St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ CATH/LEVIN1/5F/.038/100CM

Facility IP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569406
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/LEVIN1/5F/.038/100CM

Facility OP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569406
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/LEVIN1/6.5F/.038/65C

Facility IP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569346
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/LEVIN1/6.5F/.038/65C

Facility OP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569346
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/LEVIN2/5F/.038/65CM

Facility OP

$32.32

Service Code	HCPCS C1725
Hospital Charge Code	41569403
Hospital Revenue Code	278
Min. Negotiated Rate	$11.31
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.78
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	$16.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.58
Rate for Payer: Fidelis Medicare Advantage	$33.94
Rate for Payer: Group Health Inc Commercial	$16.16
Rate for Payer: Group Health Inc Medicare	$11.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.16
Rate for Payer: Hamaspik Choice Inc Medicare	$16.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.01

ZZ CATH/LEVIN2/5F/.038/65CM

Facility IP

$32.32

Service Code	HCPCS C1725
Hospital Charge Code	41569403
Hospital Revenue Code	278
Min. Negotiated Rate	$16.16
Max. Negotiated Rate	$16.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.16
Rate for Payer: Hamaspik Choice Inc Medicare	$16.16

ZZ CATH/LEVIN2/6.5F

Facility OP

$36.61

Service Code	HCPCS C1725
Hospital Charge Code	41569404
Hospital Revenue Code	278
Min. Negotiated Rate	$12.81
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.14
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	$18.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.05
Rate for Payer: Fidelis Medicare Advantage	$38.44
Rate for Payer: Group Health Inc Commercial	$18.30
Rate for Payer: Group Health Inc Medicare	$12.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.30
Rate for Payer: Hamaspik Choice Inc Medicare	$18.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.80

ZZ CATH/LEVIN2/6.5F

Facility IP

$36.61

Service Code	HCPCS C1725
Hospital Charge Code	41569404
Hospital Revenue Code	278
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$18.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.30
Rate for Payer: Hamaspik Choice Inc Medicare	$18.30

ZZ CATH/LEVIN/6F/65CM

Facility IP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569405
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/LEVIN/6F/65CM

Facility OP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569405
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 LEVIN VISCERAL 5FR 038-65

Facility OP

$56.00

Service Code	HCPCS C1725
Hospital Charge Code	41569704
Hospital Revenue Code	278
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$58.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.80
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	$28.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.20
Rate for Payer: Fidelis Medicare Advantage	$58.80
Rate for Payer: Group Health Inc Commercial	$28.00
Rate for Payer: Group Health Inc Medicare	$19.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.00
Rate for Payer: Hamaspik Choice Inc Medicare	$28.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.40

ZZ CATH LEVIN VISCERAL 5FR 038-65

Facility IP

$56.00

Service Code	HCPCS C1725
Hospital Charge Code	41569704
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$28.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.00
Rate for Payer: Hamaspik Choice Inc Medicare	$28.00

ZZ CATH MULTIPURP. I 4FR 035-100

Facility OP

$3.19

Service Code	HCPCS C1725
Hospital Charge Code	41569705
Hospital Revenue Code	278
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.75
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	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.83
Rate for Payer: Fidelis Medicare Advantage	$3.35
Rate for Payer: Group Health Inc Commercial	$1.60
Rate for Payer: Group Health Inc Medicare	$1.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.07

ZZ CATH MULTIPURP. I 4FR 035-100

Facility IP

$3.19

Service Code	HCPCS C1725
Hospital Charge Code	41569705
Hospital Revenue Code	278
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$1.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1.60

ZZ CATH/MULTIPURPOSE/4F/.035

Facility IP

$35.08

Service Code	HCPCS C1725
Hospital Charge Code	41569347
Hospital Revenue Code	278
Min. Negotiated Rate	$17.54
Max. Negotiated Rate	$17.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.54
Rate for Payer: Hamaspik Choice Inc Medicare	$17.54

