St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ DRAINAGE/MULTIPURPOSE/14.0F

Facility OP

$158.81

Service Code	HCPCS C1729
Hospital Charge Code	41569326
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/14.0F

Facility IP

$158.81

Service Code	HCPCS C1729
Hospital Charge Code	41569326
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/8.5F

Facility OP

$158.81

Service Code	HCPCS C1729
Hospital Charge Code	41569327
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/8.5F

Facility IP

$158.81

Service Code	HCPCS C1729
Hospital Charge Code	41569327
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/8.5F/15S

Facility OP

$166.91

Service Code	HCPCS C1729
Hospital Charge Code	41569328
Hospital Revenue Code	278
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$175.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.80
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	$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/8.5F/15S

Facility IP

$166.91

Service Code	HCPCS C1729
Hospital Charge Code	41569328
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/8.5F/5S

Facility OP

$166.91

Service Code	HCPCS C1729
Hospital Charge Code	41569329
Hospital Revenue Code	278
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$175.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.80
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	$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/8.5F/5S

Facility IP

$166.91

Service Code	HCPCS C1729
Hospital Charge Code	41569329
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/NEPH/8F/25CM

Facility OP

$172.23

Service Code	HCPCS C1725
Hospital Charge Code	41569336
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$180.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.73
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	$86.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$99.03
Rate for Payer: Fidelis Medicare Advantage	$180.84
Rate for Payer: Group Health Inc Commercial	$86.12
Rate for Payer: Group Health Inc Medicare	$60.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.12
Rate for Payer: Hamaspik Choice Inc Medicare	$86.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$111.95

ZZ DRAINAGE/NEPH/8F/25CM

Facility IP

$172.23

Service Code	HCPCS C1725
Hospital Charge Code	41569336
Hospital Revenue Code	278
Min. Negotiated Rate	$86.12
Max. Negotiated Rate	$86.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.12
Rate for Payer: Hamaspik Choice Inc Medicare	$86.12

ZZ DRAINAGE/NEPH/PEDIATRIC

Facility OP

$323.19

Hospital Charge Code	41569338
Hospital Revenue Code	270
Min. Negotiated Rate	$113.12
Max. Negotiated Rate	$258.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$177.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$161.60
Rate for Payer: Aetna Government	$161.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$258.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$219.77
Rate for Payer: Group Health Inc Commercial	$161.60
Rate for Payer: Group Health Inc Medicare	$113.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$161.60
Rate for Payer: Hamaspik Choice Inc Medicare	$161.60

ZZ DRAINAGE/N-U/10F-22CM

Facility OP

$219.01

Service Code	HCPCS C1729
Hospital Charge Code	41569330
Hospital Revenue Code	278
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$229.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$120.46
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	$109.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$125.93
Rate for Payer: Fidelis Medicare Advantage	$229.96
Rate for Payer: Group Health Inc Commercial	$109.50
Rate for Payer: Group Health Inc Medicare	$76.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$109.50
Rate for Payer: Hamaspik Choice Inc Medicare	$109.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$142.36

ZZ DRAINAGE/N-U/10F-22CM

Facility IP

$219.01

Service Code	HCPCS C1729
Hospital Charge Code	41569330
Hospital Revenue Code	278
Min. Negotiated Rate	$109.50
Max. Negotiated Rate	$109.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$109.50
Rate for Payer: Hamaspik Choice Inc Medicare	$109.50

ZZ DRAINAGE/N-U/10F-24CM

Facility OP

$219.01

Service Code	HCPCS C1729
Hospital Charge Code	41569331
Hospital Revenue Code	278
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$229.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$120.46
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	$109.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$125.93
Rate for Payer: Fidelis Medicare Advantage	$229.96
Rate for Payer: Group Health Inc Commercial	$109.50
Rate for Payer: Group Health Inc Medicare	$76.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$109.50
Rate for Payer: Hamaspik Choice Inc Medicare	$109.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$142.36

ZZ DRAINAGE/N-U/10F-24CM

Facility IP

$219.01

Service Code	HCPCS C1729
Hospital Charge Code	41569331
Hospital Revenue Code	278
Min. Negotiated Rate	$109.50
Max. Negotiated Rate	$109.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$109.50
Rate for Payer: Hamaspik Choice Inc Medicare	$109.50

