St. Barnabas Hospital

All Charges

Charge

Type

Price

CATH ULTRA .018 5MMX100MMX75CM

Facility OP

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	40004774
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$287.50
Rate for Payer: Fidelis Medicare Advantage	$525.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$325.00

CATH ULTRA .018 5MMX4MMX75CM

Facility IP

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	40004773
Hospital Revenue Code	278
Min. Negotiated Rate	$250.00
Max. Negotiated Rate	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

CATH ULTRA .018 5MMX4MMX75CM

Facility OP

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	40004773
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$287.50
Rate for Payer: Fidelis Medicare Advantage	$525.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$325.00

CATH ULTRA .018 6MMX100MMX130CM

Facility OP

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	40004777
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$287.50
Rate for Payer: Fidelis Medicare Advantage	$525.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$325.00

CATH ULTRA .018 6MMX100MMX130CM

Facility IP

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	40004777
Hospital Revenue Code	278
Min. Negotiated Rate	$250.00
Max. Negotiated Rate	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

CATH ULTRA .018 6MMX100MMX75CM

Facility OP

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	40004780
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$287.50
Rate for Payer: Fidelis Medicare Advantage	$525.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$325.00

CATH ULTRA .018 6MMX100MMX75CM

Facility IP

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	40004780
Hospital Revenue Code	278
Min. Negotiated Rate	$250.00
Max. Negotiated Rate	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

CATH ULTRA .018 6MMX220MMX130CM

Facility OP

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	40004778
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$287.50
Rate for Payer: Fidelis Medicare Advantage	$525.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$325.00

CATH ULTRA .018 6MMX220MMX130CM

Facility IP

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	40004778
Hospital Revenue Code	278
Min. Negotiated Rate	$250.00
Max. Negotiated Rate	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

CATH ULTRA .018 6MMX220MMX75CM

Facility IP

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	40004781
Hospital Revenue Code	278
Min. Negotiated Rate	$250.00
Max. Negotiated Rate	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

CATH ULTRA .018 6MMX220MMX75CM

Facility OP

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	40004781
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$287.50
Rate for Payer: Fidelis Medicare Advantage	$525.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$325.00

CATH ULTRA .018 6MMX4MMX130CM

Facility OP

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	40004776
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$287.50
Rate for Payer: Fidelis Medicare Advantage	$525.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$325.00

CATH ULTRA .018 6MMX4MMX130CM

Facility IP

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	40004776
Hospital Revenue Code	278
Min. Negotiated Rate	$250.00
Max. Negotiated Rate	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

CATH ULTRA .018 6MMX4MMX75CM

Facility IP

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	40004779
Hospital Revenue Code	278
Min. Negotiated Rate	$250.00
Max. Negotiated Rate	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

CATH ULTRA .018 6MMX4MMX75CM

Facility OP

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	40004779
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$287.50
Rate for Payer: Fidelis Medicare Advantage	$525.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$325.00

CATH ULTRA .035 7MMX100MMX75CM

Facility OP

$806.00

Service Code	HCPCS C1725
Hospital Charge Code	40004783
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$846.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$443.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$403.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$463.45
Rate for Payer: Fidelis Medicare Advantage	$846.30
Rate for Payer: Group Health Inc Commercial	$403.00
Rate for Payer: Group Health Inc Medicare	$282.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$403.00
Rate for Payer: Hamaspik Choice Inc Medicare	$403.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$523.90

CATH ULTRA .035 7MMX100MMX75CM

Facility IP

$806.00

Service Code	HCPCS C1725
Hospital Charge Code	40004783
Hospital Revenue Code	278
Min. Negotiated Rate	$403.00
Max. Negotiated Rate	$403.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$403.00
Rate for Payer: Hamaspik Choice Inc Medicare	$403.00

CATH ULTRA .035 7MMX200MMX75CM

Facility OP

$806.00

Service Code	HCPCS C1725
Hospital Charge Code	40004784
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$846.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$443.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$403.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$463.45
Rate for Payer: Fidelis Medicare Advantage	$846.30
Rate for Payer: Group Health Inc Commercial	$403.00
Rate for Payer: Group Health Inc Medicare	$282.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$403.00
Rate for Payer: Hamaspik Choice Inc Medicare	$403.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$523.90

CATH ULTRA .035 7MMX200MMX75CM

Facility IP

$806.00

Service Code	HCPCS C1725
Hospital Charge Code	40004784
Hospital Revenue Code	278
Min. Negotiated Rate	$403.00
Max. Negotiated Rate	$403.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$403.00
Rate for Payer: Hamaspik Choice Inc Medicare	$403.00

CATH ULTRA .035 7MMX4MMX75CM

Facility IP

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	40004782
Hospital Revenue Code	278
Min. Negotiated Rate	$250.00
Max. Negotiated Rate	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

CATH ULTRA .035 7MMX4MMX75CM

Facility OP

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	40004782
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$287.50
Rate for Payer: Fidelis Medicare Advantage	$525.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$325.00

CATH ULTV .018 5 X 100 X 75CM

Facility OP

$625.00

Hospital Charge Code	64906186
Hospital Revenue Code	279
Min. Negotiated Rate	$218.75
Max. Negotiated Rate	$500.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$343.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$312.50
Rate for Payer: Aetna Government	$312.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$425.00
Rate for Payer: Group Health Inc Commercial	$312.50
Rate for Payer: Group Health Inc Medicare	$218.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$312.50
Rate for Payer: Hamaspik Choice Inc Medicare	$312.50

CATH ULTV .018 5 X 220 X 75CM

Facility OP

$625.00

Hospital Charge Code	64906187
Hospital Revenue Code	279
Min. Negotiated Rate	$218.75
Max. Negotiated Rate	$500.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$343.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$312.50
Rate for Payer: Aetna Government	$312.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$425.00
Rate for Payer: Group Health Inc Commercial	$312.50
Rate for Payer: Group Health Inc Medicare	$218.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$312.50
Rate for Payer: Hamaspik Choice Inc Medicare	$312.50

CATH ULTV .018 5 X 4 X 75CM

Facility OP

$625.00

Hospital Charge Code	64906185
Hospital Revenue Code	279
Min. Negotiated Rate	$218.75
Max. Negotiated Rate	$500.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$343.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$312.50
Rate for Payer: Aetna Government	$312.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$425.00
Rate for Payer: Group Health Inc Commercial	$312.50
Rate for Payer: Group Health Inc Medicare	$218.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$312.50
Rate for Payer: Hamaspik Choice Inc Medicare	$312.50

CATH ULTV .018 6 X 100 X 130CM

Facility OP

$625.00

Hospital Charge Code	64906189
Hospital Revenue Code	279
Min. Negotiated Rate	$218.75
Max. Negotiated Rate	$500.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$343.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$312.50
Rate for Payer: Aetna Government	$312.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$425.00
Rate for Payer: Group Health Inc Commercial	$312.50
Rate for Payer: Group Health Inc Medicare	$218.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$312.50
Rate for Payer: Hamaspik Choice Inc Medicare	$312.50

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All Charges