ZZ CATH/MULTIPURPOSE/4F/.035

Facility OP

$35.08

Service Code	HCPCS C1725
Hospital Charge Code	41569347
Hospital Revenue Code	278
Min. Negotiated Rate	$12.28
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.29
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	$17.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.17
Rate for Payer: Fidelis Medicare Advantage	$36.83
Rate for Payer: Group Health Inc Commercial	$17.54
Rate for Payer: Group Health Inc Medicare	$12.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.54
Rate for Payer: Hamaspik Choice Inc Medicare	$17.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.80

ZZ CATH/MULTIPURPOSE/5F/65C

Facility OP

$48.91

Service Code	HCPCS C1725
Hospital Charge Code	41569348
Hospital Revenue Code	278
Min. Negotiated Rate	$17.12
Max. Negotiated Rate	$51.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.90
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	$24.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.12
Rate for Payer: Fidelis Medicare Advantage	$51.36
Rate for Payer: Group Health Inc Commercial	$24.46
Rate for Payer: Group Health Inc Medicare	$17.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.46
Rate for Payer: Hamaspik Choice Inc Medicare	$24.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.79

ZZ CATH/MULTIPURPOSE/5F/65C

Facility IP

$48.91

Service Code	HCPCS C1725
Hospital Charge Code	41569348
Hospital Revenue Code	278
Min. Negotiated Rate	$24.46
Max. Negotiated Rate	$24.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.46
Rate for Payer: Hamaspik Choice Inc Medicare	$24.46

ZZ CATH/MULTIPURPOSE/6F

Facility IP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569349
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/MULTIPURPOSE/6F

Facility OP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569349
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 OMNIFLUSH 4FR 035-65

Facility OP

$42.24

Service Code	HCPCS C1725
Hospital Charge Code	41569668
Hospital Revenue Code	278
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.23
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	$21.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.29
Rate for Payer: Fidelis Medicare Advantage	$44.35
Rate for Payer: Group Health Inc Commercial	$21.12
Rate for Payer: Group Health Inc Medicare	$14.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.12
Rate for Payer: Hamaspik Choice Inc Medicare	$21.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27.46

ZZ CATH OMNIFLUSH 4FR 035-65

Facility IP

$42.24

Service Code	HCPCS C1725
Hospital Charge Code	41569668
Hospital Revenue Code	278
Min. Negotiated Rate	$21.12
Max. Negotiated Rate	$21.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.12
Rate for Payer: Hamaspik Choice Inc Medicare	$21.12

ZZ CATH OMNIFLUSH 4FR 035-90

Facility IP

$42.24

Service Code	HCPCS C1725
Hospital Charge Code	41569669
Hospital Revenue Code	278
Min. Negotiated Rate	$21.12
Max. Negotiated Rate	$21.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.12
Rate for Payer: Hamaspik Choice Inc Medicare	$21.12

ZZ CATH OMNIFLUSH 4FR 035-90

Facility OP

$42.24

Service Code	HCPCS C1725
Hospital Charge Code	41569669
Hospital Revenue Code	278
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.23
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	$21.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.29
Rate for Payer: Fidelis Medicare Advantage	$44.35
Rate for Payer: Group Health Inc Commercial	$21.12
Rate for Payer: Group Health Inc Medicare	$14.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.12
Rate for Payer: Hamaspik Choice Inc Medicare	$21.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27.46

ZZ CATH OMNIFLUSH 5FR 038-65

Facility OP

$45.08

Service Code	HCPCS C1725
Hospital Charge Code	41569670
Hospital Revenue Code	278
Min. Negotiated Rate	$15.78
Max. Negotiated Rate	$47.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.79
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	$22.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.92
Rate for Payer: Fidelis Medicare Advantage	$47.33
Rate for Payer: Group Health Inc Commercial	$22.54
Rate for Payer: Group Health Inc Medicare	$15.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.54
Rate for Payer: Hamaspik Choice Inc Medicare	$22.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.30

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