St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC ANTINUCLEAR ANTIBODIES - ANA (ANTINUCLEAR ANTIBODIES)

Facility

$30.00

Service Code	CPT 86038
Hospital Charge Code	3028603801
Hospital Revenue Code	302
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$22.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.09
Rate for Payer: Aetna Government	$12.09
Rate for Payer: Affinity Essential Plan 1&2	$8.46
Rate for Payer: Affinity Essential Plan 3&4	$8.46
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.46
Rate for Payer: Brighton Health Commercial	$22.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.29
Rate for Payer: Elderplan Medicare Advantage	$12.09
Rate for Payer: EmblemHealth Commercial	$12.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10.88
Rate for Payer: Fidelis Essential Plan Aliesa	$10.28
Rate for Payer: Fidelis Essential Plan QHP	$10.76
Rate for Payer: Fidelis Medicare Advantage	$12.09
Rate for Payer: Fidelis Qualified Health Plan	$10.76
Rate for Payer: Group Health Inc Commercial	$12.09
Rate for Payer: Group Health Inc Medicare	$12.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.09
Rate for Payer: Hamaspik Choice Inc Medicare	$12.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.25
Rate for Payer: Healthfirst Essential Plan	$11.81
Rate for Payer: Healthfirst Medicare Advantage	$12.09
Rate for Payer: Healthfirst QHP	$12.09
Rate for Payer: Humana Medicare	$12.33
Rate for Payer: Senior Whole Health Medicare Advantage	$12.09
Rate for Payer: United Healthcare Commercial	$15.31
Rate for Payer: United Healthcare Medicare Advantage	$12.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.25
Rate for Payer: Wellcare Medicare	$10.88

HC ANTIPSYCHOTICS NOS 1-3 FLUPHENAZINE - BUNDLED CHARGE

Facility

$281.00

Service Code	CPT 80342
Hospital Charge Code	3018034209
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$224.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$154.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$210.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$224.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$191.08
Rate for Payer: EmblemHealth Commercial	$140.50
Rate for Payer: Group Health Inc Commercial	$140.50
Rate for Payer: Group Health Inc Medicare	$98.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.50
Rate for Payer: Hamaspik Choice Inc Medicare	$140.50
Rate for Payer: United Healthcare Commercial	$19.07

HC ANTIPSYCHOTICS NOS 1-3 FLUPHENAZINE - BUNDLED CHARGE

Facility

$281.00

Service Code	CPT 80342
Hospital Charge Code	3018034209
Hospital Revenue Code	301
Min. Negotiated Rate	$140.50
Max. Negotiated Rate	$140.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.50

HC ANTIPSYCHOTICS NOS 1-3 PHENOTHIAZINE SERUM - BUNDLED CHARGE

Facility

$281.00

Service Code	CPT 80342
Hospital Charge Code	3018034210
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$224.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$154.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$210.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$224.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$191.08
Rate for Payer: EmblemHealth Commercial	$140.50
Rate for Payer: Group Health Inc Commercial	$140.50
Rate for Payer: Group Health Inc Medicare	$98.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.50
Rate for Payer: Hamaspik Choice Inc Medicare	$140.50
Rate for Payer: United Healthcare Commercial	$19.07

HC ANTIPSYCHOTICS NOS 1-3 PHENOTHIAZINE SERUM - BUNDLED CHARGE

Facility

$281.00

Service Code	CPT 80342
Hospital Charge Code	3018034210
Hospital Revenue Code	301
Min. Negotiated Rate	$140.50
Max. Negotiated Rate	$140.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.50

HC ANTIPSYCHOTICS NOS 1-3 PHENOTHIAZINE URINE - BUNDLED CHARGE

Facility

$281.00

Service Code	CPT 80342
Hospital Charge Code	3018034211
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$224.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$154.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$210.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$224.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$191.08
Rate for Payer: EmblemHealth Commercial	$140.50
Rate for Payer: Group Health Inc Commercial	$140.50
Rate for Payer: Group Health Inc Medicare	$98.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.50
Rate for Payer: Hamaspik Choice Inc Medicare	$140.50
Rate for Payer: United Healthcare Commercial	$19.07

