St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ CONNECTING TUBE/DRAINAGE/YTYPE

Facility OP

$24.54

Hospital Charge Code	41569293
Hospital Revenue Code	270
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$19.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.27
Rate for Payer: Aetna Government	$12.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.69
Rate for Payer: Group Health Inc Commercial	$12.27
Rate for Payer: Group Health Inc Medicare	$8.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.27
Rate for Payer: Hamaspik Choice Inc Medicare	$12.27

ZZ CONNECTOR/FEMALE FOLEY

Facility OP

$8.88

Hospital Charge Code	41569297
Hospital Revenue Code	270
Min. Negotiated Rate	$3.11
Max. Negotiated Rate	$7.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.44
Rate for Payer: Aetna Government	$4.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.04
Rate for Payer: Group Health Inc Commercial	$4.44
Rate for Payer: Group Health Inc Medicare	$3.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.44
Rate for Payer: Hamaspik Choice Inc Medicare	$4.44

ZZ CONNECTOR/MALE FOLEY

Facility OP

$8.79

Hospital Charge Code	41569298
Hospital Revenue Code	270
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$7.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.40
Rate for Payer: Aetna Government	$4.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.98
Rate for Payer: Group Health Inc Commercial	$4.40
Rate for Payer: Group Health Inc Medicare	$3.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.40
Rate for Payer: Hamaspik Choice Inc Medicare	$4.40

ZZ CONNECTOR/ MALE LUER LOCK

Facility OP

$7.06

Hospital Charge Code	41569299
Hospital Revenue Code	270
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$5.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.53
Rate for Payer: Aetna Government	$3.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.80
Rate for Payer: Group Health Inc Commercial	$3.53
Rate for Payer: Group Health Inc Medicare	$2.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.53
Rate for Payer: Hamaspik Choice Inc Medicare	$3.53

ZZ CONNECTOR TUBE/DRAINAGE/STTYPE

Facility OP

$21.13

Hospital Charge Code	41569294
Hospital Revenue Code	270
Min. Negotiated Rate	$7.40
Max. Negotiated Rate	$16.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.56
Rate for Payer: Aetna Government	$10.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.37
Rate for Payer: Group Health Inc Commercial	$10.56
Rate for Payer: Group Health Inc Medicare	$7.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.56
Rate for Payer: Hamaspik Choice Inc Medicare	$10.56

ZZ CONNECTOR TUBE/HIGH/PRESSURE

Facility OP

$22.19

Hospital Charge Code	41569295
Hospital Revenue Code	270
Min. Negotiated Rate	$7.77
Max. Negotiated Rate	$17.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.10
Rate for Payer: Aetna Government	$11.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.09
Rate for Payer: Group Health Inc Commercial	$11.10
Rate for Payer: Group Health Inc Medicare	$7.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.10
Rate for Payer: Hamaspik Choice Inc Medicare	$11.10

ZZ CONQUEST BALL 10/4/75

Facility IP

$722.93

Service Code	HCPCS C1725
Hospital Charge Code	41569772
Hospital Revenue Code	278
Min. Negotiated Rate	$361.46
Max. Negotiated Rate	$361.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$361.46
Rate for Payer: Hamaspik Choice Inc Medicare	$361.46

ZZ CONQUEST BALL 10/4/75

Facility OP

$722.93

Service Code	HCPCS C1725
Hospital Charge Code	41569772
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$759.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$397.61
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	$361.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$415.68
Rate for Payer: Fidelis Medicare Advantage	$759.08
Rate for Payer: Group Health Inc Commercial	$361.46
Rate for Payer: Group Health Inc Medicare	$253.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$361.46
Rate for Payer: Hamaspik Choice Inc Medicare	$361.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$469.90

ZZ CONQUEST BALL 12/4/75

Facility OP

$1,909.65

Hospital Charge Code	41569773
Hospital Revenue Code	279
Min. Negotiated Rate	$668.38
Max. Negotiated Rate	$1,527.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,050.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$954.82
Rate for Payer: Aetna Government	$954.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,527.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,298.56
Rate for Payer: Group Health Inc Commercial	$954.82
Rate for Payer: Group Health Inc Medicare	$668.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.82
Rate for Payer: Hamaspik Choice Inc Medicare	$954.82

ZZ CONQUEST BALL 8/4/75

Facility OP

$722.93

Service Code	HCPCS C1725
Hospital Charge Code	41569771
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$759.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$397.61
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	$361.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$415.68
Rate for Payer: Fidelis Medicare Advantage	$759.08
Rate for Payer: Group Health Inc Commercial	$361.46
Rate for Payer: Group Health Inc Medicare	$253.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$361.46
Rate for Payer: Hamaspik Choice Inc Medicare	$361.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$469.90

ZZ CONQUEST BALL 8/4/75

Facility IP

$722.93

Service Code	HCPCS C1725
Hospital Charge Code	41569771
Hospital Revenue Code	278
Min. Negotiated Rate	$361.46
Max. Negotiated Rate	$361.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$361.46
Rate for Payer: Hamaspik Choice Inc Medicare	$361.46

ZZ CONTOUR EMBOLI 250-355

Facility IP

$277.13

Service Code	HCPCS C1884
Hospital Charge Code	41567347
Hospital Revenue Code	278
Min. Negotiated Rate	$138.56
Max. Negotiated Rate	$138.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.56
Rate for Payer: Hamaspik Choice Inc Medicare	$138.56

ZZ CONTOUR EMBOLI 250-355

Facility OP

$277.13

Service Code	HCPCS C1884
Hospital Charge Code	41567347
Hospital Revenue Code	278
Min. Negotiated Rate	$97.00
Max. Negotiated Rate	$290.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$152.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$138.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$159.35
Rate for Payer: Fidelis Medicare Advantage	$290.99
Rate for Payer: Group Health Inc Commercial	$138.56
Rate for Payer: Group Health Inc Medicare	$97.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.56
Rate for Payer: Hamaspik Choice Inc Medicare	$138.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$180.13

