St. Barnabas Hospital

All Charges

Charge

Type

Price

CATH FOLEY 24FR 30CC 2 WAY

Facility OP

$3.55

Service Code	HCPCS C1758
Hospital Charge Code	64902100
Hospital Revenue Code	279
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$2.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.97
Rate for Payer: Aetna Government	$2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.41
Rate for Payer: Group Health Inc Commercial	$1.78
Rate for Payer: Group Health Inc Medicare	$1.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.78
Rate for Payer: Hamaspik Choice Inc Medicare	$1.78

CATH FOLEY 24FR 5CC 2 WAY

Facility OP

$2.22

Hospital Charge Code	40201047
Hospital Revenue Code	270
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$1.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.11
Rate for Payer: Aetna Government	$1.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.51
Rate for Payer: Group Health Inc Commercial	$1.11
Rate for Payer: Group Health Inc Medicare	$0.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.11
Rate for Payer: Hamaspik Choice Inc Medicare	$1.11

CATH FOLEY 24FR 5CC 2 WAY

Facility OP

$6.64

Service Code	HCPCS C1758
Hospital Charge Code	64902111
Hospital Revenue Code	279
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$5.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.97
Rate for Payer: Aetna Government	$2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.52
Rate for Payer: Group Health Inc Commercial	$3.32
Rate for Payer: Group Health Inc Medicare	$2.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.32
Rate for Payer: Hamaspik Choice Inc Medicare	$3.32

CATH FOLEY 26FR 5CC 2 WAY

Facility OP

$3.73

Service Code	HCPCS C1758
Hospital Charge Code	64902112
Hospital Revenue Code	279
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$2.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.97
Rate for Payer: Aetna Government	$2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.54
Rate for Payer: Group Health Inc Commercial	$1.86
Rate for Payer: Group Health Inc Medicare	$1.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.86
Rate for Payer: Hamaspik Choice Inc Medicare	$1.86

CATH FOLEY 28FR 5CC 2 WAY

Facility OP

$6.64

Service Code	HCPCS C1758
Hospital Charge Code	64902114
Hospital Revenue Code	279
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$5.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.97
Rate for Payer: Aetna Government	$2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.52
Rate for Payer: Group Health Inc Commercial	$3.32
Rate for Payer: Group Health Inc Medicare	$2.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.32
Rate for Payer: Hamaspik Choice Inc Medicare	$3.32

CATH FOLEY 28FR 5CC 2WAY

Facility OP

$2.20

Hospital Charge Code	40201048
Hospital Revenue Code	270
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$1.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.10
Rate for Payer: Aetna Government	$1.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.50
Rate for Payer: Group Health Inc Commercial	$1.10
Rate for Payer: Group Health Inc Medicare	$0.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.10
Rate for Payer: Hamaspik Choice Inc Medicare	$1.10

CATH FOLEY 6FR 3 CC 2 WAY

Facility OP

$47.40

Hospital Charge Code	40201049
Hospital Revenue Code	270
Min. Negotiated Rate	$16.59
Max. Negotiated Rate	$37.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.70
Rate for Payer: Aetna Government	$23.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.23
Rate for Payer: Group Health Inc Commercial	$23.70
Rate for Payer: Group Health Inc Medicare	$16.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.70
Rate for Payer: Hamaspik Choice Inc Medicare	$23.70

CATH FOLEY 6FR 3CC 2 WAY 3171-06

Facility OP

$34.50

Service Code	HCPCS C1758
Hospital Charge Code	64902396
Hospital Revenue Code	279
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$27.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.97
Rate for Payer: Aetna Government	$2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.46
Rate for Payer: Group Health Inc Commercial	$17.25
Rate for Payer: Group Health Inc Medicare	$12.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.25
Rate for Payer: Hamaspik Choice Inc Medicare	$17.25

