St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ CATH/RIM/5F/.035/65CM

Facility IP

$32.32

Service Code	HCPCS C1725
Hospital Charge Code	41569359
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/RIM/6.5F/.038/65CM

Facility IP

$32.32

Service Code	HCPCS C1725
Hospital Charge Code	41569361
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/RIM/6.5F/.038/65CM

Facility OP

$32.32

Service Code	HCPCS C1725
Hospital Charge Code	41569361
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/RLG/5F/.035/65CM

Facility IP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569362
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/RLG/5F/.035/65CM

Facility OP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569362
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/RLG/6.5F

Facility OP

$32.32

Hospital Charge Code	41569363
Hospital Revenue Code	270
Min. Negotiated Rate	$11.31
Max. Negotiated Rate	$25.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.16
Rate for Payer: Aetna Government	$16.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.98
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

ZZ CATH ROSCH CELIAC 5FR 038-65

Facility IP

$56.00

Service Code	HCPCS C1725
Hospital Charge Code	41569703
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 ROSCH CELIAC 5FR 038-65

Facility OP

$56.00

Service Code	HCPCS C1725
Hospital Charge Code	41569703
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/SIMMON1/6F/65CM

Facility IP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569364
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/SIMMON1/6F/65CM

Facility OP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569364
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/SIMMON2/5F/.038/65

Facility IP

$32.32

Service Code	HCPCS C1725
Hospital Charge Code	41569371
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/SIMMON2/5F/.038/65

Facility OP

$32.32

Service Code	HCPCS C1725
Hospital Charge Code	41569371
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/SIMMONS1/4F/65CM

Facility OP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569366
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/SIMMONS1/4F/65CM

Facility IP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569366
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/SIMMONS1/5F/100CM

Facility OP

$32.32

Service Code	HCPCS C1725
Hospital Charge Code	41569367
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/SIMMONS1/5F/100CM

Facility IP

$32.32

Service Code	HCPCS C1725
Hospital Charge Code	41569367
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/SIMMONS1/5F/35/65CM

Facility IP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569368
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/SIMMONS1/5F/35/65CM

Facility OP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569368
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/SIMMONS1/6F

Facility IP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569369
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/SIMMONS1/6F

Facility OP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569369
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/SIMMONS2/4F/65

Facility IP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569370
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/SIMMONS2/4F/65

Facility OP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569370
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/SIMMONS2/5F/.038/100C

Facility IP

$32.32

Service Code	HCPCS C1725
Hospital Charge Code	41569372
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/SIMMONS2/5F/.038/100C

Facility OP

$32.32

Service Code	HCPCS C1725
Hospital Charge Code	41569372
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/SIMMONS2/6F

Facility IP

$32.32

Service Code	HCPCS C1725
Hospital Charge Code	41569373
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

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