St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZZ DRAINAGE/BILIARY/ANCHOR/10F

Facility

$172.23

Service Code	HCPCS C1725
Hospital Charge Code	41569433
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$180.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$103.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$86.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$99.03
Rate for Payer: EmblemHealth Commercial	$86.12
Rate for Payer: Fidelis Medicare Advantage	$180.84
Rate for Payer: Group Health Inc Commercial	$86.12
Rate for Payer: Group Health Inc Medicare	$60.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.12
Rate for Payer: Hamaspik Choice Inc Medicare	$86.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$111.95

ZZ DRAINAGE/BILIARY/ANCHOR/10F

Facility

$172.23

Service Code	HCPCS C1725
Hospital Charge Code	41569433
Hospital Revenue Code	278
Min. Negotiated Rate	$86.12
Max. Negotiated Rate	$86.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.12
Rate for Payer: Hamaspik Choice Inc Medicare	$86.12

ZZ DRAINAGE/BILIARY/ANCHOR/12F

Facility

$172.23

Service Code	HCPCS C1725
Hospital Charge Code	41569434
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$180.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$103.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$86.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$99.03
Rate for Payer: EmblemHealth Commercial	$86.12
Rate for Payer: Fidelis Medicare Advantage	$180.84
Rate for Payer: Group Health Inc Commercial	$86.12
Rate for Payer: Group Health Inc Medicare	$60.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.12
Rate for Payer: Hamaspik Choice Inc Medicare	$86.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$111.95

ZZ DRAINAGE/BILIARY/ANCHOR/12F

Facility

$172.23

Service Code	HCPCS C1725
Hospital Charge Code	41569434
Hospital Revenue Code	278
Min. Negotiated Rate	$86.12
Max. Negotiated Rate	$86.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.12
Rate for Payer: Hamaspik Choice Inc Medicare	$86.12

ZZ DRAINAGE/BILIARY/ANCHOR/8F

Facility

$172.23

Service Code	HCPCS C1725
Hospital Charge Code	41569435
Hospital Revenue Code	278
Min. Negotiated Rate	$86.12
Max. Negotiated Rate	$86.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.12
Rate for Payer: Hamaspik Choice Inc Medicare	$86.12

ZZ DRAINAGE/BILIARY/ANCHOR/8F

Facility

$172.23

Service Code	HCPCS C1725
Hospital Charge Code	41569435
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$180.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$103.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$86.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$99.03
Rate for Payer: EmblemHealth Commercial	$86.12
Rate for Payer: Fidelis Medicare Advantage	$180.84
Rate for Payer: Group Health Inc Commercial	$86.12
Rate for Payer: Group Health Inc Medicare	$60.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.12
Rate for Payer: Hamaspik Choice Inc Medicare	$86.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$111.95

ZZ DRAINAGE CATHETER 10F

Facility

$1,204.88

Service Code	HCPCS C1725
Hospital Charge Code	41569745
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$1,265.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$662.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$722.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$602.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$692.81
Rate for Payer: EmblemHealth Commercial	$602.44
Rate for Payer: Fidelis Medicare Advantage	$1,265.12
Rate for Payer: Group Health Inc Commercial	$602.44
Rate for Payer: Group Health Inc Medicare	$421.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$602.44
Rate for Payer: Hamaspik Choice Inc Medicare	$602.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$783.17

ZZ DRAINAGE CATHETER 10F

Facility

$1,204.88

Service Code	HCPCS C1725
Hospital Charge Code	41569745
Hospital Revenue Code	278
Min. Negotiated Rate	$602.44
Max. Negotiated Rate	$602.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$602.44
Rate for Payer: Hamaspik Choice Inc Medicare	$602.44

ZZ DRAINAGE CATHETER 12F

Facility

$1,204.88

Hospital Charge Code	41569746
Hospital Revenue Code	270
Min. Negotiated Rate	$421.71
Max. Negotiated Rate	$963.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$662.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$602.44
Rate for Payer: Aetna Government	$602.44
Rate for Payer: Brighton Health Commercial	$903.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$963.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$819.32
Rate for Payer: Group Health Inc Commercial	$602.44
Rate for Payer: Group Health Inc Medicare	$421.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$602.44
Rate for Payer: Hamaspik Choice Inc Medicare	$602.44

ZZ DRAINAGE/DOUBLE J/10F/22CM

Facility

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569314
Hospital Revenue Code	278
Min. Negotiated Rate	$119.07
Max. Negotiated Rate	$119.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07

ZZ DRAINAGE/DOUBLE J/10F/22CM

Facility

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569314
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$250.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$142.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$119.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.93
Rate for Payer: EmblemHealth Commercial	$119.07
Rate for Payer: Fidelis Medicare Advantage	$250.05
Rate for Payer: Group Health Inc Commercial	$119.07
Rate for Payer: Group Health Inc Medicare	$83.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.79

