St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE

Facility

$223.75

Service Code	HCPCS C1769
Hospital Charge Code	64904582
Hospital Revenue Code	278
Min. Negotiated Rate	$111.88
Max. Negotiated Rate	$111.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.88
Rate for Payer: Hamaspik Choice Inc Medicare	$111.88

GUIDEWIRE

Facility

$312.50

Service Code	HCPCS C1769
Hospital Charge Code	40203081
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$328.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$171.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$187.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$156.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$179.69
Rate for Payer: EmblemHealth Commercial	$156.25
Rate for Payer: Fidelis Medicare Advantage	$328.12
Rate for Payer: Group Health Inc Commercial	$156.25
Rate for Payer: Group Health Inc Medicare	$109.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.25
Rate for Payer: Hamaspik Choice Inc Medicare	$156.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$203.12

GUIDEWIRE .035X150 STR TERUMO

Facility

$62.00

Service Code	HCPCS C1769
Hospital Charge Code	40206062
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$65.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$37.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.65
Rate for Payer: EmblemHealth Commercial	$31.00
Rate for Payer: Fidelis Medicare Advantage	$65.10
Rate for Payer: Group Health Inc Commercial	$31.00
Rate for Payer: Group Health Inc Medicare	$21.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.00
Rate for Payer: Hamaspik Choice Inc Medicare	$31.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$40.30

GUIDEWIRE .035X150 STR TERUMO

Facility

$62.00

Service Code	HCPCS C1769
Hospital Charge Code	40206062
Hospital Revenue Code	278
Min. Negotiated Rate	$31.00
Max. Negotiated Rate	$31.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.00
Rate for Payer: Hamaspik Choice Inc Medicare	$31.00

GUIDEWIRE .035X180 ANG TERUMO

Facility

$62.00

Service Code	HCPCS C1769
Hospital Charge Code	40206063
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$65.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$37.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.65
Rate for Payer: EmblemHealth Commercial	$31.00
Rate for Payer: Fidelis Medicare Advantage	$65.10
Rate for Payer: Group Health Inc Commercial	$31.00
Rate for Payer: Group Health Inc Medicare	$21.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.00
Rate for Payer: Hamaspik Choice Inc Medicare	$31.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$40.30

GUIDEWIRE .035X180 ANG TERUMO

Facility

$62.00

Service Code	HCPCS C1769
Hospital Charge Code	40206063
Hospital Revenue Code	278
Min. Negotiated Rate	$31.00
Max. Negotiated Rate	$31.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.00
Rate for Payer: Hamaspik Choice Inc Medicare	$31.00

GUIDE WIRE .062 X 7

Facility

$115.00

Service Code	HCPCS C1769
Hospital Charge Code	40004888
Hospital Revenue Code	272
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$92.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$63.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$86.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$92.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$78.20
Rate for Payer: Group Health Inc Commercial	$57.50
Rate for Payer: Group Health Inc Medicare	$40.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.50
Rate for Payer: Hamaspik Choice Inc Medicare	$57.50

GUIDEWIRE 12GM TIP .014

Facility

$150.00

Service Code	HCPCS C1769
Hospital Charge Code	64906797
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$157.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$90.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$75.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.25
Rate for Payer: EmblemHealth Commercial	$75.00
Rate for Payer: Fidelis Medicare Advantage	$157.50
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$97.50

GUIDEWIRE 12GM TIP .014

Facility

$150.00

Service Code	HCPCS C1769
Hospital Charge Code	64906797
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

GUIDEWIRE 12GM TIP .018

Facility

$150.00

Service Code	HCPCS C1769
Hospital Charge Code	64906798
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

GUIDEWIRE 12GM TIP .018

Facility

$150.00

Service Code	HCPCS C1769
Hospital Charge Code	64906798
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$157.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$90.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$75.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.25
Rate for Payer: EmblemHealth Commercial	$75.00
Rate for Payer: Fidelis Medicare Advantage	$157.50
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$97.50

GUIDE WIRE 1.6MM

Facility

$65.00

Service Code	HCPCS C1769
Hospital Charge Code	64905880
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

GUIDE WIRE 1.6MM

Facility

$65.00

Service Code	HCPCS C1769
Hospital Charge Code	64905880
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$68.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$39.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: EmblemHealth Commercial	$32.50
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

GUIDEWIRE 30GM TIP .014

Facility

$150.00

Service Code	HCPCS C1769
Hospital Charge Code	64906799
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$157.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$90.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$75.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.25
Rate for Payer: EmblemHealth Commercial	$75.00
Rate for Payer: Fidelis Medicare Advantage	$157.50
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$97.50

