St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ DRAINAGE/DOUBLE J/10F/22CM

Facility IP

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569314
Hospital Revenue Code	278
Min. Negotiated Rate	$119.07
Max. Negotiated Rate	$119.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07

ZZ DRAINAGE/DOUBLE J/10F/22CM

Facility OP

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569314
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$250.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.98
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	$119.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.93
Rate for Payer: Fidelis Medicare Advantage	$250.05
Rate for Payer: Group Health Inc Commercial	$119.07
Rate for Payer: Group Health Inc Medicare	$83.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.79

ZZ DRAINAGE/DOUBLE J/10F/24CM

Facility OP

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569315
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$250.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.98
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	$119.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.93
Rate for Payer: Fidelis Medicare Advantage	$250.05
Rate for Payer: Group Health Inc Commercial	$119.07
Rate for Payer: Group Health Inc Medicare	$83.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.79

ZZ DRAINAGE/DOUBLE J/10F/24CM

Facility IP

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569315
Hospital Revenue Code	278
Min. Negotiated Rate	$119.07
Max. Negotiated Rate	$119.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07

ZZ DRAINAGE/DOUBLE J/10F/26CM

Facility IP

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569316
Hospital Revenue Code	278
Min. Negotiated Rate	$119.07
Max. Negotiated Rate	$119.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07

ZZ DRAINAGE/DOUBLE J/10F/26CM

Facility OP

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569316
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$250.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.98
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	$119.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.93
Rate for Payer: Fidelis Medicare Advantage	$250.05
Rate for Payer: Group Health Inc Commercial	$119.07
Rate for Payer: Group Health Inc Medicare	$83.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.79

ZZ DRAINAGE/DOUBLE J/8F/22CM

Facility OP

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569317
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$250.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.98
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	$119.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.93
Rate for Payer: Fidelis Medicare Advantage	$250.05
Rate for Payer: Group Health Inc Commercial	$119.07
Rate for Payer: Group Health Inc Medicare	$83.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.79

ZZ DRAINAGE/DOUBLE J/8F/22CM

Facility IP

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569317
Hospital Revenue Code	278
Min. Negotiated Rate	$119.07
Max. Negotiated Rate	$119.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07

ZZ DRAINAGE/DOUBLE J/8F/24CM

Facility IP

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569318
Hospital Revenue Code	278
Min. Negotiated Rate	$119.07
Max. Negotiated Rate	$119.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07

ZZ DRAINAGE/DOUBLE J/8F/24CM

Facility OP

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569318
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$250.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.98
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	$119.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.93
Rate for Payer: Fidelis Medicare Advantage	$250.05
Rate for Payer: Group Health Inc Commercial	$119.07
Rate for Payer: Group Health Inc Medicare	$83.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.79

ZZ DRAINAGE/DOUBLE J/8F/26CM

Facility OP

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569319
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$250.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.98
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	$119.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.93
Rate for Payer: Fidelis Medicare Advantage	$250.05
Rate for Payer: Group Health Inc Commercial	$119.07
Rate for Payer: Group Health Inc Medicare	$83.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.79

ZZ DRAINAGE/DOUBLE J/8F/26CM

Facility IP

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569319
Hospital Revenue Code	278
Min. Negotiated Rate	$119.07
Max. Negotiated Rate	$119.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07

ZZ DRAINAGE LINE

Facility OP

$34.02

Hospital Charge Code	41569637
Hospital Revenue Code	270
Min. Negotiated Rate	$11.91
Max. Negotiated Rate	$27.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.01
Rate for Payer: Aetna Government	$17.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.13
Rate for Payer: Group Health Inc Commercial	$17.01
Rate for Payer: Group Health Inc Medicare	$11.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.01
Rate for Payer: Hamaspik Choice Inc Medicare	$17.01

ZZ DRAINAGE/MILTI/8.5F/10SH/35CM

Facility OP

$166.91

Service Code	HCPCS C1725
Hospital Charge Code	41569321
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$175.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.80
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	$83.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.97
Rate for Payer: Fidelis Medicare Advantage	$175.26
Rate for Payer: Group Health Inc Commercial	$83.46
Rate for Payer: Group Health Inc Medicare	$58.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.46
Rate for Payer: Hamaspik Choice Inc Medicare	$83.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$108.49

ZZ DRAINAGE/MILTI/8.5F/10SH/35CM

Facility IP

$166.91

Service Code	HCPCS C1725
Hospital Charge Code	41569321
Hospital Revenue Code	278
Min. Negotiated Rate	$83.46
Max. Negotiated Rate	$83.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.46
Rate for Payer: Hamaspik Choice Inc Medicare	$83.46