CATH FOLEY 8 FR 3 CC 2 WAY

Facility OP

$4.30

Hospital Charge Code	40201051
Hospital Revenue Code	270
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$3.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.15
Rate for Payer: Aetna Government	$2.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.92
Rate for Payer: Group Health Inc Commercial	$2.15
Rate for Payer: Group Health Inc Medicare	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.15
Rate for Payer: Hamaspik Choice Inc Medicare	$2.15

CATH FOLEY 8FR 3CC 2 WAY 180003

Facility OP

$5.21

Service Code	HCPCS C1758
Hospital Charge Code	64902389
Hospital Revenue Code	279
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$4.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.97
Rate for Payer: Aetna Government	$2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.54
Rate for Payer: Group Health Inc Commercial	$2.60
Rate for Payer: Group Health Inc Medicare	$1.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.60
Rate for Payer: Hamaspik Choice Inc Medicare	$2.60

CATH, FOLEY, HEMATURIA 20FR

Facility OP

$53.03

Service Code	HCPCS C1758
Hospital Charge Code	64904011
Hospital Revenue Code	279
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$42.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.97
Rate for Payer: Aetna Government	$2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$42.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$36.06
Rate for Payer: Group Health Inc Commercial	$26.52
Rate for Payer: Group Health Inc Medicare	$18.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.52
Rate for Payer: Hamaspik Choice Inc Medicare	$26.52

CATH GASTRO JEJUNAL SINGLE

Facility OP

$263.90

Hospital Charge Code	64903582
Hospital Revenue Code	279
Min. Negotiated Rate	$92.36
Max. Negotiated Rate	$211.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$145.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$131.95
Rate for Payer: Aetna Government	$131.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$211.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$179.45
Rate for Payer: Group Health Inc Commercial	$131.95
Rate for Payer: Group Health Inc Medicare	$92.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.95
Rate for Payer: Hamaspik Choice Inc Medicare	$131.95

CATH GILDEWIRE 4FR ANGLED 65CM

Facility OP

$103.50

Service Code	HCPCS C1769
Hospital Charge Code	40206044
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$108.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$51.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.51
Rate for Payer: Fidelis Medicare Advantage	$108.68
Rate for Payer: Group Health Inc Commercial	$51.75
Rate for Payer: Group Health Inc Medicare	$36.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.75
Rate for Payer: Hamaspik Choice Inc Medicare	$51.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$67.28

CATH GILDEWIRE 4FR ANGLED 65CM

Facility IP

$103.50

Service Code	HCPCS C1769
Hospital Charge Code	40206044
Hospital Revenue Code	278
Min. Negotiated Rate	$51.75
Max. Negotiated Rate	$51.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.75
Rate for Payer: Hamaspik Choice Inc Medicare	$51.75

CATH HEMASTASIS GOLD PROBE 7FR

Facility OP

$735.68

Hospital Charge Code	64903097
Hospital Revenue Code	279
Min. Negotiated Rate	$257.49
Max. Negotiated Rate	$588.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$404.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$367.84
Rate for Payer: Aetna Government	$367.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$588.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$500.26
Rate for Payer: Group Health Inc Commercial	$367.84
Rate for Payer: Group Health Inc Medicare	$257.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$367.84
Rate for Payer: Hamaspik Choice Inc Medicare	$367.84

CATH HEMATURIA 24FR

Facility OP

$240.80

Hospital Charge Code	40202178
Hospital Revenue Code	270
Min. Negotiated Rate	$84.28
Max. Negotiated Rate	$192.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$120.40
Rate for Payer: Aetna Government	$120.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$192.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.74
Rate for Payer: Group Health Inc Commercial	$120.40
Rate for Payer: Group Health Inc Medicare	$84.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.40
Rate for Payer: Hamaspik Choice Inc Medicare	$120.40

