St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZZ GLIDE WIRE 25-180 ANGL

Facility

$189.24

Service Code	HCPCS C1769
Hospital Charge Code	41567117
Hospital Revenue Code	278
Min. Negotiated Rate	$94.62
Max. Negotiated Rate	$94.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.62
Rate for Payer: Hamaspik Choice Inc Medicare	$94.62

ZZ GLIDE WIRE 25-180 ANGL

Facility

$189.24

Service Code	HCPCS C1769
Hospital Charge Code	41567117
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$198.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$104.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$113.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$94.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$108.81
Rate for Payer: EmblemHealth Commercial	$94.62
Rate for Payer: Fidelis Medicare Advantage	$198.70
Rate for Payer: Group Health Inc Commercial	$94.62
Rate for Payer: Group Health Inc Medicare	$66.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.62
Rate for Payer: Hamaspik Choice Inc Medicare	$94.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$123.01

ZZ GLIDE WIRE 35-150 ANGLED

Facility

$157.34

Service Code	HCPCS C1769
Hospital Charge Code	41567120
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$165.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$94.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$90.47
Rate for Payer: EmblemHealth Commercial	$78.67
Rate for Payer: Fidelis Medicare Advantage	$165.21
Rate for Payer: Group Health Inc Commercial	$78.67
Rate for Payer: Group Health Inc Medicare	$55.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.67
Rate for Payer: Hamaspik Choice Inc Medicare	$78.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$102.27

ZZ GLIDE WIRE 35-150 ANGLED

Facility

$157.34

Service Code	HCPCS C1769
Hospital Charge Code	41567120
Hospital Revenue Code	278
Min. Negotiated Rate	$78.67
Max. Negotiated Rate	$78.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.67
Rate for Payer: Hamaspik Choice Inc Medicare	$78.67

ZZ GLIDE WIRE 35-180 ANGL

Facility

$137.85

Service Code	HCPCS C1769
Hospital Charge Code	41567112
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$144.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$75.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$82.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$68.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$79.26
Rate for Payer: EmblemHealth Commercial	$68.92
Rate for Payer: Fidelis Medicare Advantage	$144.74
Rate for Payer: Group Health Inc Commercial	$68.92
Rate for Payer: Group Health Inc Medicare	$48.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.92
Rate for Payer: Hamaspik Choice Inc Medicare	$68.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$89.60

ZZ GLIDE WIRE 35-180 ANGL

Facility

$137.85

Service Code	HCPCS C1769
Hospital Charge Code	41567112
Hospital Revenue Code	278
Min. Negotiated Rate	$68.92
Max. Negotiated Rate	$68.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.92
Rate for Payer: Hamaspik Choice Inc Medicare	$68.92

ZZ GLIDE WIRE 35-260 ANGL

Facility

$208.73

Service Code	HCPCS C1769
Hospital Charge Code	41567118
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$219.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$114.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$125.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$104.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$120.02
Rate for Payer: EmblemHealth Commercial	$104.36
Rate for Payer: Fidelis Medicare Advantage	$219.17
Rate for Payer: Group Health Inc Commercial	$104.36
Rate for Payer: Group Health Inc Medicare	$73.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$104.36
Rate for Payer: Hamaspik Choice Inc Medicare	$104.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$135.67

ZZ GLIDE WIRE 35-260 ANGL

Facility

$208.73

Service Code	HCPCS C1769
Hospital Charge Code	41567118
Hospital Revenue Code	278
Min. Negotiated Rate	$104.36
Max. Negotiated Rate	$104.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$104.36
Rate for Payer: Hamaspik Choice Inc Medicare	$104.36

ZZ GLIDE WIRE 35-260 ANGLED

Facility

$154.15

Service Code	HCPCS C1769
Hospital Charge Code	41567113
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$161.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$84.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$92.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$77.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$88.64
Rate for Payer: EmblemHealth Commercial	$77.08
Rate for Payer: Fidelis Medicare Advantage	$161.86
Rate for Payer: Group Health Inc Commercial	$77.08
Rate for Payer: Group Health Inc Medicare	$53.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.08
Rate for Payer: Hamaspik Choice Inc Medicare	$77.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$100.20

