St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SP CHANGE INT/EXT N-U

Facility

$5,365.58

Service Code	HCPCS 50387 TC
Hospital Charge Code	41548032
Hospital Revenue Code	361
Min. Negotiated Rate	$1,877.95
Max. Negotiated Rate	$4,024.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,951.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,682.79
Rate for Payer: Aetna Government	$2,682.79
Rate for Payer: Brighton Health Commercial	$4,024.18
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$2,682.79
Rate for Payer: Group Health Inc Medicare	$1,877.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,682.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2,682.79

SP CHANGE INT/EXT N-U

Facility

$5,365.58

Service Code	HCPCS 50387 TC
Hospital Charge Code	41548032
Hospital Revenue Code	361
Rate for Payer: Cash Price	$2,355.42

SP CHANGE URETEROSTOMY CATH

Facility

$5,365.58

Service Code	HCPCS 50688 TC
Hospital Charge Code	41547639
Hospital Revenue Code	361
Rate for Payer: Cash Price	$2,355.42

SP CHANGE URETEROSTOMY CATH

Facility

$5,365.58

Service Code	HCPCS 50688 TC
Hospital Charge Code	41547639
Hospital Revenue Code	361
Min. Negotiated Rate	$1,877.95
Max. Negotiated Rate	$4,024.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,951.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,682.79
Rate for Payer: Aetna Government	$2,682.79
Rate for Payer: Brighton Health Commercial	$4,024.18
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$2,682.79
Rate for Payer: Group Health Inc Medicare	$1,877.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,682.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2,682.79

SP CHANGE URTRLSTNT 1/EA/CONDUIT

Facility

$5,365.58

Service Code	HCPCS 50688 TC
Hospital Charge Code	41548034
Hospital Revenue Code	361
Min. Negotiated Rate	$1,877.95
Max. Negotiated Rate	$4,024.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,951.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,682.79
Rate for Payer: Aetna Government	$2,682.79
Rate for Payer: Brighton Health Commercial	$4,024.18
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$2,682.79
Rate for Payer: Group Health Inc Medicare	$1,877.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,682.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2,682.79

SP CHANGE URTRLSTNT 1/EA/CONDUIT

Facility

$5,365.58

Service Code	HCPCS 50688 TC
Hospital Charge Code	41548034
Hospital Revenue Code	361
Rate for Payer: Cash Price	$2,355.42

SP CHEMOTHERAPY IA ADMINISRATION

Facility

$937.70

Service Code	HCPCS 96420 TC
Hospital Charge Code	41547638
Hospital Revenue Code	331
Rate for Payer: Cash Price	$391.64

SP CHEMOTHERAPY IA ADMINISRATION

Facility

$937.70

Service Code	HCPCS 96420 TC
Hospital Charge Code	41547638
Hospital Revenue Code	331
Min. Negotiated Rate	$279.92
Max. Negotiated Rate	$703.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$515.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$468.85
Rate for Payer: Aetna Government	$468.85
Rate for Payer: Brighton Health Commercial	$703.28
Rate for Payer: Cash Price	$391.64
Rate for Payer: Cash Price	$391.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$644.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$547.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$279.92
Rate for Payer: Fidelis Essential Plan Aliesa	$279.92
Rate for Payer: Fidelis Essential Plan QHP	$294.00
Rate for Payer: Fidelis Qualified Health Plan	$294.00
Rate for Payer: Group Health Inc Commercial	$468.85
Rate for Payer: Group Health Inc Medicare	$328.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$468.85
Rate for Payer: Hamaspik Choice Inc Medicare	$468.85

SP CHEST TUBE ABSCESS HEMOTHORAX

Facility

$4,940.28

Service Code	HCPCS 32551 TC
Hospital Charge Code	41561811
Hospital Revenue Code	361
Min. Negotiated Rate	$1,729.10
Max. Negotiated Rate	$3,705.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,717.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,470.14
Rate for Payer: Aetna Government	$2,470.14
Rate for Payer: Brighton Health Commercial	$3,705.21
Rate for Payer: Cash Price	$1,852.05
Rate for Payer: Cash Price	$1,852.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$2,470.14
Rate for Payer: Group Health Inc Medicare	$1,729.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.14
Rate for Payer: Hamaspik Choice Inc Medicare	$2,470.14

SP CHEST TUBE ABSCESS HEMOTHORAX

Facility

$4,940.28

Service Code	HCPCS 32551 TC
Hospital Charge Code	41561811
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,852.05

SP CHOLEDOCHAL STENT PLACE.

