St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC CONIZATION CERVIX,LOOP ELECTRD

Facility

$8,480.00

Service Code	CPT 57522
Hospital Charge Code	3615752201
Hospital Revenue Code	361
Min. Negotiated Rate	$298.05
Max. Negotiated Rate	$6,360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,884.81
Rate for Payer: Aetna Government	$3,884.81
Rate for Payer: Affinity Essential Plan 1&2	$2,719.37
Rate for Payer: Affinity Essential Plan 3&4	$2,719.37
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,719.37
Rate for Payer: Brighton Health Commercial	$6,360.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,884.81
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: Elderplan Medicare Advantage	$3,884.81
Rate for Payer: EmblemHealth Commercial	$3,884.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,496.33
Rate for Payer: Fidelis Essential Plan Aliesa	$3,302.09
Rate for Payer: Fidelis Essential Plan QHP	$3,457.48
Rate for Payer: Fidelis Medicare Advantage	$3,884.81
Rate for Payer: Fidelis Qualified Health Plan	$3,457.48
Rate for Payer: Group Health Inc Commercial	$3,884.81
Rate for Payer: Group Health Inc Medicare	$3,884.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,884.81
Rate for Payer: Hamaspik Choice Inc Medicare	$1,674.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$298.05
Rate for Payer: Healthfirst Medicare Advantage	$3,302.09
Rate for Payer: Healthfirst QHP	$3,884.81
Rate for Payer: Humana Medicare	$3,962.51
Rate for Payer: Senior Whole Health Medicare Advantage	$3,884.81
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,884.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,884.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,690.57
Rate for Payer: Wellcare Medicare	$3,690.57

HC CONSC. SEDAT. AGE<5 1ST 30 MIN

Facility

$4,157.00

Service Code	CPT 99143
Hospital Charge Code	3709914301
Hospital Revenue Code	370
Min. Negotiated Rate	$1,454.95
Max. Negotiated Rate	$3,325.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,286.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,078.50
Rate for Payer: Aetna Government	$2,078.50
Rate for Payer: Brighton Health Commercial	$3,117.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,325.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,826.76
Rate for Payer: EmblemHealth Commercial	$2,078.50
Rate for Payer: Group Health Inc Commercial	$2,078.50
Rate for Payer: Group Health Inc Medicare	$1,454.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,078.50

HC CONSC. SEDAT. AGE<5 1ST 30 MIN

Facility

$4,157.00

Service Code	CPT 99143
Hospital Charge Code	3709914301
Hospital Revenue Code	370
Min. Negotiated Rate	$2,078.50
Max. Negotiated Rate	$2,078.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.50

HC CONSC. SEDAT. EACH ADD'L 15MIN

Facility

$4,157.00

Service Code	CPT 99145
Hospital Charge Code	3709914501
Hospital Revenue Code	370
Min. Negotiated Rate	$1,454.95
Max. Negotiated Rate	$3,325.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,286.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,078.50
Rate for Payer: Aetna Government	$2,078.50
Rate for Payer: Brighton Health Commercial	$3,117.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,325.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,826.76
Rate for Payer: EmblemHealth Commercial	$2,078.50
Rate for Payer: Group Health Inc Commercial	$2,078.50
Rate for Payer: Group Health Inc Medicare	$1,454.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,078.50

HC CONSC. SEDAT. EACH ADD'L 15MIN

Facility

$4,157.00

Service Code	CPT 99145
Hospital Charge Code	3709914501
Hospital Revenue Code	370
Min. Negotiated Rate	$2,078.50
Max. Negotiated Rate	$2,078.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.50

HC CONSULTATION MAMMO FILMS

Facility

$81.00

Service Code	CPT 76140 TC
Hospital Charge Code	3207614002
Hospital Revenue Code	320
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$64.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.27
Rate for Payer: Aetna Government	$28.27
Rate for Payer: Brighton Health Commercial	$60.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$64.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.08
Rate for Payer: EmblemHealth Commercial	$40.50
Rate for Payer: Group Health Inc Commercial	$40.50
Rate for Payer: Group Health Inc Medicare	$28.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.50
Rate for Payer: Hamaspik Choice Inc Medicare	$40.50
Rate for Payer: Healthfirst Essential Plan	$26.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$11.98

HC CONSULTATION MAMMO FILMS

Facility

$81.00

Service Code	CPT 76140 TC
Hospital Charge Code	3207614002
Hospital Revenue Code	320
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.50

