St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZZ SNARE KIT GN1000 10MM .038 120

Facility

$520.94

Service Code	HCPCS C1773
Hospital Charge Code	41569028
Hospital Revenue Code	278
Min. Negotiated Rate	$260.47
Max. Negotiated Rate	$260.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$260.47
Rate for Payer: Hamaspik Choice Inc Medicare	$260.47

ZZ SNARE KIT GN1000 10MM .038 120

Facility

$520.94

Service Code	HCPCS C1773
Hospital Charge Code	41569028
Hospital Revenue Code	278
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$546.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$286.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.00
Rate for Payer: Aetna Government	$70.00
Rate for Payer: Brighton Health Commercial	$312.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$260.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$299.54
Rate for Payer: EmblemHealth Commercial	$260.47
Rate for Payer: Fidelis Medicare Advantage	$546.99
Rate for Payer: Group Health Inc Commercial	$260.47
Rate for Payer: Group Health Inc Medicare	$182.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$260.47
Rate for Payer: Hamaspik Choice Inc Medicare	$260.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$338.61

ZZ SNARE KIT GN1500 15MM .052

Facility

$520.94

Service Code	HCPCS C1773
Hospital Charge Code	41569029
Hospital Revenue Code	278
Min. Negotiated Rate	$260.47
Max. Negotiated Rate	$260.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$260.47
Rate for Payer: Hamaspik Choice Inc Medicare	$260.47

ZZ SNARE KIT GN1500 15MM .052

Facility

$520.94

Service Code	HCPCS C1773
Hospital Charge Code	41569029
Hospital Revenue Code	278
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$546.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$286.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.00
Rate for Payer: Aetna Government	$70.00
Rate for Payer: Brighton Health Commercial	$312.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$260.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$299.54
Rate for Payer: EmblemHealth Commercial	$260.47
Rate for Payer: Fidelis Medicare Advantage	$546.99
Rate for Payer: Group Health Inc Commercial	$260.47
Rate for Payer: Group Health Inc Medicare	$182.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$260.47
Rate for Payer: Hamaspik Choice Inc Medicare	$260.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$338.61

ZZ SNARE KIT GN2500 25MM .052

Facility

$520.94

Service Code	HCPCS C1773
Hospital Charge Code	41569030
Hospital Revenue Code	278
Min. Negotiated Rate	$260.47
Max. Negotiated Rate	$260.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$260.47
Rate for Payer: Hamaspik Choice Inc Medicare	$260.47

ZZ SNARE KIT GN2500 25MM .052

Facility

$520.94

Service Code	HCPCS C1773
Hospital Charge Code	41569030
Hospital Revenue Code	278
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$546.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$286.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.00
Rate for Payer: Aetna Government	$70.00
Rate for Payer: Brighton Health Commercial	$312.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$260.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$299.54
Rate for Payer: EmblemHealth Commercial	$260.47
Rate for Payer: Fidelis Medicare Advantage	$546.99
Rate for Payer: Group Health Inc Commercial	$260.47
Rate for Payer: Group Health Inc Medicare	$182.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$260.47
Rate for Payer: Hamaspik Choice Inc Medicare	$260.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$338.61

ZZ SNARE KIT GN3500 35MM .052

Facility

$520.94

Service Code	HCPCS C1773
Hospital Charge Code	41569031
Hospital Revenue Code	278
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$546.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$286.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.00
Rate for Payer: Aetna Government	$70.00
Rate for Payer: Brighton Health Commercial	$312.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$260.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$299.54
Rate for Payer: EmblemHealth Commercial	$260.47
Rate for Payer: Fidelis Medicare Advantage	$546.99
Rate for Payer: Group Health Inc Commercial	$260.47
Rate for Payer: Group Health Inc Medicare	$182.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$260.47
Rate for Payer: Hamaspik Choice Inc Medicare	$260.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$338.61