Facility

$2,807.50

Service Code	HCPCS 47801 TC
Hospital Charge Code	41547452
Hospital Revenue Code	361
Min. Negotiated Rate	$982.62
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,544.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,403.75
Rate for Payer: Aetna Government	$1,403.75
Rate for Payer: Brighton Health Commercial	$2,105.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$1,403.75
Rate for Payer: Group Health Inc Medicare	$982.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,403.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,403.75

SP COMMON CARTID ARTY CATHER UNI

Facility

$13,920.70

Service Code	HCPCS 36223 TC
Hospital Charge Code	41103009
Hospital Revenue Code	329
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$10,440.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7,656.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,960.35
Rate for Payer: Aetna Government	$6,960.35
Rate for Payer: Brighton Health Commercial	$10,440.52
Rate for Payer: Cash Price	$6,354.94
Rate for Payer: Cash Price	$6,354.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$6,960.35
Rate for Payer: Group Health Inc Medicare	$4,872.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,960.35
Rate for Payer: Hamaspik Choice Inc Medicare	$6,960.35

SP COMMON CARTID ARTY CATHER UNI

Facility

$13,920.70

Service Code	HCPCS 36223 TC
Hospital Charge Code	41103009
Hospital Revenue Code	329
Rate for Payer: Cash Price	$6,354.94

SP COMMON FEMORAL, INSILATERAL

Facility

$1,475.15

Service Code	HCPCS 36140 TC
Hospital Charge Code	41542826
Hospital Revenue Code	361
Min. Negotiated Rate	$516.30
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$811.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$737.58
Rate for Payer: Aetna Government	$737.58
Rate for Payer: Brighton Health Commercial	$1,106.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$737.58
Rate for Payer: Group Health Inc Medicare	$516.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$737.58
Rate for Payer: Hamaspik Choice Inc Medicare	$737.58

SP COMPLETE PENILE

Facility

$339.45

Service Code	HCPCS 93980 TC
Hospital Charge Code	41201176
Hospital Revenue Code	920
Min. Negotiated Rate	$118.81
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.72
Rate for Payer: Aetna Government	$169.72
Rate for Payer: Brighton Health Commercial	$254.59
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Group Health Inc Commercial	$169.72
Rate for Payer: Group Health Inc Medicare	$118.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72

SP COMPLETE PENILE

Facility

$339.45

Service Code	HCPCS 93980 TC
Hospital Charge Code	41201176
Hospital Revenue Code	920
Rate for Payer: Cash Price	$127.14

SP COMP REN/MESE/POR ABD

Facility

$705.83

Service Code	HCPCS 93975 TC
Hospital Charge Code	41201172
Hospital Revenue Code	920
Min. Negotiated Rate	$247.04
Max. Negotiated Rate	$564.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$388.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$352.92
Rate for Payer: Aetna Government	$352.92
Rate for Payer: Brighton Health Commercial	$529.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.96
Rate for Payer: Group Health Inc Commercial	$352.92
Rate for Payer: Group Health Inc Medicare	$247.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.92
Rate for Payer: Hamaspik Choice Inc Medicare	$352.92

SP COMP REN/MESE/POR ABD

Facility

$705.83

Service Code	HCPCS 93975 TC
Hospital Charge Code	41201172
Hospital Revenue Code	920
Rate for Payer: Cash Price	$283.37

SP CONSC. SEDAT. AGE<5 1ST 30 MIN

Facility

$84.10

Service Code	HCPCS 99151 TC
Hospital Charge Code	41548613
Hospital Revenue Code	372
Min. Negotiated Rate	$29.44
Max. Negotiated Rate	$67.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.05
Rate for Payer: Aetna Government	$42.05
Rate for Payer: Brighton Health Commercial	$63.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$67.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.19
Rate for Payer: Group Health Inc Commercial	$42.05
Rate for Payer: Group Health Inc Medicare	$29.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.05
Rate for Payer: Hamaspik Choice Inc Medicare	$42.05

