St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ SNARE/LOOP/018/300CM

Facility OP

$39.33

Service Code	HCPCS C1725
Hospital Charge Code	41569485
Hospital Revenue Code	278
Min. Negotiated Rate	$13.77
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.63
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	$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 SOLID IMMOBILIZATION PLATE

Facility OP

$30.00

Hospital Charge Code	41568761
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 SPLITCATH II 14F 28CM

Facility IP

$840.00

Service Code	HCPCS C1725
Hospital Charge Code	41569859
Hospital Revenue Code	278
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$420.00

ZZ SPLITCATH II 14F 28CM

Facility OP

$840.00

Service Code	HCPCS C1725
Hospital Charge Code	41569859
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$882.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$462.00
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	$420.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$483.00
Rate for Payer: Fidelis Medicare Advantage	$882.00
Rate for Payer: Group Health Inc Commercial	$420.00
Rate for Payer: Group Health Inc Medicare	$294.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$420.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$546.00

ZZ SPLIT CATH III 14F X 28CM

Facility IP

$860.00

Service Code	HCPCS C1886
Hospital Charge Code	41561879
Hospital Revenue Code	278
Min. Negotiated Rate	$430.00
Max. Negotiated Rate	$430.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00

ZZ SPLIT CATH III 14F X 28CM

Facility OP

$860.00

Service Code	HCPCS C1886
Hospital Charge Code	41561879
Hospital Revenue Code	278
Min. Negotiated Rate	$301.00
Max. Negotiated Rate	$1,230.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$473.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,230.97
Rate for Payer: Aetna Government	$1,230.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$430.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$494.50
Rate for Payer: Fidelis Medicare Advantage	$903.00
Rate for Payer: Group Health Inc Commercial	$430.00
Rate for Payer: Group Health Inc Medicare	$301.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$559.00

ZZ SPLIT CATH III 14F X 32CM

Facility OP

$860.00

Service Code	HCPCS C1886
Hospital Charge Code	41561880
Hospital Revenue Code	278
Min. Negotiated Rate	$301.00
Max. Negotiated Rate	$1,230.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$473.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,230.97
Rate for Payer: Aetna Government	$1,230.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$430.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$494.50
Rate for Payer: Fidelis Medicare Advantage	$903.00
Rate for Payer: Group Health Inc Commercial	$430.00
Rate for Payer: Group Health Inc Medicare	$301.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$559.00

ZZ SPLIT CATH III 14F X 32CM

Facility IP

$860.00

Service Code	HCPCS C1886
Hospital Charge Code	41561880
Hospital Revenue Code	278
Min. Negotiated Rate	$430.00
Max. Negotiated Rate	$430.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00

ZZ SPLIT CATH III 14F X 36CM

Facility IP

$860.00

Service Code	HCPCS C1886
Hospital Charge Code	41561881
Hospital Revenue Code	278
Min. Negotiated Rate	$430.00
Max. Negotiated Rate	$430.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00

ZZ SPLIT CATH III 14F X 36CM

Facility OP

$860.00

Service Code	HCPCS C1886
Hospital Charge Code	41561881
Hospital Revenue Code	278
Min. Negotiated Rate	$301.00
Max. Negotiated Rate	$1,230.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$473.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,230.97
Rate for Payer: Aetna Government	$1,230.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$430.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$494.50
Rate for Payer: Fidelis Medicare Advantage	$903.00
Rate for Payer: Group Health Inc Commercial	$430.00
Rate for Payer: Group Health Inc Medicare	$301.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$559.00

ZZ SPLIT CATH III 14F X 55CM

Facility IP

$860.00

Service Code	HCPCS C1886
Hospital Charge Code	41561882
Hospital Revenue Code	278
Min. Negotiated Rate	$430.00
Max. Negotiated Rate	$430.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00

ZZ SPLIT CATH III 14F X 55CM

Facility OP

$860.00

Service Code	HCPCS C1886
Hospital Charge Code	41561882
Hospital Revenue Code	278
Min. Negotiated Rate	$301.00
Max. Negotiated Rate	$1,230.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$473.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,230.97
Rate for Payer: Aetna Government	$1,230.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$430.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$494.50
Rate for Payer: Fidelis Medicare Advantage	$903.00
Rate for Payer: Group Health Inc Commercial	$430.00
Rate for Payer: Group Health Inc Medicare	$301.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$559.00

