St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$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/MULTIPURPOSE/10.2F

Facility

$158.81

Service Code	HCPCS C1725
Hospital Charge Code	41569322
Hospital Revenue Code	278
Min. Negotiated Rate	$79.40
Max. Negotiated Rate	$79.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.40
Rate for Payer: Hamaspik Choice Inc Medicare	$79.40

ZZ DRAINAGE/MULTIPURPOSE/10.2F

Facility

$158.81

Service Code	HCPCS C1725
Hospital Charge Code	41569322
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$166.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$87.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$95.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$79.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$91.32
Rate for Payer: EmblemHealth Commercial	$79.40
Rate for Payer: Fidelis Medicare Advantage	$166.75
Rate for Payer: Group Health Inc Commercial	$79.40
Rate for Payer: Group Health Inc Medicare	$55.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.40
Rate for Payer: Hamaspik Choice Inc Medicare	$79.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$103.23

ZZ DRAINAGE/MULTIPURPOSE/10F/15S

Facility

$166.91

Service Code	HCPCS C1725
Hospital Charge Code	41569323
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/MULTIPURPOSE/10F/15S

Facility

$166.91

Service Code	HCPCS C1725
Hospital Charge Code	41569323
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/MULTIPURPOSE/10F/5S

Facility

$166.91

Service Code	HCPCS C1725
Hospital Charge Code	41569324
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/MULTIPURPOSE/10F/5S

Facility

$166.91

Service Code	HCPCS C1725
Hospital Charge Code	41569324
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/MULTIPURPOSE/12.0F

Facility

$158.81

Service Code	HCPCS C1729
Hospital Charge Code	41569325
Hospital Revenue Code	278
Min. Negotiated Rate	$79.40
Max. Negotiated Rate	$79.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.40
Rate for Payer: Hamaspik Choice Inc Medicare	$79.40

ZZ DRAINAGE/MULTIPURPOSE/12.0F

Facility

$158.81

Service Code	HCPCS C1729
Hospital Charge Code	41569325
Hospital Revenue Code	278
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$166.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$87.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.42
Rate for Payer: Aetna Government	$2.42
Rate for Payer: Brighton Health Commercial	$95.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$79.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$91.32
Rate for Payer: EmblemHealth Commercial	$79.40
Rate for Payer: Fidelis Medicare Advantage	$166.75
Rate for Payer: Group Health Inc Commercial	$79.40
Rate for Payer: Group Health Inc Medicare	$55.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.40
Rate for Payer: Hamaspik Choice Inc Medicare	$79.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$103.23

ZZ DRAINAGE/MULTIPURPOSE/14.0F

Facility

$158.81

Service Code	HCPCS C1729
Hospital Charge Code	41569326
Hospital Revenue Code	278
Min. Negotiated Rate	$79.40
Max. Negotiated Rate	$79.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.40
Rate for Payer: Hamaspik Choice Inc Medicare	$79.40

ZZ DRAINAGE/MULTIPURPOSE/14.0F

Facility

$158.81

Service Code	HCPCS C1729
Hospital Charge Code	41569326
Hospital Revenue Code	278
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$166.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$87.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.42
Rate for Payer: Aetna Government	$2.42
Rate for Payer: Brighton Health Commercial	$95.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$79.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$91.32
Rate for Payer: EmblemHealth Commercial	$79.40
Rate for Payer: Fidelis Medicare Advantage	$166.75
Rate for Payer: Group Health Inc Commercial	$79.40
Rate for Payer: Group Health Inc Medicare	$55.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.40
Rate for Payer: Hamaspik Choice Inc Medicare	$79.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$103.23

ZZ DRAINAGE/MULTIPURPOSE/8.5F

Facility

$158.81

Service Code	HCPCS C1729
Hospital Charge Code	41569327
Hospital Revenue Code	278
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$166.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$87.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.42
Rate for Payer: Aetna Government	$2.42
Rate for Payer: Brighton Health Commercial	$95.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$79.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$91.32
Rate for Payer: EmblemHealth Commercial	$79.40
Rate for Payer: Fidelis Medicare Advantage	$166.75
Rate for Payer: Group Health Inc Commercial	$79.40
Rate for Payer: Group Health Inc Medicare	$55.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.40
Rate for Payer: Hamaspik Choice Inc Medicare	$79.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$103.23

