St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZZ BS COYOTE ES 4F 2.0MMX40MM

Facility

$668.00

Service Code	HCPCS C1725
Hospital Charge Code	41561950
Hospital Revenue Code	278
Min. Negotiated Rate	$334.00
Max. Negotiated Rate	$334.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$334.00

ZZ BS COYOTE ES 4F 2.0MMX40MM

Facility

$668.00

Service Code	HCPCS C1725
Hospital Charge Code	41561950
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$701.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$367.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$400.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$334.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$384.10
Rate for Payer: EmblemHealth Commercial	$334.00
Rate for Payer: Fidelis Medicare Advantage	$701.40
Rate for Payer: Group Health Inc Commercial	$334.00
Rate for Payer: Group Health Inc Medicare	$233.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$334.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$434.20

ZZ BS COYOTE ES 4F 2.5MMX40MM

Facility

$668.00

Service Code	HCPCS C1725
Hospital Charge Code	41561949
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$701.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$367.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$400.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$334.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$384.10
Rate for Payer: EmblemHealth Commercial	$334.00
Rate for Payer: Fidelis Medicare Advantage	$701.40
Rate for Payer: Group Health Inc Commercial	$334.00
Rate for Payer: Group Health Inc Medicare	$233.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$334.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$434.20

ZZ BS COYOTE ES 4F 2.5MMX40MM

Facility

$668.00

Service Code	HCPCS C1725
Hospital Charge Code	41561949
Hospital Revenue Code	278
Min. Negotiated Rate	$334.00
Max. Negotiated Rate	$334.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$334.00

ZZ BS COYOTE ES 4F 3.0MMX40MM

Facility

$668.00

Service Code	HCPCS C1725
Hospital Charge Code	41561948
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$701.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$367.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$400.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$334.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$384.10
Rate for Payer: EmblemHealth Commercial	$334.00
Rate for Payer: Fidelis Medicare Advantage	$701.40
Rate for Payer: Group Health Inc Commercial	$334.00
Rate for Payer: Group Health Inc Medicare	$233.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$334.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$434.20

ZZ BS COYOTE ES 4F 3.0MMX40MM

Facility

$668.00

Service Code	HCPCS C1725
Hospital Charge Code	41561948
Hospital Revenue Code	278
Min. Negotiated Rate	$334.00
Max. Negotiated Rate	$334.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$334.00

ZZ BS COYOTE ES 4F 4.0MMX40MM

Facility

$668.00

Service Code	HCPCS C1725
Hospital Charge Code	41561947
Hospital Revenue Code	278
Min. Negotiated Rate	$334.00
Max. Negotiated Rate	$334.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$334.00

ZZ BS COYOTE ES 4F 4.0MMX40MM

Facility

$668.00

Service Code	HCPCS C1725
Hospital Charge Code	41561947
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$701.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$367.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$400.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$334.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$384.10
Rate for Payer: EmblemHealth Commercial	$334.00
Rate for Payer: Fidelis Medicare Advantage	$701.40
Rate for Payer: Group Health Inc Commercial	$334.00
Rate for Payer: Group Health Inc Medicare	$233.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$334.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$434.20

ZZ BS DIREXION HIFLO MICROCATH

Facility

$1,950.20

Hospital Charge Code	41561363
Hospital Revenue Code	272
Min. Negotiated Rate	$682.57
Max. Negotiated Rate	$1,560.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,072.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$975.10
Rate for Payer: Aetna Government	$975.10
Rate for Payer: Brighton Health Commercial	$1,462.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,560.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,326.14
Rate for Payer: Group Health Inc Commercial	$975.10
Rate for Payer: Group Health Inc Medicare	$682.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.10
Rate for Payer: Hamaspik Choice Inc Medicare	$975.10

