St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TELEMEDICINE PSYCH DIAG EVAL

Facility

$406.00

Service Code	HCPCS 90791 95
Hospital Charge Code	30300990
Hospital Revenue Code	900
Min. Negotiated Rate	$142.10
Max. Negotiated Rate	$324.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$213.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$203.00
Rate for Payer: Aetna Government	$203.00
Rate for Payer: Brighton Health Commercial	$304.50
Rate for Payer: Cash Price	$184.38
Rate for Payer: Cash Price	$184.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$324.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$276.08
Rate for Payer: Group Health Inc Commercial	$203.00
Rate for Payer: Group Health Inc Medicare	$142.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.00
Rate for Payer: Hamaspik Choice Inc Medicare	$203.00

TELEMEDICINE PSYCH DIAG EVAL/W SV

Facility

$406.00

Service Code	HCPCS 90792 95
Hospital Charge Code	30300998
Hospital Revenue Code	900
Rate for Payer: Cash Price	$184.38

TELEMEDICINE PSYCH DIAG EVAL/W SV

Facility

$406.00

Service Code	HCPCS 90792 95
Hospital Charge Code	30300998
Hospital Revenue Code	900
Min. Negotiated Rate	$142.10
Max. Negotiated Rate	$324.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$213.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$203.00
Rate for Payer: Aetna Government	$203.00
Rate for Payer: Brighton Health Commercial	$304.50
Rate for Payer: Cash Price	$184.38
Rate for Payer: Cash Price	$184.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$324.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$276.08
Rate for Payer: Group Health Inc Commercial	$203.00
Rate for Payer: Group Health Inc Medicare	$142.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.00
Rate for Payer: Hamaspik Choice Inc Medicare	$203.00

TELEPHONIC 11-20MINS MEDCL DISCUS

Facility

$263.60

Service Code	HCPCS 99442
Hospital Charge Code	30300898
Hospital Revenue Code	780
Min. Negotiated Rate	$20.06
Max. Negotiated Rate	$210.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$144.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.06
Rate for Payer: Aetna Government	$20.06
Rate for Payer: Brighton Health Commercial	$197.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$210.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$179.25
Rate for Payer: Group Health Inc Commercial	$131.80
Rate for Payer: Group Health Inc Medicare	$92.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.80
Rate for Payer: Hamaspik Choice Inc Medicare	$131.80

TELEPHONIC 21-30MINS MEDCL DISCUS

Facility

$395.40

Service Code	HCPCS 99443
Hospital Charge Code	30300899
Hospital Revenue Code	780
Min. Negotiated Rate	$28.36
Max. Negotiated Rate	$316.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$217.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.36
Rate for Payer: Aetna Government	$28.36
Rate for Payer: Brighton Health Commercial	$296.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$316.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$268.87
Rate for Payer: Group Health Inc Commercial	$197.70
Rate for Payer: Group Health Inc Medicare	$138.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$197.70
Rate for Payer: Hamaspik Choice Inc Medicare	$197.70

TELEPHONIC 5-10MINS MEDCL DISCUSS

Facility

$131.80

Service Code	HCPCS 99441
Hospital Charge Code	30300897
Hospital Revenue Code	780
Min. Negotiated Rate	$9.41
Max. Negotiated Rate	$105.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$72.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.41
Rate for Payer: Aetna Government	$9.41
Rate for Payer: Brighton Health Commercial	$98.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$105.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$89.62
Rate for Payer: Group Health Inc Commercial	$65.90
Rate for Payer: Group Health Inc Medicare	$46.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.90
Rate for Payer: Hamaspik Choice Inc Medicare	$65.90

TELEPH. SINGLE CHAMBR PCMKR CHECK

Facility

$109.80

Service Code	HCPCS 93293 TC
Hospital Charge Code	40804105
Hospital Revenue Code	731
Min. Negotiated Rate	$38.43
Max. Negotiated Rate	$87.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.90
Rate for Payer: Aetna Government	$54.90
Rate for Payer: Brighton Health Commercial	$82.35
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.66
Rate for Payer: Group Health Inc Commercial	$54.90
Rate for Payer: Group Health Inc Medicare	$38.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.90
Rate for Payer: Hamaspik Choice Inc Medicare	$54.90

