St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE,BALL-TIPPED,3X800 MM

Facility

$215.00

Service Code	HCPCS C1769
Hospital Charge Code	40201351
Hospital Revenue Code	278
Min. Negotiated Rate	$107.50
Max. Negotiated Rate	$107.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.50
Rate for Payer: Hamaspik Choice Inc Medicare	$107.50

GUIDE WIRE,BALL TIPPED STERILE

Facility

$236.00

Service Code	HCPCS C1769
Hospital Charge Code	40201350
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$247.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$129.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$141.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$118.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$135.70
Rate for Payer: EmblemHealth Commercial	$118.00
Rate for Payer: Fidelis Medicare Advantage	$247.80
Rate for Payer: Group Health Inc Commercial	$118.00
Rate for Payer: Group Health Inc Medicare	$82.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.00
Rate for Payer: Hamaspik Choice Inc Medicare	$118.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$153.40

GUIDE WIRE,BALL TIPPED STERILE

Facility

$236.00

Service Code	HCPCS C1769
Hospital Charge Code	40201350
Hospital Revenue Code	278
Min. Negotiated Rate	$118.00
Max. Negotiated Rate	$118.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.00
Rate for Payer: Hamaspik Choice Inc Medicare	$118.00

GUIDE WIRE BENTON .035 X 180

Facility

$40.26

Service Code	HCPCS C1769
Hospital Charge Code	64905910
Hospital Revenue Code	278
Min. Negotiated Rate	$20.13
Max. Negotiated Rate	$20.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.13
Rate for Payer: Hamaspik Choice Inc Medicare	$20.13

GUIDE WIRE BENTON .035 X 180

Facility

$40.26

Service Code	HCPCS C1769
Hospital Charge Code	64905910
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$42.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$24.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.15
Rate for Payer: EmblemHealth Commercial	$20.13
Rate for Payer: Fidelis Medicare Advantage	$42.27
Rate for Payer: Group Health Inc Commercial	$20.13
Rate for Payer: Group Health Inc Medicare	$14.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.13
Rate for Payer: Hamaspik Choice Inc Medicare	$20.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.17

GUIDEWIRE,BLL TIPPD GUID WIR3X800

Facility

$216.00

Service Code	HCPCS C1769
Hospital Charge Code	40201349
Hospital Revenue Code	278
Min. Negotiated Rate	$108.00
Max. Negotiated Rate	$108.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$108.00
Rate for Payer: Hamaspik Choice Inc Medicare	$108.00

GUIDEWIRE,BLL TIPPD GUID WIR3X800

Facility

$216.00

Service Code	HCPCS C1769
Hospital Charge Code	40201349
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$226.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$118.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$129.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$108.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.20
Rate for Payer: EmblemHealth Commercial	$108.00
Rate for Payer: Fidelis Medicare Advantage	$226.80
Rate for Payer: Group Health Inc Commercial	$108.00
Rate for Payer: Group Health Inc Medicare	$75.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$108.00
Rate for Payer: Hamaspik Choice Inc Medicare	$108.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$140.40

GUIDEWIRE DBL END .86MM

Facility

$60.00

Service Code	HCPCS C1769
Hospital Charge Code	64906902
Hospital Revenue Code	278
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.00
Rate for Payer: Hamaspik Choice Inc Medicare	$30.00

GUIDEWIRE DBL END .86MM

Facility

$60.00

Service Code	HCPCS C1769
Hospital Charge Code	64906902
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$63.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$36.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.50
Rate for Payer: EmblemHealth Commercial	$30.00
Rate for Payer: Fidelis Medicare Advantage	$63.00
Rate for Payer: Group Health Inc Commercial	$30.00
Rate for Payer: Group Health Inc Medicare	$21.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.00
Rate for Payer: Hamaspik Choice Inc Medicare	$30.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.00

GUIDE WIRE FIXO 1.4 X 100 M

Facility

$125.00

Service Code	HCPCS C1769
Hospital Charge Code	64906031
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$131.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$68.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$75.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$62.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$71.88
Rate for Payer: EmblemHealth Commercial	$62.50
Rate for Payer: Fidelis Medicare Advantage	$131.25
Rate for Payer: Group Health Inc Commercial	$62.50
Rate for Payer: Group Health Inc Medicare	$43.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.50
Rate for Payer: Hamaspik Choice Inc Medicare	$62.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$81.25

GUIDE WIRE FIXO 1.4 X 100 M

Facility

$125.00

Service Code	HCPCS C1769
Hospital Charge Code	64906031
Hospital Revenue Code	278
Min. Negotiated Rate	$62.50
Max. Negotiated Rate	$62.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.50
Rate for Payer: Hamaspik Choice Inc Medicare	$62.50

GUIDEWIRE FLEXIBLE TIP.038X150CM

Facility

$28.00

Hospital Charge Code	40200885
Hospital Revenue Code	270
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$22.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.00
Rate for Payer: Aetna Government	$14.00
Rate for Payer: Brighton Health Commercial	$21.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.04
Rate for Payer: Group Health Inc Commercial	$14.00
Rate for Payer: Group Health Inc Medicare	$9.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14.00