HC ANTIPSYCHOTICS NOS 1-3 PHENOTHIAZINE URINE - BUNDLED CHARGE

Facility

$281.00

Service Code	CPT 80342
Hospital Charge Code	3018034211
Hospital Revenue Code	301
Min. Negotiated Rate	$140.50
Max. Negotiated Rate	$140.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.50

HC ANTIPSYCHOTICS NOS 1-3 PROMAZINE - BUNDLED CHARGE

Facility

$281.00

Service Code	CPT 80342
Hospital Charge Code	3018034212
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$224.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$154.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$210.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$224.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$191.08
Rate for Payer: EmblemHealth Commercial	$140.50
Rate for Payer: Group Health Inc Commercial	$140.50
Rate for Payer: Group Health Inc Medicare	$98.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.50
Rate for Payer: Hamaspik Choice Inc Medicare	$140.50
Rate for Payer: United Healthcare Commercial	$19.07

HC ANTIPSYCHOTICS NOS 1-3 PROMAZINE - BUNDLED CHARGE

Facility

$281.00

Service Code	CPT 80342
Hospital Charge Code	3018034212
Hospital Revenue Code	301
Min. Negotiated Rate	$140.50
Max. Negotiated Rate	$140.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.50

HC ANTIPSYCHOTICS NOS 1-3 PROMETHAZINE - BUNDLED CHARGE

Facility

$281.00

Service Code	CPT 80342
Hospital Charge Code	3018034213
Hospital Revenue Code	301
Min. Negotiated Rate	$140.50
Max. Negotiated Rate	$140.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.50

HC ANTIPSYCHOTICS NOS 1-3 PROMETHAZINE - BUNDLED CHARGE

Facility

$281.00

Service Code	CPT 80342
Hospital Charge Code	3018034213
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$224.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$154.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$210.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$224.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$191.08
Rate for Payer: EmblemHealth Commercial	$140.50
Rate for Payer: Group Health Inc Commercial	$140.50
Rate for Payer: Group Health Inc Medicare	$98.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.50
Rate for Payer: Hamaspik Choice Inc Medicare	$140.50
Rate for Payer: United Healthcare Commercial	$19.07

HC ANTIPSYCHOTICS NOS 1-3 TRIFLUOPERAZINE - BUNDLED CHARGE

Facility

$281.00

Service Code	CPT 80342
Hospital Charge Code	3018034214
Hospital Revenue Code	301
Min. Negotiated Rate	$140.50
Max. Negotiated Rate	$140.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.50

HC ANTIPSYCHOTICS NOS 1-3 TRIFLUOPERAZINE - BUNDLED CHARGE

Facility

$281.00

Service Code	CPT 80342
Hospital Charge Code	3018034214
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$224.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$154.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$210.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$224.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$191.08
Rate for Payer: EmblemHealth Commercial	$140.50
Rate for Payer: Group Health Inc Commercial	$140.50
Rate for Payer: Group Health Inc Medicare	$98.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.50
Rate for Payer: Hamaspik Choice Inc Medicare	$140.50
Rate for Payer: United Healthcare Commercial	$19.07

HC ANTIPSYCHOTICS NOS 4-6 CHLORPROMAZINE - BUNDLED CHARGE

Facility

$562.00

Service Code	CPT 80343
Hospital Charge Code	3018034301
Hospital Revenue Code	301
Min. Negotiated Rate	$281.00
Max. Negotiated Rate	$281.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.00

HC ANTIPSYCHOTICS NOS 4-6 CHLORPROMAZINE - BUNDLED CHARGE

Facility

$562.00

Service Code	CPT 80343
Hospital Charge Code	3018034301
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$449.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$309.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$421.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$449.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$382.16
Rate for Payer: EmblemHealth Commercial	$281.00
Rate for Payer: Group Health Inc Commercial	$281.00
Rate for Payer: Group Health Inc Medicare	$196.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.00
Rate for Payer: Hamaspik Choice Inc Medicare	$281.00
Rate for Payer: United Healthcare Commercial	$19.07

HC ANTIPSYCHOTICS NOS 4-6 FLUPHENAZINE - BUNDLED CHARGE

Facility

$562.00

Service Code	CPT 80343
Hospital Charge Code	3018034302
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$449.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$309.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$421.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$449.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$382.16
Rate for Payer: EmblemHealth Commercial	$281.00
Rate for Payer: Group Health Inc Commercial	$281.00
Rate for Payer: Group Health Inc Medicare	$196.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.00
Rate for Payer: Hamaspik Choice Inc Medicare	$281.00
Rate for Payer: United Healthcare Commercial	$19.07