ZZ GLIDE WIRE 35-260 ANGLED

Facility

$154.15

Service Code	HCPCS C1769
Hospital Charge Code	41567113
Hospital Revenue Code	278
Min. Negotiated Rate	$77.08
Max. Negotiated Rate	$77.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.08
Rate for Payer: Hamaspik Choice Inc Medicare	$77.08

ZZ GLIDE WIRE 35-80 ANGLE

Facility

$157.34

Service Code	HCPCS C1769
Hospital Charge Code	41567119
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$165.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$94.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$90.47
Rate for Payer: EmblemHealth Commercial	$78.67
Rate for Payer: Fidelis Medicare Advantage	$165.21
Rate for Payer: Group Health Inc Commercial	$78.67
Rate for Payer: Group Health Inc Medicare	$55.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.67
Rate for Payer: Hamaspik Choice Inc Medicare	$78.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$102.27

ZZ GLIDE WIRE 35-80 ANGLE

Facility

$157.34

Service Code	HCPCS C1769
Hospital Charge Code	41567119
Hospital Revenue Code	278
Min. Negotiated Rate	$78.67
Max. Negotiated Rate	$78.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.67
Rate for Payer: Hamaspik Choice Inc Medicare	$78.67

ZZ GLIDE WIRE 38-150 ANGL

Facility

$98.87

Service Code	HCPCS C1769
Hospital Charge Code	41567114
Hospital Revenue Code	278
Min. Negotiated Rate	$49.44
Max. Negotiated Rate	$49.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.44
Rate for Payer: Hamaspik Choice Inc Medicare	$49.44

ZZ GLIDE WIRE 38-150 ANGL

Facility

$98.87

Service Code	HCPCS C1769
Hospital Charge Code	41567114
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$103.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$54.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$59.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$49.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$56.85
Rate for Payer: EmblemHealth Commercial	$49.44
Rate for Payer: Fidelis Medicare Advantage	$103.81
Rate for Payer: Group Health Inc Commercial	$49.44
Rate for Payer: Group Health Inc Medicare	$34.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.44
Rate for Payer: Hamaspik Choice Inc Medicare	$49.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$64.27

ZZ GLIDEWIRE ANGEL TIP 150CM/3CM

Facility

$438.00

Service Code	HCPCS C1769
Hospital Charge Code	41569949
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$459.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$240.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$262.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$219.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$251.85
Rate for Payer: EmblemHealth Commercial	$219.00
Rate for Payer: Fidelis Medicare Advantage	$459.90
Rate for Payer: Group Health Inc Commercial	$219.00
Rate for Payer: Group Health Inc Medicare	$153.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$219.00
Rate for Payer: Hamaspik Choice Inc Medicare	$219.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$284.70

ZZ GLIDEWIRE ANGEL TIP 150CM/3CM

Facility

$438.00

Service Code	HCPCS C1769
Hospital Charge Code	41569949
Hospital Revenue Code	278
Min. Negotiated Rate	$219.00
Max. Negotiated Rate	$219.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$219.00
Rate for Payer: Hamaspik Choice Inc Medicare	$219.00

ZZ GLIDEWIRE ANGEL TIP 260CM/3CM

Facility

$475.20

Service Code	HCPCS C1769
Hospital Charge Code	41569951
Hospital Revenue Code	278
Min. Negotiated Rate	$237.60
Max. Negotiated Rate	$237.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$237.60
Rate for Payer: Hamaspik Choice Inc Medicare	$237.60

ZZ GLIDEWIRE ANGEL TIP 260CM/3CM

Facility

$475.20

Service Code	HCPCS C1769
Hospital Charge Code	41569951
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$498.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$261.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$285.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$237.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$273.24
Rate for Payer: EmblemHealth Commercial	$237.60
Rate for Payer: Fidelis Medicare Advantage	$498.96
Rate for Payer: Group Health Inc Commercial	$237.60
Rate for Payer: Group Health Inc Medicare	$166.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$237.60
Rate for Payer: Hamaspik Choice Inc Medicare	$237.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$308.88