GUIDE WIRE GLIDEWIRE .025 STR

Facility

$589.70

Service Code	HCPCS C1769
Hospital Charge Code	64903147
Hospital Revenue Code	278
Min. Negotiated Rate	$294.85
Max. Negotiated Rate	$294.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$294.85
Rate for Payer: Hamaspik Choice Inc Medicare	$294.85

GUIDE WIRE GLIDEWIRE .025 STR

Facility

$589.70

Service Code	HCPCS C1769
Hospital Charge Code	64903147
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$619.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$324.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$353.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$294.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$339.08
Rate for Payer: EmblemHealth Commercial	$294.85
Rate for Payer: Fidelis Medicare Advantage	$619.18
Rate for Payer: Group Health Inc Commercial	$294.85
Rate for Payer: Group Health Inc Medicare	$206.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$294.85
Rate for Payer: Hamaspik Choice Inc Medicare	$294.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$383.30

GUIDE WIRE GLIDEWIRE .035 STR

Facility

$358.45

Service Code	HCPCS C1769
Hospital Charge Code	64903149
Hospital Revenue Code	278
Min. Negotiated Rate	$179.22
Max. Negotiated Rate	$179.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.22
Rate for Payer: Hamaspik Choice Inc Medicare	$179.22

GUIDE WIRE GLIDEWIRE .035 STR

Facility

$358.45

Service Code	HCPCS C1769
Hospital Charge Code	64903149
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$376.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$197.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$215.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$179.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$206.11
Rate for Payer: EmblemHealth Commercial	$179.22
Rate for Payer: Fidelis Medicare Advantage	$376.37
Rate for Payer: Group Health Inc Commercial	$179.22
Rate for Payer: Group Health Inc Medicare	$125.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.22
Rate for Payer: Hamaspik Choice Inc Medicare	$179.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$232.99

GUIDEWIRE GRND SLM .014 300CM

Facility

$105.00

Service Code	HCPCS C1725
Hospital Charge Code	64906255
Hospital Revenue Code	278
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$110.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$63.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$60.38
Rate for Payer: EmblemHealth Commercial	$52.50
Rate for Payer: Fidelis Medicare Advantage	$110.25
Rate for Payer: Group Health Inc Commercial	$52.50
Rate for Payer: Group Health Inc Medicare	$36.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$68.25

GUIDEWIRE GRND SLM .014 300CM

Facility

$105.00

Service Code	HCPCS C1725
Hospital Charge Code	64906255
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50

GUIDE WIRE HYDRO COATED

Facility

$76.75

Service Code	HCPCS C1769
Hospital Charge Code	64903625
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$80.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$46.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.13
Rate for Payer: EmblemHealth Commercial	$38.38
Rate for Payer: Fidelis Medicare Advantage	$80.59
Rate for Payer: Group Health Inc Commercial	$38.38
Rate for Payer: Group Health Inc Medicare	$26.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.38
Rate for Payer: Hamaspik Choice Inc Medicare	$38.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$49.89

GUIDE WIRE HYDRO COATED

Facility

$76.75

Service Code	HCPCS C1769
Hospital Charge Code	64903625
Hospital Revenue Code	278
Min. Negotiated Rate	$38.38
Max. Negotiated Rate	$38.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.38
Rate for Payer: Hamaspik Choice Inc Medicare	$38.38

GUIDE WIRE HYPROCURE

Facility

$37.50

Service Code	HCPCS C1769
Hospital Charge Code	64905953
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$39.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$22.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.56
Rate for Payer: EmblemHealth Commercial	$18.75
Rate for Payer: Fidelis Medicare Advantage	$39.38
Rate for Payer: Group Health Inc Commercial	$18.75
Rate for Payer: Group Health Inc Medicare	$13.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.75
Rate for Payer: Hamaspik Choice Inc Medicare	$18.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$24.38

GUIDE WIRE HYPROCURE

Facility

$37.50

Service Code	HCPCS C1769
Hospital Charge Code	64905953
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.75
Rate for Payer: Hamaspik Choice Inc Medicare	$18.75

GUIDE WIRE INTRODUCER ABBOTT

Facility

$6.00

Service Code	HCPCS C1769
Hospital Charge Code	66522095
Hospital Revenue Code	278
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00

GUIDE WIRE INTRODUCER ABBOTT

Facility

$6.00

Service Code	HCPCS C1769
Hospital Charge Code	66522095
Hospital Revenue Code	278
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$6.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$3.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.45
Rate for Payer: EmblemHealth Commercial	$3.00
Rate for Payer: Fidelis Medicare Advantage	$6.30
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

GUIDE WIRE LC .035 X 6

Facility

$87.50

Service Code	HCPCS C1769
Hospital Charge Code	64906054
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$91.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$52.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$43.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$50.31
Rate for Payer: EmblemHealth Commercial	$43.75
Rate for Payer: Fidelis Medicare Advantage	$91.88
Rate for Payer: Group Health Inc Commercial	$43.75
Rate for Payer: Group Health Inc Medicare	$30.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.75
Rate for Payer: Hamaspik Choice Inc Medicare	$43.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$56.88

Know your out-of-pocket cost for care.

All Charges