St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

GUIDE WIRE LC .035 X 6

Facility

$87.50

Service Code	HCPCS C1769
Hospital Charge Code	64906054
Hospital Revenue Code	278
Min. Negotiated Rate	$43.75
Max. Negotiated Rate	$43.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.75
Rate for Payer: Hamaspik Choice Inc Medicare	$43.75

GUIDE WIRE LUNDERQUIST EX-STIFF

Facility

$242.50

Service Code	HCPCS C1769
Hospital Charge Code	64903903
Hospital Revenue Code	278
Min. Negotiated Rate	$121.25
Max. Negotiated Rate	$121.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$121.25
Rate for Payer: Hamaspik Choice Inc Medicare	$121.25

GUIDE WIRE LUNDERQUIST EX-STIFF

Facility

$242.50

Service Code	HCPCS C1769
Hospital Charge Code	64903903
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$254.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$133.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$145.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$121.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$139.44
Rate for Payer: EmblemHealth Commercial	$121.25
Rate for Payer: Fidelis Medicare Advantage	$254.62
Rate for Payer: Group Health Inc Commercial	$121.25
Rate for Payer: Group Health Inc Medicare	$84.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$121.25
Rate for Payer: Hamaspik Choice Inc Medicare	$121.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$157.62

GUIDE WIRE NON-THR 4 X 0.045

Facility

$112.50

Service Code	HCPCS C1769
Hospital Charge Code	64906056
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.25
Rate for Payer: Hamaspik Choice Inc Medicare	$56.25

GUIDE WIRE NON-THR 4 X 0.045

Facility

$112.50

Service Code	HCPCS C1769
Hospital Charge Code	64906056
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$118.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$67.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$64.69
Rate for Payer: EmblemHealth Commercial	$56.25
Rate for Payer: Fidelis Medicare Advantage	$118.12
Rate for Payer: Group Health Inc Commercial	$56.25
Rate for Payer: Group Health Inc Medicare	$39.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.25
Rate for Payer: Hamaspik Choice Inc Medicare	$56.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$73.12

GUIDE WIRE ORTHO 0.091IN DI

Facility

$97.50

Service Code	HCPCS C1769
Hospital Charge Code	64906024
Hospital Revenue Code	278
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$48.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.75
Rate for Payer: Hamaspik Choice Inc Medicare	$48.75

GUIDE WIRE ORTHO 0.091IN DI

Facility

$97.50

Service Code	HCPCS C1769
Hospital Charge Code	64906024
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$102.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$58.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$56.06
Rate for Payer: EmblemHealth Commercial	$48.75
Rate for Payer: Fidelis Medicare Advantage	$102.38
Rate for Payer: Group Health Inc Commercial	$48.75
Rate for Payer: Group Health Inc Medicare	$34.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.75
Rate for Payer: Hamaspik Choice Inc Medicare	$48.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$63.38

GUIDE WIRE ORTHO 2.2MM DIA

Facility

$335.00

Service Code	HCPCS C1769
Hospital Charge Code	64904484
Hospital Revenue Code	278
Min. Negotiated Rate	$167.50
Max. Negotiated Rate	$167.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$167.50
Rate for Payer: Hamaspik Choice Inc Medicare	$167.50

GUIDE WIRE ORTHO 2.2MM DIA

Facility

$335.00

Service Code	HCPCS C1769
Hospital Charge Code	64904484
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$351.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$184.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$201.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$167.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$192.62
Rate for Payer: EmblemHealth Commercial	$167.50
Rate for Payer: Fidelis Medicare Advantage	$351.75
Rate for Payer: Group Health Inc Commercial	$167.50
Rate for Payer: Group Health Inc Medicare	$117.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$167.50
Rate for Payer: Hamaspik Choice Inc Medicare	$167.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$217.75

GUIDE WIRE ORTHO 2.5MM DIA

Facility

$335.00

Service Code	HCPCS C1769
Hospital Charge Code	64904482
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$351.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$184.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$201.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$167.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$192.62
Rate for Payer: EmblemHealth Commercial	$167.50
Rate for Payer: Fidelis Medicare Advantage	$351.75
Rate for Payer: Group Health Inc Commercial	$167.50
Rate for Payer: Group Health Inc Medicare	$117.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$167.50
Rate for Payer: Hamaspik Choice Inc Medicare	$167.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$217.75

GUIDE WIRE ORTHO 2.5MM DIA

Facility

$335.00

Service Code	HCPCS C1769
Hospital Charge Code	64904482
Hospital Revenue Code	278
Min. Negotiated Rate	$167.50
Max. Negotiated Rate	$167.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$167.50
Rate for Payer: Hamaspik Choice Inc Medicare	$167.50

GUIDEWIRE ORTHO 3.2 X 300MM

Facility

$251.13

Service Code	HCPCS C1769
Hospital Charge Code	64906174
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$263.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$138.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$150.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$125.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.40
Rate for Payer: EmblemHealth Commercial	$125.56
Rate for Payer: Fidelis Medicare Advantage	$263.69
Rate for Payer: Group Health Inc Commercial	$125.56
Rate for Payer: Group Health Inc Medicare	$87.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.56
Rate for Payer: Hamaspik Choice Inc Medicare	$125.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$163.23

