St. Barnabas Hospital

All Charges

Charge

Type

Price

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

ZZ PERCLOSE PROGLIDE 6FRENCH

Facility OP

$470.00

Hospital Charge Code	41569887
Hospital Revenue Code	270
Min. Negotiated Rate	$164.50
Max. Negotiated Rate	$376.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$258.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$235.00
Rate for Payer: Aetna Government	$235.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$376.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$319.60
Rate for Payer: Group Health Inc Commercial	$235.00
Rate for Payer: Group Health Inc Medicare	$164.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.00
Rate for Payer: Hamaspik Choice Inc Medicare	$235.00

ZZ PET FDG PER 45MCI

Facility OP

$310.00

Service Code	HCPCS A9552
Hospital Charge Code	41568739
Hospital Revenue Code	343
Min. Negotiated Rate	$108.50
Max. Negotiated Rate	$260.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$170.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$260.79
Rate for Payer: Aetna Government	$260.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$248.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$210.80
Rate for Payer: Group Health Inc Commercial	$155.00
Rate for Payer: Group Health Inc Medicare	$108.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$155.00
Rate for Payer: Hamaspik Choice Inc Medicare	$155.00

ZZ PET N-13 AMMONIA PER 40MCI

Facility OP

$550.00

Service Code	HCPCS A9526
Hospital Charge Code	41568741
Hospital Revenue Code	343
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$496.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$302.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$496.80
Rate for Payer: Aetna Government	$496.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$440.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$374.00
Rate for Payer: Group Health Inc Commercial	$275.00
Rate for Payer: Group Health Inc Medicare	$192.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$275.00

ZZ PETRI DISHES

Facility OP

$278.12

Hospital Charge Code	41568877
Hospital Revenue Code	270
Min. Negotiated Rate	$97.34
Max. Negotiated Rate	$222.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$152.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$139.06
Rate for Payer: Aetna Government	$139.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$222.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$189.12
Rate for Payer: Group Health Inc Commercial	$139.06
Rate for Payer: Group Health Inc Medicare	$97.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.06
Rate for Payer: Hamaspik Choice Inc Medicare	$139.06

ZZ PETRI DISHES

Facility OP

$1,978.77

Service Code	HCPCS 77032
Hospital Charge Code	41568873
Hospital Revenue Code	270
Min. Negotiated Rate	$692.57
Max. Negotiated Rate	$1,583.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,088.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$989.38
Rate for Payer: Aetna Government	$989.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,583.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,345.56
Rate for Payer: Group Health Inc Commercial	$989.38
Rate for Payer: Group Health Inc Medicare	$692.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$989.38
Rate for Payer: Hamaspik Choice Inc Medicare	$989.38

ZZ PICC/4F/CV/60CM/CLAMPLESS

Facility IP

$691.04

Service Code	HCPCS C1751
Hospital Charge Code	41569461
Hospital Revenue Code	278
Min. Negotiated Rate	$345.52
Max. Negotiated Rate	$345.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$345.52
Rate for Payer: Hamaspik Choice Inc Medicare	$345.52

ZZ PICC/4F/CV/60CM/CLAMPLESS

Facility OP

$691.04

Service Code	HCPCS C1751
Hospital Charge Code	41569461
Hospital Revenue Code	278
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$725.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$380.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.08
Rate for Payer: Aetna Government	$7.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$345.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$397.35
Rate for Payer: Fidelis Medicare Advantage	$725.59
Rate for Payer: Group Health Inc Commercial	$345.52
Rate for Payer: Group Health Inc Medicare	$241.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$345.52
Rate for Payer: Hamaspik Choice Inc Medicare	$345.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$449.18

ZZ PICC/4F/SINGLE LUMEN

Facility IP

$114.48

Service Code	HCPCS C1751
Hospital Charge Code	41569468
Hospital Revenue Code	278
Min. Negotiated Rate	$57.24
Max. Negotiated Rate	$57.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.24
Rate for Payer: Hamaspik Choice Inc Medicare	$57.24

ZZ PICC/4F/SINGLE LUMEN

Facility OP

$114.48

Service Code	HCPCS C1751
Hospital Charge Code	41569468
Hospital Revenue Code	278
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$120.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.08
Rate for Payer: Aetna Government	$7.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.83
Rate for Payer: Fidelis Medicare Advantage	$120.20
Rate for Payer: Group Health Inc Commercial	$57.24
Rate for Payer: Group Health Inc Medicare	$40.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.24
Rate for Payer: Hamaspik Choice Inc Medicare	$57.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$74.41

ZZ PICC DBL LUM 5FR

Facility OP

$253.03

Service Code	HCPCS C1751
Hospital Charge Code	41569640
Hospital Revenue Code	278
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$265.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$139.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.08
Rate for Payer: Aetna Government	$7.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$126.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$145.49
Rate for Payer: Fidelis Medicare Advantage	$265.68
Rate for Payer: Group Health Inc Commercial	$126.52
Rate for Payer: Group Health Inc Medicare	$88.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.52
Rate for Payer: Hamaspik Choice Inc Medicare	$126.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$164.47

ZZ PICC DBL LUM 5FR

Facility IP

$253.03

Service Code	HCPCS C1751
Hospital Charge Code	41569640
Hospital Revenue Code	278
Min. Negotiated Rate	$126.52
Max. Negotiated Rate	$126.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.52
Rate for Payer: Hamaspik Choice Inc Medicare	$126.52