HC CONSULTATION - OUTSIDE FILMS

Facility

$81.00

Service Code	CPT 76140 TC
Hospital Charge Code	3207614003
Hospital Revenue Code	320
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$64.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.27
Rate for Payer: Aetna Government	$28.27
Rate for Payer: Brighton Health Commercial	$60.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$64.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.08
Rate for Payer: EmblemHealth Commercial	$40.50
Rate for Payer: Group Health Inc Commercial	$40.50
Rate for Payer: Group Health Inc Medicare	$28.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.50
Rate for Payer: Hamaspik Choice Inc Medicare	$40.50
Rate for Payer: Healthfirst Essential Plan	$26.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$11.98

HC CONSULTATION - OUTSIDE FILMS

Facility

$81.00

Service Code	CPT 76140 TC
Hospital Charge Code	3207614003
Hospital Revenue Code	320
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.50

HC CONSULTATION WITH FAMILY

Facility

$100.00

Service Code	CPT 90887
Hospital Charge Code	9009088701
Hospital Revenue Code	900
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$50.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00

HC CONSULTATION WITH FAMILY

Facility

$100.00

Service Code	CPT 90887
Hospital Charge Code	9009088701
Hospital Revenue Code	900
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$186.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.80
Rate for Payer: Aetna Government	$64.80
Rate for Payer: Brighton Health Commercial	$75.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.00
Rate for Payer: EmblemHealth Commercial	$50.00
Rate for Payer: Group Health Inc Commercial	$50.00
Rate for Payer: Group Health Inc Medicare	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00
Rate for Payer: United Healthcare Commercial	$50.00

HC CONSULTATION X-RAY FILMS

Facility

$81.00

Service Code	CPT 76140 TC
Hospital Charge Code	3207614001
Hospital Revenue Code	320
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.50

HC CONSULTATION X-RAY FILMS

Facility

$81.00

Service Code	CPT 76140 TC
Hospital Charge Code	3207614001
Hospital Revenue Code	320
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$64.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.27
Rate for Payer: Aetna Government	$28.27
Rate for Payer: Brighton Health Commercial	$60.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$64.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.08
Rate for Payer: EmblemHealth Commercial	$40.50
Rate for Payer: Group Health Inc Commercial	$40.50
Rate for Payer: Group Health Inc Medicare	$28.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.50
Rate for Payer: Hamaspik Choice Inc Medicare	$40.50
Rate for Payer: Healthfirst Essential Plan	$26.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$11.98

HC CONTINUOUS INTRAOPERATIVE NEUROPHYSIOLOGY MONITORING, 15 MINS

Facility

$99.00

Service Code	CPT 95940
Hospital Charge Code	9209594001
Hospital Revenue Code	920
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$49.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.50

HC CONTINUOUS INTRAOPERATIVE NEUROPHYSIOLOGY MONITORING, 15 MINS

Facility

$99.00

Service Code	CPT 95940
Hospital Charge Code	9209594001
Hospital Revenue Code	920
Min. Negotiated Rate	$28.47
Max. Negotiated Rate	$94.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$54.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.47
Rate for Payer: Aetna Government	$28.47
Rate for Payer: Brighton Health Commercial	$74.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$79.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$67.32
Rate for Payer: EmblemHealth Commercial	$49.50
Rate for Payer: Group Health Inc Commercial	$49.50
Rate for Payer: Group Health Inc Medicare	$34.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.50
Rate for Payer: Hamaspik Choice Inc Medicare	$49.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35.56
Rate for Payer: United Healthcare Commercial	$94.00

HC CONTRACTED HOME HEALTH AGENCY SERVICES, ALL SERVICES PROVIDED UNDER CONTRACT, PER DAY

Facility

$150.00

Service Code	CPT T1022
Hospital Charge Code	570T102201
Hospital Revenue Code	570
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$120.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.00
Rate for Payer: Aetna Government	$50.00
Rate for Payer: Brighton Health Commercial	$112.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$120.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.00
Rate for Payer: EmblemHealth Commercial	$75.00
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

HC CONTRACTED HOME HEALTH AGENCY SERVICES, ALL SERVICES PROVIDED UNDER CONTRACT, PER DAY

Facility

$150.00

Service Code	CPT T1022
Hospital Charge Code	570T102201
Hospital Revenue Code	570
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00