CATH HEMOSTASIS GOLD PROBE 7FR

Facility OP

$362.00

Hospital Charge Code	40209785
Hospital Revenue Code	270
Min. Negotiated Rate	$126.70
Max. Negotiated Rate	$289.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$199.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$181.00
Rate for Payer: Aetna Government	$181.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$289.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$246.16
Rate for Payer: Group Health Inc Commercial	$181.00
Rate for Payer: Group Health Inc Medicare	$126.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$181.00
Rate for Payer: Hamaspik Choice Inc Medicare	$181.00

CATH, HEPARIN CTD 40FR STRAIGHT

Facility OP

$21.93

Hospital Charge Code	64903175
Hospital Revenue Code	279
Min. Negotiated Rate	$7.68
Max. Negotiated Rate	$17.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.96
Rate for Payer: Aetna Government	$10.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.91
Rate for Payer: Group Health Inc Commercial	$10.96
Rate for Payer: Group Health Inc Medicare	$7.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.96
Rate for Payer: Hamaspik Choice Inc Medicare	$10.96

CATH IMAGER

Facility OP

$53.43

Service Code	HCPCS C1758
Hospital Charge Code	64907160
Hospital Revenue Code	278
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$56.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.97
Rate for Payer: Aetna Government	$2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.72
Rate for Payer: Fidelis Medicare Advantage	$56.10
Rate for Payer: Group Health Inc Commercial	$26.72
Rate for Payer: Group Health Inc Medicare	$18.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.72
Rate for Payer: Hamaspik Choice Inc Medicare	$26.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34.73

CATH IMAGER

Facility IP

$53.43

Service Code	HCPCS C1758
Hospital Charge Code	64907160
Hospital Revenue Code	278
Min. Negotiated Rate	$26.72
Max. Negotiated Rate	$26.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.72
Rate for Payer: Hamaspik Choice Inc Medicare	$26.72

CATH INDIGO RX 140CM

Facility OP

$4,180.00

Service Code	HCPCS C1887
Hospital Charge Code	64906784
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$4,389.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,299.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,090.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,403.50
Rate for Payer: Fidelis Medicare Advantage	$4,389.00
Rate for Payer: Group Health Inc Commercial	$2,090.00
Rate for Payer: Group Health Inc Medicare	$1,463.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,090.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,090.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,717.00

CATH INDIGO RX 140CM

Facility IP

$4,180.00

Service Code	HCPCS C1887
Hospital Charge Code	64906784
Hospital Revenue Code	278
Min. Negotiated Rate	$2,090.00
Max. Negotiated Rate	$2,090.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,090.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,090.00

CATH INDWELLING SLIT SET

Facility OP

$289.21

Hospital Charge Code	64905683
Hospital Revenue Code	279
Min. Negotiated Rate	$101.22
Max. Negotiated Rate	$231.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$159.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$144.60
Rate for Payer: Aetna Government	$144.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$231.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$196.66
Rate for Payer: Group Health Inc Commercial	$144.60
Rate for Payer: Group Health Inc Medicare	$101.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$144.60
Rate for Payer: Hamaspik Choice Inc Medicare	$144.60

CATH INTRAUTERINE PRESSURE

Facility OP

$55.00

Hospital Charge Code	64902369
Hospital Revenue Code	279
Min. Negotiated Rate	$19.25
Max. Negotiated Rate	$44.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.50
Rate for Payer: Aetna Government	$27.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$44.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.40
Rate for Payer: Group Health Inc Commercial	$27.50
Rate for Payer: Group Health Inc Medicare	$19.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.50
Rate for Payer: Hamaspik Choice Inc Medicare	$27.50

CATH INTROCAN SAFETY 18G 2.5

Facility OP

$671.43

Hospital Charge Code	64902667
Hospital Revenue Code	279
Min. Negotiated Rate	$235.00
Max. Negotiated Rate	$537.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$369.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$335.72
Rate for Payer: Aetna Government	$335.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$537.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$456.57
Rate for Payer: Group Health Inc Commercial	$335.72
Rate for Payer: Group Health Inc Medicare	$235.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$335.72
Rate for Payer: Hamaspik Choice Inc Medicare	$335.72

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