St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

VISTASEQ HEREDITARY CANCER PANEL

Facility

$0.01

Service Code	HCPCS 81162
Hospital Charge Code	40601029
Hospital Revenue Code	310
Rate for Payer: Cash Price	$1,824.88

VISUAL FIELD

Facility

$166.60

Service Code	HCPCS 92082 TC
Hospital Charge Code	42101600
Hospital Revenue Code	920
Min. Negotiated Rate	$58.31
Max. Negotiated Rate	$133.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$83.30
Rate for Payer: Aetna Government	$83.30
Rate for Payer: Brighton Health Commercial	$124.95
Rate for Payer: Cash Price	$70.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$113.29
Rate for Payer: Group Health Inc Commercial	$83.30
Rate for Payer: Group Health Inc Medicare	$58.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.30
Rate for Payer: Hamaspik Choice Inc Medicare	$83.30

VISUAL FIELD

Facility

$166.60

Service Code	HCPCS 92082 TC
Hospital Charge Code	42101600
Hospital Revenue Code	920
Rate for Payer: Cash Price	$70.74

VISUAL FIELD COMPUTERIZED

Facility

$330.23

Service Code	HCPCS 92083 TC
Hospital Charge Code	30305355
Hospital Revenue Code	510
Rate for Payer: Cash Price	$147.72

VISUAL FIELD COMPUTERIZED

Facility

$330.23

Service Code	HCPCS 92083 TC
Hospital Charge Code	30305355
Hospital Revenue Code	510
Min. Negotiated Rate	$165.12
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$181.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$165.12
Rate for Payer: Aetna Government	$165.12
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$147.72
Rate for Payer: Cash Price	$147.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.12
Rate for Payer: Hamaspik Choice Inc Medicare	$165.12

VISUAL FIELD COMPUTERIZED

Facility

$330.23

Service Code	HCPCS 92083 TC
Hospital Charge Code	42101700
Hospital Revenue Code	519
Min. Negotiated Rate	$165.12
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$181.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$165.12
Rate for Payer: Aetna Government	$165.12
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$147.72
Rate for Payer: Cash Price	$147.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.12
Rate for Payer: Hamaspik Choice Inc Medicare	$165.12

VISUAL FIELD COMPUTERIZED

Facility

$330.23

Service Code	HCPCS 92083 TC
Hospital Charge Code	42101700
Hospital Revenue Code	519
Rate for Payer: Cash Price	$147.72

VISUAL FIELD EXAMINATION(S)

Facility

$166.60

Service Code	HCPCS 92081 TC
Hospital Charge Code	30301147
Hospital Revenue Code	510
Min. Negotiated Rate	$83.30
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$83.30
Rate for Payer: Aetna Government	$83.30
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$70.74
Rate for Payer: Cash Price	$70.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.30
Rate for Payer: Hamaspik Choice Inc Medicare	$83.30

VISUAL FIELD EXAMINATION(S)

Facility

$166.60

Service Code	HCPCS 92081 TC
Hospital Charge Code	30301147
Hospital Revenue Code	510
Rate for Payer: Cash Price	$70.74

VISUAL REINFORCE AUDIOMETRY-PEDS

Facility

$419.03

Service Code	HCPCS 92579
Hospital Charge Code	42004512
Hospital Revenue Code	471
Rate for Payer: Cash Price	$180.64

VISUAL REINFORCE AUDIOMETRY-PEDS

Facility

$419.03

Service Code	HCPCS 92579
Hospital Charge Code	42004512
Hospital Revenue Code	471
Min. Negotiated Rate	$144.51
Max. Negotiated Rate	$335.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$230.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.64
Rate for Payer: Aetna Government	$180.64
Rate for Payer: Brighton Health Commercial	$314.27
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cash Price	$180.64
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$180.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$335.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$284.94
Rate for Payer: Elderplan Medicare Advantage	$180.64
Rate for Payer: EmblemHealth Commercial	$180.64
Rate for Payer: Fidelis Essential Plan Aliesa	$153.54
Rate for Payer: Fidelis Essential Plan QHP	$160.77
Rate for Payer: Fidelis Medicare Advantage	$180.64
Rate for Payer: Fidelis Qualified Health Plan	$160.77
Rate for Payer: Group Health Inc Commercial	$180.64
Rate for Payer: Group Health Inc Medicare	$180.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.52
Rate for Payer: Hamaspik Choice Inc Medicare	$180.64
Rate for Payer: Healthfirst Medicare Advantage	$153.54
Rate for Payer: Healthfirst QHP	$180.64
Rate for Payer: Senior Whole Health Medicare Advantage	$180.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$180.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$144.51
Rate for Payer: Wellcare Medicare	$171.61

