St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ WIRE/AMPLATZ SS/.035/180CM

Facility IP

$474.16

Service Code	HCPCS C1769
Hospital Charge Code	41569216
Hospital Revenue Code	278
Min. Negotiated Rate	$237.08
Max. Negotiated Rate	$237.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$237.08
Rate for Payer: Hamaspik Choice Inc Medicare	$237.08

ZZ WIRE/AMPLATZ SS/.035/180CM

Facility OP

$474.16

Service Code	HCPCS C1769
Hospital Charge Code	41569216
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$497.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$260.79
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	$237.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$272.64
Rate for Payer: Fidelis Medicare Advantage	$497.87
Rate for Payer: Group Health Inc Commercial	$237.08
Rate for Payer: Group Health Inc Medicare	$165.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$237.08
Rate for Payer: Hamaspik Choice Inc Medicare	$237.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$308.20

ZZ WIRE/AMPLATZ SS/.035/260CM

Facility OP

$495.42

Service Code	HCPCS C1769
Hospital Charge Code	41569217
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$520.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$272.48
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	$247.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$284.87
Rate for Payer: Fidelis Medicare Advantage	$520.19
Rate for Payer: Group Health Inc Commercial	$247.71
Rate for Payer: Group Health Inc Medicare	$173.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$247.71
Rate for Payer: Hamaspik Choice Inc Medicare	$247.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$322.02

ZZ WIRE/AMPLATZ SS/.035/260CM

Facility IP

$495.42

Service Code	HCPCS C1769
Hospital Charge Code	41569217
Hospital Revenue Code	278
Min. Negotiated Rate	$247.71
Max. Negotiated Rate	$247.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$247.71
Rate for Payer: Hamaspik Choice Inc Medicare	$247.71

ZZ WIRE/AMPLATZ SS/.038/145CM

Facility IP

$323.19

Service Code	HCPCS C1769
Hospital Charge Code	41569218
Hospital Revenue Code	278
Min. Negotiated Rate	$161.60
Max. Negotiated Rate	$161.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$161.60
Rate for Payer: Hamaspik Choice Inc Medicare	$161.60

ZZ WIRE/AMPLATZ SS/.038/145CM

Facility OP

$323.19

Service Code	HCPCS C1769
Hospital Charge Code	41569218
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$339.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$177.75
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	$161.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$185.83
Rate for Payer: Fidelis Medicare Advantage	$339.35
Rate for Payer: Group Health Inc Commercial	$161.60
Rate for Payer: Group Health Inc Medicare	$113.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$161.60
Rate for Payer: Hamaspik Choice Inc Medicare	$161.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$210.07

ZZ WIRE/AMPLATZ SS/.038/260CM

Facility IP

$495.42

Service Code	HCPCS C1769
Hospital Charge Code	41569219
Hospital Revenue Code	278
Min. Negotiated Rate	$247.71
Max. Negotiated Rate	$247.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$247.71
Rate for Payer: Hamaspik Choice Inc Medicare	$247.71

ZZ WIRE/AMPLATZ SS/.038/260CM

Facility OP

$495.42

Service Code	HCPCS C1769
Hospital Charge Code	41569219
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$520.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$272.48
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	$247.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$284.87
Rate for Payer: Fidelis Medicare Advantage	$520.19
Rate for Payer: Group Health Inc Commercial	$247.71
Rate for Payer: Group Health Inc Medicare	$173.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$247.71
Rate for Payer: Hamaspik Choice Inc Medicare	$247.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$322.02

ZZ WIRE/AMPLATZ STIFF/.038/180CM

Facility IP

$44.35

Service Code	HCPCS C1769
Hospital Charge Code	41569221
Hospital Revenue Code	278
Min. Negotiated Rate	$22.18
Max. Negotiated Rate	$22.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.18
Rate for Payer: Hamaspik Choice Inc Medicare	$22.18

ZZ WIRE/AMPLATZ STIFF/.038/180CM

Facility OP

$44.35

Service Code	HCPCS C1769
Hospital Charge Code	41569221
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$46.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.39
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	$22.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.50
Rate for Payer: Fidelis Medicare Advantage	$46.57
Rate for Payer: Group Health Inc Commercial	$22.18
Rate for Payer: Group Health Inc Medicare	$15.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.18
Rate for Payer: Hamaspik Choice Inc Medicare	$22.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.83

ZZ WIRE/BENTSON/.032/145CM

Facility OP

$39.33

Hospital Charge Code	41569145
Hospital Revenue Code	270
Min. Negotiated Rate	$13.77
Max. Negotiated Rate	$31.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.66
Rate for Payer: Aetna Government	$19.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.74
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

ZZ WIRE/BENTSON/.035/145CM

Facility OP

$30.43

Hospital Charge Code	41569146
Hospital Revenue Code	270
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$24.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.22
Rate for Payer: Aetna Government	$15.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.69
Rate for Payer: Group Health Inc Commercial	$15.22
Rate for Payer: Group Health Inc Medicare	$10.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.22
Rate for Payer: Hamaspik Choice Inc Medicare	$15.22

ZZ WIRE/BENTSON/.038/145CM

Facility OP

$30.43

Hospital Charge Code	41569147
Hospital Revenue Code	270
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$24.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.22
Rate for Payer: Aetna Government	$15.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.69
Rate for Payer: Group Health Inc Commercial	$15.22
Rate for Payer: Group Health Inc Medicare	$10.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.22
Rate for Payer: Hamaspik Choice Inc Medicare	$15.22