ZZ DRAINAGE/MULTI/10.2/10SH/35CM

Facility IP

$166.91

Service Code	HCPCS C1725
Hospital Charge Code	41569320
Hospital Revenue Code	278
Min. Negotiated Rate	$83.46
Max. Negotiated Rate	$83.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.46
Rate for Payer: Hamaspik Choice Inc Medicare	$83.46

ZZ DRAINAGE/MULTI/10.2/10SH/35CM

Facility OP

$166.91

Service Code	HCPCS C1725
Hospital Charge Code	41569320
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$175.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.80
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	$83.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.97
Rate for Payer: Fidelis Medicare Advantage	$175.26
Rate for Payer: Group Health Inc Commercial	$83.46
Rate for Payer: Group Health Inc Medicare	$58.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.46
Rate for Payer: Hamaspik Choice Inc Medicare	$83.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$108.49

ZZ DRAINAGE/MULTIPURPOSE/10.2F

Facility OP

$158.81

Service Code	HCPCS C1725
Hospital Charge Code	41569322
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$166.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$87.35
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	$79.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$91.32
Rate for Payer: Fidelis Medicare Advantage	$166.75
Rate for Payer: Group Health Inc Commercial	$79.40
Rate for Payer: Group Health Inc Medicare	$55.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.40
Rate for Payer: Hamaspik Choice Inc Medicare	$79.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$103.23

ZZ DRAINAGE/MULTIPURPOSE/10.2F

Facility IP

$158.81

Service Code	HCPCS C1725
Hospital Charge Code	41569322
Hospital Revenue Code	278
Min. Negotiated Rate	$79.40
Max. Negotiated Rate	$79.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.40
Rate for Payer: Hamaspik Choice Inc Medicare	$79.40

ZZ DRAINAGE/MULTIPURPOSE/10F/15S

Facility OP

$166.91

Service Code	HCPCS C1725
Hospital Charge Code	41569323
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$175.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.80
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	$83.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.97
Rate for Payer: Fidelis Medicare Advantage	$175.26
Rate for Payer: Group Health Inc Commercial	$83.46
Rate for Payer: Group Health Inc Medicare	$58.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.46
Rate for Payer: Hamaspik Choice Inc Medicare	$83.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$108.49

ZZ DRAINAGE/MULTIPURPOSE/10F/15S

Facility IP

$166.91

Service Code	HCPCS C1725
Hospital Charge Code	41569323
Hospital Revenue Code	278
Min. Negotiated Rate	$83.46
Max. Negotiated Rate	$83.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.46
Rate for Payer: Hamaspik Choice Inc Medicare	$83.46

ZZ DRAINAGE/MULTIPURPOSE/10F/5S

Facility IP

$166.91

Service Code	HCPCS C1725
Hospital Charge Code	41569324
Hospital Revenue Code	278
Min. Negotiated Rate	$83.46
Max. Negotiated Rate	$83.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.46
Rate for Payer: Hamaspik Choice Inc Medicare	$83.46

ZZ DRAINAGE/MULTIPURPOSE/10F/5S

Facility OP

$166.91

Service Code	HCPCS C1725
Hospital Charge Code	41569324
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$175.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.80
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	$83.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.97
Rate for Payer: Fidelis Medicare Advantage	$175.26
Rate for Payer: Group Health Inc Commercial	$83.46
Rate for Payer: Group Health Inc Medicare	$58.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.46
Rate for Payer: Hamaspik Choice Inc Medicare	$83.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$108.49

ZZ DRAINAGE/MULTIPURPOSE/12.0F

Facility OP

$158.81

Service Code	HCPCS C1729
Hospital Charge Code	41569325
Hospital Revenue Code	278
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$166.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$87.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.42
Rate for Payer: Aetna Government	$2.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$79.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$91.32
Rate for Payer: Fidelis Medicare Advantage	$166.75
Rate for Payer: Group Health Inc Commercial	$79.40
Rate for Payer: Group Health Inc Medicare	$55.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.40
Rate for Payer: Hamaspik Choice Inc Medicare	$79.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$103.23

ZZ DRAINAGE/MULTIPURPOSE/12.0F

Facility IP

$158.81

Service Code	HCPCS C1729
Hospital Charge Code	41569325
Hospital Revenue Code	278
Min. Negotiated Rate	$79.40
Max. Negotiated Rate	$79.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.40
Rate for Payer: Hamaspik Choice Inc Medicare	$79.40

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All Charges