ZZ BS DIREXION MICROCATHETER

Facility

$1,225.00

Hospital Charge Code	41561359
Hospital Revenue Code	272
Min. Negotiated Rate	$428.75
Max. Negotiated Rate	$980.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$673.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$612.50
Rate for Payer: Aetna Government	$612.50
Rate for Payer: Brighton Health Commercial	$918.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$980.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$833.00
Rate for Payer: Group Health Inc Commercial	$612.50
Rate for Payer: Group Health Inc Medicare	$428.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$612.50
Rate for Payer: Hamaspik Choice Inc Medicare	$612.50

ZZ BS MUSTANG 5F 6.0MMX40MM

Facility

$700.00

Hospital Charge Code	41561942
Hospital Revenue Code	270
Min. Negotiated Rate	$245.00
Max. Negotiated Rate	$560.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$385.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$350.00
Rate for Payer: Aetna Government	$350.00
Rate for Payer: Brighton Health Commercial	$525.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$560.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$476.00
Rate for Payer: Group Health Inc Commercial	$350.00
Rate for Payer: Group Health Inc Medicare	$245.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00

ZZ BS MUSTANG 5F 6.0MMX40MM

Facility

$700.00

Hospital Charge Code	41561943
Hospital Revenue Code	270
Min. Negotiated Rate	$245.00
Max. Negotiated Rate	$560.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$385.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$350.00
Rate for Payer: Aetna Government	$350.00
Rate for Payer: Brighton Health Commercial	$525.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$560.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$476.00
Rate for Payer: Group Health Inc Commercial	$350.00
Rate for Payer: Group Health Inc Medicare	$245.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00

ZZ BS POLARCATH 5.5F 5.0MMX40MM

Facility

$2,170.00

Hospital Charge Code	41561941
Hospital Revenue Code	270
Min. Negotiated Rate	$759.50
Max. Negotiated Rate	$1,736.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,193.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,085.00
Rate for Payer: Aetna Government	$1,085.00
Rate for Payer: Brighton Health Commercial	$1,627.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,736.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,475.60
Rate for Payer: Group Health Inc Commercial	$1,085.00
Rate for Payer: Group Health Inc Medicare	$759.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,085.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,085.00

ZZ BS POLARCATH INFLATION UNIT

Facility

$1,920.00

Hospital Charge Code	41561940
Hospital Revenue Code	270
Min. Negotiated Rate	$672.00
Max. Negotiated Rate	$1,536.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,056.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$960.00
Rate for Payer: Aetna Government	$960.00
Rate for Payer: Brighton Health Commercial	$1,440.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,536.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,305.60
Rate for Payer: Group Health Inc Commercial	$960.00
Rate for Payer: Group Health Inc Medicare	$672.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$960.00
Rate for Payer: Hamaspik Choice Inc Medicare	$960.00

ZZ BS STERLING 4F 4.0MMX40MM

Facility

$668.00

Service Code	HCPCS C1725
Hospital Charge Code	41561946
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$701.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$367.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$400.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$334.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$384.10
Rate for Payer: EmblemHealth Commercial	$334.00
Rate for Payer: Fidelis Medicare Advantage	$701.40
Rate for Payer: Group Health Inc Commercial	$334.00
Rate for Payer: Group Health Inc Medicare	$233.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$334.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$434.20

ZZ BS STERLING 4F 4.0MMX40MM

Facility

$668.00

Service Code	HCPCS C1725
Hospital Charge Code	41561946
Hospital Revenue Code	278
Min. Negotiated Rate	$334.00
Max. Negotiated Rate	$334.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$334.00

ZZ BS STERLING 4F 5.0MMX40MM

Facility

$668.00

Hospital Charge Code	41561945
Hospital Revenue Code	279
Min. Negotiated Rate	$233.80
Max. Negotiated Rate	$534.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$367.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$334.00
Rate for Payer: Aetna Government	$334.00
Rate for Payer: Brighton Health Commercial	$501.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$534.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$454.24
Rate for Payer: Group Health Inc Commercial	$334.00
Rate for Payer: Group Health Inc Medicare	$233.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$334.00