GUIDEWIRE ORTHO 3.2 X 300MM

Facility

$251.13

Service Code	HCPCS C1769
Hospital Charge Code	64906174
Hospital Revenue Code	278
Min. Negotiated Rate	$125.56
Max. Negotiated Rate	$125.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.56
Rate for Payer: Hamaspik Choice Inc Medicare	$125.56

GUIDE WIRE ORTHO 3MM DIA 10

Facility

$356.25

Service Code	HCPCS C1769
Hospital Charge Code	64904052
Hospital Revenue Code	278
Min. Negotiated Rate	$178.12
Max. Negotiated Rate	$178.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$178.12
Rate for Payer: Hamaspik Choice Inc Medicare	$178.12

GUIDE WIRE ORTHO 3MM DIA 10

Facility

$356.25

Service Code	HCPCS C1769
Hospital Charge Code	64904052
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$374.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$195.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$213.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$178.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$204.84
Rate for Payer: EmblemHealth Commercial	$178.12
Rate for Payer: Fidelis Medicare Advantage	$374.06
Rate for Payer: Group Health Inc Commercial	$178.12
Rate for Payer: Group Health Inc Medicare	$124.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$178.12
Rate for Payer: Hamaspik Choice Inc Medicare	$178.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$231.56

GUIDE WIRE ORTHO 3MM DIA 80 A

Facility

$335.00

Service Code	HCPCS C1769
Hospital Charge Code	64904050
Hospital Revenue Code	278
Min. Negotiated Rate	$167.50
Max. Negotiated Rate	$167.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$167.50
Rate for Payer: Hamaspik Choice Inc Medicare	$167.50

GUIDE WIRE ORTHO 3MM DIA 80 A

Facility

$335.00

Service Code	HCPCS C1769
Hospital Charge Code	64904050
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$351.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$184.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$201.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$167.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$192.62
Rate for Payer: EmblemHealth Commercial	$167.50
Rate for Payer: Fidelis Medicare Advantage	$351.75
Rate for Payer: Group Health Inc Commercial	$167.50
Rate for Payer: Group Health Inc Medicare	$117.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$167.50
Rate for Payer: Hamaspik Choice Inc Medicare	$167.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$217.75

GUIDE WIRE ORTHO 3MM DIA 80 B

Facility

$335.00

Service Code	HCPCS C1769
Hospital Charge Code	64904423
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$351.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$184.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$201.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$167.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$192.62
Rate for Payer: EmblemHealth Commercial	$167.50
Rate for Payer: Fidelis Medicare Advantage	$351.75
Rate for Payer: Group Health Inc Commercial	$167.50
Rate for Payer: Group Health Inc Medicare	$117.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$167.50
Rate for Payer: Hamaspik Choice Inc Medicare	$167.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$217.75

GUIDE WIRE ORTHO 3MM DIA 80 B

Facility

$335.00

Service Code	HCPCS C1769
Hospital Charge Code	64904423
Hospital Revenue Code	278
Min. Negotiated Rate	$167.50
Max. Negotiated Rate	$167.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$167.50
Rate for Payer: Hamaspik Choice Inc Medicare	$167.50

GUIDE WIRE ORTHO KIRSCHNER

Facility

$125.00

Service Code	HCPCS C1769
Hospital Charge Code	64905552
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 ORTHO KIRSCHNER

Facility

$125.00

Service Code	HCPCS C1769
Hospital Charge Code	64905552
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

GUIDE WIRE ORTHOPEDIC 1.4MM DIA

Facility

$187.50

Service Code	HCPCS C1769
Hospital Charge Code	64904478
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$196.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$103.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$112.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$93.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$107.81
Rate for Payer: EmblemHealth Commercial	$93.75
Rate for Payer: Fidelis Medicare Advantage	$196.88
Rate for Payer: Group Health Inc Commercial	$93.75
Rate for Payer: Group Health Inc Medicare	$65.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$93.75
Rate for Payer: Hamaspik Choice Inc Medicare	$93.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$121.88

GUIDE WIRE ORTHOPEDIC 1.4MM DIA

Facility

$187.50

Service Code	HCPCS C1769
Hospital Charge Code	64904478
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$93.75
Rate for Payer: Hamaspik Choice Inc Medicare	$93.75

GUIDE WIRE ORTHOPEDIC 1.4MM DIA

Facility

$12.50

Service Code	HCPCS C1769
Hospital Charge Code	64904496
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$13.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$7.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.19
Rate for Payer: EmblemHealth Commercial	$6.25
Rate for Payer: Fidelis Medicare Advantage	$13.12
Rate for Payer: Group Health Inc Commercial	$6.25
Rate for Payer: Group Health Inc Medicare	$4.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.25
Rate for Payer: Hamaspik Choice Inc Medicare	$6.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.12

GUIDE WIRE ORTHOPEDIC 1.4MM DIA

Facility

$12.50

Service Code	HCPCS C1769
Hospital Charge Code	64904496
Hospital Revenue Code	278
Min. Negotiated Rate	$6.25
Max. Negotiated Rate	$6.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.25
Rate for Payer: Hamaspik Choice Inc Medicare	$6.25

Know your out-of-pocket cost for care.

All Charges