St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC 1ST/SBSQ PSYC COLLAB CARE

Facility

$112.00

Service Code	CPT 99494
Hospital Charge Code	9009949401
Hospital Revenue Code	900
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$56.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.00

HC 1ST/SBSQ PSYC COLLAB CARE

Facility

$112.00

Service Code	CPT 99494
Hospital Charge Code	9009949401
Hospital Revenue Code	900
Min. Negotiated Rate	$32.00
Max. Negotiated Rate	$89.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.00
Rate for Payer: Aetna Government	$32.00
Rate for Payer: Brighton Health Commercial	$84.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$89.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.16
Rate for Payer: EmblemHealth Commercial	$56.00
Rate for Payer: Group Health Inc Commercial	$56.00
Rate for Payer: Group Health Inc Medicare	$39.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.00
Rate for Payer: Hamaspik Choice Inc Medicare	$56.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$43.92
Rate for Payer: United Healthcare Commercial	$56.00

HC 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION - CT 3D RECONSTRUCT

Facility

$1,132.00

Service Code	CPT 76377 TC
Hospital Charge Code	3507637701
Hospital Revenue Code	350
Min. Negotiated Rate	$566.00
Max. Negotiated Rate	$566.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$566.00

HC 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION - CT 3D RECONSTRUCT

Facility

$1,132.00

Service Code	CPT 76377 TC
Hospital Charge Code	3507637701
Hospital Revenue Code	350
Min. Negotiated Rate	$32.94
Max. Negotiated Rate	$905.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$622.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.94
Rate for Payer: Aetna Government	$32.94
Rate for Payer: Brighton Health Commercial	$849.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$905.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$769.76
Rate for Payer: EmblemHealth Commercial	$44.43
Rate for Payer: Group Health Inc Commercial	$566.00
Rate for Payer: Group Health Inc Medicare	$396.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$566.00
Rate for Payer: Hamaspik Choice Inc Medicare	$566.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$44.43
Rate for Payer: Healthfirst Essential Plan	$134.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$59.91

HC 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION - CT 3D RECONSTRUCT

Facility

$486.00

Service Code	CPT 76376 TC
Hospital Charge Code	3507637601
Hospital Revenue Code	350
Min. Negotiated Rate	$243.00
Max. Negotiated Rate	$243.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.00

HC 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION - CT 3D RECONSTRUCT

Facility

$486.00

Service Code	CPT 76376 TC
Hospital Charge Code	3507637601
Hospital Revenue Code	350
Min. Negotiated Rate	$13.96
Max. Negotiated Rate	$388.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$267.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.96
Rate for Payer: Aetna Government	$13.96
Rate for Payer: Brighton Health Commercial	$364.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$388.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$330.48
Rate for Payer: EmblemHealth Commercial	$17.32
Rate for Payer: Group Health Inc Commercial	$243.00
Rate for Payer: Group Health Inc Medicare	$170.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.00
Rate for Payer: Hamaspik Choice Inc Medicare	$243.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17.32
Rate for Payer: Healthfirst Essential Plan	$104.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$46.58

HC 3D RENDER W/INTRP POSTPROCES - 3D RENDERING ON AN INDEP WORKSTATION

Facility

$1,132.00

Service Code	CPT 76377 TC
Hospital Charge Code	3507637702
Hospital Revenue Code	350
Min. Negotiated Rate	$32.94
Max. Negotiated Rate	$905.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$622.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.94
Rate for Payer: Aetna Government	$32.94
Rate for Payer: Brighton Health Commercial	$849.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$905.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$769.76
Rate for Payer: EmblemHealth Commercial	$44.43
Rate for Payer: Group Health Inc Commercial	$566.00
Rate for Payer: Group Health Inc Medicare	$396.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$566.00
Rate for Payer: Hamaspik Choice Inc Medicare	$566.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$44.43
Rate for Payer: Healthfirst Essential Plan	$134.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$59.91

HC 3D RENDER W/INTRP POSTPROCES - 3D RENDERING ON AN INDEP WORKSTATION

Facility

$1,132.00

Service Code	CPT 76377 TC
Hospital Charge Code	3507637702
Hospital Revenue Code	350
Min. Negotiated Rate	$566.00
Max. Negotiated Rate	$566.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$566.00

HC 3D RENDER W/INTRP POSTPROCES - CRT DUAL

Facility

$1,132.00

Service Code	CPT 76377 TC
Hospital Charge Code	6107637701
Hospital Revenue Code	610
Min. Negotiated Rate	$566.00
Max. Negotiated Rate	$566.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$566.00