ZZ BS STERLING 4F 6.0MMX40MM

Facility

$668.00

Hospital Charge Code	41561944
Hospital Revenue Code	279
Min. Negotiated Rate	$233.80
Max. Negotiated Rate	$534.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$367.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$334.00
Rate for Payer: Aetna Government	$334.00
Rate for Payer: Brighton Health Commercial	$501.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$534.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$454.24
Rate for Payer: Group Health Inc Commercial	$334.00
Rate for Payer: Group Health Inc Medicare	$233.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$334.00

ZZ BS TRANSEND 0.018IN165CM

Facility

$484.00

Hospital Charge Code	41561902
Hospital Revenue Code	270
Min. Negotiated Rate	$169.40
Max. Negotiated Rate	$387.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$266.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$242.00
Rate for Payer: Aetna Government	$242.00
Rate for Payer: Brighton Health Commercial	$363.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$387.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$329.12
Rate for Payer: Group Health Inc Commercial	$242.00
Rate for Payer: Group Health Inc Medicare	$169.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$242.00
Rate for Payer: Hamaspik Choice Inc Medicare	$242.00

ZZ BS V-14 C/W 0.014INX300CM

Facility

$440.00

Hospital Charge Code	41561939
Hospital Revenue Code	270
Min. Negotiated Rate	$154.00
Max. Negotiated Rate	$352.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$242.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$220.00
Rate for Payer: Aetna Government	$220.00
Rate for Payer: Brighton Health Commercial	$330.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$352.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$299.20
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

ZZ BS V-18 CONTROL WIRE

Facility

$192.24

Service Code	HCPCS C1769
Hospital Charge Code	41561885
Hospital Revenue Code	278
Min. Negotiated Rate	$96.12
Max. Negotiated Rate	$96.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.12
Rate for Payer: Hamaspik Choice Inc Medicare	$96.12

ZZ BS V-18 CONTROL WIRE

Facility

$192.24

Service Code	HCPCS C1769
Hospital Charge Code	41561885
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$201.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$105.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$115.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$110.54
Rate for Payer: EmblemHealth Commercial	$96.12
Rate for Payer: Fidelis Medicare Advantage	$201.85
Rate for Payer: Group Health Inc Commercial	$96.12
Rate for Payer: Group Health Inc Medicare	$67.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.12
Rate for Payer: Hamaspik Choice Inc Medicare	$96.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$124.96

ZZ BS V-18 C/W 0.018INX150CM

Facility

$182.46

Hospital Charge Code	41561905
Hospital Revenue Code	270
Min. Negotiated Rate	$63.86
Max. Negotiated Rate	$145.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$100.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$91.23
Rate for Payer: Aetna Government	$91.23
Rate for Payer: Brighton Health Commercial	$136.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$145.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.07
Rate for Payer: Group Health Inc Commercial	$91.23
Rate for Payer: Group Health Inc Medicare	$63.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.23
Rate for Payer: Hamaspik Choice Inc Medicare	$91.23

ZZ BS V-18 C/W 0.018INX200CM

Facility

$192.24

Hospital Charge Code	41561907
Hospital Revenue Code	270
Min. Negotiated Rate	$67.28
Max. Negotiated Rate	$153.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$105.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$96.12
Rate for Payer: Aetna Government	$96.12
Rate for Payer: Brighton Health Commercial	$144.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$153.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$130.72
Rate for Payer: Group Health Inc Commercial	$96.12
Rate for Payer: Group Health Inc Medicare	$67.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.12
Rate for Payer: Hamaspik Choice Inc Medicare	$96.12

ZZ BS V-18 C/W 0.81IN165CM

Facility

$424.00

Hospital Charge Code	41561903
Hospital Revenue Code	270
Min. Negotiated Rate	$148.40
Max. Negotiated Rate	$339.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$233.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$212.00
Rate for Payer: Aetna Government	$212.00
Rate for Payer: Brighton Health Commercial	$318.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$339.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$288.32
Rate for Payer: Group Health Inc Commercial	$212.00
Rate for Payer: Group Health Inc Medicare	$148.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$212.00
Rate for Payer: Hamaspik Choice Inc Medicare	$212.00

Know your out-of-pocket cost for care.

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