St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZZ PICC LINE 4F/65 MORPH SINGLE

Facility

$220.00

Service Code	HCPCS C1887
Hospital Charge Code	41568415
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$231.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$121.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Brighton Health Commercial	$132.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$110.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$126.50
Rate for Payer: EmblemHealth Commercial	$110.00
Rate for Payer: Fidelis Medicare Advantage	$231.00
Rate for Payer: Group Health Inc Commercial	$110.00
Rate for Payer: Group Health Inc Medicare	$77.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$143.00

ZZ PICC LINE 4F/65 MORPH SINGLE

Facility

$220.00

Service Code	HCPCS C1887
Hospital Charge Code	41568415
Hospital Revenue Code	278
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$110.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00

ZZ PICC LINE/4F GROSHONG SINGLE

Facility

$304.06

Service Code	HCPCS C1751
Hospital Charge Code	41569464
Hospital Revenue Code	278
Min. Negotiated Rate	$152.03
Max. Negotiated Rate	$152.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.03
Rate for Payer: Hamaspik Choice Inc Medicare	$152.03

ZZ PICC LINE/4F GROSHONG SINGLE

Facility

$304.06

Service Code	HCPCS C1751
Hospital Charge Code	41569464
Hospital Revenue Code	278
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$319.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$167.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.08
Rate for Payer: Aetna Government	$7.08
Rate for Payer: Brighton Health Commercial	$182.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$152.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$174.83
Rate for Payer: EmblemHealth Commercial	$152.03
Rate for Payer: Fidelis Medicare Advantage	$319.26
Rate for Payer: Group Health Inc Commercial	$152.03
Rate for Payer: Group Health Inc Medicare	$106.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.03
Rate for Payer: Hamaspik Choice Inc Medicare	$152.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$197.64

ZZ PICC LINE/4F SINGLE LUMEN

Facility

$114.48

Service Code	HCPCS C1751
Hospital Charge Code	41569521
Hospital Revenue Code	278
Min. Negotiated Rate	$57.24
Max. Negotiated Rate	$57.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.24
Rate for Payer: Hamaspik Choice Inc Medicare	$57.24

ZZ PICC LINE/4F SINGLE LUMEN

Facility

$114.48

Service Code	HCPCS C1751
Hospital Charge Code	41569521
Hospital Revenue Code	278
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$120.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.08
Rate for Payer: Aetna Government	$7.08
Rate for Payer: Brighton Health Commercial	$68.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.83
Rate for Payer: EmblemHealth Commercial	$57.24
Rate for Payer: Fidelis Medicare Advantage	$120.20
Rate for Payer: Group Health Inc Commercial	$57.24
Rate for Payer: Group Health Inc Medicare	$40.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.24
Rate for Payer: Hamaspik Choice Inc Medicare	$57.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$74.41

ZZ PICC LINE/5F GROSHONG DUBBLE

Facility

$304.06

Service Code	HCPCS C1751
Hospital Charge Code	41569465
Hospital Revenue Code	278
Min. Negotiated Rate	$152.03
Max. Negotiated Rate	$152.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.03
Rate for Payer: Hamaspik Choice Inc Medicare	$152.03

ZZ PICC LINE/5F GROSHONG DUBBLE

Facility

$304.06

Service Code	HCPCS C1751
Hospital Charge Code	41569465
Hospital Revenue Code	278
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$319.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$167.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.08
Rate for Payer: Aetna Government	$7.08
Rate for Payer: Brighton Health Commercial	$182.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$152.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$174.83
Rate for Payer: EmblemHealth Commercial	$152.03
Rate for Payer: Fidelis Medicare Advantage	$319.26
Rate for Payer: Group Health Inc Commercial	$152.03
Rate for Payer: Group Health Inc Medicare	$106.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.03
Rate for Payer: Hamaspik Choice Inc Medicare	$152.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$197.64

