St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC BYPASS GRAFT AORTOILLIAC

Facility

$4,892.00

Service Code	CPT 35637 TC
Hospital Charge Code	3613563701
Hospital Revenue Code	361
Min. Negotiated Rate	$1,496.00
Max. Negotiated Rate	$3,669.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,690.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,967.66
Rate for Payer: Aetna Government	$1,967.66
Rate for Payer: Brighton Health Commercial	$3,669.00
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	$2,446.00
Rate for Payer: Group Health Inc Commercial	$2,446.00
Rate for Payer: Group Health Inc Medicare	$1,712.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,446.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,446.00
Rate for Payer: United Healthcare Commercial	$1,496.00

HC BYPASS GRAFT AORTOILLIAC

Facility

$4,892.00

Service Code	CPT 35637 TC
Hospital Charge Code	3613563701
Hospital Revenue Code	361
Min. Negotiated Rate	$2,446.00
Max. Negotiated Rate	$2,446.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,446.00

HC BYPASS GRAFT/FEMORAL POPLITEAL

Facility

$3,741.00

Service Code	CPT 35656 TC
Hospital Charge Code	3613565601
Hospital Revenue Code	361
Min. Negotiated Rate	$1,238.92
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,057.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,238.92
Rate for Payer: Aetna Government	$1,238.92
Rate for Payer: Brighton Health Commercial	$2,805.75
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	$1,870.50
Rate for Payer: Group Health Inc Commercial	$1,870.50
Rate for Payer: Group Health Inc Medicare	$1,309.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,870.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,870.50
Rate for Payer: United Healthcare Commercial	$1,496.00

HC BYPASS GRAFT/FEMORAL POPLITEAL

Facility

$3,741.00

Service Code	CPT 35656 TC
Hospital Charge Code	3613565601
Hospital Revenue Code	361
Min. Negotiated Rate	$1,870.50
Max. Negotiated Rate	$1,870.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,870.50

HC BYPASS GRAFT/ILLEO FEMORAL

Facility

$3,931.00

Service Code	CPT 35665 TC
Hospital Charge Code	3613566501
Hospital Revenue Code	361
Min. Negotiated Rate	$1,965.50
Max. Negotiated Rate	$1,965.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,965.50

HC BYPASS GRAFT/ILLEO FEMORAL

Facility

$3,931.00

Service Code	CPT 35665 TC
Hospital Charge Code	3613566501
Hospital Revenue Code	361
Min. Negotiated Rate	$1,338.90
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,162.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,338.90
Rate for Payer: Aetna Government	$1,338.90
Rate for Payer: Brighton Health Commercial	$2,948.25
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	$1,965.50
Rate for Payer: Group Health Inc Commercial	$1,965.50
Rate for Payer: Group Health Inc Medicare	$1,375.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,965.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,965.50
Rate for Payer: United Healthcare Commercial	$1,496.00

HC BYPASS GRAFT SUBCLAVIAN/SUBCLAVIAN

Facility

$3,043.00

Service Code	CPT 35612 TC
Hospital Charge Code	3613561201
Hospital Revenue Code	361
Min. Negotiated Rate	$1,065.05
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,673.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,225.69
Rate for Payer: Aetna Government	$1,225.69
Rate for Payer: Brighton Health Commercial	$2,282.25
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	$1,521.50
Rate for Payer: Group Health Inc Commercial	$1,521.50
Rate for Payer: Group Health Inc Medicare	$1,065.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,521.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,521.50
Rate for Payer: United Healthcare Commercial	$1,496.00

HC BYPASS GRAFT SUBCLAVIAN/SUBCLAVIAN

Facility

$3,043.00

Service Code	CPT 35612 TC
Hospital Charge Code	3613561201
Hospital Revenue Code	361
Min. Negotiated Rate	$1,521.50
Max. Negotiated Rate	$1,521.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,521.50

HC BYPASS GRFT/SUBCLAVIAN/AXILLAR

Facility

$3,187.00

Service Code	CPT 35616 TC
Hospital Charge Code	3613561601
Hospital Revenue Code	361
Min. Negotiated Rate	$1,115.45
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,752.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,260.02
Rate for Payer: Aetna Government	$1,260.02
Rate for Payer: Brighton Health Commercial	$2,390.25
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	$1,593.50
Rate for Payer: Group Health Inc Commercial	$1,593.50
Rate for Payer: Group Health Inc Medicare	$1,115.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,593.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,593.50
Rate for Payer: United Healthcare Commercial	$1,496.00

HC BYPASS GRFT/SUBCLAVIAN/AXILLAR

Facility

$3,187.00

Service Code	CPT 35616 TC
Hospital Charge Code	3613561601
Hospital Revenue Code	361
Min. Negotiated Rate	$1,593.50
Max. Negotiated Rate	$1,593.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,593.50

