St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHEST CATHETER

Facility

$4,940.28

Service Code	HCPCS 32551
Hospital Charge Code	40000100
Hospital Revenue Code	360
Min. Negotiated Rate	$780.00
Max. Negotiated Rate	$3,705.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,852.05
Rate for Payer: Aetna Government	$1,852.05
Rate for Payer: Affinity Essential Plan 1&2	$1,296.44
Rate for Payer: Affinity Essential Plan 3&4	$1,296.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,296.44
Rate for Payer: Brighton Health Commercial	$3,705.21
Rate for Payer: Cash Price	$1,852.05
Rate for Payer: Cash Price	$1,852.05
Rate for Payer: Cash Price	$1,852.05
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,852.05
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: Elderplan Medicare Advantage	$1,852.05
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,574.24
Rate for Payer: Fidelis Essential Plan QHP	$1,648.32
Rate for Payer: Fidelis Medicare Advantage	$1,852.05
Rate for Payer: Fidelis Qualified Health Plan	$1,648.32
Rate for Payer: Group Health Inc Commercial	$1,852.05
Rate for Payer: Group Health Inc Medicare	$1,852.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.14
Rate for Payer: Hamaspik Choice Inc Medicare	$1,852.05
Rate for Payer: Healthfirst Medicare Advantage	$1,574.24
Rate for Payer: Healthfirst QHP	$1,852.05
Rate for Payer: Humana Medicare	$1,889.09
Rate for Payer: Senior Whole Health Medicare Advantage	$1,852.05
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$1,852.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,852.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,481.64
Rate for Payer: Wellcare Medicare	$1,759.45

CHEST DRAINAGE PLEURVAC INFANT

Facility

$104.21

Hospital Charge Code	64902380
Hospital Revenue Code	270
Min. Negotiated Rate	$36.47
Max. Negotiated Rate	$83.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$52.10
Rate for Payer: Aetna Government	$52.10
Rate for Payer: Brighton Health Commercial	$78.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$83.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$70.86
Rate for Payer: Group Health Inc Commercial	$52.10
Rate for Payer: Group Health Inc Medicare	$36.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.10
Rate for Payer: Hamaspik Choice Inc Medicare	$52.10

CHEST DRAINAGE PLEURVAC PEDS 8000

Facility

$93.75

Hospital Charge Code	64902382
Hospital Revenue Code	270
Min. Negotiated Rate	$32.81
Max. Negotiated Rate	$75.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$46.88
Rate for Payer: Aetna Government	$46.88
Rate for Payer: Brighton Health Commercial	$70.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$75.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$63.75
Rate for Payer: Group Health Inc Commercial	$46.88
Rate for Payer: Group Health Inc Medicare	$32.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.88
Rate for Payer: Hamaspik Choice Inc Medicare	$46.88

CHEST DRAIN VALVE

Facility

$21.26

Hospital Charge Code	40200868
Hospital Revenue Code	270
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$17.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.63
Rate for Payer: Aetna Government	$10.63
Rate for Payer: Brighton Health Commercial	$15.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.46
Rate for Payer: Group Health Inc Commercial	$10.63
Rate for Payer: Group Health Inc Medicare	$7.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.63
Rate for Payer: Hamaspik Choice Inc Medicare	$10.63

CHEST PAIN

Facility

$23,873.12

Service Code	MSDRG 313
Min. Negotiated Rate	$6,204.87
Max. Negotiated Rate	$23,873.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10,669.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17,362.27
Rate for Payer: Aetna Government	$17,362.27
Rate for Payer: Brighton Health Commercial	$10,492.20
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$17,709.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12,495.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$10,312.11
Rate for Payer: Elderplan Medicare Advantage	$16,494.16
Rate for Payer: EmblemHealth Commercial	$6,204.87
Rate for Payer: Fidelis Medicare Advantage	$17,362.27
Rate for Payer: Group Health Inc Commercial	$17,362.27
Rate for Payer: Group Health Inc Medicare	$17,362.27
Rate for Payer: Hamaspik Choice Inc Medicare	$17,362.27
Rate for Payer: Healthfirst Medicare Advantage	$8,073.46
Rate for Payer: Humana Medicare	$23,873.12
Rate for Payer: Senior Whole Health Medicare Advantage	$17,362.27
Rate for Payer: United Healthcare Commercial	$14,390.23
Rate for Payer: United Healthcare Medicare Advantage	$17,362.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17,362.27
Rate for Payer: Wellcare Medicare	$16,494.16

