St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ SHEATH/CHECK-FLO/9F

Facility IP

$94.88

Service Code	HCPCS C1892
Hospital Charge Code	41569477
Hospital Revenue Code	278
Min. Negotiated Rate	$47.44
Max. Negotiated Rate	$47.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.44
Rate for Payer: Hamaspik Choice Inc Medicare	$47.44

ZZ SHEATH LUNDERQUIST

Facility OP

$53.16

Service Code	HCPCS C1892
Hospital Charge Code	41569472
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$55.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.24
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	$26.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.57
Rate for Payer: Fidelis Medicare Advantage	$55.82
Rate for Payer: Group Health Inc Commercial	$26.58
Rate for Payer: Group Health Inc Medicare	$18.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.58
Rate for Payer: Hamaspik Choice Inc Medicare	$26.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34.55

ZZ SHEATH LUNDERQUIST

Facility IP

$53.16

Service Code	HCPCS C1892
Hospital Charge Code	41569472
Hospital Revenue Code	278
Min. Negotiated Rate	$26.58
Max. Negotiated Rate	$26.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.58
Rate for Payer: Hamaspik Choice Inc Medicare	$26.58

ZZ SHEATH/PINNACLE/10F/10CM

Facility IP

$393.36

Service Code	HCPCS C1892
Hospital Charge Code	41569478
Hospital Revenue Code	278
Min. Negotiated Rate	$196.68
Max. Negotiated Rate	$196.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$196.68
Rate for Payer: Hamaspik Choice Inc Medicare	$196.68

ZZ SHEATH/PINNACLE/10F/10CM

Facility OP

$393.36

Service Code	HCPCS C1892
Hospital Charge Code	41569478
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$413.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$216.35
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	$196.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$226.18
Rate for Payer: Fidelis Medicare Advantage	$413.03
Rate for Payer: Group Health Inc Commercial	$196.68
Rate for Payer: Group Health Inc Medicare	$137.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$196.68
Rate for Payer: Hamaspik Choice Inc Medicare	$196.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$255.68

ZZ SHEATH/PINNACLE/4F/10CM

Facility OP

$393.36

Service Code	HCPCS C1892
Hospital Charge Code	41569479
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$413.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$216.35
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	$196.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$226.18
Rate for Payer: Fidelis Medicare Advantage	$413.03
Rate for Payer: Group Health Inc Commercial	$196.68
Rate for Payer: Group Health Inc Medicare	$137.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$196.68
Rate for Payer: Hamaspik Choice Inc Medicare	$196.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$255.68

ZZ SHEATH/PINNACLE/4F/10CM

Facility IP

$393.36

Service Code	HCPCS C1892
Hospital Charge Code	41569479
Hospital Revenue Code	278
Min. Negotiated Rate	$196.68
Max. Negotiated Rate	$196.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$196.68
Rate for Payer: Hamaspik Choice Inc Medicare	$196.68

ZZ SHEATH/PINNACLE/5F/10CM

Facility OP

$393.36

Service Code	HCPCS C1892
Hospital Charge Code	41569480
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$413.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$216.35
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	$196.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$226.18
Rate for Payer: Fidelis Medicare Advantage	$413.03
Rate for Payer: Group Health Inc Commercial	$196.68
Rate for Payer: Group Health Inc Medicare	$137.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$196.68
Rate for Payer: Hamaspik Choice Inc Medicare	$196.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$255.68

ZZ SHEATH/PINNACLE/5F/10CM

Facility IP

$393.36

Service Code	HCPCS C1892
Hospital Charge Code	41569480
Hospital Revenue Code	278
Min. Negotiated Rate	$196.68
Max. Negotiated Rate	$196.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$196.68
Rate for Payer: Hamaspik Choice Inc Medicare	$196.68

ZZ SHEATH/PINNACLE/6F/10CM

Facility IP

$393.36

Service Code	HCPCS C1892
Hospital Charge Code	41569481
Hospital Revenue Code	278
Min. Negotiated Rate	$196.68
Max. Negotiated Rate	$196.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$196.68
Rate for Payer: Hamaspik Choice Inc Medicare	$196.68

ZZ SHEATH/PINNACLE/6F/10CM

Facility OP

$393.36

Service Code	HCPCS C1892
Hospital Charge Code	41569481
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$413.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$216.35
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	$196.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$226.18
Rate for Payer: Fidelis Medicare Advantage	$413.03
Rate for Payer: Group Health Inc Commercial	$196.68
Rate for Payer: Group Health Inc Medicare	$137.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$196.68
Rate for Payer: Hamaspik Choice Inc Medicare	$196.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$255.68

ZZ SHEATH/PINNACLE/7F/10CM

Facility IP

$393.36

Service Code	HCPCS C1892
Hospital Charge Code	41569482
Hospital Revenue Code	278
Min. Negotiated Rate	$196.68
Max. Negotiated Rate	$196.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$196.68
Rate for Payer: Hamaspik Choice Inc Medicare	$196.68

ZZ SHEATH/PINNACLE/7F/10CM

Facility OP

$393.36

Service Code	HCPCS C1892
Hospital Charge Code	41569482
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$413.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$216.35
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	$196.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$226.18
Rate for Payer: Fidelis Medicare Advantage	$413.03
Rate for Payer: Group Health Inc Commercial	$196.68
Rate for Payer: Group Health Inc Medicare	$137.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$196.68
Rate for Payer: Hamaspik Choice Inc Medicare	$196.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$255.68

