St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ PEEL-AWAY/9F/15CM

Facility IP

$80.80

Service Code	HCPCS C1892
Hospital Charge Code	41569282
Hospital Revenue Code	278
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$40.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.40
Rate for Payer: Hamaspik Choice Inc Medicare	$40.40

ZZ PEEL-AWAY/9F/15CM

Facility OP

$80.80

Service Code	HCPCS C1892
Hospital Charge Code	41569282
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$84.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.46
Rate for Payer: Fidelis Medicare Advantage	$84.84
Rate for Payer: Group Health Inc Commercial	$40.40
Rate for Payer: Group Health Inc Medicare	$28.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.40
Rate for Payer: Hamaspik Choice Inc Medicare	$40.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.52

ZZ PEEL-AWAY/9F/30CM

Facility IP

$100.04

Service Code	HCPCS C1892
Hospital Charge Code	41569283
Hospital Revenue Code	278
Min. Negotiated Rate	$50.02
Max. Negotiated Rate	$50.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.02
Rate for Payer: Hamaspik Choice Inc Medicare	$50.02

ZZ PEEL-AWAY/9F/30CM

Facility OP

$100.04

Service Code	HCPCS C1892
Hospital Charge Code	41569283
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$105.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.52
Rate for Payer: Fidelis Medicare Advantage	$105.04
Rate for Payer: Group Health Inc Commercial	$50.02
Rate for Payer: Group Health Inc Medicare	$35.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.02
Rate for Payer: Hamaspik Choice Inc Medicare	$50.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.03

ZZ PEEL-AWAY/9F/60CM

Facility IP

$80.80

Service Code	HCPCS C1892
Hospital Charge Code	41569520
Hospital Revenue Code	278
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$40.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.40
Rate for Payer: Hamaspik Choice Inc Medicare	$40.40

ZZ PEEL-AWAY/9F/60CM

Facility OP

$80.80

Service Code	HCPCS C1892
Hospital Charge Code	41569520
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$84.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.46
Rate for Payer: Fidelis Medicare Advantage	$84.84
Rate for Payer: Group Health Inc Commercial	$40.40
Rate for Payer: Group Health Inc Medicare	$28.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.40
Rate for Payer: Hamaspik Choice Inc Medicare	$40.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.52

ZZ PEELAWAY SH 11 38 30

Facility IP

$143.52

Service Code	HCPCS C1892
Hospital Charge Code	41567046
Hospital Revenue Code	278
Min. Negotiated Rate	$71.76
Max. Negotiated Rate	$71.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.76
Rate for Payer: Hamaspik Choice Inc Medicare	$71.76

ZZ PEELAWAY SH 11 38 30

Facility OP

$143.52

Service Code	HCPCS C1892
Hospital Charge Code	41567046
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$150.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$71.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$82.52
Rate for Payer: Fidelis Medicare Advantage	$150.70
Rate for Payer: Group Health Inc Commercial	$71.76
Rate for Payer: Group Health Inc Medicare	$50.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.76
Rate for Payer: Hamaspik Choice Inc Medicare	$71.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$93.29

ZZ PEELAWAY SH 11 38 45

Facility IP

$143.52

Service Code	HCPCS C1892
Hospital Charge Code	41567047
Hospital Revenue Code	278
Min. Negotiated Rate	$71.76
Max. Negotiated Rate	$71.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.76
Rate for Payer: Hamaspik Choice Inc Medicare	$71.76

ZZ PEELAWAY SH 11 38 45

Facility OP

$143.52

Service Code	HCPCS C1892
Hospital Charge Code	41567047
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$150.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$71.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$82.52
Rate for Payer: Fidelis Medicare Advantage	$150.70
Rate for Payer: Group Health Inc Commercial	$71.76
Rate for Payer: Group Health Inc Medicare	$50.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.76
Rate for Payer: Hamaspik Choice Inc Medicare	$71.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$93.29

ZZ PEELAWAY SH 13 38 30

Facility IP

$143.52

Service Code	HCPCS C1892
Hospital Charge Code	41567048
Hospital Revenue Code	278
Min. Negotiated Rate	$71.76
Max. Negotiated Rate	$71.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.76
Rate for Payer: Hamaspik Choice Inc Medicare	$71.76

ZZ PEELAWAY SH 13 38 30

Facility OP

$143.52

Service Code	HCPCS C1892
Hospital Charge Code	41567048
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$150.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$71.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$82.52
Rate for Payer: Fidelis Medicare Advantage	$150.70
Rate for Payer: Group Health Inc Commercial	$71.76
Rate for Payer: Group Health Inc Medicare	$50.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.76
Rate for Payer: Hamaspik Choice Inc Medicare	$71.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$93.29

ZZ PEELAWAY SH 13 38 45

Facility OP

$143.52

Service Code	HCPCS C1892
Hospital Charge Code	41567049
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$150.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$71.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$82.52
Rate for Payer: Fidelis Medicare Advantage	$150.70
Rate for Payer: Group Health Inc Commercial	$71.76
Rate for Payer: Group Health Inc Medicare	$50.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.76
Rate for Payer: Hamaspik Choice Inc Medicare	$71.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$93.29