ZZ STANDARD COILS 35 4 3

Facility OP

$117.30

Service Code	HCPCS C1884
Hospital Charge Code	41567138
Hospital Revenue Code	278
Min. Negotiated Rate	$41.06
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$67.45
Rate for Payer: Fidelis Medicare Advantage	$123.16
Rate for Payer: Group Health Inc Commercial	$58.65
Rate for Payer: Group Health Inc Medicare	$41.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.65
Rate for Payer: Hamaspik Choice Inc Medicare	$58.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$76.24

ZZ STANDARD COILS 35 4 3

Facility IP

$117.30

Service Code	HCPCS C1884
Hospital Charge Code	41567138
Hospital Revenue Code	278
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$58.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.65
Rate for Payer: Hamaspik Choice Inc Medicare	$58.65

ZZ STANDARD COILS 35 5 5

Facility IP

$117.30

Service Code	HCPCS C1884
Hospital Charge Code	41567139
Hospital Revenue Code	278
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$58.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.65
Rate for Payer: Hamaspik Choice Inc Medicare	$58.65

ZZ STANDARD COILS 35 5 5

Facility OP

$117.30

Service Code	HCPCS C1884
Hospital Charge Code	41567139
Hospital Revenue Code	278
Min. Negotiated Rate	$41.06
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$67.45
Rate for Payer: Fidelis Medicare Advantage	$123.16
Rate for Payer: Group Health Inc Commercial	$58.65
Rate for Payer: Group Health Inc Medicare	$41.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.65
Rate for Payer: Hamaspik Choice Inc Medicare	$58.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$76.24

ZZ STANDARD COILS 35 5 8

Facility OP

$117.30

Service Code	HCPCS C1884
Hospital Charge Code	41567140
Hospital Revenue Code	278
Min. Negotiated Rate	$41.06
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$67.45
Rate for Payer: Fidelis Medicare Advantage	$123.16
Rate for Payer: Group Health Inc Commercial	$58.65
Rate for Payer: Group Health Inc Medicare	$41.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.65
Rate for Payer: Hamaspik Choice Inc Medicare	$58.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$76.24

ZZ STANDARD COILS 35 5 8

Facility IP

$117.30

Service Code	HCPCS C1884
Hospital Charge Code	41567140
Hospital Revenue Code	278
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$58.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.65
Rate for Payer: Hamaspik Choice Inc Medicare	$58.65

ZZ STANDARD CONN. TUBING

Facility OP

$33.82

Hospital Charge Code	41567501
Hospital Revenue Code	270
Min. Negotiated Rate	$11.84
Max. Negotiated Rate	$27.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.91
Rate for Payer: Aetna Government	$16.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.00
Rate for Payer: Group Health Inc Commercial	$16.91
Rate for Payer: Group Health Inc Medicare	$11.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.91
Rate for Payer: Hamaspik Choice Inc Medicare	$16.91

ZZ STAT LOCK UNIV PLUS

Facility OP

$28.35

Hospital Charge Code	41569566
Hospital Revenue Code	270
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$22.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.18
Rate for Payer: Aetna Government	$14.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.28
Rate for Payer: Group Health Inc Commercial	$14.18
Rate for Payer: Group Health Inc Medicare	$9.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.18
Rate for Payer: Hamaspik Choice Inc Medicare	$14.18

ZZ STAY FIX

Facility OP

$19.50

Hospital Charge Code	41561916
Hospital Revenue Code	270
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$15.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.75
Rate for Payer: Aetna Government	$9.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.26
Rate for Payer: Group Health Inc Commercial	$9.75
Rate for Payer: Group Health Inc Medicare	$6.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.75
Rate for Payer: Hamaspik Choice Inc Medicare	$9.75

ZZ ST CATH W/NO SIDE PT 100

Facility OP

$48.91

Service Code	HCPCS C1725
Hospital Charge Code	41567188
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 ST CATH W/NO SIDE PT 100

Facility IP

$48.91

Service Code	HCPCS C1725
Hospital Charge Code	41567188
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 ST CATH W/NO SIDE PT 80

Facility IP

$48.91

Service Code	HCPCS C1725
Hospital Charge Code	41567189
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 ST CATH W/NO SIDE PT 80

Facility OP

$48.91

Service Code	HCPCS C1725
Hospital Charge Code	41567189
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

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