St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TC-99M PENTETATE

Facility

$7.35

Service Code	HCPCS A9539
Hospital Charge Code	41656576
Hospital Revenue Code	343
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$25.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.94
Rate for Payer: Aetna Government	$25.94
Rate for Payer: Brighton Health Commercial	$5.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.00
Rate for Payer: Group Health Inc Commercial	$3.68
Rate for Payer: Group Health Inc Medicare	$2.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.68
Rate for Payer: Hamaspik Choice Inc Medicare	$3.68

TC-99M PENTETATE AEROSOL

Facility

$6.12

Service Code	HCPCS A9567
Hospital Charge Code	41646577
Hospital Revenue Code	343
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.40
Rate for Payer: Aetna Government	$3.40
Rate for Payer: Brighton Health Commercial	$4.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.16
Rate for Payer: Group Health Inc Commercial	$3.06
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06

TC-99M PENTETATE AEROSOL

Facility

$6.12

Service Code	HCPCS A9567
Hospital Charge Code	41656577
Hospital Revenue Code	343
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.40
Rate for Payer: Aetna Government	$3.40
Rate for Payer: Brighton Health Commercial	$4.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.16
Rate for Payer: Group Health Inc Commercial	$3.06
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06

TCD EMBOLI DETCT W/INJ

Facility

$339.45

Service Code	HCPCS 93893 TC
Hospital Charge Code	41301523
Hospital Revenue Code	920
Rate for Payer: Cash Price	$127.14

TCD EMBOLI DETCT W/INJ

Facility

$339.45

Service Code	HCPCS 93893 TC
Hospital Charge Code	41301523
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

TCD EMBOLI DETECT W/O INJ

Facility

$339.45

Service Code	HCPCS 93892 TC
Hospital Charge Code	41301522
Hospital Revenue Code	920
Rate for Payer: Cash Price	$127.14

TCD EMBOLI DETECT W/O INJ

Facility

$339.45

Service Code	HCPCS 93892 TC
Hospital Charge Code	41301522
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

TCD VASOREACTIVITY STUDY

Facility

$705.83

Service Code	HCPCS 93890 TC
Hospital Charge Code	41301521
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

TCD VASOREACTIVITY STUDY

Facility

$705.83

Service Code	HCPCS 93890 TC
Hospital Charge Code	41301521
Hospital Revenue Code	920
Rate for Payer: Cash Price	$283.37

T CELL ABSOLUTE COUNT/RATIO

Facility

$117.45

Service Code	HCPCS 86360
Hospital Charge Code	40629622
Hospital Revenue Code	300
Min. Negotiated Rate	$37.58
Max. Negotiated Rate	$88.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$46.98
Rate for Payer: Aetna Government	$46.98
Rate for Payer: Brighton Health Commercial	$88.09
Rate for Payer: Cash Price	$46.98
Rate for Payer: Cash Price	$46.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$46.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$74.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$63.21
Rate for Payer: Elderplan Medicare Advantage	$46.98
Rate for Payer: EmblemHealth Commercial	$46.98
Rate for Payer: Fidelis Essential Plan Aliesa	$39.93
Rate for Payer: Fidelis Essential Plan QHP	$41.81
Rate for Payer: Fidelis Medicare Advantage	$46.98
Rate for Payer: Fidelis Qualified Health Plan	$41.81
Rate for Payer: Group Health Inc Commercial	$46.98
Rate for Payer: Group Health Inc Medicare	$46.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.72
Rate for Payer: Hamaspik Choice Inc Medicare	$46.98
Rate for Payer: Healthfirst Medicare Advantage	$46.98
Rate for Payer: Healthfirst QHP	$46.98
Rate for Payer: Senior Whole Health Medicare Advantage	$46.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37.58
Rate for Payer: Wellcare Medicare	$42.28

T CELL ABSOLUTE COUNT/RATIO

Facility

$117.45

Service Code	HCPCS 86360
Hospital Charge Code	40629622
Hospital Revenue Code	300
Rate for Payer: Cash Price	$46.98