HC ANTIPSYCHOTICS NOS 4-6 FLUPHENAZINE - BUNDLED CHARGE

Facility

$562.00

Service Code	CPT 80343
Hospital Charge Code	3018034302
Hospital Revenue Code	301
Min. Negotiated Rate	$281.00
Max. Negotiated Rate	$281.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.00

HC ANTIPSYCHOTICS NOS 4-6 PHENOTHIAZINE SERUM - BUNDLED CHARGE

Facility

$562.00

Service Code	CPT 80343
Hospital Charge Code	3018034303
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$449.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$309.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$421.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$449.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$382.16
Rate for Payer: EmblemHealth Commercial	$281.00
Rate for Payer: Group Health Inc Commercial	$281.00
Rate for Payer: Group Health Inc Medicare	$196.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.00
Rate for Payer: Hamaspik Choice Inc Medicare	$281.00
Rate for Payer: United Healthcare Commercial	$19.07

HC ANTIPSYCHOTICS NOS 4-6 PHENOTHIAZINE SERUM - BUNDLED CHARGE

Facility

$562.00

Service Code	CPT 80343
Hospital Charge Code	3018034303
Hospital Revenue Code	301
Min. Negotiated Rate	$281.00
Max. Negotiated Rate	$281.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.00

HC ANTIPSYCHOTICS NOS 4-6 PHENOTHIAZINE URINE - BUNDLED CHARGE

Facility

$562.00

Service Code	CPT 80343
Hospital Charge Code	3018034304
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$449.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$309.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$421.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$449.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$382.16
Rate for Payer: EmblemHealth Commercial	$281.00
Rate for Payer: Group Health Inc Commercial	$281.00
Rate for Payer: Group Health Inc Medicare	$196.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.00
Rate for Payer: Hamaspik Choice Inc Medicare	$281.00
Rate for Payer: United Healthcare Commercial	$19.07

HC ANTIPSYCHOTICS NOS 4-6 PHENOTHIAZINE URINE - BUNDLED CHARGE

Facility

$562.00

Service Code	CPT 80343
Hospital Charge Code	3018034304
Hospital Revenue Code	301
Min. Negotiated Rate	$281.00
Max. Negotiated Rate	$281.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.00

HC ANTIPSYCHOTICS NOS 4-6 PROMAZINE - BUNDLED CHARGE

Facility

$562.00

Service Code	CPT 80343
Hospital Charge Code	3018034305
Hospital Revenue Code	301
Min. Negotiated Rate	$281.00
Max. Negotiated Rate	$281.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.00

HC ANTIPSYCHOTICS NOS 4-6 PROMAZINE - BUNDLED CHARGE

Facility

$562.00

Service Code	CPT 80343
Hospital Charge Code	3018034305
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$449.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$309.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$421.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$449.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$382.16
Rate for Payer: EmblemHealth Commercial	$281.00
Rate for Payer: Group Health Inc Commercial	$281.00
Rate for Payer: Group Health Inc Medicare	$196.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.00
Rate for Payer: Hamaspik Choice Inc Medicare	$281.00
Rate for Payer: United Healthcare Commercial	$19.07

HC ANTIPSYCHOTICS NOS 4-6 PROMETHAZINE - BUNDLED CHARGE

Facility

$562.00

Service Code	CPT 80343
Hospital Charge Code	3018034306
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$449.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$309.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$421.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$449.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$382.16
Rate for Payer: EmblemHealth Commercial	$281.00
Rate for Payer: Group Health Inc Commercial	$281.00
Rate for Payer: Group Health Inc Medicare	$196.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.00
Rate for Payer: Hamaspik Choice Inc Medicare	$281.00
Rate for Payer: United Healthcare Commercial	$19.07

HC ANTIPSYCHOTICS NOS 4-6 PROMETHAZINE - BUNDLED CHARGE

Facility

$562.00

Service Code	CPT 80343
Hospital Charge Code	3018034306
Hospital Revenue Code	301
Min. Negotiated Rate	$281.00
Max. Negotiated Rate	$281.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.00

Know your out-of-pocket cost for care.

All Charges