ZZ PEELAWAY SH 13 38 45

Facility IP

$143.52

Service Code	HCPCS C1892
Hospital Charge Code	41567049
Hospital Revenue Code	278
Min. Negotiated Rate	$71.76
Max. Negotiated Rate	$71.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.76
Rate for Payer: Hamaspik Choice Inc Medicare	$71.76

ZZ PEELAWAY SH 14 38 30

Facility IP

$143.52

Service Code	HCPCS C1892
Hospital Charge Code	41567050
Hospital Revenue Code	278
Min. Negotiated Rate	$71.76
Max. Negotiated Rate	$71.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.76
Rate for Payer: Hamaspik Choice Inc Medicare	$71.76

ZZ PEELAWAY SH 14 38 30

Facility OP

$143.52

Service Code	HCPCS C1892
Hospital Charge Code	41567050
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$150.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$71.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$82.52
Rate for Payer: Fidelis Medicare Advantage	$150.70
Rate for Payer: Group Health Inc Commercial	$71.76
Rate for Payer: Group Health Inc Medicare	$50.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.76
Rate for Payer: Hamaspik Choice Inc Medicare	$71.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$93.29

ZZ PEELAWAY SH 14 38 45

Facility OP

$143.52

Service Code	HCPCS C1892
Hospital Charge Code	41567051
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$150.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$71.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$82.52
Rate for Payer: Fidelis Medicare Advantage	$150.70
Rate for Payer: Group Health Inc Commercial	$71.76
Rate for Payer: Group Health Inc Medicare	$50.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.76
Rate for Payer: Hamaspik Choice Inc Medicare	$71.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$93.29

ZZ PEELAWAY SH 14 38 45

Facility IP

$143.52

Service Code	HCPCS C1892
Hospital Charge Code	41567051
Hospital Revenue Code	278
Min. Negotiated Rate	$71.76
Max. Negotiated Rate	$71.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.76
Rate for Payer: Hamaspik Choice Inc Medicare	$71.76

ZZ PEELAWAY SH 8 38 30

Facility IP

$143.52

Service Code	HCPCS C1892
Hospital Charge Code	41567052
Hospital Revenue Code	278
Min. Negotiated Rate	$71.76
Max. Negotiated Rate	$71.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.76
Rate for Payer: Hamaspik Choice Inc Medicare	$71.76

ZZ PEELAWAY SH 8 38 30

Facility OP

$143.52

Service Code	HCPCS C1892
Hospital Charge Code	41567052
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$150.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$71.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$82.52
Rate for Payer: Fidelis Medicare Advantage	$150.70
Rate for Payer: Group Health Inc Commercial	$71.76
Rate for Payer: Group Health Inc Medicare	$50.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.76
Rate for Payer: Hamaspik Choice Inc Medicare	$71.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$93.29

ZZ PEELAWAY SH 8 38 45

Facility OP

$143.52

Service Code	HCPCS C1892
Hospital Charge Code	41567053
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$150.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$71.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$82.52
Rate for Payer: Fidelis Medicare Advantage	$150.70
Rate for Payer: Group Health Inc Commercial	$71.76
Rate for Payer: Group Health Inc Medicare	$50.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.76
Rate for Payer: Hamaspik Choice Inc Medicare	$71.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$93.29

ZZ PEELAWAY SH 8 38 45

Facility IP

$143.52

Service Code	HCPCS C1892
Hospital Charge Code	41567053
Hospital Revenue Code	278
Min. Negotiated Rate	$71.76
Max. Negotiated Rate	$71.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.76
Rate for Payer: Hamaspik Choice Inc Medicare	$71.76

ZZ PEELAWAY SH 9 38 30

Facility IP

$143.52

Service Code	HCPCS C1892
Hospital Charge Code	41567054
Hospital Revenue Code	278
Min. Negotiated Rate	$71.76
Max. Negotiated Rate	$71.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.76
Rate for Payer: Hamaspik Choice Inc Medicare	$71.76

ZZ PEELAWAY SH 9 38 30

Facility OP

$143.52

Service Code	HCPCS C1892
Hospital Charge Code	41567054
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$150.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$71.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$82.52
Rate for Payer: Fidelis Medicare Advantage	$150.70
Rate for Payer: Group Health Inc Commercial	$71.76
Rate for Payer: Group Health Inc Medicare	$50.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.76
Rate for Payer: Hamaspik Choice Inc Medicare	$71.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$93.29

ZZ PEELAWAY SH 9 38 35

Facility IP

$143.52

Service Code	HCPCS C1892
Hospital Charge Code	41567055
Hospital Revenue Code	278
Min. Negotiated Rate	$71.76
Max. Negotiated Rate	$71.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.76
Rate for Payer: Hamaspik Choice Inc Medicare	$71.76

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