St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

WIRE, GUIDE 3.2 X 444MM THRD

Facility

$368.00

Service Code	HCPCS C1769
Hospital Charge Code	40003334
Hospital Revenue Code	272
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$294.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$202.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$276.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$294.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$250.24
Rate for Payer: Group Health Inc Commercial	$184.00
Rate for Payer: Group Health Inc Medicare	$128.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$184.00
Rate for Payer: Hamaspik Choice Inc Medicare	$184.00

WIRE, GUIDE 3.2 X 444MM THRD

Facility

$460.00

Service Code	HCPCS C1769
Hospital Charge Code	64906106
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$483.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$253.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$276.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$230.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$264.50
Rate for Payer: EmblemHealth Commercial	$230.00
Rate for Payer: Fidelis Medicare Advantage	$483.00
Rate for Payer: Group Health Inc Commercial	$230.00
Rate for Payer: Group Health Inc Medicare	$161.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$230.00
Rate for Payer: Hamaspik Choice Inc Medicare	$230.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$299.00

WIRE, GUIDE 3.2 X 444MM THRD

Facility

$460.00

Service Code	HCPCS C1769
Hospital Charge Code	64906106
Hospital Revenue Code	278
Min. Negotiated Rate	$230.00
Max. Negotiated Rate	$230.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$230.00
Rate for Payer: Hamaspik Choice Inc Medicare	$230.00

WIRE, GUIDE 3.2X444MM THRD

Facility

$368.00

Service Code	HCPCS C1769
Hospital Charge Code	40204591
Hospital Revenue Code	272
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$294.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$202.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$276.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$294.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$250.24
Rate for Payer: Group Health Inc Commercial	$184.00
Rate for Payer: Group Health Inc Medicare	$128.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$184.00
Rate for Payer: Hamaspik Choice Inc Medicare	$184.00

WIRE, GUIDE 3.2 X 44MM THRD

Facility

$368.00

Service Code	HCPCS C1769
Hospital Charge Code	40007510
Hospital Revenue Code	272
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$294.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$202.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$276.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$294.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$250.24
Rate for Payer: Group Health Inc Commercial	$184.00
Rate for Payer: Group Health Inc Medicare	$128.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$184.00
Rate for Payer: Hamaspik Choice Inc Medicare	$184.00

WIRE, GUIDE BALLT 3.0X100CM

Facility

$352.00

Service Code	HCPCS C1769
Hospital Charge Code	40007509
Hospital Revenue Code	272
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$281.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$193.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$264.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$281.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$239.36
Rate for Payer: Group Health Inc Commercial	$176.00
Rate for Payer: Group Health Inc Medicare	$123.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$176.00
Rate for Payer: Hamaspik Choice Inc Medicare	$176.00

WIRE, GUIDE BALLT 3.0X100CM

Facility

$440.00

Service Code	HCPCS C1769
Hospital Charge Code	64906105
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$462.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$242.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$264.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$220.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$253.00
Rate for Payer: EmblemHealth Commercial	$220.00
Rate for Payer: Fidelis Medicare Advantage	$462.00
Rate for Payer: Group Health Inc Commercial	$220.00
Rate for Payer: Group Health Inc Medicare	$154.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.00
Rate for Payer: Hamaspik Choice Inc Medicare	$220.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$286.00

WIRE, GUIDE BALLT 3.0X100CM

Facility

$352.00

Service Code	HCPCS C1769
Hospital Charge Code	40204590
Hospital Revenue Code	272
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$281.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$193.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$264.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$281.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$239.36
Rate for Payer: Group Health Inc Commercial	$176.00
Rate for Payer: Group Health Inc Medicare	$123.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$176.00
Rate for Payer: Hamaspik Choice Inc Medicare	$176.00

WIRE, GUIDE BALLT 3.0X100CM

Facility

$440.00

Service Code	HCPCS C1769
Hospital Charge Code	64906105
Hospital Revenue Code	278
Min. Negotiated Rate	$220.00
Max. Negotiated Rate	$220.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.00
Rate for Payer: Hamaspik Choice Inc Medicare	$220.00

WIRE GUIDE B-TIP 3.0 X 125MM

Facility

$305.98

Service Code	HCPCS C1713
Hospital Charge Code	64907005
Hospital Revenue Code	278
Min. Negotiated Rate	$107.09
Max. Negotiated Rate	$321.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$168.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$183.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$152.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$175.94
Rate for Payer: EmblemHealth Commercial	$152.99
Rate for Payer: Fidelis Medicare Advantage	$321.28
Rate for Payer: Group Health Inc Commercial	$152.99
Rate for Payer: Group Health Inc Medicare	$107.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.99
Rate for Payer: Hamaspik Choice Inc Medicare	$152.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$198.89

WIRE GUIDE B-TIP 3.0 X 125MM

Facility

$305.98

Service Code	HCPCS C1713
Hospital Charge Code	64907005
Hospital Revenue Code	278
Min. Negotiated Rate	$152.99
Max. Negotiated Rate	$152.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.99
Rate for Payer: Hamaspik Choice Inc Medicare	$152.99

WIRE GUIDE EXTRA ST

Facility

$278.00

Service Code	HCPCS C1769
Hospital Charge Code	64906027
Hospital Revenue Code	278
Min. Negotiated Rate	$139.00
Max. Negotiated Rate	$139.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.00
Rate for Payer: Hamaspik Choice Inc Medicare	$139.00

WIRE GUIDE EXTRA ST

Facility

$278.00

Service Code	HCPCS C1769
Hospital Charge Code	64906027
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$291.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$152.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$166.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$139.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$159.85
Rate for Payer: EmblemHealth Commercial	$139.00
Rate for Payer: Fidelis Medicare Advantage	$291.90
Rate for Payer: Group Health Inc Commercial	$139.00
Rate for Payer: Group Health Inc Medicare	$97.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.00
Rate for Payer: Hamaspik Choice Inc Medicare	$139.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$180.70

