St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

GUIDE WIRE ORTHOPEDIC 2.8MM DIA

Facility

$87.50

Service Code	HCPCS C1769
Hospital Charge Code	64904762
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

GUIDE WIRE ORTHOPEDIC 2.8MM DIA

Facility

$87.50

Service Code	HCPCS C1769
Hospital Charge Code	64904762
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 ORTHOPEDIC 2MM DIA 15

Facility

$96.00

Service Code	HCPCS C1769
Hospital Charge Code	64904702
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$100.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$57.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.20
Rate for Payer: EmblemHealth Commercial	$48.00
Rate for Payer: Fidelis Medicare Advantage	$100.80
Rate for Payer: Group Health Inc Commercial	$48.00
Rate for Payer: Group Health Inc Medicare	$33.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.00
Rate for Payer: Hamaspik Choice Inc Medicare	$48.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$62.40

GUIDE WIRE ORTHOPEDIC 2MM DIA 15

Facility

$96.00

Service Code	HCPCS C1769
Hospital Charge Code	64904702
Hospital Revenue Code	278
Min. Negotiated Rate	$48.00
Max. Negotiated Rate	$48.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.00
Rate for Payer: Hamaspik Choice Inc Medicare	$48.00

GUIDE WIRE ORTHOPEDIC 3.2 DIA X

Facility

$228.75

Service Code	HCPCS C1769
Hospital Charge Code	64905985
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$240.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$125.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$137.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$114.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$131.53
Rate for Payer: EmblemHealth Commercial	$114.38
Rate for Payer: Fidelis Medicare Advantage	$240.19
Rate for Payer: Group Health Inc Commercial	$114.38
Rate for Payer: Group Health Inc Medicare	$80.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.38
Rate for Payer: Hamaspik Choice Inc Medicare	$114.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$148.69

GUIDE WIRE ORTHOPEDIC 3.2 DIA X

Facility

$228.75

Service Code	HCPCS C1769
Hospital Charge Code	64905985
Hospital Revenue Code	278
Min. Negotiated Rate	$114.38
Max. Negotiated Rate	$114.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.38
Rate for Payer: Hamaspik Choice Inc Medicare	$114.38

GUIDE WIRE ORTHOPEDIC 3.2MM DIA

Facility

$82.50

Service Code	HCPCS C1769
Hospital Charge Code	64904529
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$86.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$49.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.44
Rate for Payer: EmblemHealth Commercial	$41.25
Rate for Payer: Fidelis Medicare Advantage	$86.62
Rate for Payer: Group Health Inc Commercial	$41.25
Rate for Payer: Group Health Inc Medicare	$28.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.25
Rate for Payer: Hamaspik Choice Inc Medicare	$41.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$53.62

GUIDE WIRE ORTHOPEDIC 3.2MM DIA

Facility

$82.50

Service Code	HCPCS C1769
Hospital Charge Code	64905118
Hospital Revenue Code	278
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.25
Rate for Payer: Hamaspik Choice Inc Medicare	$41.25

GUIDE WIRE ORTHOPEDIC 3.2MM DIA

Facility

$82.50

Service Code	HCPCS C1769
Hospital Charge Code	64905118
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$86.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$49.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.44
Rate for Payer: EmblemHealth Commercial	$41.25
Rate for Payer: Fidelis Medicare Advantage	$86.62
Rate for Payer: Group Health Inc Commercial	$41.25
Rate for Payer: Group Health Inc Medicare	$28.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.25
Rate for Payer: Hamaspik Choice Inc Medicare	$41.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$53.62

GUIDE WIRE ORTHOPEDIC 3.2MM DIA

Facility

$82.50

Service Code	HCPCS C1769
Hospital Charge Code	64904529
Hospital Revenue Code	278
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.25
Rate for Payer: Hamaspik Choice Inc Medicare	$41.25

GUIDE WIRE SENSOR.035 DU-DLX ANG

Facility

$199.60

Hospital Charge Code	40200814
Hospital Revenue Code	270
Min. Negotiated Rate	$69.86
Max. Negotiated Rate	$159.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$109.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$99.80
Rate for Payer: Aetna Government	$99.80
Rate for Payer: Brighton Health Commercial	$149.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$159.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$135.73
Rate for Payer: Group Health Inc Commercial	$99.80
Rate for Payer: Group Health Inc Medicare	$69.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.80
Rate for Payer: Hamaspik Choice Inc Medicare	$99.80

GUIDE WIRE SENSOR.035 DU-FLX ANG

Facility

$134.15

Service Code	HCPCS C1769
Hospital Charge Code	64904212
Hospital Revenue Code	278
Min. Negotiated Rate	$67.08
Max. Negotiated Rate	$67.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.08
Rate for Payer: Hamaspik Choice Inc Medicare	$67.08

GUIDE WIRE SENSOR.035 DU-FLX ANG

Facility

$134.15

Service Code	HCPCS C1769
Hospital Charge Code	64904212
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$140.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$73.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$80.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$67.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.14
Rate for Payer: EmblemHealth Commercial	$67.08
Rate for Payer: Fidelis Medicare Advantage	$140.86
Rate for Payer: Group Health Inc Commercial	$67.08
Rate for Payer: Group Health Inc Medicare	$46.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.08
Rate for Payer: Hamaspik Choice Inc Medicare	$67.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$87.20