ZZ DRAINAGE/MULTIPURPOSE/8.5F

Facility

$158.81

Service Code	HCPCS C1729
Hospital Charge Code	41569327
Hospital Revenue Code	278
Min. Negotiated Rate	$79.40
Max. Negotiated Rate	$79.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.40
Rate for Payer: Hamaspik Choice Inc Medicare	$79.40

ZZ DRAINAGE/MULTIPURPOSE/8.5F/15S

Facility

$166.91

Service Code	HCPCS C1729
Hospital Charge Code	41569328
Hospital Revenue Code	278
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$175.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.42
Rate for Payer: Aetna Government	$2.42
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/MULTIPURPOSE/8.5F/15S

Facility

$166.91

Service Code	HCPCS C1729
Hospital Charge Code	41569328
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/MULTIPURPOSE/8.5F/5S

Facility

$166.91

Service Code	HCPCS C1729
Hospital Charge Code	41569329
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/MULTIPURPOSE/8.5F/5S

Facility

$166.91

Service Code	HCPCS C1729
Hospital Charge Code	41569329
Hospital Revenue Code	278
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$175.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.42
Rate for Payer: Aetna Government	$2.42
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/NEPH/8F/25CM

Facility

$172.23

Service Code	HCPCS C1725
Hospital Charge Code	41569336
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/NEPH/8F/25CM

Facility

$172.23

Service Code	HCPCS C1725
Hospital Charge Code	41569336
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/NEPH/PEDIATRIC

Facility

$323.19

Hospital Charge Code	41569338
Hospital Revenue Code	270
Min. Negotiated Rate	$113.12
Max. Negotiated Rate	$258.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$177.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$161.60
Rate for Payer: Aetna Government	$161.60
Rate for Payer: Brighton Health Commercial	$242.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$258.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$219.77
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

ZZ DRAINAGE/N-U/10F-22CM

Facility

$219.01

Service Code	HCPCS C1729
Hospital Charge Code	41569330
Hospital Revenue Code	278
Min. Negotiated Rate	$109.50
Max. Negotiated Rate	$109.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$109.50
Rate for Payer: Hamaspik Choice Inc Medicare	$109.50

ZZ DRAINAGE/N-U/10F-22CM

Facility

$219.01

Service Code	HCPCS C1729
Hospital Charge Code	41569330
Hospital Revenue Code	278
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$229.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$120.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.42
Rate for Payer: Aetna Government	$2.42
Rate for Payer: Brighton Health Commercial	$131.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$109.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$125.93
Rate for Payer: EmblemHealth Commercial	$109.50
Rate for Payer: Fidelis Medicare Advantage	$229.96
Rate for Payer: Group Health Inc Commercial	$109.50
Rate for Payer: Group Health Inc Medicare	$76.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$109.50
Rate for Payer: Hamaspik Choice Inc Medicare	$109.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$142.36

ZZ DRAINAGE/N-U/10F-24CM

Facility

$219.01

Service Code	HCPCS C1729
Hospital Charge Code	41569331
Hospital Revenue Code	278
Min. Negotiated Rate	$109.50
Max. Negotiated Rate	$109.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$109.50
Rate for Payer: Hamaspik Choice Inc Medicare	$109.50

ZZ DRAINAGE/N-U/10F-24CM

Facility

$219.01

Service Code	HCPCS C1729
Hospital Charge Code	41569331
Hospital Revenue Code	278
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$229.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$120.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.42
Rate for Payer: Aetna Government	$2.42
Rate for Payer: Brighton Health Commercial	$131.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$109.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$125.93
Rate for Payer: EmblemHealth Commercial	$109.50
Rate for Payer: Fidelis Medicare Advantage	$229.96
Rate for Payer: Group Health Inc Commercial	$109.50
Rate for Payer: Group Health Inc Medicare	$76.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$109.50
Rate for Payer: Hamaspik Choice Inc Medicare	$109.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$142.36

ZZ DRAINAGE/N-U/10F-26CM

Facility

$219.01

Service Code	HCPCS C1729
Hospital Charge Code	41569332
Hospital Revenue Code	278
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$229.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$120.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.42
Rate for Payer: Aetna Government	$2.42
Rate for Payer: Brighton Health Commercial	$131.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$109.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$125.93
Rate for Payer: EmblemHealth Commercial	$109.50
Rate for Payer: Fidelis Medicare Advantage	$229.96
Rate for Payer: Group Health Inc Commercial	$109.50
Rate for Payer: Group Health Inc Medicare	$76.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$109.50
Rate for Payer: Hamaspik Choice Inc Medicare	$109.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$142.36

Know your out-of-pocket cost for care.

All Charges