St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SP VENOUS PRT RMV

Facility

$1,909.65

Service Code	HCPCS 36590 TC
Hospital Charge Code	41549848
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,852.05

SP VENOUS PRT RMV

Facility

$1,909.65

Service Code	HCPCS 36590 TC
Hospital Charge Code	41549848
Hospital Revenue Code	361
Min. Negotiated Rate	$668.38
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,050.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$954.82
Rate for Payer: Aetna Government	$954.82
Rate for Payer: Brighton Health Commercial	$1,432.24
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	$954.82
Rate for Payer: Group Health Inc Medicare	$668.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.82
Rate for Payer: Hamaspik Choice Inc Medicare	$954.82

SP VENOUS PUNCTURE >1ST

Facility

$2,363.06

Service Code	HCPCS 36012 TC
Hospital Charge Code	41542688
Hospital Revenue Code	361
Min. Negotiated Rate	$827.07
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,299.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,181.53
Rate for Payer: Aetna Government	$1,181.53
Rate for Payer: Brighton Health Commercial	$1,772.30
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	$1,181.53
Rate for Payer: Group Health Inc Medicare	$827.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,181.53
Rate for Payer: Hamaspik Choice Inc Medicare	$1,181.53

SP VENOUS PUNCTURE 1ST

Facility

$2,814.83

Service Code	HCPCS 36011 TC
Hospital Charge Code	41542687
Hospital Revenue Code	361
Min. Negotiated Rate	$985.19
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,548.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,407.42
Rate for Payer: Aetna Government	$1,407.42
Rate for Payer: Brighton Health Commercial	$2,111.12
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	$1,407.42
Rate for Payer: Group Health Inc Medicare	$985.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,407.42
Rate for Payer: Hamaspik Choice Inc Medicare	$1,407.42

SP VEN PORT > 5 YRS OLD

Facility

$8,393.53

Service Code	HCPCS 36571 TC
Hospital Charge Code	41549842
Hospital Revenue Code	361
Rate for Payer: Cash Price	$3,686.08

SP VEN PORT > 5 YRS OLD

Facility

$8,393.53

Service Code	HCPCS 36571 TC
Hospital Charge Code	41549842
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$6,295.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,616.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,196.76
Rate for Payer: Aetna Government	$4,196.76
Rate for Payer: Brighton Health Commercial	$6,295.15
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
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	$4,196.76
Rate for Payer: Group Health Inc Medicare	$2,937.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.76
Rate for Payer: Hamaspik Choice Inc Medicare	$4,196.76

SP VERTEB AUG LUMBAR

Facility

$18,618.83

Service Code	HCPCS 22514 TC
Hospital Charge Code	41543554
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$13,964.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10,240.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9,309.42
Rate for Payer: Aetna Government	$9,309.42
Rate for Payer: Brighton Health Commercial	$13,964.12
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Cash Price	$8,273.12
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	$9,309.42
Rate for Payer: Group Health Inc Medicare	$6,516.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,309.42
Rate for Payer: Hamaspik Choice Inc Medicare	$9,309.42

SP VERTEB AUG LUMBAR

Facility

$18,618.83

Service Code	HCPCS 22514 TC
Hospital Charge Code	41543554
Hospital Revenue Code	361
Rate for Payer: Cash Price	$8,273.12

SP VERTEB AUGMENT EACH ADDL

Facility

$13,964.12

Service Code	HCPCS 22515 TC
Hospital Charge Code	41543555
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$10,473.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7,680.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,982.06
Rate for Payer: Aetna Government	$6,982.06
Rate for Payer: Brighton Health Commercial	$10,473.09
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	$6,982.06
Rate for Payer: Group Health Inc Medicare	$4,887.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,982.06
Rate for Payer: Hamaspik Choice Inc Medicare	$6,982.06

SP VERTEB AUG THORACIC

Facility

$18,618.83

Service Code	HCPCS 22513 TC
Hospital Charge Code	41543553
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$13,964.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10,240.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9,309.42
Rate for Payer: Aetna Government	$9,309.42
Rate for Payer: Brighton Health Commercial	$13,964.12
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Cash Price	$8,273.12
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	$9,309.42
Rate for Payer: Group Health Inc Medicare	$6,516.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,309.42
Rate for Payer: Hamaspik Choice Inc Medicare	$9,309.42