HC CAH PRO FEE EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB

Facility

$979.00

Service Code	CPT 99281
Hospital Charge Code	9819928101
Hospital Revenue Code	981
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$783.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$538.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$107.58
Rate for Payer: Aetna Government	$107.58
Rate for Payer: Affinity Essential Plan 1&2	$75.31
Rate for Payer: Affinity Essential Plan 3&4	$75.31
Rate for Payer: Affinity Medicaid/CHP/HARP	$75.31
Rate for Payer: Brighton Health Commercial	$734.25
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$107.58
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$107.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$783.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$665.72
Rate for Payer: Elderplan Medicare Advantage	$107.58
Rate for Payer: EmblemHealth Commercial	$107.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$96.82
Rate for Payer: Fidelis Essential Plan Aliesa	$91.44
Rate for Payer: Fidelis Essential Plan QHP	$95.75
Rate for Payer: Fidelis Medicare Advantage	$107.58
Rate for Payer: Fidelis Qualified Health Plan	$95.75
Rate for Payer: Group Health Inc Commercial	$107.58
Rate for Payer: Group Health Inc Medicare	$107.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.58
Rate for Payer: Hamaspik Choice Inc Medicare	$107.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$12.80
Rate for Payer: Healthfirst Medicare Advantage	$91.44
Rate for Payer: Healthfirst QHP	$107.58
Rate for Payer: Humana Medicare	$109.73
Rate for Payer: Senior Whole Health Medicare Advantage	$107.58
Rate for Payer: United Healthcare Medicare Advantage	$107.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$107.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$102.20
Rate for Payer: Wellcare Medicare	$102.20

HC CAH PRO FEE EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB

Facility

$979.00

Service Code	CPT 99281
Hospital Charge Code	9819928101
Hospital Revenue Code	981
Min. Negotiated Rate	$489.50
Max. Negotiated Rate	$489.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$489.50

HC CAH PRO FEE EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY

Facility

$979.00

Service Code	CPT 99282
Hospital Charge Code	9819928201
Hospital Revenue Code	981
Min. Negotiated Rate	$489.50
Max. Negotiated Rate	$489.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$489.50

HC CAH PRO FEE EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY

Facility

$979.00

Service Code	CPT 99282
Hospital Charge Code	9819928201
Hospital Revenue Code	981
Min. Negotiated Rate	$46.76
Max. Negotiated Rate	$783.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$538.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$193.49
Rate for Payer: Aetna Government	$193.49
Rate for Payer: Affinity Essential Plan 1&2	$135.44
Rate for Payer: Affinity Essential Plan 3&4	$135.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$135.44
Rate for Payer: Brighton Health Commercial	$734.25
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$193.49
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$193.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$783.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$665.72
Rate for Payer: Elderplan Medicare Advantage	$193.49
Rate for Payer: EmblemHealth Commercial	$193.49
Rate for Payer: Fidelis CHP/HARP/Medicaid	$174.14
Rate for Payer: Fidelis Essential Plan Aliesa	$164.47
Rate for Payer: Fidelis Essential Plan QHP	$172.21
Rate for Payer: Fidelis Medicare Advantage	$193.49
Rate for Payer: Fidelis Qualified Health Plan	$172.21
Rate for Payer: Group Health Inc Commercial	$193.49
Rate for Payer: Group Health Inc Medicare	$193.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$193.49
Rate for Payer: Hamaspik Choice Inc Medicare	$193.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$46.76
Rate for Payer: Healthfirst Medicare Advantage	$164.47
Rate for Payer: Healthfirst QHP	$193.49
Rate for Payer: Humana Medicare	$197.36
Rate for Payer: Senior Whole Health Medicare Advantage	$193.49
Rate for Payer: United Healthcare Medicare Advantage	$193.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$193.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$183.82
Rate for Payer: Wellcare Medicare	$183.82

HC CAH PRO FEE OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN

Facility

$75.00

Service Code	CPT 99213
Hospital Charge Code	9839921301
Hospital Revenue Code	983
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$73.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$39.90
Rate for Payer: Aetna Government	$39.90
Rate for Payer: Brighton Health Commercial	$56.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.00
Rate for Payer: EmblemHealth Commercial	$37.50
Rate for Payer: Group Health Inc Commercial	$37.50
Rate for Payer: Group Health Inc Medicare	$26.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.50
Rate for Payer: Hamaspik Choice Inc Medicare	$37.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$73.09

HC CAH PRO FEE OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN

Facility

$75.00

Service Code	CPT 99213
Hospital Charge Code	9839921301
Hospital Revenue Code	983
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.50

HC CAH PRO FEE OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN

Facility

$112.00

Service Code	CPT 99214
Hospital Charge Code	9839921401
Hospital Revenue Code	983
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$107.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.00
Rate for Payer: Aetna Government	$54.00
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	$107.63

HC CAH PRO FEE OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN

Facility

$112.00

Service Code	CPT 99214
Hospital Charge Code	9839921401
Hospital Revenue Code	983
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$56.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.00

