St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TECHNETIUM TC-99 PERTECHNET 30MCI

Facility

$1.32

Service Code	HCPCS A9512
Hospital Charge Code	41646570
Hospital Revenue Code	343
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$1.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.32
Rate for Payer: Aetna Government	$1.32
Rate for Payer: Brighton Health Commercial	$0.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.90
Rate for Payer: Group Health Inc Commercial	$0.66
Rate for Payer: Group Health Inc Medicare	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.66
Rate for Payer: Hamaspik Choice Inc Medicare	$0.66

TECHNET TC 99M SULFUR COLLOID CO KIT [171666]

Facility

$751.40

Service Code	NDC 45567003001
Hospital Charge Code	45567003001
Hospital Revenue Code	250
Min. Negotiated Rate	$262.99
Max. Negotiated Rate	$601.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$413.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$375.70
Rate for Payer: Aetna Government	$375.70
Rate for Payer: Brighton Health Commercial	$563.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$601.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$510.95
Rate for Payer: Group Health Inc Commercial	$375.70
Rate for Payer: Group Health Inc Medicare	$262.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$375.70
Rate for Payer: Hamaspik Choice Inc Medicare	$375.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$488.41

TECH TC-99M FILTERED SULFER COLL

Facility

$275.00

Service Code	HCPCS A9541
Hospital Charge Code	41646592
Hospital Revenue Code	343
Min. Negotiated Rate	$96.25
Max. Negotiated Rate	$221.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$151.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$221.38
Rate for Payer: Aetna Government	$221.38
Rate for Payer: Brighton Health Commercial	$206.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$220.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$187.00
Rate for Payer: Group Health Inc Commercial	$137.50
Rate for Payer: Group Health Inc Medicare	$96.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.50
Rate for Payer: Hamaspik Choice Inc Medicare	$137.50

TECH TC-99M FILTERED SULFUR COLL

Facility

$275.00

Service Code	HCPCS A9541
Hospital Charge Code	41656592
Hospital Revenue Code	343
Min. Negotiated Rate	$96.25
Max. Negotiated Rate	$221.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$151.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$221.38
Rate for Payer: Aetna Government	$221.38
Rate for Payer: Brighton Health Commercial	$206.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$220.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$187.00
Rate for Payer: Group Health Inc Commercial	$137.50
Rate for Payer: Group Health Inc Medicare	$96.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.50
Rate for Payer: Hamaspik Choice Inc Medicare	$137.50

TECNIS ITEC PRELOADED 1PC MONO PC

Facility

$260.00

Service Code	HCPCS C1780
Hospital Charge Code	64906496
Hospital Revenue Code	276
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$273.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$143.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.26
Rate for Payer: Aetna Government	$2.26
Rate for Payer: Brighton Health Commercial	$156.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$208.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$176.80
Rate for Payer: EmblemHealth Commercial	$130.00
Rate for Payer: Fidelis Medicare Advantage	$273.00
Rate for Payer: Group Health Inc Commercial	$130.00
Rate for Payer: Group Health Inc Medicare	$91.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.00
Rate for Payer: Hamaspik Choice Inc Medicare	$130.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$169.00

TECOVIRIMAT 200 MG/20ML IV SOLN [186767]

Facility

$0.00

Service Code	NDC 50072001001
Hospital Charge Code	50072001001
Hospital Revenue Code	278
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00

TECOVIRIMAT 200 MG/20ML IV SOLN [186767]

Facility

$0.00

Service Code	NDC 50072001001
Hospital Charge Code	50072001001
Hospital Revenue Code	278
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.00
Rate for Payer: Aetna Government	$0.00
Rate for Payer: Brighton Health Commercial	$0.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.00
Rate for Payer: EmblemHealth Commercial	$0.00
Rate for Payer: Fidelis Medicare Advantage	$0.00
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.00

TECOVIRIMAT CAPUSLES

Facility

$0.01

Hospital Charge Code	41650379
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TECOVIRIMAT CAPUSLES

Facility

$0.01

Hospital Charge Code	41640379
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TECOVIRIMAT INJ

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41640380
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TECOVIRIMAT INJ

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41650380
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

TECOVIRIMAT INJ

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41640380
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

TECOVIRIMAT INJ

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41650380
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

TEDIZOLID PHOSPHATE 200 MG PO TABS [126393]

Facility

$506.25

Service Code	NDC 72000031006
Hospital Charge Code	72000031006
Hospital Revenue Code	250
Min. Negotiated Rate	$177.19
Max. Negotiated Rate	$405.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$278.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$253.12
Rate for Payer: Aetna Government	$253.12
Rate for Payer: Brighton Health Commercial	$379.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$405.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$344.25
Rate for Payer: Group Health Inc Commercial	$253.12
Rate for Payer: Group Health Inc Medicare	$177.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$253.12
Rate for Payer: Hamaspik Choice Inc Medicare	$253.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$329.06

Ted Stockings

Facility

$16.65

Hospital Charge Code	40206000
Hospital Revenue Code	270
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$13.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.32
Rate for Payer: Aetna Government	$8.32
Rate for Payer: Brighton Health Commercial	$12.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.32
Rate for Payer: Group Health Inc Commercial	$8.32
Rate for Payer: Group Health Inc Medicare	$5.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.32
Rate for Payer: Hamaspik Choice Inc Medicare	$8.32

TEETH EXT.

Facility

$616.78

Service Code	HCPCS 41899
Hospital Charge Code	40011315
Hospital Revenue Code	360
Rate for Payer: Cash Price	$282.47

TEETH EXT.

