St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ GLIDE WIRE 35-260 ANGLED

Facility OP

$154.15

Service Code	HCPCS C1769
Hospital Charge Code	41567113
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$161.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$84.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$77.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$88.64
Rate for Payer: Fidelis Medicare Advantage	$161.86
Rate for Payer: Group Health Inc Commercial	$77.08
Rate for Payer: Group Health Inc Medicare	$53.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.08
Rate for Payer: Hamaspik Choice Inc Medicare	$77.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$100.20

ZZ GLIDE WIRE 35-80 ANGLE

Facility IP

$157.34

Service Code	HCPCS C1769
Hospital Charge Code	41567119
Hospital Revenue Code	278
Min. Negotiated Rate	$78.67
Max. Negotiated Rate	$78.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.67
Rate for Payer: Hamaspik Choice Inc Medicare	$78.67

ZZ GLIDE WIRE 35-80 ANGLE

Facility OP

$157.34

Service Code	HCPCS C1769
Hospital Charge Code	41567119
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$165.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$90.47
Rate for Payer: Fidelis Medicare Advantage	$165.21
Rate for Payer: Group Health Inc Commercial	$78.67
Rate for Payer: Group Health Inc Medicare	$55.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.67
Rate for Payer: Hamaspik Choice Inc Medicare	$78.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$102.27

ZZ GLIDE WIRE 38-150 ANGL

Facility IP

$98.87

Service Code	HCPCS C1769
Hospital Charge Code	41567114
Hospital Revenue Code	278
Min. Negotiated Rate	$49.44
Max. Negotiated Rate	$49.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.44
Rate for Payer: Hamaspik Choice Inc Medicare	$49.44

ZZ GLIDE WIRE 38-150 ANGL

Facility OP

$98.87

Service Code	HCPCS C1769
Hospital Charge Code	41567114
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$103.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$54.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$49.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$56.85
Rate for Payer: Fidelis Medicare Advantage	$103.81
Rate for Payer: Group Health Inc Commercial	$49.44
Rate for Payer: Group Health Inc Medicare	$34.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.44
Rate for Payer: Hamaspik Choice Inc Medicare	$49.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$64.27

ZZ GLIDEWIRE ANGEL TIP 150CM/3CM

Facility OP

$438.00

Service Code	HCPCS C1769
Hospital Charge Code	41569949
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$459.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$240.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$219.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$251.85
Rate for Payer: Fidelis Medicare Advantage	$459.90
Rate for Payer: Group Health Inc Commercial	$219.00
Rate for Payer: Group Health Inc Medicare	$153.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$219.00
Rate for Payer: Hamaspik Choice Inc Medicare	$219.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$284.70

ZZ GLIDEWIRE ANGEL TIP 150CM/3CM

Facility IP

$438.00

Service Code	HCPCS C1769
Hospital Charge Code	41569949
Hospital Revenue Code	278
Min. Negotiated Rate	$219.00
Max. Negotiated Rate	$219.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$219.00
Rate for Payer: Hamaspik Choice Inc Medicare	$219.00

ZZ GLIDEWIRE ANGEL TIP 260CM/3CM

Facility OP

$475.20

Service Code	HCPCS C1769
Hospital Charge Code	41569951
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$498.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$261.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$237.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$273.24
Rate for Payer: Fidelis Medicare Advantage	$498.96
Rate for Payer: Group Health Inc Commercial	$237.60
Rate for Payer: Group Health Inc Medicare	$166.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$237.60
Rate for Payer: Hamaspik Choice Inc Medicare	$237.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$308.88

ZZ GLIDEWIRE ANGEL TIP 260CM/3CM

Facility IP

$475.20

Service Code	HCPCS C1769
Hospital Charge Code	41569951
Hospital Revenue Code	278
Min. Negotiated Rate	$237.60
Max. Negotiated Rate	$237.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$237.60
Rate for Payer: Hamaspik Choice Inc Medicare	$237.60

ZZ GLIDEWR STRAIGHT TIP 150CM/3CM

Facility OP

$316.80

Service Code	HCPCS C1769
Hospital Charge Code	41569950
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$332.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$174.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$158.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$182.16
Rate for Payer: Fidelis Medicare Advantage	$332.64
Rate for Payer: Group Health Inc Commercial	$158.40
Rate for Payer: Group Health Inc Medicare	$110.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$158.40
Rate for Payer: Hamaspik Choice Inc Medicare	$158.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$205.92

ZZ GLIDEWR STRAIGHT TIP 150CM/3CM

Facility IP

$316.80

Service Code	HCPCS C1769
Hospital Charge Code	41569950
Hospital Revenue Code	278
Min. Negotiated Rate	$158.40
Max. Negotiated Rate	$158.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$158.40
Rate for Payer: Hamaspik Choice Inc Medicare	$158.40

ZZ GREENFLD IVC FILT FEM

Facility IP

$3,247.14

Service Code	HCPCS C1880
Hospital Charge Code	41567148
Hospital Revenue Code	278
Min. Negotiated Rate	$1,623.57
Max. Negotiated Rate	$1,623.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,623.57
Rate for Payer: Hamaspik Choice Inc Medicare	$1,623.57