WIRE, GUIDE IT 3.0X100CM

Facility

$352.00

Service Code	HCPCS C1769
Hospital Charge Code	40003333
Hospital Revenue Code	272
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$281.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$193.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$264.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$281.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$239.36
Rate for Payer: Group Health Inc Commercial	$176.00
Rate for Payer: Group Health Inc Medicare	$123.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$176.00
Rate for Payer: Hamaspik Choice Inc Medicare	$176.00

WIRE GUIDE JAGWIRE .035X260CM STR

Facility

$368.75

Service Code	HCPCS C1769
Hospital Charge Code	64904005
Hospital Revenue Code	278
Min. Negotiated Rate	$184.38
Max. Negotiated Rate	$184.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$184.38
Rate for Payer: Hamaspik Choice Inc Medicare	$184.38

WIRE GUIDE JAGWIRE .035X260CM STR

Facility

$368.75

Service Code	HCPCS C1769
Hospital Charge Code	64904005
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$387.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$202.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$221.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$184.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$212.03
Rate for Payer: EmblemHealth Commercial	$184.38
Rate for Payer: Fidelis Medicare Advantage	$387.19
Rate for Payer: Group Health Inc Commercial	$184.38
Rate for Payer: Group Health Inc Medicare	$129.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$184.38
Rate for Payer: Hamaspik Choice Inc Medicare	$184.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$239.69

WIRE, GUIDE NCB-PH 1.6X190MM

Facility

$55.63

Service Code	HCPCS C1769
Hospital Charge Code	64906104
Hospital Revenue Code	278
Min. Negotiated Rate	$27.82
Max. Negotiated Rate	$27.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.82
Rate for Payer: Hamaspik Choice Inc Medicare	$27.82

WIRE, GUIDE NCB-PH 1.6X190MM

Facility

$55.63

Service Code	HCPCS C1769
Hospital Charge Code	64906104
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$58.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$33.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.99
Rate for Payer: EmblemHealth Commercial	$27.82
Rate for Payer: Fidelis Medicare Advantage	$58.41
Rate for Payer: Group Health Inc Commercial	$27.82
Rate for Payer: Group Health Inc Medicare	$19.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.82
Rate for Payer: Hamaspik Choice Inc Medicare	$27.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.16

WIRE GUIDE TROCAR TIP 1.35MM

Facility

$20.00

Service Code	HCPCS C1769
Hospital Charge Code	64906361
Hospital Revenue Code	278
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$10.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10.00

WIRE GUIDE TROCAR TIP 1.35MM

Facility

$20.00

Service Code	HCPCS C1769
Hospital Charge Code	64906361
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$21.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$12.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.50
Rate for Payer: EmblemHealth Commercial	$10.00
Rate for Payer: Fidelis Medicare Advantage	$21.00
Rate for Payer: Group Health Inc Commercial	$10.00
Rate for Payer: Group Health Inc Medicare	$7.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.00

WIRE HYDRO

Facility

$97.50

Hospital Charge Code	64905072
Hospital Revenue Code	270
Min. Negotiated Rate	$34.12
Max. Negotiated Rate	$78.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$48.75
Rate for Payer: Aetna Government	$48.75
Rate for Payer: Brighton Health Commercial	$73.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$66.30
Rate for Payer: Group Health Inc Commercial	$48.75
Rate for Payer: Group Health Inc Medicare	$34.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.75
Rate for Payer: Hamaspik Choice Inc Medicare	$48.75

WIRE K

Facility

$185.00

Service Code	HCPCS C1713
Hospital Charge Code	64906982
Hospital Revenue Code	278
Min. Negotiated Rate	$64.75
Max. Negotiated Rate	$194.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$101.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$111.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$92.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$106.38
Rate for Payer: EmblemHealth Commercial	$92.50
Rate for Payer: Fidelis Medicare Advantage	$194.25
Rate for Payer: Group Health Inc Commercial	$92.50
Rate for Payer: Group Health Inc Medicare	$64.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.50
Rate for Payer: Hamaspik Choice Inc Medicare	$92.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$120.25

WIRE K

Facility

$185.00

Service Code	HCPCS C1713
Hospital Charge Code	64906982
Hospital Revenue Code	278
Min. Negotiated Rate	$92.50
Max. Negotiated Rate	$92.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.50
Rate for Payer: Hamaspik Choice Inc Medicare	$92.50

WIRE K .035 X 9 2PT DM TRAUMA

Facility

$42.08

Hospital Charge Code	64902703
Hospital Revenue Code	270
Min. Negotiated Rate	$14.73
Max. Negotiated Rate	$33.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.04
Rate for Payer: Aetna Government	$21.04
Rate for Payer: Brighton Health Commercial	$31.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.61
Rate for Payer: Group Health Inc Commercial	$21.04
Rate for Payer: Group Health Inc Medicare	$14.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.04
Rate for Payer: Hamaspik Choice Inc Medicare	$21.04

WIRE K .045 X 9 DIAMOND PT

Facility

$290.00

Hospital Charge Code	64902924
Hospital Revenue Code	270
Min. Negotiated Rate	$101.50
Max. Negotiated Rate	$232.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$159.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$145.00
Rate for Payer: Aetna Government	$145.00
Rate for Payer: Brighton Health Commercial	$217.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$232.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$197.20
Rate for Payer: Group Health Inc Commercial	$145.00
Rate for Payer: Group Health Inc Medicare	$101.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$145.00
Rate for Payer: Hamaspik Choice Inc Medicare	$145.00

Know your out-of-pocket cost for care.

All Charges