ZZ SNARE KIT GN3500 35MM .052

Facility

$520.94

Service Code	HCPCS C1773
Hospital Charge Code	41569031
Hospital Revenue Code	278
Min. Negotiated Rate	$260.47
Max. Negotiated Rate	$260.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$260.47
Rate for Payer: Hamaspik Choice Inc Medicare	$260.47

ZZ SNARE KIT GN500 5MM .038 120CM

Facility

$520.94

Service Code	HCPCS C1773
Hospital Charge Code	41569027
Hospital Revenue Code	278
Min. Negotiated Rate	$260.47
Max. Negotiated Rate	$260.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$260.47
Rate for Payer: Hamaspik Choice Inc Medicare	$260.47

ZZ SNARE KIT GN500 5MM .038 120CM

Facility

$520.94

Service Code	HCPCS C1773
Hospital Charge Code	41569027
Hospital Revenue Code	278
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$546.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$286.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.00
Rate for Payer: Aetna Government	$70.00
Rate for Payer: Brighton Health Commercial	$312.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$260.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$299.54
Rate for Payer: EmblemHealth Commercial	$260.47
Rate for Payer: Fidelis Medicare Advantage	$546.99
Rate for Payer: Group Health Inc Commercial	$260.47
Rate for Payer: Group Health Inc Medicare	$182.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$260.47
Rate for Payer: Hamaspik Choice Inc Medicare	$260.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$338.61

ZZ SNARE/LOOP/018/300CM

Facility

$39.33

Service Code	HCPCS C1725
Hospital Charge Code	41569485
Hospital Revenue Code	278
Min. Negotiated Rate	$13.77
Max. Negotiated Rate	$44.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$23.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.61
Rate for Payer: EmblemHealth Commercial	$19.66
Rate for Payer: Fidelis Medicare Advantage	$41.30
Rate for Payer: Group Health Inc Commercial	$19.66
Rate for Payer: Group Health Inc Medicare	$13.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.66
Rate for Payer: Hamaspik Choice Inc Medicare	$19.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.56

ZZ SNARE/LOOP/018/300CM

Facility

$39.33

Service Code	HCPCS C1725
Hospital Charge Code	41569485
Hospital Revenue Code	278
Min. Negotiated Rate	$19.66
Max. Negotiated Rate	$19.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.66
Rate for Payer: Hamaspik Choice Inc Medicare	$19.66

ZZ SOLID IMMOBILIZATION PLATE

Facility

$30.00

Hospital Charge Code	41568761
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

ZZ SPLITCATH II 14F 28CM

Facility

$840.00

Service Code	HCPCS C1725
Hospital Charge Code	41569859
Hospital Revenue Code	278
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$420.00

ZZ SPLITCATH II 14F 28CM

Facility

$840.00

Service Code	HCPCS C1725
Hospital Charge Code	41569859
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$882.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$462.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$504.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$420.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$483.00
Rate for Payer: EmblemHealth Commercial	$420.00
Rate for Payer: Fidelis Medicare Advantage	$882.00
Rate for Payer: Group Health Inc Commercial	$420.00
Rate for Payer: Group Health Inc Medicare	$294.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$420.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$546.00

ZZ SPLIT CATH III 14F X 28CM

Facility

$860.00

Service Code	HCPCS C1886
Hospital Charge Code	41561879
Hospital Revenue Code	278
Min. Negotiated Rate	$301.00
Max. Negotiated Rate	$1,230.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$473.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,230.97
Rate for Payer: Aetna Government	$1,230.97
Rate for Payer: Brighton Health Commercial	$516.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$430.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$494.50
Rate for Payer: EmblemHealth Commercial	$430.00
Rate for Payer: Fidelis Medicare Advantage	$903.00
Rate for Payer: Group Health Inc Commercial	$430.00
Rate for Payer: Group Health Inc Medicare	$301.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$559.00

ZZ SPLIT CATH III 14F X 28CM

Facility

$860.00

Service Code	HCPCS C1886
Hospital Charge Code	41561879
Hospital Revenue Code	278
Min. Negotiated Rate	$430.00
Max. Negotiated Rate	$430.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00