SP VERTEB AUG THORACIC

Facility

$18,618.83

Service Code	HCPCS 22513 TC
Hospital Charge Code	41543553
Hospital Revenue Code	361
Rate for Payer: Cash Price	$8,273.12

SP VERTEB LUMBOSACRAL INJ

Facility

$8,291.05

Service Code	HCPCS 22511 TC
Hospital Charge Code	41543551
Hospital Revenue Code	361
Rate for Payer: Cash Price	$3,743.15

SP VERTEB LUMBOSACRAL INJ

Facility

$8,291.05

Service Code	HCPCS 22511 TC
Hospital Charge Code	41543551
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$6,218.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,560.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,145.52
Rate for Payer: Aetna Government	$4,145.52
Rate for Payer: Brighton Health Commercial	$6,218.29
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
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	$4,145.52
Rate for Payer: Group Health Inc Medicare	$2,901.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,145.52
Rate for Payer: Hamaspik Choice Inc Medicare	$4,145.52

SP VERTEBROPLASTY ADDL INJ

Facility

$1,957.50

Service Code	HCPCS 22512 TC
Hospital Charge Code	41543552
Hospital Revenue Code	361
Min. Negotiated Rate	$685.12
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,076.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$978.75
Rate for Payer: Aetna Government	$978.75
Rate for Payer: Brighton Health Commercial	$1,468.12
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	$978.75
Rate for Payer: Group Health Inc Medicare	$685.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$978.75
Rate for Payer: Hamaspik Choice Inc Medicare	$978.75

SP VISC TRANSLUMBAR

Facility

$5,248.77

Service Code	HCPCS 0235T
Hospital Charge Code	41542764
Hospital Revenue Code	361
Min. Negotiated Rate	$1,837.07
Max. Negotiated Rate	$3,936.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,886.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,162.54
Rate for Payer: Aetna Government	$2,162.54
Rate for Payer: Brighton Health Commercial	$3,936.58
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	$2,624.38
Rate for Payer: Group Health Inc Medicare	$1,837.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,624.38
Rate for Payer: Hamaspik Choice Inc Medicare	$2,624.38

SP WHITAKER TEST

Facility

$1,685.60

Service Code	HCPCS 50396 TC
Hospital Charge Code	41547455
Hospital Revenue Code	361
Rate for Payer: Cash Price	$789.96

SP WHITAKER TEST

Facility

$1,685.60

Service Code	HCPCS 50396 TC
Hospital Charge Code	41547455
Hospital Revenue Code	361
Min. Negotiated Rate	$589.96
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$927.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$842.80
Rate for Payer: Aetna Government	$842.80
Rate for Payer: Brighton Health Commercial	$1,264.20
Rate for Payer: Cash Price	$789.96
Rate for Payer: Cash Price	$789.96
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	$842.80
Rate for Payer: Group Health Inc Medicare	$589.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$842.80
Rate for Payer: Hamaspik Choice Inc Medicare	$842.80

SP WRIST ARTHOGRAM

Facility

$525.71

Service Code	HCPCS 25246 TC
Hospital Charge Code	41561910
Hospital Revenue Code	361
Min. Negotiated Rate	$184.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$289.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$262.86
Rate for Payer: Aetna Government	$262.86
Rate for Payer: Brighton Health Commercial	$394.28
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	$262.86
Rate for Payer: Group Health Inc Medicare	$184.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.86
Rate for Payer: Hamaspik Choice Inc Medicare	$262.86

SQ/IM INJECTION

Facility

$183.15

Service Code	HCPCS 96372
Hospital Charge Code	40509905
Hospital Revenue Code	269
Rate for Payer: Cash Price	$81.46

