St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ CATH/SIMMONS2/6F

Facility OP

$32.32

Service Code	HCPCS C1725
Hospital Charge Code	41569373
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/.038/65CM

Facility OP

$32.32

Service Code	HCPCS C1725
Hospital Charge Code	41569365
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/.038/65CM

Facility IP

$32.32

Service Code	HCPCS C1725
Hospital Charge Code	41569365
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/SIMMONS3/5F/.038/65C

Facility OP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569374
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/SIMMONS3/5F/.038/65C

Facility IP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569374
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/SIMMONS3/5F/35/100CM

Facility OP

$32.32

Service Code	HCPCS C1725
Hospital Charge Code	41569375
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/SIMMONS3/5F/35/100CM

Facility IP

$32.32

Service Code	HCPCS C1725
Hospital Charge Code	41569375
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 SOS OMNI SELEC1 5FR038-80

Facility OP

$226.80

Service Code	HCPCS C1725
Hospital Charge Code	41569727
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 SOS OMNI SELEC1 5FR038-80

Facility IP

$226.80

Service Code	HCPCS C1725
Hospital Charge Code	41569727
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 SOS OMNI SELEC2 5FR038-80

Facility OP

$226.80

Service Code	HCPCS C1725
Hospital Charge Code	41569728
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 SOS OMNI SELEC2 5FR038-80

Facility IP

$226.80

Service Code	HCPCS C1725
Hospital Charge Code	41569728
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 SOS OMNI SELEC3 5FR038-80

Facility IP

$226.80

Service Code	HCPCS C1725
Hospital Charge Code	41569729
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 SOS OMNI SELEC3 5FR038-80

Facility OP

$226.80

Service Code	HCPCS C1725
Hospital Charge Code	41569729
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/STRAIGHT/4F/.035/0SH

Facility IP

$33.00

Service Code	HCPCS C1725
Hospital Charge Code	41569360
Hospital Revenue Code	278
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.50
Rate for Payer: Hamaspik Choice Inc Medicare	$16.50

ZZ CATH/STRAIGHT/4F/.035/0SH

Facility OP

$33.00

Service Code	HCPCS C1725
Hospital Charge Code	41569360
Hospital Revenue Code	278
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.15
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	$16.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.98
Rate for Payer: Fidelis Medicare Advantage	$34.65
Rate for Payer: Group Health Inc Commercial	$16.50
Rate for Payer: Group Health Inc Medicare	$11.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.50
Rate for Payer: Hamaspik Choice Inc Medicare	$16.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.45

ZZ CATH/STRAIGHT/4F/.035/10S

Facility OP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569522
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/STRAIGHT/4F/.035/10S

Facility IP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569522
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/STRAIGHT/5F/65/10SH

Facility IP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569523
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/STRAIGHT/5F/65/10SH

Facility OP

$37.21

Service Code	HCPCS C1725
Hospital Charge Code	41569523
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/STRAIGHT/5F/90/10SH

Facility IP

$32.32

Service Code	HCPCS C1725
Hospital Charge Code	41569524
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/STRAIGHT/5F/90/10SH

Facility OP

$32.32

Service Code	HCPCS C1725
Hospital Charge Code	41569524
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 STRAIGHT FLUSH 5FR 035-70

Facility IP

$46.78

Service Code	HCPCS C1725
Hospital Charge Code	41569698
Hospital Revenue Code	278
Min. Negotiated Rate	$23.39
Max. Negotiated Rate	$23.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.39
Rate for Payer: Hamaspik Choice Inc Medicare	$23.39

ZZ CATH STRAIGHT FLUSH 5FR 035-70

Facility OP

$46.78

Service Code	HCPCS C1725
Hospital Charge Code	41569698
Hospital Revenue Code	278
Min. Negotiated Rate	$16.37
Max. Negotiated Rate	$49.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.73
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	$23.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.90
Rate for Payer: Fidelis Medicare Advantage	$49.12
Rate for Payer: Group Health Inc Commercial	$23.39
Rate for Payer: Group Health Inc Medicare	$16.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.39
Rate for Payer: Hamaspik Choice Inc Medicare	$23.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.41

ZZ CATH/STRAIGHT/SIZING/SF

Facility IP

$61.14

Service Code	HCPCS C1725
Hospital Charge Code	41569026
Hospital Revenue Code	278
Min. Negotiated Rate	$30.57
Max. Negotiated Rate	$30.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.57
Rate for Payer: Hamaspik Choice Inc Medicare	$30.57

ZZ CATH/STRAIGHT/SIZING/SF

Facility OP

$61.14

Service Code	HCPCS C1725
Hospital Charge Code	41569026
Hospital Revenue Code	278
Min. Negotiated Rate	$21.40
Max. Negotiated Rate	$64.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.63
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	$30.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.16
Rate for Payer: Fidelis Medicare Advantage	$64.20
Rate for Payer: Group Health Inc Commercial	$30.57
Rate for Payer: Group Health Inc Medicare	$21.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.57
Rate for Payer: Hamaspik Choice Inc Medicare	$30.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.74

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