ZZ SPLIT CATH III 14F X 32CM

Facility

$860.00

Service Code	HCPCS C1886
Hospital Charge Code	41561880
Hospital Revenue Code	278
Min. Negotiated Rate	$430.00
Max. Negotiated Rate	$430.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00

ZZ SPLIT CATH III 14F X 32CM

Facility

$860.00

Service Code	HCPCS C1886
Hospital Charge Code	41561880
Hospital Revenue Code	278
Min. Negotiated Rate	$301.00
Max. Negotiated Rate	$1,230.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$473.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,230.97
Rate for Payer: Aetna Government	$1,230.97
Rate for Payer: Brighton Health Commercial	$516.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$430.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$494.50
Rate for Payer: EmblemHealth Commercial	$430.00
Rate for Payer: Fidelis Medicare Advantage	$903.00
Rate for Payer: Group Health Inc Commercial	$430.00
Rate for Payer: Group Health Inc Medicare	$301.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$559.00

ZZ SPLIT CATH III 14F X 36CM

Facility

$860.00

Service Code	HCPCS C1886
Hospital Charge Code	41561881
Hospital Revenue Code	278
Min. Negotiated Rate	$301.00
Max. Negotiated Rate	$1,230.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$473.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,230.97
Rate for Payer: Aetna Government	$1,230.97
Rate for Payer: Brighton Health Commercial	$516.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$430.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$494.50
Rate for Payer: EmblemHealth Commercial	$430.00
Rate for Payer: Fidelis Medicare Advantage	$903.00
Rate for Payer: Group Health Inc Commercial	$430.00
Rate for Payer: Group Health Inc Medicare	$301.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$559.00

ZZ SPLIT CATH III 14F X 36CM

Facility

$860.00

Service Code	HCPCS C1886
Hospital Charge Code	41561881
Hospital Revenue Code	278
Min. Negotiated Rate	$430.00
Max. Negotiated Rate	$430.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00

ZZ SPLIT CATH III 14F X 55CM

Facility

$860.00

Service Code	HCPCS C1886
Hospital Charge Code	41561882
Hospital Revenue Code	278
Min. Negotiated Rate	$301.00
Max. Negotiated Rate	$1,230.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$473.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,230.97
Rate for Payer: Aetna Government	$1,230.97
Rate for Payer: Brighton Health Commercial	$516.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$430.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$494.50
Rate for Payer: EmblemHealth Commercial	$430.00
Rate for Payer: Fidelis Medicare Advantage	$903.00
Rate for Payer: Group Health Inc Commercial	$430.00
Rate for Payer: Group Health Inc Medicare	$301.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$559.00

ZZ SPLIT CATH III 14F X 55CM

Facility

$860.00

Service Code	HCPCS C1886
Hospital Charge Code	41561882
Hospital Revenue Code	278
Min. Negotiated Rate	$430.00
Max. Negotiated Rate	$430.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00

ZZ STANDARD COILS 35 4 3

Facility

$117.30

Service Code	HCPCS C1884
Hospital Charge Code	41567138
Hospital Revenue Code	278
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$58.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.65
Rate for Payer: Hamaspik Choice Inc Medicare	$58.65

ZZ STANDARD COILS 35 4 3

Facility

$117.30

Service Code	HCPCS C1884
Hospital Charge Code	41567138
Hospital Revenue Code	278
Min. Negotiated Rate	$41.06
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Brighton Health Commercial	$70.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$67.45
Rate for Payer: EmblemHealth Commercial	$58.65
Rate for Payer: Fidelis Medicare Advantage	$123.16
Rate for Payer: Group Health Inc Commercial	$58.65
Rate for Payer: Group Health Inc Medicare	$41.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.65
Rate for Payer: Hamaspik Choice Inc Medicare	$58.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$76.24

Know your out-of-pocket cost for care.

All Charges