TELEPH. SINGLE CHAMBR PCMKR CHECK

Facility

$109.80

Service Code	HCPCS 93293 TC
Hospital Charge Code	40804105
Hospital Revenue Code	731
Rate for Payer: Cash Price	$43.61

TELESCOPE GUIDE EXTENSION

Facility

$1,000.00

Service Code	HCPCS C1887
Hospital Charge Code	66521493
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$1,050.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$550.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Brighton Health Commercial	$600.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$575.00
Rate for Payer: EmblemHealth Commercial	$500.00
Rate for Payer: Fidelis Medicare Advantage	$1,050.00
Rate for Payer: Group Health Inc Commercial	$500.00
Rate for Payer: Group Health Inc Medicare	$350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$650.00

TELESCOPE GUIDE EXTENSION

Facility

$1,000.00

Service Code	HCPCS C1887
Hospital Charge Code	66521493
Hospital Revenue Code	278
Min. Negotiated Rate	$500.00
Max. Negotiated Rate	$500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$500.00

TELE-TERMOMETER W/PROBE

Facility

$122.26

Hospital Charge Code	40206002
Hospital Revenue Code	270
Min. Negotiated Rate	$42.79
Max. Negotiated Rate	$97.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$67.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$61.13
Rate for Payer: Aetna Government	$61.13
Rate for Payer: Brighton Health Commercial	$91.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$97.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$83.14
Rate for Payer: Group Health Inc Commercial	$61.13
Rate for Payer: Group Health Inc Medicare	$42.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.13
Rate for Payer: Hamaspik Choice Inc Medicare	$61.13

TELETHERAPY ISODOSE COMP PLAN

Facility

$1,015.13

Service Code	HCPCS 77307 TC
Hospital Charge Code	66542935
Hospital Revenue Code	333
Rate for Payer: Cash Price	$427.29

TELETHERAPY ISODOSE COMP PLAN

Facility

$1,015.13

Service Code	HCPCS 77307 TC
Hospital Charge Code	66542935
Hospital Revenue Code	333
Min. Negotiated Rate	$279.92
Max. Negotiated Rate	$812.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$558.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$507.56
Rate for Payer: Aetna Government	$507.56
Rate for Payer: Brighton Health Commercial	$761.35
Rate for Payer: Cash Price	$427.29
Rate for Payer: Cash Price	$427.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$812.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.29
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	$507.56
Rate for Payer: Group Health Inc Medicare	$355.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$507.56
Rate for Payer: Hamaspik Choice Inc Medicare	$507.56

TELETHX ISODOSE PLAN SIMP

Facility

$1,015.13

Service Code	HCPCS 77306 TC
Hospital Charge Code	66542934
Hospital Revenue Code	333
Rate for Payer: Cash Price	$427.29

TELETHX ISODOSE PLAN SIMP

Facility

$1,015.13

Service Code	HCPCS 77306 TC
Hospital Charge Code	66542934
Hospital Revenue Code	333
Min. Negotiated Rate	$279.92
Max. Negotiated Rate	$812.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$558.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$507.56
Rate for Payer: Aetna Government	$507.56
Rate for Payer: Brighton Health Commercial	$761.35
Rate for Payer: Cash Price	$427.29
Rate for Payer: Cash Price	$427.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$812.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.29
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	$507.56
Rate for Payer: Group Health Inc Medicare	$355.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$507.56
Rate for Payer: Hamaspik Choice Inc Medicare	$507.56

TELETHX ISODOSE PLAN SIMPLE

Facility

$1,015.13

Service Code	HCPCS 77306 TC
Hospital Charge Code	66541263
Hospital Revenue Code	333
Rate for Payer: Cash Price	$427.29