SQ/IM INJECTION

Facility

$183.15

Service Code	HCPCS 96372
Hospital Charge Code	40509905
Hospital Revenue Code	269
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$1,336.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$100.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$81.46
Rate for Payer: Aetna Government	$81.46
Rate for Payer: Amida Care Medicaid	$13.36
Rate for Payer: Brighton Health Commercial	$137.36
Rate for Payer: Cash Price	$81.46
Rate for Payer: Cash Price	$81.46
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$81.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$146.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.54
Rate for Payer: Elderplan Medicare Advantage	$81.46
Rate for Payer: EmblemHealth Commercial	$81.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,336.00
Rate for Payer: Fidelis Essential Plan Aliesa	$13.36
Rate for Payer: Fidelis Essential Plan QHP	$13.36
Rate for Payer: Fidelis Medicare Advantage	$81.46
Rate for Payer: Fidelis Qualified Health Plan	$14.03
Rate for Payer: Group Health Inc Commercial	$81.46
Rate for Payer: Group Health Inc Medicare	$81.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.36
Rate for Payer: Hamaspik Choice Inc Medicare	$81.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$13.36
Rate for Payer: Healthfirst Essential Plan	$30.06
Rate for Payer: Healthfirst Medicare Advantage	$69.24
Rate for Payer: Healthfirst QHP	$13.36
Rate for Payer: Senior Whole Health Medicare Advantage	$81.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$13.36
Rate for Payer: SOMOS Essential	$13.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$81.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$65.17
Rate for Payer: Wellcare Medicare	$77.39

SQ LIVE YELLOW FEVER VACCINE

Facility

$358.63

Service Code	HCPCS 90717
Hospital Charge Code	30101238
Hospital Revenue Code	636
Min. Negotiated Rate	$179.32
Max. Negotiated Rate	$179.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.32
Rate for Payer: Hamaspik Choice Inc Medicare	$179.32

SQ LIVE YELLOW FEVER VACCINE

Facility

$358.63

Service Code	HCPCS 90717
Hospital Charge Code	30101238
Hospital Revenue Code	636
Min. Negotiated Rate	$125.52
Max. Negotiated Rate	$233.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$197.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$143.47
Rate for Payer: Aetna Government	$143.47
Rate for Payer: Brighton Health Commercial	$215.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$179.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$206.21
Rate for Payer: Group Health Inc Commercial	$179.32
Rate for Payer: Group Health Inc Medicare	$125.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.32
Rate for Payer: Hamaspik Choice Inc Medicare	$179.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$233.11

SREP S/N/A/G/TR/E, 20.1-30.0CM

Facility

$967.73

Service Code	HCPCS 12006
Hospital Charge Code	30103257
Hospital Revenue Code	450
Rate for Payer: Cash Price	$461.12

SREP S/N/A/G/TR/E, 20.1-30.0CM

Facility

$967.73

Service Code	HCPCS 12006
Hospital Charge Code	30103257
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$461.12
Rate for Payer: Aetna Government	$461.12
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$461.12
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$461.12
Rate for Payer: Cash Price	$461.12
Rate for Payer: Cash Price	$461.12
Rate for Payer: Cash Price	$461.12
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$461.12
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: Elderplan Medicare Advantage	$461.12
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$391.95
Rate for Payer: Fidelis Essential Plan QHP	$410.40
Rate for Payer: Fidelis Medicare Advantage	$461.12
Rate for Payer: Fidelis Qualified Health Plan	$410.40
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$483.86
Rate for Payer: Hamaspik Choice Inc Medicare	$461.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$461.12
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$461.12
Rate for Payer: Senior Whole Health Medicare Advantage	$461.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$461.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$368.90
Rate for Payer: Wellcare Medicare	$438.06

SREP S/N/A/G/TR/E, OVER 30CM

Facility

$529.23

Service Code	HCPCS 12007
Hospital Charge Code	30103258
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$231.52
Rate for Payer: Aetna Government	$231.52
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$231.52
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$231.52
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: Elderplan Medicare Advantage	$231.52
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$196.79
Rate for Payer: Fidelis Essential Plan QHP	$206.05
Rate for Payer: Fidelis Medicare Advantage	$231.52
Rate for Payer: Fidelis Qualified Health Plan	$206.05
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.62
Rate for Payer: Hamaspik Choice Inc Medicare	$231.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$231.52
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$231.52
Rate for Payer: Senior Whole Health Medicare Advantage	$231.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$231.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$185.22
Rate for Payer: Wellcare Medicare	$219.94

Know your out-of-pocket cost for care.

All Charges