St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZZ XCELA SINGLE PICC 5F

Facility

$210.00

Hospital Charge Code	41561937
Hospital Revenue Code	270
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$168.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$115.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$105.00
Rate for Payer: Aetna Government	$105.00
Rate for Payer: Brighton Health Commercial	$157.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$168.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$142.80
Rate for Payer: Group Health Inc Commercial	$105.00
Rate for Payer: Group Health Inc Medicare	$73.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.00
Rate for Payer: Hamaspik Choice Inc Medicare	$105.00

ZZ XPEEDIOR 135 CM

Facility

$2,847.05

Service Code	HCPCS C1769
Hospital Charge Code	41569774
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$2,989.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,565.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$1,708.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,423.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,637.05
Rate for Payer: EmblemHealth Commercial	$1,423.53
Rate for Payer: Fidelis Medicare Advantage	$2,989.40
Rate for Payer: Group Health Inc Commercial	$1,423.53
Rate for Payer: Group Health Inc Medicare	$996.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,423.53
Rate for Payer: Hamaspik Choice Inc Medicare	$1,423.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,850.58

ZZ XPEEDIOR 135 CM

Facility

$2,847.05

Service Code	HCPCS C1769
Hospital Charge Code	41569774
Hospital Revenue Code	278
Min. Negotiated Rate	$1,423.53
Max. Negotiated Rate	$1,423.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,423.53
Rate for Payer: Hamaspik Choice Inc Medicare	$1,423.53

ZZ XPEEDIOR 140 CM

Facility

$2,841.38

Service Code	HCPCS C1769
Hospital Charge Code	41569775
Hospital Revenue Code	278
Min. Negotiated Rate	$1,420.69
Max. Negotiated Rate	$1,420.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,420.69
Rate for Payer: Hamaspik Choice Inc Medicare	$1,420.69

ZZ XPEEDIOR 140 CM

Facility

$2,841.38

Service Code	HCPCS C1769
Hospital Charge Code	41569775
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$2,983.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,562.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$1,704.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,420.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,633.79
Rate for Payer: EmblemHealth Commercial	$1,420.69
Rate for Payer: Fidelis Medicare Advantage	$2,983.45
Rate for Payer: Group Health Inc Commercial	$1,420.69
Rate for Payer: Group Health Inc Medicare	$994.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,420.69
Rate for Payer: Hamaspik Choice Inc Medicare	$1,420.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,846.90

ZZ XXL BALOON 14-4/5.8/75

Facility

$961.78

Service Code	HCPCS C1725
Hospital Charge Code	41567276
Hospital Revenue Code	278
Min. Negotiated Rate	$480.89
Max. Negotiated Rate	$480.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$480.89
Rate for Payer: Hamaspik Choice Inc Medicare	$480.89

ZZ XXL BALOON 14-4/5.8/75

Facility

$961.78

Service Code	HCPCS C1725
Hospital Charge Code	41567276
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$1,009.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$528.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$577.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$480.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$553.02
Rate for Payer: EmblemHealth Commercial	$480.89
Rate for Payer: Fidelis Medicare Advantage	$1,009.87
Rate for Payer: Group Health Inc Commercial	$480.89
Rate for Payer: Group Health Inc Medicare	$336.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$480.89
Rate for Payer: Hamaspik Choice Inc Medicare	$480.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$625.16

ZZ XXL BALOON 16-4/5.8/75

Facility

$1,059.59

Service Code	HCPCS C1725
Hospital Charge Code	41567277
Hospital Revenue Code	278
Min. Negotiated Rate	$529.79
Max. Negotiated Rate	$529.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$529.79
Rate for Payer: Hamaspik Choice Inc Medicare	$529.79

ZZ XXL BALOON 16-4/5.8/75

Facility

$1,059.59

Service Code	HCPCS C1725
Hospital Charge Code	41567277
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$1,112.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$582.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$635.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$529.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$609.26
Rate for Payer: EmblemHealth Commercial	$529.79
Rate for Payer: Fidelis Medicare Advantage	$1,112.57
Rate for Payer: Group Health Inc Commercial	$529.79
Rate for Payer: Group Health Inc Medicare	$370.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$529.79
Rate for Payer: Hamaspik Choice Inc Medicare	$529.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$688.73

Know your out-of-pocket cost for care.