ZZ GLIDEWR STRAIGHT TIP 150CM/3CM

Facility

$316.80

Service Code	HCPCS C1769
Hospital Charge Code	41569950
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$332.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$174.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$190.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$158.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$182.16
Rate for Payer: EmblemHealth Commercial	$158.40
Rate for Payer: Fidelis Medicare Advantage	$332.64
Rate for Payer: Group Health Inc Commercial	$158.40
Rate for Payer: Group Health Inc Medicare	$110.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$158.40
Rate for Payer: Hamaspik Choice Inc Medicare	$158.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$205.92

ZZ GLIDEWR STRAIGHT TIP 150CM/3CM

Facility

$316.80

Service Code	HCPCS C1769
Hospital Charge Code	41569950
Hospital Revenue Code	278
Min. Negotiated Rate	$158.40
Max. Negotiated Rate	$158.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$158.40
Rate for Payer: Hamaspik Choice Inc Medicare	$158.40

ZZ GREENFLD IVC FILT FEM

Facility

$3,247.14

Service Code	HCPCS C1880
Hospital Charge Code	41567148
Hospital Revenue Code	278
Min. Negotiated Rate	$57.08
Max. Negotiated Rate	$3,409.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,785.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$57.08
Rate for Payer: Aetna Government	$57.08
Rate for Payer: Brighton Health Commercial	$1,948.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,623.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,867.11
Rate for Payer: EmblemHealth Commercial	$1,623.57
Rate for Payer: Fidelis Medicare Advantage	$3,409.50
Rate for Payer: Group Health Inc Commercial	$1,623.57
Rate for Payer: Group Health Inc Medicare	$1,136.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,623.57
Rate for Payer: Hamaspik Choice Inc Medicare	$1,623.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,110.64

ZZ GREENFLD IVC FILT FEM

Facility

$3,247.14

Service Code	HCPCS C1880
Hospital Charge Code	41567148
Hospital Revenue Code	278
Min. Negotiated Rate	$1,623.57
Max. Negotiated Rate	$1,623.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,623.57
Rate for Payer: Hamaspik Choice Inc Medicare	$1,623.57

ZZ GREENFLD IVC FILT JUG

Facility

$3,247.14

Service Code	HCPCS C1880
Hospital Charge Code	41567147
Hospital Revenue Code	278
Min. Negotiated Rate	$1,623.57
Max. Negotiated Rate	$1,623.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,623.57
Rate for Payer: Hamaspik Choice Inc Medicare	$1,623.57

ZZ GREENFLD IVC FILT JUG

Facility

$3,247.14

Service Code	HCPCS C1880
Hospital Charge Code	41567147
Hospital Revenue Code	278
Min. Negotiated Rate	$57.08
Max. Negotiated Rate	$3,409.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,785.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$57.08
Rate for Payer: Aetna Government	$57.08
Rate for Payer: Brighton Health Commercial	$1,948.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,623.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,867.11
Rate for Payer: EmblemHealth Commercial	$1,623.57
Rate for Payer: Fidelis Medicare Advantage	$3,409.50
Rate for Payer: Group Health Inc Commercial	$1,623.57
Rate for Payer: Group Health Inc Medicare	$1,136.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,623.57
Rate for Payer: Hamaspik Choice Inc Medicare	$1,623.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,110.64

ZZ GRID IMMOBILIZATION PLATE

Facility

$30.00

Hospital Charge Code	41568760
Hospital Revenue Code	270
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$24.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.00
Rate for Payer: Aetna Government	$15.00
Rate for Payer: Brighton Health Commercial	$22.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.40
Rate for Payer: Group Health Inc Commercial	$15.00
Rate for Payer: Group Health Inc Medicare	$10.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00
Rate for Payer: Hamaspik Choice Inc Medicare	$15.00

Know your out-of-pocket cost for care.

All Charges