ZZ DRAINAGE/DOUBLE J/10F/24CM

Facility

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569315
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$250.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$142.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$119.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.93
Rate for Payer: EmblemHealth Commercial	$119.07
Rate for Payer: Fidelis Medicare Advantage	$250.05
Rate for Payer: Group Health Inc Commercial	$119.07
Rate for Payer: Group Health Inc Medicare	$83.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.79

ZZ DRAINAGE/DOUBLE J/10F/24CM

Facility

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569315
Hospital Revenue Code	278
Min. Negotiated Rate	$119.07
Max. Negotiated Rate	$119.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07

ZZ DRAINAGE/DOUBLE J/10F/26CM

Facility

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569316
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$250.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$142.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$119.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.93
Rate for Payer: EmblemHealth Commercial	$119.07
Rate for Payer: Fidelis Medicare Advantage	$250.05
Rate for Payer: Group Health Inc Commercial	$119.07
Rate for Payer: Group Health Inc Medicare	$83.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.79

ZZ DRAINAGE/DOUBLE J/10F/26CM

Facility

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569316
Hospital Revenue Code	278
Min. Negotiated Rate	$119.07
Max. Negotiated Rate	$119.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07

ZZ DRAINAGE/DOUBLE J/8F/22CM

Facility

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569317
Hospital Revenue Code	278
Min. Negotiated Rate	$119.07
Max. Negotiated Rate	$119.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07

ZZ DRAINAGE/DOUBLE J/8F/22CM

Facility

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569317
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$250.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$142.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$119.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.93
Rate for Payer: EmblemHealth Commercial	$119.07
Rate for Payer: Fidelis Medicare Advantage	$250.05
Rate for Payer: Group Health Inc Commercial	$119.07
Rate for Payer: Group Health Inc Medicare	$83.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.79

ZZ DRAINAGE/DOUBLE J/8F/24CM

Facility

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569318
Hospital Revenue Code	278
Min. Negotiated Rate	$119.07
Max. Negotiated Rate	$119.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07

ZZ DRAINAGE/DOUBLE J/8F/24CM

Facility

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569318
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$250.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$142.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$119.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.93
Rate for Payer: EmblemHealth Commercial	$119.07
Rate for Payer: Fidelis Medicare Advantage	$250.05
Rate for Payer: Group Health Inc Commercial	$119.07
Rate for Payer: Group Health Inc Medicare	$83.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.79

ZZ DRAINAGE/DOUBLE J/8F/26CM

Facility

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569319
Hospital Revenue Code	278
Min. Negotiated Rate	$119.07
Max. Negotiated Rate	$119.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07

ZZ DRAINAGE/DOUBLE J/8F/26CM

Facility

$238.14

Service Code	HCPCS C1725
Hospital Charge Code	41569319
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$250.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$142.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$119.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.93
Rate for Payer: EmblemHealth Commercial	$119.07
Rate for Payer: Fidelis Medicare Advantage	$250.05
Rate for Payer: Group Health Inc Commercial	$119.07
Rate for Payer: Group Health Inc Medicare	$83.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.07
Rate for Payer: Hamaspik Choice Inc Medicare	$119.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.79

ZZ DRAINAGE LINE

Facility

$34.02

Hospital Charge Code	41569637
Hospital Revenue Code	270
Min. Negotiated Rate	$11.91
Max. Negotiated Rate	$27.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.01
Rate for Payer: Aetna Government	$17.01
Rate for Payer: Brighton Health Commercial	$25.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.13
Rate for Payer: Group Health Inc Commercial	$17.01
Rate for Payer: Group Health Inc Medicare	$11.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.01
Rate for Payer: Hamaspik Choice Inc Medicare	$17.01

ZZ DRAINAGE/MILTI/8.5F/10SH/35CM

Facility

$166.91

Service Code	HCPCS C1725
Hospital Charge Code	41569321
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$175.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$100.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$83.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.97
Rate for Payer: EmblemHealth Commercial	$83.46
Rate for Payer: Fidelis Medicare Advantage	$175.26
Rate for Payer: Group Health Inc Commercial	$83.46
Rate for Payer: Group Health Inc Medicare	$58.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.46
Rate for Payer: Hamaspik Choice Inc Medicare	$83.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$108.49

ZZ DRAINAGE/MILTI/8.5F/10SH/35CM

Facility

$166.91

Service Code	HCPCS C1725
Hospital Charge Code	41569321
Hospital Revenue Code	278
Min. Negotiated Rate	$83.46
Max. Negotiated Rate	$83.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.46
Rate for Payer: Hamaspik Choice Inc Medicare	$83.46

ZZ DRAINAGE/MULTI/10.2/10SH/35CM

Facility

$166.91

Service Code	HCPCS C1725
Hospital Charge Code	41569320
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$175.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$100.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$83.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.97
Rate for Payer: EmblemHealth Commercial	$83.46
Rate for Payer: Fidelis Medicare Advantage	$175.26
Rate for Payer: Group Health Inc Commercial	$83.46
Rate for Payer: Group Health Inc Medicare	$58.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.46
Rate for Payer: Hamaspik Choice Inc Medicare	$83.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$108.49

Know your out-of-pocket cost for care.

All Charges