ZZ SHEATH/PINNACLE/9F/10CM

Facility OP

$393.36

Service Code	HCPCS C1892
Hospital Charge Code	41569483
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$413.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$216.35
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	$196.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$226.18
Rate for Payer: Fidelis Medicare Advantage	$413.03
Rate for Payer: Group Health Inc Commercial	$196.68
Rate for Payer: Group Health Inc Medicare	$137.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$196.68
Rate for Payer: Hamaspik Choice Inc Medicare	$196.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$255.68

ZZ SHEATH/PINNACLE/9F/10CM

Facility IP

$393.36

Service Code	HCPCS C1892
Hospital Charge Code	41569483
Hospital Revenue Code	278
Min. Negotiated Rate	$196.68
Max. Negotiated Rate	$196.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$196.68
Rate for Payer: Hamaspik Choice Inc Medicare	$196.68

ZZ SHEATH/STRAIGHT/7-30CM/RB

Facility OP

$77.87

Service Code	HCPCS C1892
Hospital Charge Code	41569484
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$81.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.83
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	$38.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.78
Rate for Payer: Fidelis Medicare Advantage	$81.76
Rate for Payer: Group Health Inc Commercial	$38.94
Rate for Payer: Group Health Inc Medicare	$27.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.94
Rate for Payer: Hamaspik Choice Inc Medicare	$38.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$50.62

ZZ SHEATH/STRAIGHT/7-30CM/RB

Facility IP

$77.87

Service Code	HCPCS C1892
Hospital Charge Code	41569484
Hospital Revenue Code	278
Min. Negotiated Rate	$38.94
Max. Negotiated Rate	$38.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.94
Rate for Payer: Hamaspik Choice Inc Medicare	$38.94

ZZ SIM GLIDCTH 4FR 100 CM

Facility OP

$779.63

Service Code	HCPCS C1725
Hospital Charge Code	41567519
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$818.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$428.80
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	$389.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$448.29
Rate for Payer: Fidelis Medicare Advantage	$818.61
Rate for Payer: Group Health Inc Commercial	$389.82
Rate for Payer: Group Health Inc Medicare	$272.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$389.82
Rate for Payer: Hamaspik Choice Inc Medicare	$389.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$506.76

ZZ SIM GLIDCTH 4FR 100 CM

Facility IP

$779.63

Service Code	HCPCS C1725
Hospital Charge Code	41567519
Hospital Revenue Code	278
Min. Negotiated Rate	$389.82
Max. Negotiated Rate	$389.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$389.82
Rate for Payer: Hamaspik Choice Inc Medicare	$389.82

ZZ SIMMONS SIDEWIN CATH 5

Facility IP

$48.91

Service Code	HCPCS C1725
Hospital Charge Code	41567166
Hospital Revenue Code	278
Min. Negotiated Rate	$24.46
Max. Negotiated Rate	$24.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.46
Rate for Payer: Hamaspik Choice Inc Medicare	$24.46

ZZ SIMMONS SIDEWIN CATH 5

Facility OP

$48.91

Service Code	HCPCS C1725
Hospital Charge Code	41567166
Hospital Revenue Code	278
Min. Negotiated Rate	$17.12
Max. Negotiated Rate	$51.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.90
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	$24.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.12
Rate for Payer: Fidelis Medicare Advantage	$51.36
Rate for Payer: Group Health Inc Commercial	$24.46
Rate for Payer: Group Health Inc Medicare	$17.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.46
Rate for Payer: Hamaspik Choice Inc Medicare	$24.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.79

ZZ SIMM SIDEWINDER CTH

Facility IP

$48.91

Service Code	HCPCS C1725
Hospital Charge Code	41567164
Hospital Revenue Code	278
Min. Negotiated Rate	$24.46
Max. Negotiated Rate	$24.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.46
Rate for Payer: Hamaspik Choice Inc Medicare	$24.46

ZZ SIMM SIDEWINDER CTH

Facility OP

$48.91

Service Code	HCPCS C1725
Hospital Charge Code	41567164
Hospital Revenue Code	278
Min. Negotiated Rate	$17.12
Max. Negotiated Rate	$51.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.90
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	$24.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.12
Rate for Payer: Fidelis Medicare Advantage	$51.36
Rate for Payer: Group Health Inc Commercial	$24.46
Rate for Payer: Group Health Inc Medicare	$17.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.46
Rate for Payer: Hamaspik Choice Inc Medicare	$24.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.79

ZZ SLK BRAID/3.5 MTRIC #K 834

Facility IP

$102.51

Service Code	HCPCS C1725
Hospital Charge Code	41569012
Hospital Revenue Code	278
Min. Negotiated Rate	$51.26
Max. Negotiated Rate	$51.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.26
Rate for Payer: Hamaspik Choice Inc Medicare	$51.26

ZZ SLK BRAID/3.5 MTRIC #K 834

Facility OP

$102.51

Service Code	HCPCS C1725
Hospital Charge Code	41569012
Hospital Revenue Code	278
Min. Negotiated Rate	$35.88
Max. Negotiated Rate	$107.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.38
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	$51.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.94
Rate for Payer: Fidelis Medicare Advantage	$107.64
Rate for Payer: Group Health Inc Commercial	$51.26
Rate for Payer: Group Health Inc Medicare	$35.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.26
Rate for Payer: Hamaspik Choice Inc Medicare	$51.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.63

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