St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE THREADED 1.35MM 894338

Facility

$40.00

Service Code	HCPCS C1769
Hospital Charge Code	64906591
Hospital Revenue Code	278
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$20.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.00
Rate for Payer: Hamaspik Choice Inc Medicare	$20.00

GUIDEWIRE THREADED 1.35MM 894338

Facility

$40.00

Service Code	HCPCS C1769
Hospital Charge Code	64906591
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$42.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$24.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.00
Rate for Payer: EmblemHealth Commercial	$20.00
Rate for Payer: Fidelis Medicare Advantage	$42.00
Rate for Payer: Group Health Inc Commercial	$20.00
Rate for Payer: Group Health Inc Medicare	$14.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.00
Rate for Payer: Hamaspik Choice Inc Medicare	$20.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.00

GUIDEWIRE TIP TROCAR .045

Facility

$44.00

Service Code	HCPCS C1769
Hospital Charge Code	64906903
Hospital Revenue Code	278
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$22.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.00
Rate for Payer: Hamaspik Choice Inc Medicare	$22.00

GUIDEWIRE TIP TROCAR .045

Facility

$44.00

Service Code	HCPCS C1769
Hospital Charge Code	64906903
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$46.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$26.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.30
Rate for Payer: EmblemHealth Commercial	$22.00
Rate for Payer: Fidelis Medicare Advantage	$46.20
Rate for Payer: Group Health Inc Commercial	$22.00
Rate for Payer: Group Health Inc Medicare	$15.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.00
Rate for Payer: Hamaspik Choice Inc Medicare	$22.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.60

GUIDE WIRE UNIGLIDE HYDROPHILIC

Facility

$87.50

Service Code	HCPCS C1769
Hospital Charge Code	64904940
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 UNIGLIDE HYDROPHILIC

Facility

$87.50

Service Code	HCPCS C1769
Hospital Charge Code	64904940
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 UNTHREADED 1.4 150MM

Facility

$582.50

Service Code	HCPCS C1769
Hospital Charge Code	64906009
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$611.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$320.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$349.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$291.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$334.94
Rate for Payer: EmblemHealth Commercial	$291.25
Rate for Payer: Fidelis Medicare Advantage	$611.62
Rate for Payer: Group Health Inc Commercial	$291.25
Rate for Payer: Group Health Inc Medicare	$203.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$291.25
Rate for Payer: Hamaspik Choice Inc Medicare	$291.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$378.62

GUIDE WIRE UNTHREADED 1.4 150MM

Facility

$582.50

Service Code	HCPCS C1769
Hospital Charge Code	64906009
Hospital Revenue Code	278
Min. Negotiated Rate	$291.25
Max. Negotiated Rate	$291.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$291.25
Rate for Payer: Hamaspik Choice Inc Medicare	$291.25

GUIDE WIRE UNTHREADED 2.0MM X 15

Facility

$317.50

Service Code	HCPCS C1769
Hospital Charge Code	64906006
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$333.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$174.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$190.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$158.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$182.56
Rate for Payer: EmblemHealth Commercial	$158.75
Rate for Payer: Fidelis Medicare Advantage	$333.38
Rate for Payer: Group Health Inc Commercial	$158.75
Rate for Payer: Group Health Inc Medicare	$111.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$158.75
Rate for Payer: Hamaspik Choice Inc Medicare	$158.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$206.38

GUIDE WIRE UNTHREADED 2.0MM X 15

Facility

$317.50

Service Code	HCPCS C1769
Hospital Charge Code	64906006
Hospital Revenue Code	278
Min. Negotiated Rate	$158.75
Max. Negotiated Rate	$158.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$158.75
Rate for Payer: Hamaspik Choice Inc Medicare	$158.75

GUIDE WIRE VASC 0.035IN DIA

Facility

$72.10

Service Code	HCPCS C1769
Hospital Charge Code	64903584
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$75.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$43.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$41.46
Rate for Payer: EmblemHealth Commercial	$36.05
Rate for Payer: Fidelis Medicare Advantage	$75.70
Rate for Payer: Group Health Inc Commercial	$36.05
Rate for Payer: Group Health Inc Medicare	$25.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.05
Rate for Payer: Hamaspik Choice Inc Medicare	$36.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.86

GUIDE WIRE VASC 0.035IN DIA

Facility

$72.10

Service Code	HCPCS C1769
Hospital Charge Code	64903584
Hospital Revenue Code	278
Min. Negotiated Rate	$36.05
Max. Negotiated Rate	$36.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.05
Rate for Payer: Hamaspik Choice Inc Medicare	$36.05

GUIDEWIRE VASC .035 260CM

Facility

$1,312.50

Service Code	HCPCS C1769
Hospital Charge Code	64906166
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$1,378.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$721.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$787.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$656.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$754.69
Rate for Payer: EmblemHealth Commercial	$656.25
Rate for Payer: Fidelis Medicare Advantage	$1,378.12
Rate for Payer: Group Health Inc Commercial	$656.25
Rate for Payer: Group Health Inc Medicare	$459.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$656.25
Rate for Payer: Hamaspik Choice Inc Medicare	$656.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$853.12

GUIDEWIRE VASC .035 260CM

Facility

$1,312.50

Service Code	HCPCS C1769
Hospital Charge Code	64906166
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$656.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$656.25
Rate for Payer: Hamaspik Choice Inc Medicare	$656.25