HC 3D RENDER W/INTRP POSTPROCES - CRT DUAL

Facility

$1,132.00

Service Code	CPT 76377 TC
Hospital Charge Code	6107637701
Hospital Revenue Code	610
Min. Negotiated Rate	$32.94
Max. Negotiated Rate	$905.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$622.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.94
Rate for Payer: Aetna Government	$32.94
Rate for Payer: Brighton Health Commercial	$849.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$905.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$769.76
Rate for Payer: EmblemHealth Commercial	$44.43
Rate for Payer: Group Health Inc Commercial	$566.00
Rate for Payer: Group Health Inc Medicare	$396.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$566.00
Rate for Payer: Hamaspik Choice Inc Medicare	$566.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$44.43
Rate for Payer: Healthfirst Essential Plan	$134.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$59.91

HC 3D RENDER W/INTRP POSTPROCES - CRT DUAL DEFIB

Facility

$1,132.00

Service Code	CPT 76377 TC
Hospital Charge Code	6107637702
Hospital Revenue Code	610
Min. Negotiated Rate	$566.00
Max. Negotiated Rate	$566.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$566.00

HC 3D RENDER W/INTRP POSTPROCES - CRT DUAL DEFIB

Facility

$1,132.00

Service Code	CPT 76377 TC
Hospital Charge Code	6107637702
Hospital Revenue Code	610
Min. Negotiated Rate	$32.94
Max. Negotiated Rate	$905.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$622.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.94
Rate for Payer: Aetna Government	$32.94
Rate for Payer: Brighton Health Commercial	$849.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$905.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$769.76
Rate for Payer: EmblemHealth Commercial	$44.43
Rate for Payer: Group Health Inc Commercial	$566.00
Rate for Payer: Group Health Inc Medicare	$396.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$566.00
Rate for Payer: Hamaspik Choice Inc Medicare	$566.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$44.43
Rate for Payer: Healthfirst Essential Plan	$134.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$59.91

HC 3D RENDER W/INTRP POSTPROCES - CRT SINGLE

Facility

$1,132.00

Service Code	CPT 76377 TC
Hospital Charge Code	6107637703
Hospital Revenue Code	610
Min. Negotiated Rate	$566.00
Max. Negotiated Rate	$566.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$566.00

HC 3D RENDER W/INTRP POSTPROCES - CRT SINGLE

Facility

$1,132.00

Service Code	CPT 76377 TC
Hospital Charge Code	6107637703
Hospital Revenue Code	610
Min. Negotiated Rate	$32.94
Max. Negotiated Rate	$905.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$622.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.94
Rate for Payer: Aetna Government	$32.94
Rate for Payer: Brighton Health Commercial	$849.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$905.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$769.76
Rate for Payer: EmblemHealth Commercial	$44.43
Rate for Payer: Group Health Inc Commercial	$566.00
Rate for Payer: Group Health Inc Medicare	$396.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$566.00
Rate for Payer: Hamaspik Choice Inc Medicare	$566.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$44.43
Rate for Payer: Healthfirst Essential Plan	$134.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$59.91

HC 4 SINGLE STINGING INSECT VENOMS

Facility

$183.00

Service Code	CPT 95148
Hospital Charge Code	5109514801
Hospital Revenue Code	510
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$100.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$86.96
Rate for Payer: Aetna Government	$86.96
Rate for Payer: Affinity Essential Plan 1&2	$60.87
Rate for Payer: Affinity Essential Plan 3&4	$60.87
Rate for Payer: Affinity Medicaid/CHP/HARP	$60.87
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$86.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: Elderplan Medicare Advantage	$86.96
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$78.26
Rate for Payer: Fidelis Essential Plan Aliesa	$73.92
Rate for Payer: Fidelis Essential Plan QHP	$77.39
Rate for Payer: Fidelis Medicare Advantage	$86.96
Rate for Payer: Fidelis Qualified Health Plan	$77.39
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	$86.96
Rate for Payer: Hamaspik Choice Inc Medicare	$86.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.85
Rate for Payer: Healthfirst Medicare Advantage	$73.92
Rate for Payer: Healthfirst QHP	$86.96
Rate for Payer: Humana Medicare	$88.70
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$91.31
Rate for Payer: Senior Whole Health Medicare Advantage	$86.96
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$86.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$86.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$82.61
Rate for Payer: Wellcare Medicare	$82.61

HC 4 SINGLE STINGING INSECT VENOMS

Facility

$183.00

Service Code	CPT 95148
Hospital Charge Code	5109514801
Hospital Revenue Code	510
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.50

HC 4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE

Facility

$241.00

Service Code	CPT 90649
Hospital Charge Code	6369064901
Hospital Revenue Code	636
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$120.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50
Rate for Payer: Hamaspik Choice Inc Medicare	$120.50