CHEST PHYSIOTHERAPY

Facility

$330.23

Service Code	HCPCS 94667
Hospital Charge Code	40302150
Hospital Revenue Code	410
Rate for Payer: Cash Price	$147.72

CHEST PHYSIOTHERAPY

Facility

$330.23

Service Code	HCPCS 94667
Hospital Charge Code	40302150
Hospital Revenue Code	410
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$247.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$181.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$147.72
Rate for Payer: Aetna Government	$147.72
Rate for Payer: Affinity Essential Plan 1&2	$103.40
Rate for Payer: Affinity Essential Plan 3&4	$103.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$103.40
Rate for Payer: Brighton Health Commercial	$247.67
Rate for Payer: Cash Price	$147.72
Rate for Payer: Cash Price	$147.72
Rate for Payer: Cash Price	$147.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$147.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.45
Rate for Payer: Elderplan Medicare Advantage	$147.72
Rate for Payer: EmblemHealth Commercial	$147.72
Rate for Payer: Fidelis Essential Plan Aliesa	$125.56
Rate for Payer: Fidelis Essential Plan QHP	$131.47
Rate for Payer: Fidelis Medicare Advantage	$147.72
Rate for Payer: Fidelis Qualified Health Plan	$131.47
Rate for Payer: Group Health Inc Commercial	$147.72
Rate for Payer: Group Health Inc Medicare	$147.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.12
Rate for Payer: Hamaspik Choice Inc Medicare	$147.72
Rate for Payer: Healthfirst Medicare Advantage	$125.56
Rate for Payer: Healthfirst QHP	$147.72
Rate for Payer: Humana Medicare	$150.67
Rate for Payer: Senior Whole Health Medicare Advantage	$147.72
Rate for Payer: United Healthcare Commercial	$165.12
Rate for Payer: United Healthcare Medicare Advantage	$147.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$147.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$118.18
Rate for Payer: Wellcare Medicare	$140.33

CHEVRON BUNIONECTOMY

Facility

$8,291.05

Service Code	HCPCS 28296
Hospital Charge Code	40082805
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$6,218.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,743.15
Rate for Payer: Aetna Government	$3,743.15
Rate for Payer: Affinity Essential Plan 1&2	$2,620.20
Rate for Payer: Affinity Essential Plan 3&4	$2,620.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,620.20
Rate for Payer: Brighton Health Commercial	$6,218.29
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,743.15
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: Elderplan Medicare Advantage	$3,743.15
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,181.68
Rate for Payer: Fidelis Essential Plan QHP	$3,331.40
Rate for Payer: Fidelis Medicare Advantage	$3,743.15
Rate for Payer: Fidelis Qualified Health Plan	$3,331.40
Rate for Payer: Group Health Inc Commercial	$3,743.15
Rate for Payer: Group Health Inc Medicare	$3,743.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,145.52
Rate for Payer: Hamaspik Choice Inc Medicare	$3,743.15
Rate for Payer: Healthfirst Medicare Advantage	$3,181.68
Rate for Payer: Healthfirst QHP	$3,743.15
Rate for Payer: Humana Medicare	$3,818.01
Rate for Payer: Senior Whole Health Medicare Advantage	$3,743.15
Rate for Payer: United Healthcare Commercial	$1,835.00
Rate for Payer: United Healthcare Medicare Advantage	$3,743.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,743.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,994.52
Rate for Payer: Wellcare Medicare	$3,555.99

CHEVRON BUNIONECTOMY

Facility

$8,291.05

Service Code	HCPCS 28296
Hospital Charge Code	40082805
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,743.15

CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS

Professional

Both

$2,007.29

Service Code	HCPCS 77295
Min. Negotiated Rate	$1,505.47
Max. Negotiated Rate	$1,505.47
Rate for Payer: Cash Price	$553.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,505.47
Rate for Payer: SOMOS Essential	$1,505.47

CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS

Professional

Both

$1,100.16

Service Code	HCPCS 77295 TC
Min. Negotiated Rate	$825.12
Max. Negotiated Rate	$825.12
Rate for Payer: Cash Price	$304.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$825.12
Rate for Payer: SOMOS Essential	$825.12

CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS

Professional

Both

$907.13

Service Code	HCPCS 77295 26
Min. Negotiated Rate	$680.35
Max. Negotiated Rate	$680.35
Rate for Payer: Cash Price	$248.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$680.35
Rate for Payer: SOMOS Essential	$680.35

CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION

Professional

Both

$151.59

Service Code	HCPCS 76377 26
Min. Negotiated Rate	$113.69
Max. Negotiated Rate	$113.69
Rate for Payer: Cash Price	$41.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$113.69
Rate for Payer: SOMOS Essential	$113.69

CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION

Professional

Both

$166.60

Service Code	HCPCS 76377 TC
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Cash Price	$48.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$124.95
Rate for Payer: SOMOS Essential	$124.95

CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION

Professional

Both

$318.19

Service Code	HCPCS 76377
Min. Negotiated Rate	$238.64
Max. Negotiated Rate	$238.64
Rate for Payer: Cash Price	$90.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$238.64
Rate for Payer: SOMOS Essential	$238.64

CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION

Professional

Both

$64.54

Service Code	HCPCS 76376 TC
Min. Negotiated Rate	$48.40
Max. Negotiated Rate	$48.40
Rate for Payer: Cash Price	$18.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$48.40
Rate for Payer: SOMOS Essential	$48.40

CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION

Professional

Both

$37.84

Service Code	HCPCS 76376 26
Min. Negotiated Rate	$28.38
Max. Negotiated Rate	$28.38
Rate for Payer: Cash Price	$10.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28.38
Rate for Payer: SOMOS Essential	$28.38

CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION

Professional

Both

$102.41

Service Code	HCPCS 76376
Min. Negotiated Rate	$76.81
Max. Negotiated Rate	$76.81
Rate for Payer: Cash Price	$29.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$76.81
Rate for Payer: SOMOS Essential	$76.81

CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING

Professional

Both

$1,389.33

Service Code	HCPCS 78278
Min. Negotiated Rate	$1,042.00
Max. Negotiated Rate	$1,042.00
Rate for Payer: Cash Price	$373.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,042.00
Rate for Payer: SOMOS Essential	$1,042.00

CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING

Professional

Both

$183.82

Service Code	HCPCS 78278 26
Min. Negotiated Rate	$137.86
Max. Negotiated Rate	$137.86
Rate for Payer: Cash Price	$50.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$137.86
Rate for Payer: SOMOS Essential	$137.86

CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING

Professional

Both

$1,205.51

Service Code	HCPCS 78278 TC
Min. Negotiated Rate	$904.13
Max. Negotiated Rate	$904.13
Rate for Payer: Cash Price	$323.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$904.13
Rate for Payer: SOMOS Essential	$904.13

CHG ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE

Professional

Both

$1,057.46

Service Code	HCPCS 78456 TC
Min. Negotiated Rate	$793.10
Max. Negotiated Rate	$793.10
Rate for Payer: Cash Price	$287.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$793.10
Rate for Payer: SOMOS Essential	$793.10

CHG ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE

Professional

Both

$1,242.50

Service Code	HCPCS 78456
Min. Negotiated Rate	$931.88
Max. Negotiated Rate	$931.88
Rate for Payer: Cash Price	$337.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$931.88
Rate for Payer: SOMOS Essential	$931.88

CHG ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE

Professional

Both

$185.08

Service Code	HCPCS 78456 26
Min. Negotiated Rate	$138.81
Max. Negotiated Rate	$138.81
Rate for Payer: Cash Price	$50.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$138.81
Rate for Payer: SOMOS Essential	$138.81

CHG ADRENAL IMAGING CORTEX &/MEDULLA

Professional

Both

$1,787.42

Service Code	HCPCS 78075
Min. Negotiated Rate	$1,340.56
Max. Negotiated Rate	$1,340.56
Rate for Payer: Cash Price	$477.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,340.56
Rate for Payer: SOMOS Essential	$1,340.56

Know your out-of-pocket cost for care.

All Charges