ZZ PICC LINE/5F SINGLE LUMEN

Facility

$114.48

Service Code	HCPCS C1751
Hospital Charge Code	41569466
Hospital Revenue Code	278
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$120.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.08
Rate for Payer: Aetna Government	$7.08
Rate for Payer: Brighton Health Commercial	$68.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.83
Rate for Payer: EmblemHealth Commercial	$57.24
Rate for Payer: Fidelis Medicare Advantage	$120.20
Rate for Payer: Group Health Inc Commercial	$57.24
Rate for Payer: Group Health Inc Medicare	$40.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.24
Rate for Payer: Hamaspik Choice Inc Medicare	$57.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$74.41

ZZ PICC LINE/5F SINGLE LUMEN

Facility

$114.48

Service Code	HCPCS C1751
Hospital Charge Code	41569466
Hospital Revenue Code	278
Min. Negotiated Rate	$57.24
Max. Negotiated Rate	$57.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.24
Rate for Payer: Hamaspik Choice Inc Medicare	$57.24

ZZ PICC LINE 7F/65 MORPHEUS DUAL

Facility

$220.00

Service Code	HCPCS C1887
Hospital Charge Code	41568416
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$231.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$121.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Brighton Health Commercial	$132.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$110.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$126.50
Rate for Payer: EmblemHealth Commercial	$110.00
Rate for Payer: Fidelis Medicare Advantage	$231.00
Rate for Payer: Group Health Inc Commercial	$110.00
Rate for Payer: Group Health Inc Medicare	$77.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$143.00

ZZ PICC LINE 7F/65 MORPHEUS DUAL

Facility

$220.00

Service Code	HCPCS C1887
Hospital Charge Code	41568416
Hospital Revenue Code	278
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$110.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00

ZZ PICC LINE/7F DUAL LUMEN

Facility

$153.75

Service Code	HCPCS C1751
Hospital Charge Code	41569467
Hospital Revenue Code	278
Min. Negotiated Rate	$76.88
Max. Negotiated Rate	$76.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.88
Rate for Payer: Hamaspik Choice Inc Medicare	$76.88

ZZ PICC LINE/7F DUAL LUMEN

Facility

$153.75

Service Code	HCPCS C1751
Hospital Charge Code	41569467
Hospital Revenue Code	278
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$161.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$84.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.08
Rate for Payer: Aetna Government	$7.08
Rate for Payer: Brighton Health Commercial	$92.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$76.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$88.41
Rate for Payer: EmblemHealth Commercial	$76.88
Rate for Payer: Fidelis Medicare Advantage	$161.44
Rate for Payer: Group Health Inc Commercial	$76.88
Rate for Payer: Group Health Inc Medicare	$53.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.88
Rate for Payer: Hamaspik Choice Inc Medicare	$76.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$99.94

ZZ PICC LINES 4, 1 LUMEN

Facility

$163.01

Service Code	HCPCS C1751
Hospital Charge Code	41567313
Hospital Revenue Code	278
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$171.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.08
Rate for Payer: Aetna Government	$7.08
Rate for Payer: Brighton Health Commercial	$97.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.73
Rate for Payer: EmblemHealth Commercial	$81.50
Rate for Payer: Fidelis Medicare Advantage	$171.16
Rate for Payer: Group Health Inc Commercial	$81.50
Rate for Payer: Group Health Inc Medicare	$57.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.50
Rate for Payer: Hamaspik Choice Inc Medicare	$81.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.96

ZZ PICC LINES 4, 1 LUMEN

Facility

$163.01

Service Code	HCPCS C1751
Hospital Charge Code	41567313
Hospital Revenue Code	278
Min. Negotiated Rate	$81.50
Max. Negotiated Rate	$81.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.50
Rate for Payer: Hamaspik Choice Inc Medicare	$81.50

ZZ PICC LINES 5, 1 LUMEN

Facility

$163.01

Service Code	HCPCS C1751
Hospital Charge Code	41567315
Hospital Revenue Code	278
Min. Negotiated Rate	$81.50
Max. Negotiated Rate	$81.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.50
Rate for Payer: Hamaspik Choice Inc Medicare	$81.50