ZZ CONTOUR EMBOLI 355-500

Facility OP

$277.13

Hospital Charge Code	41567348
Hospital Revenue Code	270
Min. Negotiated Rate	$97.00
Max. Negotiated Rate	$221.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$152.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$138.56
Rate for Payer: Aetna Government	$138.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$221.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$188.45
Rate for Payer: Group Health Inc Commercial	$138.56
Rate for Payer: Group Health Inc Medicare	$97.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.56
Rate for Payer: Hamaspik Choice Inc Medicare	$138.56

ZZ CONTOUR EMBOLI 500-710

Facility OP

$277.13

Hospital Charge Code	41567349
Hospital Revenue Code	270
Min. Negotiated Rate	$97.00
Max. Negotiated Rate	$221.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$152.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$138.56
Rate for Payer: Aetna Government	$138.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$221.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$188.45
Rate for Payer: Group Health Inc Commercial	$138.56
Rate for Payer: Group Health Inc Medicare	$97.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.56
Rate for Payer: Hamaspik Choice Inc Medicare	$138.56

ZZ CONTRA FLUSH II 5FR 035-65

Facility IP

$50.89

Service Code	HCPCS C1725
Hospital Charge Code	41569699
Hospital Revenue Code	278
Min. Negotiated Rate	$25.44
Max. Negotiated Rate	$25.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.44
Rate for Payer: Hamaspik Choice Inc Medicare	$25.44

ZZ CONTRA FLUSH II 5FR 035-65

Facility OP

$50.89

Service Code	HCPCS C1725
Hospital Charge Code	41569699
Hospital Revenue Code	278
Min. Negotiated Rate	$17.81
Max. Negotiated Rate	$53.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.99
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	$25.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.26
Rate for Payer: Fidelis Medicare Advantage	$53.43
Rate for Payer: Group Health Inc Commercial	$25.44
Rate for Payer: Group Health Inc Medicare	$17.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.44
Rate for Payer: Hamaspik Choice Inc Medicare	$25.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$33.08

ZZ CONTRAST CONT SPK ASS

Facility OP

$9.92

Hospital Charge Code	41567003
Hospital Revenue Code	270
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$7.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.96
Rate for Payer: Aetna Government	$4.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.75
Rate for Payer: Group Health Inc Commercial	$4.96
Rate for Payer: Group Health Inc Medicare	$3.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.96
Rate for Payer: Hamaspik Choice Inc Medicare	$4.96

ZZ COOK 1 WAY STOPCOCK

Facility OP

$6.32

Hospital Charge Code	41569605
Hospital Revenue Code	270
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$5.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.16
Rate for Payer: Aetna Government	$3.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.30
Rate for Payer: Group Health Inc Commercial	$3.16
Rate for Payer: Group Health Inc Medicare	$2.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.16
Rate for Payer: Hamaspik Choice Inc Medicare	$3.16

ZZ COOK 7 FRENCH PEELAWAY INT SET

Facility OP

$99.75

Hospital Charge Code	41569833
Hospital Revenue Code	270
Min. Negotiated Rate	$34.91
Max. Negotiated Rate	$79.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$54.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$49.88
Rate for Payer: Aetna Government	$49.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$79.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$67.83
Rate for Payer: Group Health Inc Commercial	$49.88
Rate for Payer: Group Health Inc Medicare	$34.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.88
Rate for Payer: Hamaspik Choice Inc Medicare	$49.88

ZZ COOK BALLOON DILA/CATH5MMX10CM

Facility OP

$420.00

Service Code	HCPCS C1725
Hospital Charge Code	41561804
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$441.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$231.00
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	$210.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$241.50
Rate for Payer: Fidelis Medicare Advantage	$441.00
Rate for Payer: Group Health Inc Commercial	$210.00
Rate for Payer: Group Health Inc Medicare	$147.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.00
Rate for Payer: Hamaspik Choice Inc Medicare	$210.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$273.00

ZZ COOK BALLOON DILA/CATH5MMX10CM

Facility IP

$420.00

Service Code	HCPCS C1725
Hospital Charge Code	41561804
Hospital Revenue Code	278
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$210.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.00
Rate for Payer: Hamaspik Choice Inc Medicare	$210.00

ZZ COOK BALLOON DILA/CATH 6MMX4CM

Facility OP

$420.00

Service Code	HCPCS C1725
Hospital Charge Code	41561802
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$441.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$231.00
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	$210.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$241.50
Rate for Payer: Fidelis Medicare Advantage	$441.00
Rate for Payer: Group Health Inc Commercial	$210.00
Rate for Payer: Group Health Inc Medicare	$147.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.00
Rate for Payer: Hamaspik Choice Inc Medicare	$210.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$273.00

ZZ COOK BALLOON DILA/CATH 6MMX4CM

Facility IP

$420.00

Service Code	HCPCS C1725
Hospital Charge Code	41561802
Hospital Revenue Code	278
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$210.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.00
Rate for Payer: Hamaspik Choice Inc Medicare	$210.00

ZZ COOK BALLOON DILA/CATH 6MMX6CM

Facility OP

$420.00

Service Code	HCPCS C1725
Hospital Charge Code	41561806
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$441.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$231.00
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	$210.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$241.50
Rate for Payer: Fidelis Medicare Advantage	$441.00
Rate for Payer: Group Health Inc Commercial	$210.00
Rate for Payer: Group Health Inc Medicare	$147.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.00
Rate for Payer: Hamaspik Choice Inc Medicare	$210.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$273.00

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