VITAL CAPACITY

Facility

$419.03

Service Code	HCPCS 94150 TC
Hospital Charge Code	40306950
Hospital Revenue Code	460
Min. Negotiated Rate	$146.66
Max. Negotiated Rate	$335.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$230.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$209.52
Rate for Payer: Aetna Government	$209.52
Rate for Payer: Brighton Health Commercial	$314.27
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$335.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$284.94
Rate for Payer: Group Health Inc Commercial	$209.52
Rate for Payer: Group Health Inc Medicare	$146.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.52
Rate for Payer: Hamaspik Choice Inc Medicare	$209.52

VITAL CAPACITY

Facility

$419.03

Service Code	HCPCS 94150 TC
Hospital Charge Code	40306950
Hospital Revenue Code	460
Rate for Payer: Cash Price	$180.64

VITAMIN A 10000 UNITS CAP

Facility

$0.03

Hospital Charge Code	41643251
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

VITAMIN A 10000 UNITS CAP

Facility

$0.03

Hospital Charge Code	41653251
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

VITAMIN A 15 MG/ML IM SOLN [172236]

Facility

$431.25

Service Code	NDC 70199002611
Hospital Charge Code	70199002611
Hospital Revenue Code	250
Min. Negotiated Rate	$150.94
Max. Negotiated Rate	$345.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$237.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$215.62
Rate for Payer: Aetna Government	$215.62
Rate for Payer: Brighton Health Commercial	$323.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$345.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$293.25
Rate for Payer: Group Health Inc Commercial	$215.62
Rate for Payer: Group Health Inc Medicare	$150.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$215.62
Rate for Payer: Hamaspik Choice Inc Medicare	$215.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$280.31

VITAMIN A 3 MG (10000 UT) PO CAPS [172226]

Facility

$0.03

Service Code	NDC 00761043310
Hospital Charge Code	00761043310
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

VITAMIN A 50,000 UNITS/ML INJ

Facility

$46.58

Hospital Charge Code	41654444
Hospital Revenue Code	250
Min. Negotiated Rate	$16.30
Max. Negotiated Rate	$37.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.29
Rate for Payer: Aetna Government	$23.29
Rate for Payer: Brighton Health Commercial	$34.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.67
Rate for Payer: Group Health Inc Commercial	$23.29
Rate for Payer: Group Health Inc Medicare	$16.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.29
Rate for Payer: Hamaspik Choice Inc Medicare	$23.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.28

VITAMIN A 50,000 UNITS/ML INJ

Facility

$46.58

Hospital Charge Code	41644444
Hospital Revenue Code	250
Min. Negotiated Rate	$16.30
Max. Negotiated Rate	$37.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.29
Rate for Payer: Aetna Government	$23.29
Rate for Payer: Brighton Health Commercial	$34.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.67
Rate for Payer: Group Health Inc Commercial	$23.29
Rate for Payer: Group Health Inc Medicare	$16.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.29
Rate for Payer: Hamaspik Choice Inc Medicare	$23.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.28

VITAMIN A & D EX OINT [165019]

Facility

$0.02

Service Code	NDC 67777021507
Hospital Charge Code	67777021507
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
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	$0.01
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

VITAMIN A & D OINT 5 GRAMS

Facility

$0.23

Hospital Charge Code	41641513
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.16
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.15

VITAMIN A & D OINT 5 GRAMS

Facility

$0.23

Hospital Charge Code	41651513
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.16
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.15

VITAMIN A, SERUM

Facility

$29.03

Service Code	HCPCS 84590
Hospital Charge Code	40609129
Hospital Revenue Code	300
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$21.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.61
Rate for Payer: Aetna Government	$11.61
Rate for Payer: Brighton Health Commercial	$21.77
Rate for Payer: Cash Price	$11.61
Rate for Payer: Cash Price	$11.61
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$11.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.60
Rate for Payer: Elderplan Medicare Advantage	$11.61
Rate for Payer: EmblemHealth Commercial	$11.61
Rate for Payer: Fidelis Essential Plan Aliesa	$9.87
Rate for Payer: Fidelis Essential Plan QHP	$10.33
Rate for Payer: Fidelis Medicare Advantage	$11.61
Rate for Payer: Fidelis Qualified Health Plan	$10.33
Rate for Payer: Group Health Inc Commercial	$11.61
Rate for Payer: Group Health Inc Medicare	$11.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.52
Rate for Payer: Hamaspik Choice Inc Medicare	$11.61
Rate for Payer: Healthfirst Medicare Advantage	$11.61
Rate for Payer: Healthfirst QHP	$11.61
Rate for Payer: Senior Whole Health Medicare Advantage	$11.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.29
Rate for Payer: Wellcare Medicare	$10.45

VITAMIN A, SERUM

Facility

$29.03

Service Code	HCPCS 84590
Hospital Charge Code	40609129
Hospital Revenue Code	300
Rate for Payer: Cash Price	$11.61

VITAMIN B12 100 MCG PO TABS [33523]

Facility

$0.31

Service Code	NDC 50268085211
Hospital Charge Code	50268085211
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.21
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

Know your out-of-pocket cost for care.

All Charges