T CELL ABSOLUTE COUNT/RATIO

Facility

$117.45

Service Code	HCPCS 86360
Hospital Charge Code	30305610
Hospital Revenue Code	302
Min. Negotiated Rate	$37.58
Max. Negotiated Rate	$88.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$46.98
Rate for Payer: Aetna Government	$46.98
Rate for Payer: Brighton Health Commercial	$88.09
Rate for Payer: Cash Price	$46.98
Rate for Payer: Cash Price	$46.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$46.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$74.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$63.21
Rate for Payer: Elderplan Medicare Advantage	$46.98
Rate for Payer: EmblemHealth Commercial	$46.98
Rate for Payer: Fidelis Essential Plan Aliesa	$39.93
Rate for Payer: Fidelis Essential Plan QHP	$41.81
Rate for Payer: Fidelis Medicare Advantage	$46.98
Rate for Payer: Fidelis Qualified Health Plan	$41.81
Rate for Payer: Group Health Inc Commercial	$46.98
Rate for Payer: Group Health Inc Medicare	$46.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.72
Rate for Payer: Hamaspik Choice Inc Medicare	$46.98
Rate for Payer: Healthfirst Medicare Advantage	$46.98
Rate for Payer: Healthfirst QHP	$46.98
Rate for Payer: Senior Whole Health Medicare Advantage	$46.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37.58
Rate for Payer: Wellcare Medicare	$42.28

T CELL ABSOLUTE COUNT/RATIO

Facility

$117.45

Service Code	HCPCS 86360
Hospital Charge Code	30305610
Hospital Revenue Code	302
Rate for Payer: Cash Price	$46.98

TDAP (VFC) 0.5ML IM SYR

Facility

$0.01

Service Code	HCPCS 90715
Hospital Charge Code	41649572
Hospital Revenue Code	636
Max. Negotiated Rate	$41.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.80
Rate for Payer: Aetna Government	$35.80
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41.43
Rate for Payer: SOMOS Essential	$41.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TDAP (VFC) 0.5ML IM SYR

Facility

$0.01

Service Code	HCPCS 90715
Hospital Charge Code	41659570
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

TDAP (VFC) 0.5ML IM SYR

Facility

$0.01

Service Code	HCPCS 90715
Hospital Charge Code	41649572
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

TDAP (VFC) 0.5ML IM SYR

Facility

$0.01

Service Code	HCPCS 90715
Hospital Charge Code	41659572
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

TDAP (VFC) 0.5ML IM SYR

Facility

$0.01

Service Code	HCPCS 90715
Hospital Charge Code	41659570
Hospital Revenue Code	636
Max. Negotiated Rate	$41.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.80
Rate for Payer: Aetna Government	$35.80
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41.43
Rate for Payer: SOMOS Essential	$41.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TDAP (VFC) 0.5ML IM SYR

Facility

$0.01

Service Code	HCPCS 90715
Hospital Charge Code	41659572
Hospital Revenue Code	636
Max. Negotiated Rate	$41.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.80
Rate for Payer: Aetna Government	$35.80
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41.43
Rate for Payer: SOMOS Essential	$41.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TDAP (VFC) 0.5ML IM VIAL

Facility

$0.01

Service Code	HCPCS 90715
Hospital Charge Code	41659571
Hospital Revenue Code	636
Max. Negotiated Rate	$41.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.80
Rate for Payer: Aetna Government	$35.80
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41.43
Rate for Payer: SOMOS Essential	$41.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TDAP (VFC) 0.5ML IM VIAL

Facility

$0.01

Service Code	HCPCS 90715
Hospital Charge Code	41649571
Hospital Revenue Code	636
Max. Negotiated Rate	$41.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.80
Rate for Payer: Aetna Government	$35.80
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41.43
Rate for Payer: SOMOS Essential	$41.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TDAP (VFC) 0.5ML IM VIAL

Facility

$0.01

Service Code	HCPCS 90715
Hospital Charge Code	41659571
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

TDAP (VFC) 0.5ML IM VIAL

Facility

$0.01

Service Code	HCPCS 90715
Hospital Charge Code	41649571
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

TDAP (VFC) O.5ML IM SYR

Facility

$0.01

Service Code	HCPCS 90715
Hospital Charge Code	41649570
Hospital Revenue Code	636
Max. Negotiated Rate	$41.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.80
Rate for Payer: Aetna Government	$35.80
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41.43
Rate for Payer: SOMOS Essential	$41.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TDAP (VFC) O.5ML IM SYR

Facility

$0.01

Service Code	HCPCS 90715
Hospital Charge Code	41649570
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

Know your out-of-pocket cost for care.

All Charges