ZZ DRAINAGE/N-U/10F-26CM

Facility IP

$219.01

Service Code	HCPCS C1729
Hospital Charge Code	41569332
Hospital Revenue Code	278
Min. Negotiated Rate	$109.50
Max. Negotiated Rate	$109.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$109.50
Rate for Payer: Hamaspik Choice Inc Medicare	$109.50

ZZ DRAINAGE/N-U/10F-26CM

Facility OP

$219.01

Service Code	HCPCS C1729
Hospital Charge Code	41569332
Hospital Revenue Code	278
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$229.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$120.46
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	$109.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$125.93
Rate for Payer: Fidelis Medicare Advantage	$229.96
Rate for Payer: Group Health Inc Commercial	$109.50
Rate for Payer: Group Health Inc Medicare	$76.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$109.50
Rate for Payer: Hamaspik Choice Inc Medicare	$109.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$142.36

ZZ DRAINAGE/N-U/8F-22CM

Facility OP

$223.26

Hospital Charge Code	41569333
Hospital Revenue Code	270
Min. Negotiated Rate	$78.14
Max. Negotiated Rate	$178.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$122.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$111.63
Rate for Payer: Aetna Government	$111.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$178.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$151.82
Rate for Payer: Group Health Inc Commercial	$111.63
Rate for Payer: Group Health Inc Medicare	$78.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.63
Rate for Payer: Hamaspik Choice Inc Medicare	$111.63

ZZ DRAINAGE/N-U/8F-24CM

Facility OP

$223.26

Service Code	HCPCS C1729
Hospital Charge Code	41569334
Hospital Revenue Code	278
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$234.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$122.79
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	$111.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$128.37
Rate for Payer: Fidelis Medicare Advantage	$234.42
Rate for Payer: Group Health Inc Commercial	$111.63
Rate for Payer: Group Health Inc Medicare	$78.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.63
Rate for Payer: Hamaspik Choice Inc Medicare	$111.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$145.12

ZZ DRAINAGE/N-U/8F-24CM

Facility IP

$223.26

Service Code	HCPCS C1729
Hospital Charge Code	41569334
Hospital Revenue Code	278
Min. Negotiated Rate	$111.63
Max. Negotiated Rate	$111.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.63
Rate for Payer: Hamaspik Choice Inc Medicare	$111.63

ZZ DRAINAGE/N-U/8F-26CM

Facility OP

$223.26

Service Code	HCPCS C1729
Hospital Charge Code	41569335
Hospital Revenue Code	278
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$234.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$122.79
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	$111.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$128.37
Rate for Payer: Fidelis Medicare Advantage	$234.42
Rate for Payer: Group Health Inc Commercial	$111.63
Rate for Payer: Group Health Inc Medicare	$78.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.63
Rate for Payer: Hamaspik Choice Inc Medicare	$111.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$145.12

ZZ DRAINAGE/N-U/8F-26CM

Facility IP

$223.26

Service Code	HCPCS C1729
Hospital Charge Code	41569335
Hospital Revenue Code	278
Min. Negotiated Rate	$111.63
Max. Negotiated Rate	$111.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.63
Rate for Payer: Hamaspik Choice Inc Medicare	$111.63

ZZ DRAINAGE/PCN/10FANNA PASCAL.

Facility OP

$121.74

Service Code	HCPCS C1725
Hospital Charge Code	41569339
Hospital Revenue Code	278
Min. Negotiated Rate	$42.61
Max. Negotiated Rate	$127.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.96
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	$60.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$70.00
Rate for Payer: Fidelis Medicare Advantage	$127.83
Rate for Payer: Group Health Inc Commercial	$60.87
Rate for Payer: Group Health Inc Medicare	$42.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.87
Rate for Payer: Hamaspik Choice Inc Medicare	$60.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$79.13

ZZ DRAINAGE/PCN/10FANNA PASCAL.

Facility IP

$121.74

Service Code	HCPCS C1725
Hospital Charge Code	41569339
Hospital Revenue Code	278
Min. Negotiated Rate	$60.87
Max. Negotiated Rate	$60.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.87
Rate for Payer: Hamaspik Choice Inc Medicare	$60.87

ZZ DRAINAGE/PCN/10F FIRM

Facility IP

$172.23

Service Code	HCPCS C1729
Hospital Charge Code	41569340
Hospital Revenue Code	278
Min. Negotiated Rate	$86.12
Max. Negotiated Rate	$86.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.12
Rate for Payer: Hamaspik Choice Inc Medicare	$86.12

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