ZZ PICC LINES 5, 1 LUMEN

Facility

$163.01

Service Code	HCPCS C1751
Hospital Charge Code	41567315
Hospital Revenue Code	278
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$171.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.08
Rate for Payer: Aetna Government	$7.08
Rate for Payer: Brighton Health Commercial	$97.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.73
Rate for Payer: EmblemHealth Commercial	$81.50
Rate for Payer: Fidelis Medicare Advantage	$171.16
Rate for Payer: Group Health Inc Commercial	$81.50
Rate for Payer: Group Health Inc Medicare	$57.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.50
Rate for Payer: Hamaspik Choice Inc Medicare	$81.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.96

ZZ PICC LINES 5, 2 LUMEN

Facility

$221.84

Service Code	HCPCS C1751
Hospital Charge Code	41567314
Hospital Revenue Code	278
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$232.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$122.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.08
Rate for Payer: Aetna Government	$7.08
Rate for Payer: Brighton Health Commercial	$133.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$110.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$127.56
Rate for Payer: EmblemHealth Commercial	$110.92
Rate for Payer: Fidelis Medicare Advantage	$232.93
Rate for Payer: Group Health Inc Commercial	$110.92
Rate for Payer: Group Health Inc Medicare	$77.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.92
Rate for Payer: Hamaspik Choice Inc Medicare	$110.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$144.20

ZZ PICC LINES 5, 2 LUMEN

Facility

$221.84

Service Code	HCPCS C1751
Hospital Charge Code	41567314
Hospital Revenue Code	278
Min. Negotiated Rate	$110.92
Max. Negotiated Rate	$110.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.92
Rate for Payer: Hamaspik Choice Inc Medicare	$110.92

ZZ PIGTAIL CATHETER 4

Facility

$97.10

Service Code	HCPCS C1725
Hospital Charge Code	41567162
Hospital Revenue Code	278
Min. Negotiated Rate	$33.98
Max. Negotiated Rate	$101.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$58.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.83
Rate for Payer: EmblemHealth Commercial	$48.55
Rate for Payer: Fidelis Medicare Advantage	$101.96
Rate for Payer: Group Health Inc Commercial	$48.55
Rate for Payer: Group Health Inc Medicare	$33.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.55
Rate for Payer: Hamaspik Choice Inc Medicare	$48.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$63.12

ZZ PIGTAIL CATHETER 4

Facility

$97.10

Service Code	HCPCS C1725
Hospital Charge Code	41567162
Hospital Revenue Code	278
Min. Negotiated Rate	$48.55
Max. Negotiated Rate	$48.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.55
Rate for Payer: Hamaspik Choice Inc Medicare	$48.55

ZZ PIX CATHETER SET

Facility

$225.03

Hospital Charge Code	41567318
Hospital Revenue Code	270
Min. Negotiated Rate	$78.76
Max. Negotiated Rate	$180.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$123.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$112.52
Rate for Payer: Aetna Government	$112.52
Rate for Payer: Brighton Health Commercial	$168.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$180.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.02
Rate for Payer: Group Health Inc Commercial	$112.52
Rate for Payer: Group Health Inc Medicare	$78.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.52
Rate for Payer: Hamaspik Choice Inc Medicare	$112.52

ZZ PLATINU PLUS WR 18-180

Facility

$277.13

Service Code	HCPCS C1769
Hospital Charge Code	41567127
Hospital Revenue Code	278
Min. Negotiated Rate	$138.56
Max. Negotiated Rate	$138.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.56
Rate for Payer: Hamaspik Choice Inc Medicare	$138.56

ZZ PLATINU PLUS WR 18-180

Facility

$277.13

Service Code	HCPCS C1769
Hospital Charge Code	41567127
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$290.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$152.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$166.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$138.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$159.35
Rate for Payer: EmblemHealth Commercial	$138.56
Rate for Payer: Fidelis Medicare Advantage	$290.99
Rate for Payer: Group Health Inc Commercial	$138.56
Rate for Payer: Group Health Inc Medicare	$97.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.56
Rate for Payer: Hamaspik Choice Inc Medicare	$138.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$180.13

Know your out-of-pocket cost for care.

All Charges