SP CONSC. SEDAT. AGE<5 1ST 30 MIN

Facility

$4,157.25

Service Code	HCPCS 99143
Hospital Charge Code	30102476
Hospital Revenue Code	370
Min. Negotiated Rate	$1,455.04
Max. Negotiated Rate	$3,325.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,286.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,078.62
Rate for Payer: Aetna Government	$2,078.62
Rate for Payer: Brighton Health Commercial	$3,117.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,325.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,826.93
Rate for Payer: Group Health Inc Commercial	$2,078.62
Rate for Payer: Group Health Inc Medicare	$1,455.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.62
Rate for Payer: Hamaspik Choice Inc Medicare	$2,078.62

SP CONSC. SEDAT. AGE>5 1ST 30 MIN

Facility

$792.83

Service Code	HCPCS 99144
Hospital Charge Code	30102472
Hospital Revenue Code	370
Min. Negotiated Rate	$277.49
Max. Negotiated Rate	$634.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$436.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$396.42
Rate for Payer: Aetna Government	$396.42
Rate for Payer: Brighton Health Commercial	$594.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$634.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$539.12
Rate for Payer: Group Health Inc Commercial	$396.42
Rate for Payer: Group Health Inc Medicare	$277.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.42
Rate for Payer: Hamaspik Choice Inc Medicare	$396.42

SP CONSC. SEDAT. AGE>5 1ST 30 MIN

Facility

$84.10

Service Code	HCPCS 99152 TC
Hospital Charge Code	41548612
Hospital Revenue Code	370
Min. Negotiated Rate	$29.44
Max. Negotiated Rate	$67.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.05
Rate for Payer: Aetna Government	$42.05
Rate for Payer: Brighton Health Commercial	$63.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$67.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.19
Rate for Payer: Group Health Inc Commercial	$42.05
Rate for Payer: Group Health Inc Medicare	$29.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.05
Rate for Payer: Hamaspik Choice Inc Medicare	$42.05

SP CONSC. SEDAT. EACH ADD'L 15MIN

Facility

$42.05

Service Code	HCPCS 99153 TC
Hospital Charge Code	41548614
Hospital Revenue Code	370
Min. Negotiated Rate	$14.72
Max. Negotiated Rate	$33.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.02
Rate for Payer: Aetna Government	$21.02
Rate for Payer: Brighton Health Commercial	$31.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.59
Rate for Payer: Group Health Inc Commercial	$21.02
Rate for Payer: Group Health Inc Medicare	$14.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.02
Rate for Payer: Hamaspik Choice Inc Medicare	$21.02

SP CONSC. SEDAT. EACH ADD'L 15MIN

Facility

$4,157.25

Service Code	HCPCS 99145
Hospital Charge Code	30102477
Hospital Revenue Code	370
Min. Negotiated Rate	$1,455.04
Max. Negotiated Rate	$3,325.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,286.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,078.62
Rate for Payer: Aetna Government	$2,078.62
Rate for Payer: Brighton Health Commercial	$3,117.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,325.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,826.93
Rate for Payer: Group Health Inc Commercial	$2,078.62
Rate for Payer: Group Health Inc Medicare	$1,455.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.62
Rate for Payer: Hamaspik Choice Inc Medicare	$2,078.62

SP CONTRAST INJ CK VEN ACCESS

Facility

$556.50

Service Code	HCPCS 36598 TC
Hospital Charge Code	41548029
Hospital Revenue Code	361
Min. Negotiated Rate	$194.78
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$278.25
Rate for Payer: Aetna Government	$278.25
Rate for Payer: Brighton Health Commercial	$417.38
Rate for Payer: Cash Price	$247.87
Rate for Payer: Cash Price	$247.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$278.25
Rate for Payer: Group Health Inc Medicare	$194.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.25
Rate for Payer: Hamaspik Choice Inc Medicare	$278.25

Know your out-of-pocket cost for care.

All Charges