ZZ PICC LINE/3F SINGLE LUMEN

Facility IP

$114.48

Service Code	HCPCS C1751
Hospital Charge Code	41569462
Hospital Revenue Code	278
Min. Negotiated Rate	$57.24
Max. Negotiated Rate	$57.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.24
Rate for Payer: Hamaspik Choice Inc Medicare	$57.24

ZZ PICC LINE/3F SINGLE LUMEN

Facility OP

$114.48

Service Code	HCPCS C1751
Hospital Charge Code	41569462
Hospital Revenue Code	278
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$120.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.08
Rate for Payer: Aetna Government	$7.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.83
Rate for Payer: Fidelis Medicare Advantage	$120.20
Rate for Payer: Group Health Inc Commercial	$57.24
Rate for Payer: Group Health Inc Medicare	$40.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.24
Rate for Payer: Hamaspik Choice Inc Medicare	$57.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$74.41

ZZ PICC LINE 4F/65 MORPH SINGLE

Facility OP

$220.00

Service Code	HCPCS C1887
Hospital Charge Code	41568415
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$231.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$121.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$110.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$126.50
Rate for Payer: Fidelis Medicare Advantage	$231.00
Rate for Payer: Group Health Inc Commercial	$110.00
Rate for Payer: Group Health Inc Medicare	$77.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$143.00

ZZ PICC LINE 4F/65 MORPH SINGLE

Facility IP

$220.00

Service Code	HCPCS C1887
Hospital Charge Code	41568415
Hospital Revenue Code	278
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$110.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00

ZZ PICC LINE/4F GROSHONG SINGLE

Facility OP

$304.06

Service Code	HCPCS C1751
Hospital Charge Code	41569464
Hospital Revenue Code	278
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$319.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$167.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.08
Rate for Payer: Aetna Government	$7.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$152.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$174.83
Rate for Payer: Fidelis Medicare Advantage	$319.26
Rate for Payer: Group Health Inc Commercial	$152.03
Rate for Payer: Group Health Inc Medicare	$106.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.03
Rate for Payer: Hamaspik Choice Inc Medicare	$152.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$197.64

ZZ PICC LINE/4F GROSHONG SINGLE

Facility IP

$304.06

Service Code	HCPCS C1751
Hospital Charge Code	41569464
Hospital Revenue Code	278
Min. Negotiated Rate	$152.03
Max. Negotiated Rate	$152.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.03
Rate for Payer: Hamaspik Choice Inc Medicare	$152.03

ZZ PICC LINE/4F SINGLE LUMEN

Facility OP

$114.48

Service Code	HCPCS C1751
Hospital Charge Code	41569521
Hospital Revenue Code	278
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$120.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.08
Rate for Payer: Aetna Government	$7.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.83
Rate for Payer: Fidelis Medicare Advantage	$120.20
Rate for Payer: Group Health Inc Commercial	$57.24
Rate for Payer: Group Health Inc Medicare	$40.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.24
Rate for Payer: Hamaspik Choice Inc Medicare	$57.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$74.41

ZZ PICC LINE/4F SINGLE LUMEN

Facility IP

$114.48

Service Code	HCPCS C1751
Hospital Charge Code	41569521
Hospital Revenue Code	278
Min. Negotiated Rate	$57.24
Max. Negotiated Rate	$57.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.24
Rate for Payer: Hamaspik Choice Inc Medicare	$57.24

ZZ PICC LINE/5F GROSHONG DUBBLE

Facility OP

$304.06

Service Code	HCPCS C1751
Hospital Charge Code	41569465
Hospital Revenue Code	278
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$319.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$167.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.08
Rate for Payer: Aetna Government	$7.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$152.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$174.83
Rate for Payer: Fidelis Medicare Advantage	$319.26
Rate for Payer: Group Health Inc Commercial	$152.03
Rate for Payer: Group Health Inc Medicare	$106.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.03
Rate for Payer: Hamaspik Choice Inc Medicare	$152.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$197.64

ZZ PICC LINE/5F GROSHONG DUBBLE

Facility IP

$304.06

Service Code	HCPCS C1751
Hospital Charge Code	41569465
Hospital Revenue Code	278
Min. Negotiated Rate	$152.03
Max. Negotiated Rate	$152.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.03
Rate for Payer: Hamaspik Choice Inc Medicare	$152.03

ZZ PICC LINE/5F SINGLE LUMEN

Facility OP

$114.48

Service Code	HCPCS C1751
Hospital Charge Code	41569466
Hospital Revenue Code	278
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$120.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.08
Rate for Payer: Aetna Government	$7.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.83
Rate for Payer: Fidelis Medicare Advantage	$120.20
Rate for Payer: Group Health Inc Commercial	$57.24
Rate for Payer: Group Health Inc Medicare	$40.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.24
Rate for Payer: Hamaspik Choice Inc Medicare	$57.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$74.41

ZZ PICC LINE/5F SINGLE LUMEN

Facility IP

$114.48

Service Code	HCPCS C1751
Hospital Charge Code	41569466
Hospital Revenue Code	278
Min. Negotiated Rate	$57.24
Max. Negotiated Rate	$57.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.24
Rate for Payer: Hamaspik Choice Inc Medicare	$57.24

ZZ PICC LINE 7F/65 MORPHEUS DUAL

Facility OP

$220.00

Service Code	HCPCS C1887
Hospital Charge Code	41568416
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$231.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$121.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$110.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$126.50
Rate for Payer: Fidelis Medicare Advantage	$231.00
Rate for Payer: Group Health Inc Commercial	$110.00
Rate for Payer: Group Health Inc Medicare	$77.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$143.00

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