HC CALCULUS ASSAY,INFRARED SPECTR - KIDNEY STONE ANALYSIS

Facility

$32.00

Service Code	CPT 82365
Hospital Charge Code	3018236501
Hospital Revenue Code	301
Min. Negotiated Rate	$9.03
Max. Negotiated Rate	$28.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.90
Rate for Payer: Aetna Government	$12.90
Rate for Payer: Affinity Essential Plan 1&2	$9.03
Rate for Payer: Affinity Essential Plan 3&4	$9.03
Rate for Payer: Affinity Medicaid/CHP/HARP	$9.03
Rate for Payer: Brighton Health Commercial	$24.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.44
Rate for Payer: Elderplan Medicare Advantage	$12.90
Rate for Payer: EmblemHealth Commercial	$12.90
Rate for Payer: Fidelis CHP/HARP/Medicaid	$11.61
Rate for Payer: Fidelis Essential Plan Aliesa	$10.96
Rate for Payer: Fidelis Essential Plan QHP	$11.48
Rate for Payer: Fidelis Medicare Advantage	$12.90
Rate for Payer: Fidelis Qualified Health Plan	$11.48
Rate for Payer: Group Health Inc Commercial	$12.90
Rate for Payer: Group Health Inc Medicare	$12.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.90
Rate for Payer: Hamaspik Choice Inc Medicare	$12.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$12.51
Rate for Payer: Healthfirst Essential Plan	$28.15
Rate for Payer: Healthfirst Medicare Advantage	$12.90
Rate for Payer: Healthfirst QHP	$12.90
Rate for Payer: Humana Medicare	$13.16
Rate for Payer: Senior Whole Health Medicare Advantage	$12.90
Rate for Payer: United Healthcare Commercial	$16.33
Rate for Payer: United Healthcare Medicare Advantage	$12.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12.51
Rate for Payer: Wellcare Medicare	$11.61

HC CALCULUS ASSAY,INFRARED SPECTR - KIDNEY STONE ANALYSIS

Facility

$32.00

Service Code	CPT 82365
Hospital Charge Code	3018236501
Hospital Revenue Code	301
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$16.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.00

HC CALPROTECTIN, FECAL

Facility

$49.00

Service Code	CPT 83993
Hospital Charge Code	3018399301
Hospital Revenue Code	301
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$24.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.50

HC CALPROTECTIN, FECAL

Facility

$49.00

Service Code	CPT 83993
Hospital Charge Code	3018399301
Hospital Revenue Code	301
Min. Negotiated Rate	$11.39
Max. Negotiated Rate	$36.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.63
Rate for Payer: Aetna Government	$19.63
Rate for Payer: Affinity Essential Plan 1&2	$13.74
Rate for Payer: Affinity Essential Plan 3&4	$13.74
Rate for Payer: Affinity Medicaid/CHP/HARP	$13.74
Rate for Payer: Brighton Health Commercial	$36.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$19.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.07
Rate for Payer: Elderplan Medicare Advantage	$19.63
Rate for Payer: EmblemHealth Commercial	$19.63
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17.67
Rate for Payer: Fidelis Essential Plan Aliesa	$16.69
Rate for Payer: Fidelis Essential Plan QHP	$17.47
Rate for Payer: Fidelis Medicare Advantage	$19.63
Rate for Payer: Fidelis Qualified Health Plan	$17.47
Rate for Payer: Group Health Inc Commercial	$19.63
Rate for Payer: Group Health Inc Medicare	$19.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.63
Rate for Payer: Hamaspik Choice Inc Medicare	$19.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$11.39
Rate for Payer: Healthfirst Essential Plan	$25.63
Rate for Payer: Healthfirst Medicare Advantage	$19.63
Rate for Payer: Healthfirst QHP	$19.63
Rate for Payer: Humana Medicare	$20.02
Rate for Payer: Senior Whole Health Medicare Advantage	$19.63
Rate for Payer: United Healthcare Commercial	$24.86
Rate for Payer: United Healthcare Medicare Advantage	$19.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$11.39
Rate for Payer: Wellcare Medicare	$17.67

HC CAMS METHYLPREDNISOLONE 40 MG INJ

Facility

$1.00

Service Code	CPT J1030
Hospital Charge Code	636J103001
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50

HC CAMS METHYLPREDNISOLONE 40 MG INJ

Facility

$1.00

Service Code	CPT J1030
Hospital Charge Code	636J103001
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$5.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.63
Rate for Payer: Aetna Government	$5.63
Rate for Payer: Brighton Health Commercial	$0.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
Rate for Payer: EmblemHealth Commercial	$0.50
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

HC CAMS TRIAMCINOLONE ACETONIDE INJ

Facility

$94.00

Service Code	CPT J3301
Hospital Charge Code	636J330101
Hospital Revenue Code	636
Min. Negotiated Rate	$47.00
Max. Negotiated Rate	$47.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.00
Rate for Payer: Hamaspik Choice Inc Medicare	$47.00

Know your out-of-pocket cost for care.

All Charges