HC 4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE

Facility

$241.00

Service Code	CPT 90649
Hospital Charge Code	6369064901
Hospital Revenue Code	636
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$163.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$163.24
Rate for Payer: Aetna Government	$163.24
Rate for Payer: Brighton Health Commercial	$144.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$120.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$138.57
Rate for Payer: EmblemHealth Commercial	$120.50
Rate for Payer: Group Health Inc Commercial	$120.50
Rate for Payer: Group Health Inc Medicare	$84.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50
Rate for Payer: Hamaspik Choice Inc Medicare	$120.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$156.65

HC 9VHPV VACC 2/3 DOSE SCHED IM USE

Facility

$17.00

Service Code	CPT 90651
Hospital Charge Code	6369065101
Hospital Revenue Code	636
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$23,021.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$258.54
Rate for Payer: Aetna Government	$258.54
Rate for Payer: Affinity Essential Plan 1&2	$517.97
Rate for Payer: Affinity Essential Plan 3&4	$517.97
Rate for Payer: Affinity Medicaid/CHP/HARP	$230.21
Rate for Payer: Amida Care Medicaid	$230.21
Rate for Payer: Brighton Health Commercial	$10.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: EmblemHealth Commercial	$8.50
Rate for Payer: EmblemHealth Essential Plan 1&2	$517.97
Rate for Payer: EmblemHealth Essential Plan 3&4	$230.21
Rate for Payer: Fidelis CHP/HARP/Medicaid	$230.21
Rate for Payer: Fidelis Essential Plan Aliesa	$517.97
Rate for Payer: Fidelis Essential Plan QHP	$517.97
Rate for Payer: Fidelis Qualified Health Plan	$241.72
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$230.21
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,021.00
Rate for Payer: Healthfirst Essential Plan	$517.97
Rate for Payer: Healthfirst QHP	$375.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$230.21
Rate for Payer: SOMOS Essential	$517.97
Rate for Payer: United Healthcare Essential Plan 1&2	$517.97
Rate for Payer: United Healthcare Essential Plan 3&4	$253.23
Rate for Payer: United Healthcare Medicaid	$230.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$230.21

HC 9VHPV VACC 2/3 DOSE SCHED IM USE

Facility

$17.00

Service Code	CPT 90651
Hospital Charge Code	6369065101
Hospital Revenue Code	636
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

HC ABDOMINAL PARACENTESIS W/ IMAGING

Facility

$2,475.00

Service Code	CPT 49083 TC
Hospital Charge Code	3614908301
Hospital Revenue Code	361
Min. Negotiated Rate	$334.10
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$334.10
Rate for Payer: Aetna Government	$334.10
Rate for Payer: Brighton Health Commercial	$1,856.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,092.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,628.64
Rate for Payer: EmblemHealth Commercial	$1,237.50
Rate for Payer: Group Health Inc Commercial	$1,237.50
Rate for Payer: Group Health Inc Medicare	$866.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,237.50
Rate for Payer: Hamaspik Choice Inc Medicare	$503.39
Rate for Payer: United Healthcare Commercial	$1,409.00

HC ABDOMINAL PARACENTESIS W/ IMAGING

Facility

$2,475.00

Service Code	CPT 49083 TC
Hospital Charge Code	3614908301
Hospital Revenue Code	361
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,237.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,237.50

HC ABDOMINAL PARACENTESIS W/O IMAGE

Facility

$2,475.00

Service Code	CPT 49082 TC
Hospital Charge Code	3614908201
Hospital Revenue Code	361
Min. Negotiated Rate	$219.35
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$219.35
Rate for Payer: Aetna Government	$219.35
Rate for Payer: Brighton Health Commercial	$1,856.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,092.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,628.64
Rate for Payer: EmblemHealth Commercial	$1,237.50
Rate for Payer: Group Health Inc Commercial	$1,237.50
Rate for Payer: Group Health Inc Medicare	$866.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,237.50
Rate for Payer: Hamaspik Choice Inc Medicare	$503.39
Rate for Payer: United Healthcare Commercial	$1,409.00

HC ABDOMINAL PARACENTESIS W/O IMAGE

Facility

$2,475.00

Service Code	CPT 49082 TC
Hospital Charge Code	3614908201
Hospital Revenue Code	361
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,237.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,237.50

HC ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE

Facility

$2,380.00

Service Code	CPT 49083 TC
Hospital Charge Code	3614908302
Hospital Revenue Code	361
Min. Negotiated Rate	$1,190.00
Max. Negotiated Rate	$1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,190.00

Know your out-of-pocket cost for care.

All Charges