TELETHX ISODOSE PLAN SIMPLE

Facility

$1,015.13

Service Code	HCPCS 77306 TC
Hospital Charge Code	66541263
Hospital Revenue Code	333
Min. Negotiated Rate	$279.92
Max. Negotiated Rate	$812.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$558.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$507.56
Rate for Payer: Aetna Government	$507.56
Rate for Payer: Brighton Health Commercial	$761.35
Rate for Payer: Cash Price	$427.29
Rate for Payer: Cash Price	$427.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$812.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.29
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	$507.56
Rate for Payer: Group Health Inc Medicare	$355.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$507.56
Rate for Payer: Hamaspik Choice Inc Medicare	$507.56

TEMAZEPAM 15 MG CAP

Facility

$1.00

Hospital Charge Code	41640175
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

TEMAZEPAM 15 MG CAP

Facility

$1.00

Hospital Charge Code	41650175
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

TEMAZEPAM 15 MG PO CAPS [7753]

Facility

$0.74

Service Code	NDC 00228207610
Hospital Charge Code	00228207610
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.37
Rate for Payer: Aetna Government	$0.37
Rate for Payer: Brighton Health Commercial	$0.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.50
Rate for Payer: Group Health Inc Commercial	$0.37
Rate for Payer: Group Health Inc Medicare	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.37
Rate for Payer: Hamaspik Choice Inc Medicare	$0.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.48

TEMAZEPAM 15 MG PO CAPS [7753]

Facility

$0.82

Service Code	NDC 67877014601
Hospital Charge Code	67877014601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.41
Rate for Payer: Aetna Government	$0.41
Rate for Payer: Brighton Health Commercial	$0.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.55
Rate for Payer: Group Health Inc Commercial	$0.41
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41
Rate for Payer: Hamaspik Choice Inc Medicare	$0.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.53

TEMOZOLOMIDE 100 MG PO CAPS [25894]

Facility

$287.77

Service Code	HCPCS J8700
Hospital Charge Code	16729005054
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$230.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$158.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.36
Rate for Payer: Aetna Government	$0.36
Rate for Payer: Brighton Health Commercial	$215.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$230.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$195.68
Rate for Payer: Group Health Inc Commercial	$143.88
Rate for Payer: Group Health Inc Medicare	$100.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.88
Rate for Payer: Hamaspik Choice Inc Medicare	$143.88
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.19
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.20
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.20
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$187.05

TEMP ANCHORAGE DEV W FLAP

Facility

$320.00

Service Code	HCPCS D7293
Hospital Charge Code	42303427
Hospital Revenue Code	361
Min. Negotiated Rate	$110.12
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$176.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$110.12
Rate for Payer: Aetna Government	$110.12
Rate for Payer: Brighton Health Commercial	$240.00
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	$160.00
Rate for Payer: Group Health Inc Medicare	$112.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00

TEMP ANCHORAGE DEV W/O FLAP

Facility

$320.00

Service Code	HCPCS D7294
Hospital Charge Code	42303428
Hospital Revenue Code	361
Min. Negotiated Rate	$91.96
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$176.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$91.96
Rate for Payer: Aetna Government	$91.96
Rate for Payer: Brighton Health Commercial	$240.00
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	$160.00
Rate for Payer: Group Health Inc Medicare	$112.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00

TEMP FIX PINS

Facility

$217.50

Hospital Charge Code	64906015
Hospital Revenue Code	270
Min. Negotiated Rate	$76.12
Max. Negotiated Rate	$174.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$119.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$108.75
Rate for Payer: Aetna Government	$108.75
Rate for Payer: Brighton Health Commercial	$163.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$174.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$147.90
Rate for Payer: Group Health Inc Commercial	$108.75
Rate for Payer: Group Health Inc Medicare	$76.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$108.75
Rate for Payer: Hamaspik Choice Inc Medicare	$108.75

Know your out-of-pocket cost for care.

All Charges