GUIDEWRE VASC 300V14TPER

Facility

$215.31

Service Code	HCPCS C1769
Hospital Charge Code	64906324
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$226.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$118.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$129.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$107.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$123.80
Rate for Payer: EmblemHealth Commercial	$107.66
Rate for Payer: Fidelis Medicare Advantage	$226.08
Rate for Payer: Group Health Inc Commercial	$107.66
Rate for Payer: Group Health Inc Medicare	$75.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.66
Rate for Payer: Hamaspik Choice Inc Medicare	$107.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$139.95

GUIDEWRE VASC 300V14TPER

Facility

$215.31

Service Code	HCPCS C1769
Hospital Charge Code	64906324
Hospital Revenue Code	278
Min. Negotiated Rate	$107.66
Max. Negotiated Rate	$107.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.66
Rate for Payer: Hamaspik Choice Inc Medicare	$107.66

GUN MENISCAL DEPLOYMENT

Facility

$570.00

Hospital Charge Code	64904832
Hospital Revenue Code	270
Min. Negotiated Rate	$199.50
Max. Negotiated Rate	$456.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$313.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$285.00
Rate for Payer: Aetna Government	$285.00
Rate for Payer: Brighton Health Commercial	$427.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$456.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$387.60
Rate for Payer: Group Health Inc Commercial	$285.00
Rate for Payer: Group Health Inc Medicare	$199.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$285.00
Rate for Payer: Hamaspik Choice Inc Medicare	$285.00

G U SOUNDS (RU)

Facility

$57.76

Hospital Charge Code	40207813
Hospital Revenue Code	270
Min. Negotiated Rate	$20.22
Max. Negotiated Rate	$46.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.88
Rate for Payer: Aetna Government	$28.88
Rate for Payer: Brighton Health Commercial	$43.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.28
Rate for Payer: Group Health Inc Commercial	$28.88
Rate for Payer: Group Health Inc Medicare	$20.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.88
Rate for Payer: Hamaspik Choice Inc Medicare	$28.88

GYNECARE INTER ABSORB BARRIER

Facility

$480.00

Service Code	HCPCS C1762
Hospital Charge Code	40205523
Hospital Revenue Code	278
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$240.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$240.00
Rate for Payer: Hamaspik Choice Inc Medicare	$240.00

GYNECARE INTER ABSORB BARRIER

Facility

$480.00

Service Code	HCPCS C1762
Hospital Charge Code	40205523
Hospital Revenue Code	278
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$1,879.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$264.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,879.82
Rate for Payer: Aetna Government	$1,879.82
Rate for Payer: Brighton Health Commercial	$288.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$240.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$276.00
Rate for Payer: EmblemHealth Commercial	$240.00
Rate for Payer: Fidelis Medicare Advantage	$504.00
Rate for Payer: Group Health Inc Commercial	$240.00
Rate for Payer: Group Health Inc Medicare	$168.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$240.00
Rate for Payer: Hamaspik Choice Inc Medicare	$240.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$312.00

GYNECARE INTERCEED 3INX4IN

Facility

$480.00

Service Code	HCPCS C1762
Hospital Charge Code	40203007
Hospital Revenue Code	278
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$240.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$240.00
Rate for Payer: Hamaspik Choice Inc Medicare	$240.00

GYNECARE INTERCEED 3INX4IN

Facility

$480.00

Service Code	HCPCS C1762
Hospital Charge Code	40203007
Hospital Revenue Code	278
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$1,879.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$264.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,879.82
Rate for Payer: Aetna Government	$1,879.82
Rate for Payer: Brighton Health Commercial	$288.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$240.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$276.00
Rate for Payer: EmblemHealth Commercial	$240.00
Rate for Payer: Fidelis Medicare Advantage	$504.00
Rate for Payer: Group Health Inc Commercial	$240.00
Rate for Payer: Group Health Inc Medicare	$168.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$240.00
Rate for Payer: Hamaspik Choice Inc Medicare	$240.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$312.00

GYNECARE TVT DEVICE

Facility

$1,890.00

Hospital Charge Code	40200485
Hospital Revenue Code	270
Min. Negotiated Rate	$661.50
Max. Negotiated Rate	$1,512.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,039.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$945.00
Rate for Payer: Aetna Government	$945.00
Rate for Payer: Brighton Health Commercial	$1,417.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,512.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,285.20
Rate for Payer: Group Health Inc Commercial	$945.00
Rate for Payer: Group Health Inc Medicare	$661.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$945.00
Rate for Payer: Hamaspik Choice Inc Medicare	$945.00

GYPSONA HP, LPL2, XFAST PLASTER

Facility

$2.93

Hospital Charge Code	64901916
Hospital Revenue Code	270
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$2.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.46
Rate for Payer: Aetna Government	$1.46
Rate for Payer: Brighton Health Commercial	$2.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.99
Rate for Payer: Group Health Inc Commercial	$1.46
Rate for Payer: Group Health Inc Medicare	$1.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.46
Rate for Payer: Hamaspik Choice Inc Medicare	$1.46

GYRUS ACMI VACU 10MM CURVED RIGID

Facility

$94.00

Hospital Charge Code	40200468
Hospital Revenue Code	270
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$75.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.00
Rate for Payer: Aetna Government	$47.00
Rate for Payer: Brighton Health Commercial	$70.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$75.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$63.92
Rate for Payer: Group Health Inc Commercial	$47.00
Rate for Payer: Group Health Inc Medicare	$32.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.00
Rate for Payer: Hamaspik Choice Inc Medicare	$47.00

Know your out-of-pocket cost for care.

All Charges