GUIDEWIRE 30GM TIP .014

Facility

$150.00

Service Code	HCPCS C1769
Hospital Charge Code	64906799
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

GUIDEWIRE 30GM TIP .018

Facility

$150.00

Service Code	HCPCS C1769
Hospital Charge Code	64906800
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$157.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$90.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$75.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.25
Rate for Payer: EmblemHealth Commercial	$75.00
Rate for Payer: Fidelis Medicare Advantage	$157.50
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$97.50

GUIDEWIRE 30GM TIP .018

Facility

$150.00

Service Code	HCPCS C1769
Hospital Charge Code	64906800
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

GUIDEWIRE 45 ANG .46X180CMX3

Facility

$269.00

Service Code	HCPCS C1769
Hospital Charge Code	40008274
Hospital Revenue Code	272
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$215.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$147.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$201.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$215.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$182.92
Rate for Payer: Group Health Inc Commercial	$134.50
Rate for Payer: Group Health Inc Medicare	$94.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.50
Rate for Payer: Hamaspik Choice Inc Medicare	$134.50

GUIDEWIRE 45 ANG .46X180X3CM

Facility

$269.00

Service Code	HCPCS C1769
Hospital Charge Code	40008293
Hospital Revenue Code	272
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$215.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$147.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$201.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$215.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$182.92
Rate for Payer: Group Health Inc Commercial	$134.50
Rate for Payer: Group Health Inc Medicare	$94.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.50
Rate for Payer: Hamaspik Choice Inc Medicare	$134.50

GUIDEWIRE AMPLATZ SUPER STIFF

Facility

$280.00

Hospital Charge Code	40200883
Hospital Revenue Code	270
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$224.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$154.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$140.00
Rate for Payer: Aetna Government	$140.00
Rate for Payer: Brighton Health Commercial	$210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$224.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$190.40
Rate for Payer: Group Health Inc Commercial	$140.00
Rate for Payer: Group Health Inc Medicare	$98.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.00
Rate for Payer: Hamaspik Choice Inc Medicare	$140.00

GUIDEWIRE ANGLED .038

Facility

$460.00

Service Code	HCPCS C1769
Hospital Charge Code	40200884
Hospital Revenue Code	278
Min. Negotiated Rate	$230.00
Max. Negotiated Rate	$230.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$230.00
Rate for Payer: Hamaspik Choice Inc Medicare	$230.00

GUIDEWIRE ANGLED .038

Facility

$460.00

Service Code	HCPCS C1769
Hospital Charge Code	40200884
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$483.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$253.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$276.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$230.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$264.50
Rate for Payer: EmblemHealth Commercial	$230.00
Rate for Payer: Fidelis Medicare Advantage	$483.00
Rate for Payer: Group Health Inc Commercial	$230.00
Rate for Payer: Group Health Inc Medicare	$161.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$230.00
Rate for Payer: Hamaspik Choice Inc Medicare	$230.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$299.00

GUIDE WIRE BALL TIP 3 X 1000

Facility

$146.00

Service Code	HCPCS C1769
Hospital Charge Code	40201348
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$153.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$87.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$73.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$83.95
Rate for Payer: EmblemHealth Commercial	$73.00
Rate for Payer: Fidelis Medicare Advantage	$153.30
Rate for Payer: Group Health Inc Commercial	$73.00
Rate for Payer: Group Health Inc Medicare	$51.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.00
Rate for Payer: Hamaspik Choice Inc Medicare	$73.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$94.90

GUIDE WIRE BALL TIP 3 X 1000

Facility

$146.00

Service Code	HCPCS C1769
Hospital Charge Code	40201348
Hospital Revenue Code	278
Min. Negotiated Rate	$73.00
Max. Negotiated Rate	$73.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.00
Rate for Payer: Hamaspik Choice Inc Medicare	$73.00

GUIDEWIRE,BALL-TIPPED,3X800 MM

Facility

$215.00

Service Code	HCPCS C1769
Hospital Charge Code	40201351
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$225.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$118.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$129.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$107.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$123.62
Rate for Payer: EmblemHealth Commercial	$107.50
Rate for Payer: Fidelis Medicare Advantage	$225.75
Rate for Payer: Group Health Inc Commercial	$107.50
Rate for Payer: Group Health Inc Medicare	$75.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.50
Rate for Payer: Hamaspik Choice Inc Medicare	$107.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$139.75

Know your out-of-pocket cost for care.

All Charges