ZZ WIRE/COONS/.035/145CM

Facility OP

$40.74

Hospital Charge Code	41569148
Hospital Revenue Code	270
Min. Negotiated Rate	$14.26
Max. Negotiated Rate	$32.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.37
Rate for Payer: Aetna Government	$20.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.70
Rate for Payer: Group Health Inc Commercial	$20.37
Rate for Payer: Group Health Inc Medicare	$14.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.37
Rate for Payer: Hamaspik Choice Inc Medicare	$20.37

ZZ WIRE/COONS/.035/180CM

Facility OP

$44.87

Hospital Charge Code	41569149
Hospital Revenue Code	270
Min. Negotiated Rate	$15.70
Max. Negotiated Rate	$35.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.44
Rate for Payer: Aetna Government	$22.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.51
Rate for Payer: Group Health Inc Commercial	$22.44
Rate for Payer: Group Health Inc Medicare	$15.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.44
Rate for Payer: Hamaspik Choice Inc Medicare	$22.44

ZZ WIRE/COONS/.035/260CM

Facility OP

$54.67

Hospital Charge Code	41569150
Hospital Revenue Code	270
Min. Negotiated Rate	$19.13
Max. Negotiated Rate	$43.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.34
Rate for Payer: Aetna Government	$27.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$43.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.18
Rate for Payer: Group Health Inc Commercial	$27.34
Rate for Payer: Group Health Inc Medicare	$19.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.34
Rate for Payer: Hamaspik Choice Inc Medicare	$27.34

ZZ WIRE/COONS/.038/145CM

Facility OP

$40.74

Hospital Charge Code	41569151
Hospital Revenue Code	270
Min. Negotiated Rate	$14.26
Max. Negotiated Rate	$32.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.37
Rate for Payer: Aetna Government	$20.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.70
Rate for Payer: Group Health Inc Commercial	$20.37
Rate for Payer: Group Health Inc Medicare	$14.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.37
Rate for Payer: Hamaspik Choice Inc Medicare	$20.37

ZZ WIRE/COONS/.038/260CM

Facility OP

$54.67

Hospital Charge Code	41569152
Hospital Revenue Code	270
Min. Negotiated Rate	$19.13
Max. Negotiated Rate	$43.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.34
Rate for Payer: Aetna Government	$27.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$43.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.18
Rate for Payer: Group Health Inc Commercial	$27.34
Rate for Payer: Group Health Inc Medicare	$19.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.34
Rate for Payer: Hamaspik Choice Inc Medicare	$27.34

ZZ WIRE/COPE/.018/60CM

Facility OP

$60.84

Hospital Charge Code	41569153
Hospital Revenue Code	270
Min. Negotiated Rate	$21.29
Max. Negotiated Rate	$48.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.42
Rate for Payer: Aetna Government	$30.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$41.37
Rate for Payer: Group Health Inc Commercial	$30.42
Rate for Payer: Group Health Inc Medicare	$21.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.42
Rate for Payer: Hamaspik Choice Inc Medicare	$30.42

ZZ WIRE/EMBOLIZATION/.045/180CM

Facility OP

$14.95

Hospital Charge Code	41569155
Hospital Revenue Code	270
Min. Negotiated Rate	$5.23
Max. Negotiated Rate	$11.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.48
Rate for Payer: Aetna Government	$7.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.17
Rate for Payer: Group Health Inc Commercial	$7.48
Rate for Payer: Group Health Inc Medicare	$5.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.48
Rate for Payer: Hamaspik Choice Inc Medicare	$7.48

ZZ WIRE/FASDASHER/.014/195CM

Facility OP

$350.84

Hospital Charge Code	41569156
Hospital Revenue Code	270
Min. Negotiated Rate	$122.79
Max. Negotiated Rate	$280.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.42
Rate for Payer: Aetna Government	$175.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$280.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$238.57
Rate for Payer: Group Health Inc Commercial	$175.42
Rate for Payer: Group Health Inc Medicare	$122.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.42
Rate for Payer: Hamaspik Choice Inc Medicare	$175.42

ZZ WIRE/GLIDE/.018/180CM

Facility IP

$669.77

Service Code	HCPCS C1769
Hospital Charge Code	41569162
Hospital Revenue Code	278
Min. Negotiated Rate	$334.88
Max. Negotiated Rate	$334.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.88
Rate for Payer: Hamaspik Choice Inc Medicare	$334.88

ZZ WIRE/GLIDE/.018/180CM

Facility OP

$669.77

Service Code	HCPCS C1769
Hospital Charge Code	41569162
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$703.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$368.37
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	$334.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$385.12
Rate for Payer: Fidelis Medicare Advantage	$703.26
Rate for Payer: Group Health Inc Commercial	$334.88
Rate for Payer: Group Health Inc Medicare	$234.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.88
Rate for Payer: Hamaspik Choice Inc Medicare	$334.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$435.35

ZZ WIRE/GLIDE/.025/180CM

Facility IP

$651.17

Service Code	HCPCS C1769
Hospital Charge Code	41569163
Hospital Revenue Code	278
Min. Negotiated Rate	$325.58
Max. Negotiated Rate	$325.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.58
Rate for Payer: Hamaspik Choice Inc Medicare	$325.58

ZZ WIRE/GLIDE/.025/180CM

Facility OP

$651.17

Service Code	HCPCS C1769
Hospital Charge Code	41569163
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$683.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$358.14
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	$325.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$374.42
Rate for Payer: Fidelis Medicare Advantage	$683.73
Rate for Payer: Group Health Inc Commercial	$325.58
Rate for Payer: Group Health Inc Medicare	$227.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.58
Rate for Payer: Hamaspik Choice Inc Medicare	$325.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$423.26

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