HC CONTRAST EXAM ABDOMINL AORTA - IR AORTAGRAM ABDOMNL SERIALOGRAM

Facility

$8,393.00

Service Code	CPT 75625 TC
Hospital Charge Code	3237562501
Hospital Revenue Code	323
Min. Negotiated Rate	$4,196.50
Max. Negotiated Rate	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50

HC CONTRAST EXAM ABDOMINL AORTA - IR AORTAGRAM ABDOMNL SERIALOGRAM

Facility

$8,393.00

Service Code	CPT 75625 TC
Hospital Charge Code	3237562501
Hospital Revenue Code	323
Min. Negotiated Rate	$61.70
Max. Negotiated Rate	$6,294.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,616.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.86
Rate for Payer: Aetna Government	$64.86
Rate for Payer: Brighton Health Commercial	$6,294.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,336.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,650.49
Rate for Payer: EmblemHealth Commercial	$61.70
Rate for Payer: Group Health Inc Commercial	$4,196.50
Rate for Payer: Group Health Inc Medicare	$2,937.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,196.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$61.70
Rate for Payer: Healthfirst Essential Plan	$312.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$138.92

HC CONTRAST EXAM ABDOMINL AORTA - IR AORTAGRAM ABDOMNL SERIALOGRAM CHG

Facility

$8,393.00

Service Code	CPT 75625 TC
Hospital Charge Code	3237562502
Hospital Revenue Code	323
Min. Negotiated Rate	$61.70
Max. Negotiated Rate	$6,294.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,616.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.86
Rate for Payer: Aetna Government	$64.86
Rate for Payer: Brighton Health Commercial	$6,294.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,336.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,650.49
Rate for Payer: EmblemHealth Commercial	$61.70
Rate for Payer: Group Health Inc Commercial	$4,196.50
Rate for Payer: Group Health Inc Medicare	$2,937.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,196.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$61.70
Rate for Payer: Healthfirst Essential Plan	$312.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$138.92

HC CONTRAST EXAM ABDOMINL AORTA - IR AORTAGRAM ABDOMNL SERIALOGRAM CHG

Facility

$8,393.00

Service Code	CPT 75625 TC
Hospital Charge Code	3237562502
Hospital Revenue Code	323
Min. Negotiated Rate	$4,196.50
Max. Negotiated Rate	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50

HC CONTRAST EXAM THORACIC AORTA - IR AORTAGRAM THORACIC SERIALOGRAM

Facility

$13,920.00

Service Code	CPT 75605 TC
Hospital Charge Code	3237560501
Hospital Revenue Code	323
Min. Negotiated Rate	$65.13
Max. Negotiated Rate	$10,440.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7,656.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.13
Rate for Payer: Aetna Government	$65.13
Rate for Payer: Brighton Health Commercial	$10,440.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,336.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,650.49
Rate for Payer: EmblemHealth Commercial	$71.33
Rate for Payer: Group Health Inc Commercial	$6,960.00
Rate for Payer: Group Health Inc Medicare	$4,872.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,960.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,960.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$71.33
Rate for Payer: Healthfirst Essential Plan	$312.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$138.77

HC CONTRAST EXAM THORACIC AORTA - IR AORTAGRAM THORACIC SERIALOGRAM

Facility

$13,920.00

Service Code	CPT 75605 TC
Hospital Charge Code	3237560501
Hospital Revenue Code	323
Min. Negotiated Rate	$6,960.00
Max. Negotiated Rate	$6,960.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,960.00

HC CONTRAST INJ,ABSCESS/CYST VIA CATH TUBE

Facility

$4,542.00

Service Code	CPT 49424 TC
Hospital Charge Code	3614942401
Hospital Revenue Code	361
Min. Negotiated Rate	$2,271.00
Max. Negotiated Rate	$2,271.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,271.00

HC CONTRAST INJ,ABSCESS/CYST VIA CATH TUBE

Facility

$4,542.00

Service Code	CPT 49424 TC
Hospital Charge Code	3614942401
Hospital Revenue Code	361
Min. Negotiated Rate	$167.20
Max. Negotiated Rate	$3,406.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$167.20
Rate for Payer: Aetna Government	$167.20
Rate for Payer: Brighton Health Commercial	$3,406.50
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	$2,271.00
Rate for Payer: Group Health Inc Commercial	$2,271.00
Rate for Payer: Group Health Inc Medicare	$1,589.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,271.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,271.00
Rate for Payer: United Healthcare Commercial	$1,113.00

Know your out-of-pocket cost for care.

All Charges