GUIDE WIRE SENSOR ST 038/3CM FLEX

Facility

$114.40

Hospital Charge Code	40200815
Hospital Revenue Code	270
Min. Negotiated Rate	$40.04
Max. Negotiated Rate	$91.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$57.20
Rate for Payer: Aetna Government	$57.20
Rate for Payer: Brighton Health Commercial	$85.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$91.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.79
Rate for Payer: Group Health Inc Commercial	$57.20
Rate for Payer: Group Health Inc Medicare	$40.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.20
Rate for Payer: Hamaspik Choice Inc Medicare	$57.20

GUIDE WIRE SENSOR ST 038/3CMFLEX

Facility

$116.47

Service Code	HCPCS C1769
Hospital Charge Code	64903910
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$122.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$69.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$66.97
Rate for Payer: EmblemHealth Commercial	$58.24
Rate for Payer: Fidelis Medicare Advantage	$122.29
Rate for Payer: Group Health Inc Commercial	$58.24
Rate for Payer: Group Health Inc Medicare	$40.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.24
Rate for Payer: Hamaspik Choice Inc Medicare	$58.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$75.71

GUIDE WIRE SENSOR ST 038/3CMFLEX

Facility

$116.47

Service Code	HCPCS C1769
Hospital Charge Code	64903910
Hospital Revenue Code	278
Min. Negotiated Rate	$58.24
Max. Negotiated Rate	$58.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.24
Rate for Payer: Hamaspik Choice Inc Medicare	$58.24

GUIDEWIRE SGW-200SD

Facility

$235.00

Hospital Charge Code	40200211
Hospital Revenue Code	270
Min. Negotiated Rate	$82.25
Max. Negotiated Rate	$188.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$129.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$117.50
Rate for Payer: Aetna Government	$117.50
Rate for Payer: Brighton Health Commercial	$176.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$188.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$159.80
Rate for Payer: Group Health Inc Commercial	$117.50
Rate for Payer: Group Health Inc Medicare	$82.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$117.50
Rate for Payer: Hamaspik Choice Inc Medicare	$117.50

GUIDEWIRE SHARP

Facility

$123.73

Service Code	HCPCS C1769
Hospital Charge Code	64906183
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$129.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$68.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$74.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$61.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$71.14
Rate for Payer: EmblemHealth Commercial	$61.86
Rate for Payer: Fidelis Medicare Advantage	$129.92
Rate for Payer: Group Health Inc Commercial	$61.86
Rate for Payer: Group Health Inc Medicare	$43.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.86
Rate for Payer: Hamaspik Choice Inc Medicare	$61.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$80.42

GUIDEWIRE SHARP

Facility

$123.73

Service Code	HCPCS C1769
Hospital Charge Code	64906183
Hospital Revenue Code	278
Min. Negotiated Rate	$61.86
Max. Negotiated Rate	$61.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.86
Rate for Payer: Hamaspik Choice Inc Medicare	$61.86

GUIDEWIRE,SMOOTH-TIPPED STERILE

Facility

$236.00

Service Code	HCPCS C1769
Hospital Charge Code	40201352
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

GUIDEWIRE,SMOOTH-TIPPED STERILE

Facility

$236.00

Service Code	HCPCS C1769
Hospital Charge Code	40201352
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

GUIDEWIRE STRAIGHT 3CM

Facility

$119.60

Service Code	HCPCS C1769
Hospital Charge Code	40200991
Hospital Revenue Code	278
Min. Negotiated Rate	$59.80
Max. Negotiated Rate	$59.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.80
Rate for Payer: Hamaspik Choice Inc Medicare	$59.80

GUIDEWIRE STRAIGHT 3CM

Facility

$119.60

Service Code	HCPCS C1769
Hospital Charge Code	40200991
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$125.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$65.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$71.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$59.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.77
Rate for Payer: EmblemHealth Commercial	$59.80
Rate for Payer: Fidelis Medicare Advantage	$125.58
Rate for Payer: Group Health Inc Commercial	$59.80
Rate for Payer: Group Health Inc Medicare	$41.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.80
Rate for Payer: Hamaspik Choice Inc Medicare	$59.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$77.74

GUIDEWIRE SUP STIF 035/260 ANG TP

Facility

$272.00

Service Code	HCPCS C1769
Hospital Charge Code	64906252
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$285.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$149.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$163.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$136.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$156.40
Rate for Payer: EmblemHealth Commercial	$136.00
Rate for Payer: Fidelis Medicare Advantage	$285.60
Rate for Payer: Group Health Inc Commercial	$136.00
Rate for Payer: Group Health Inc Medicare	$95.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$136.00
Rate for Payer: Hamaspik Choice Inc Medicare	$136.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$176.80

GUIDEWIRE SUP STIF 035/260 ANG TP

Facility

$272.00

Service Code	HCPCS C1769
Hospital Charge Code	64906252
Hospital Revenue Code	278
Min. Negotiated Rate	$136.00
Max. Negotiated Rate	$136.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$136.00
Rate for Payer: Hamaspik Choice Inc Medicare	$136.00

Know your out-of-pocket cost for care.

All Charges