ZZ GREENFLD IVC FILT FEM

Facility OP

$3,247.14

Service Code	HCPCS C1880
Hospital Charge Code	41567148
Hospital Revenue Code	278
Min. Negotiated Rate	$57.08
Max. Negotiated Rate	$3,409.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,785.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$57.08
Rate for Payer: Aetna Government	$57.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,623.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,867.11
Rate for Payer: Fidelis Medicare Advantage	$3,409.50
Rate for Payer: Group Health Inc Commercial	$1,623.57
Rate for Payer: Group Health Inc Medicare	$1,136.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,623.57
Rate for Payer: Hamaspik Choice Inc Medicare	$1,623.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,110.64

ZZ GREENFLD IVC FILT JUG

Facility IP

$3,247.14

Service Code	HCPCS C1880
Hospital Charge Code	41567147
Hospital Revenue Code	278
Min. Negotiated Rate	$1,623.57
Max. Negotiated Rate	$1,623.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,623.57
Rate for Payer: Hamaspik Choice Inc Medicare	$1,623.57

ZZ GREENFLD IVC FILT JUG

Facility OP

$3,247.14

Service Code	HCPCS C1880
Hospital Charge Code	41567147
Hospital Revenue Code	278
Min. Negotiated Rate	$57.08
Max. Negotiated Rate	$3,409.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,785.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$57.08
Rate for Payer: Aetna Government	$57.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,623.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,867.11
Rate for Payer: Fidelis Medicare Advantage	$3,409.50
Rate for Payer: Group Health Inc Commercial	$1,623.57
Rate for Payer: Group Health Inc Medicare	$1,136.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,623.57
Rate for Payer: Hamaspik Choice Inc Medicare	$1,623.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,110.64

ZZ GRID IMMOBILIZATION PLATE

Facility OP

$30.00

Hospital Charge Code	41568760
Hospital Revenue Code	270
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$24.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.00
Rate for Payer: Aetna Government	$15.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.40
Rate for Payer: Group Health Inc Commercial	$15.00
Rate for Payer: Group Health Inc Medicare	$10.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00
Rate for Payer: Hamaspik Choice Inc Medicare	$15.00

ZZ GROUNDING PAD

Facility OP

$5.84

Hospital Charge Code	41568532
Hospital Revenue Code	270
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$4.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.92
Rate for Payer: Aetna Government	$2.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.97
Rate for Payer: Group Health Inc Commercial	$2.92
Rate for Payer: Group Health Inc Medicare	$2.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.92
Rate for Payer: Hamaspik Choice Inc Medicare	$2.92

ZZ GT GUIDEWIRE

Facility IP

$342.00

Service Code	HCPCS C1769
Hospital Charge Code	41569961
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$171.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$171.00
Rate for Payer: Hamaspik Choice Inc Medicare	$171.00

ZZ GT GUIDEWIRE

Facility OP

$342.00

Service Code	HCPCS C1769
Hospital Charge Code	41569961
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$359.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$188.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$171.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$196.65
Rate for Payer: Fidelis Medicare Advantage	$359.10
Rate for Payer: Group Health Inc Commercial	$171.00
Rate for Payer: Group Health Inc Medicare	$119.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$171.00
Rate for Payer: Hamaspik Choice Inc Medicare	$171.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$222.30

ZZ GUIDE WIRE 35-145-3 BH

Facility IP

$39.33

Service Code	HCPCS C1769
Hospital Charge Code	41567100
Hospital Revenue Code	278
Min. Negotiated Rate	$19.66
Max. Negotiated Rate	$19.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.66
Rate for Payer: Hamaspik Choice Inc Medicare	$19.66

ZZ GUIDE WIRE 35-145-3 BH

Facility OP

$39.33

Service Code	HCPCS C1769
Hospital Charge Code	41567100
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$41.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.61
Rate for Payer: Fidelis Medicare Advantage	$41.30
Rate for Payer: Group Health Inc Commercial	$19.66
Rate for Payer: Group Health Inc Medicare	$13.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.66
Rate for Payer: Hamaspik Choice Inc Medicare	$19.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.56

ZZ GUIDE WIRE 35-145 BH

Facility IP

$52.09

Service Code	HCPCS C1769
Hospital Charge Code	41567102
Hospital Revenue Code	278
Min. Negotiated Rate	$26.04
Max. Negotiated Rate	$26.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.04
Rate for Payer: Hamaspik Choice Inc Medicare	$26.04

ZZ GUIDE WIRE 35-145 BH

Facility OP

$52.09

Service Code	HCPCS C1769
Hospital Charge Code	41567102
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$54.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.95
Rate for Payer: Fidelis Medicare Advantage	$54.69
Rate for Payer: Group Health Inc Commercial	$26.04
Rate for Payer: Group Health Inc Medicare	$18.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.04
Rate for Payer: Hamaspik Choice Inc Medicare	$26.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$33.86

ZZ GUIDE WIRE 35-180

Facility IP

$40.75

Service Code	HCPCS C1769
Hospital Charge Code	41567096
Hospital Revenue Code	278
Min. Negotiated Rate	$20.38
Max. Negotiated Rate	$20.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.38
Rate for Payer: Hamaspik Choice Inc Medicare	$20.38

ZZ GUIDE WIRE 35-180

Facility OP

$40.75

Service Code	HCPCS C1769
Hospital Charge Code	41567096
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$42.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.43
Rate for Payer: Fidelis Medicare Advantage	$42.79
Rate for Payer: Group Health Inc Commercial	$20.38
Rate for Payer: Group Health Inc Medicare	$14.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.38
Rate for Payer: Hamaspik Choice Inc Medicare	$20.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.49

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