Facility

$616.78

Service Code	HCPCS 41899
Hospital Charge Code	40011315
Hospital Revenue Code	360
Min. Negotiated Rate	$225.98
Max. Negotiated Rate	$142,987.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,880.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$282.47
Rate for Payer: Aetna Government	$282.47
Rate for Payer: Amida Care Medicaid	$1,429.87
Rate for Payer: Brighton Health Commercial	$462.58
Rate for Payer: Cash Price	$282.47
Rate for Payer: Cash Price	$282.47
Rate for Payer: Cash Price	$282.47
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$282.47
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	$282.47
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$142,987.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,429.87
Rate for Payer: Fidelis Essential Plan QHP	$1,429.87
Rate for Payer: Fidelis Medicare Advantage	$282.47
Rate for Payer: Fidelis Qualified Health Plan	$1,501.36
Rate for Payer: Group Health Inc Commercial	$282.47
Rate for Payer: Group Health Inc Medicare	$282.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,429.87
Rate for Payer: Hamaspik Choice Inc Medicare	$282.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,429.87
Rate for Payer: Healthfirst Essential Plan	$3,217.21
Rate for Payer: Healthfirst Medicare Advantage	$240.10
Rate for Payer: Healthfirst QHP	$1,429.87
Rate for Payer: Senior Whole Health Medicare Advantage	$282.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,429.87
Rate for Payer: SOMOS Essential	$3,217.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$282.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$225.98
Rate for Payer: Wellcare Medicare	$268.35

TEFLON GRAFT

Facility

$208.73

Hospital Charge Code	40000380
Hospital Revenue Code	272
Min. Negotiated Rate	$73.06
Max. Negotiated Rate	$166.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$114.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$104.36
Rate for Payer: Aetna Government	$104.36
Rate for Payer: Brighton Health Commercial	$156.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$166.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$141.94
Rate for Payer: Group Health Inc Commercial	$104.36
Rate for Payer: Group Health Inc Medicare	$73.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$104.36
Rate for Payer: Hamaspik Choice Inc Medicare	$104.36

TEGRETOL (CARBAMAZEPINE)

Facility

$36.43

Service Code	HCPCS 80156
Hospital Charge Code	40602015
Hospital Revenue Code	301
Rate for Payer: Cash Price	$14.57

TEGRETOL (CARBAMAZEPINE)

Facility

$36.43

Service Code	HCPCS 80156
Hospital Charge Code	40602015
Hospital Revenue Code	301
Min. Negotiated Rate	$11.66
Max. Negotiated Rate	$27.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.57
Rate for Payer: Aetna Government	$14.57
Rate for Payer: Brighton Health Commercial	$27.32
Rate for Payer: Cash Price	$14.57
Rate for Payer: Cash Price	$14.57
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$14.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.58
Rate for Payer: Elderplan Medicare Advantage	$14.57
Rate for Payer: EmblemHealth Commercial	$14.57
Rate for Payer: Fidelis Essential Plan Aliesa	$12.38
Rate for Payer: Fidelis Essential Plan QHP	$12.97
Rate for Payer: Fidelis Medicare Advantage	$14.57
Rate for Payer: Fidelis Qualified Health Plan	$12.97
Rate for Payer: Group Health Inc Commercial	$14.57
Rate for Payer: Group Health Inc Medicare	$14.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.22
Rate for Payer: Hamaspik Choice Inc Medicare	$14.57
Rate for Payer: Healthfirst Medicare Advantage	$14.57
Rate for Payer: Healthfirst QHP	$14.57
Rate for Payer: Senior Whole Health Medicare Advantage	$14.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$11.66
Rate for Payer: Wellcare Medicare	$13.11

TELEDENTISTRY - ASYNCHRONOUS

Facility

$12.56

Service Code	HCPCS D9996
Hospital Charge Code	42300734
Hospital Revenue Code	361
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.28
Rate for Payer: Aetna Government	$6.28
Rate for Payer: Brighton Health Commercial	$9.42
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	$6.28
Rate for Payer: Group Health Inc Medicare	$4.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.28
Rate for Payer: Hamaspik Choice Inc Medicare	$6.28

TELEDENTTISTRY - SYNCHRONOUS

Facility

$23.48

Service Code	HCPCS D9995
Hospital Charge Code	42300733
Hospital Revenue Code	361
Min. Negotiated Rate	$8.22
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.74
Rate for Payer: Aetna Government	$11.74
Rate for Payer: Brighton Health Commercial	$17.61
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	$11.74
Rate for Payer: Group Health Inc Medicare	$8.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.74
Rate for Payer: Hamaspik Choice Inc Medicare	$11.74

TELEHEALTH FACILITY FEE

Facility

$130.00

Service Code	HCPCS Q3014
Hospital Charge Code	30300134
Hospital Revenue Code	780
Min. Negotiated Rate	$26.65
Max. Negotiated Rate	$104.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.65
Rate for Payer: Aetna Government	$26.65
Rate for Payer: Brighton Health Commercial	$97.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$104.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$88.40
Rate for Payer: Group Health Inc Commercial	$65.00
Rate for Payer: Group Health Inc Medicare	$45.50
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00

TELEHEATLH ORIG SITE FACLITY FEE

Facility

$69.40

Service Code	HCPCS Q3014
Hospital Charge Code	42300729
Hospital Revenue Code	361
Min. Negotiated Rate	$24.29
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.65
Rate for Payer: Aetna Government	$26.65
Rate for Payer: Brighton Health Commercial	$52.05
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	$34.70
Rate for Payer: Group Health Inc Medicare	$24.29
Rate for Payer: Hamaspik Choice Inc Medicare	$34.70

TELEMEDICINE PSYCH DIAG EVAL

Facility

$406.00

Service Code	HCPCS 90791 95
Hospital Charge Code	30300990
Hospital Revenue Code	900
Rate for Payer: Cash Price	$184.38

Know your out-of-pocket cost for care.

All Charges