MP

Facility OP

$75.84

Service Code	HCPCS C1725
Hospital Charge Code	41567194
Hospital Revenue Code	278
Min. Negotiated Rate	$26.54
Max. Negotiated Rate	$79.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.71
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	$37.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.61
Rate for Payer: Fidelis Medicare Advantage	$79.63
Rate for Payer: Group Health Inc Commercial	$37.92
Rate for Payer: Group Health Inc Medicare	$26.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.92
Rate for Payer: Hamaspik Choice Inc Medicare	$37.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$49.30

ZZ CATHETER 5 18 5 MP

Facility IP

$75.84

Service Code	HCPCS C1725
Hospital Charge Code	41567194
Hospital Revenue Code	278
Min. Negotiated Rate	$37.92
Max. Negotiated Rate	$37.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.92
Rate for Payer: Hamaspik Choice Inc Medicare	$37.92

ZZ CATHETER 8/25

Facility OP

$257.63

Service Code	HCPCS C1725
Hospital Charge Code	41567230
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$270.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$141.70
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	$128.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$148.14
Rate for Payer: Fidelis Medicare Advantage	$270.51
Rate for Payer: Group Health Inc Commercial	$128.82
Rate for Payer: Group Health Inc Medicare	$90.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$128.82
Rate for Payer: Hamaspik Choice Inc Medicare	$128.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$167.46

ZZ CATHETER 8/25

Facility IP

$257.63

Service Code	HCPCS C1725
Hospital Charge Code	41567230
Hospital Revenue Code	278
Min. Negotiated Rate	$128.82
Max. Negotiated Rate	$128.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$128.82
Rate for Payer: Hamaspik Choice Inc Medicare	$128.82

ZZ CATHGLIDE 5FR100CM

Facility IP

$136.73

Service Code	HCPCS C1725
Hospital Charge Code	41569664
Hospital Revenue Code	278
Min. Negotiated Rate	$68.36
Max. Negotiated Rate	$68.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.36
Rate for Payer: Hamaspik Choice Inc Medicare	$68.36

ZZ CATHGLIDE 5FR100CM

Facility OP

$136.73

Service Code	HCPCS C1725
Hospital Charge Code	41569664
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$143.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$75.20
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	$68.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$78.62
Rate for Payer: Fidelis Medicare Advantage	$143.57
Rate for Payer: Group Health Inc Commercial	$68.36
Rate for Payer: Group Health Inc Medicare	$47.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.36
Rate for Payer: Hamaspik Choice Inc Medicare	$68.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$88.87

ZZ CATH/GLIDE AT/5F/.038/100

Facility OP

$593.23

Service Code	HCPCS C1725
Hospital Charge Code	41569387
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$622.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$326.28
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	$296.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$341.11
Rate for Payer: Fidelis Medicare Advantage	$622.89
Rate for Payer: Group Health Inc Commercial	$296.62
Rate for Payer: Group Health Inc Medicare	$207.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$296.62
Rate for Payer: Hamaspik Choice Inc Medicare	$296.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$385.60

ZZ CATH/GLIDE AT/5F/.038/100

Facility IP

$593.23

Service Code	HCPCS C1725
Hospital Charge Code	41569387
Hospital Revenue Code	278
Min. Negotiated Rate	$296.62
Max. Negotiated Rate	$296.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$296.62
Rate for Payer: Hamaspik Choice Inc Medicare	$296.62

ZZ CATH/GLIDECATH AT/4F/100

Facility IP

$584.72

Service Code	HCPCS C1725
Hospital Charge Code	41569389
Hospital Revenue Code	278
Min. Negotiated Rate	$292.36
Max. Negotiated Rate	$292.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$292.36
Rate for Payer: Hamaspik Choice Inc Medicare	$292.36

ZZ CATH/GLIDECATH AT/4F/100

Facility OP

$584.72

Service Code	HCPCS C1725
Hospital Charge Code	41569389
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$613.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$321.60
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	$292.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$336.21
Rate for Payer: Fidelis Medicare Advantage	$613.96
Rate for Payer: Group Health Inc Commercial	$292.36
Rate for Payer: Group Health Inc Medicare	$204.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$292.36
Rate for Payer: Hamaspik Choice Inc Medicare	$292.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$380.07

ZZ CATH/GLIDE CATH AT 4F/65CM

Facility OP

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569390
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$569.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$298.21
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	$271.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$311.76
Rate for Payer: Fidelis Medicare Advantage	$569.31
Rate for Payer: Group Health Inc Commercial	$271.10
Rate for Payer: Group Health Inc Medicare	$189.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$271.10
Rate for Payer: Hamaspik Choice Inc Medicare	$271.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$352.43

ZZ CATH/GLIDE CATH AT 4F/65CM

Facility IP

$542.20

Service Code	HCPCS C1725
Hospital Charge Code	41569390
Hospital Revenue Code	278
Min. Negotiated Rate	$271.10
Max. Negotiated Rate	$271.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$271.10
Rate for Payer: Hamaspik Choice Inc Medicare	$271.10

ZZ CATH/GLIDE CATH AT/5F/65CM

Facility IP

$558.14

Service Code	HCPCS C1725
Hospital Charge Code	41569391
Hospital Revenue Code	278
Min. Negotiated Rate	$279.07
Max. Negotiated Rate	$279.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$279.07
Rate for Payer: Hamaspik Choice Inc Medicare	$279.07

ZZ CATH/GLIDE CATH AT/5F/65CM

Facility OP

$558.14

Service Code	HCPCS C1725
Hospital Charge Code	41569391
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$586.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.98
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	$279.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$320.93
Rate for Payer: Fidelis Medicare Advantage	$586.05
Rate for Payer: Group Health Inc Commercial	$279.07
Rate for Payer: Group Health Inc Medicare	$195.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$279.07
Rate for Payer: Hamaspik Choice Inc Medicare	$279.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$362.79

ZZ CATHGLIDE COBRA I 4FR038 65CM

Facility IP

$9.11

Service Code	HCPCS C1725
Hospital Charge Code	41569665
Hospital Revenue Code	278
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$4.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.56
Rate for Payer: Hamaspik Choice Inc Medicare	$4.56

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