St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC DRUG SCREENING FENTANYL - FENTANYL URINE

Facility

$89.00

Service Code	CPT 80354
Hospital Charge Code	3018035401
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$71.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$66.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$71.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$60.52
Rate for Payer: EmblemHealth Commercial	$44.50
Rate for Payer: Group Health Inc Commercial	$44.50
Rate for Payer: Group Health Inc Medicare	$31.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.50
Rate for Payer: Hamaspik Choice Inc Medicare	$44.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.05
Rate for Payer: Healthfirst Essential Plan	$11.36
Rate for Payer: United Healthcare Commercial	$21.99
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.05

HC DRUG SCREENING FENTANYL - FENTANYL URINE

Facility

$89.00

Service Code	CPT 80354
Hospital Charge Code	3018035401
Hospital Revenue Code	301
Min. Negotiated Rate	$44.50
Max. Negotiated Rate	$44.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.50

HC DRUG SCREENING METHADONE - METHADONE & METABOLITE LEVEL

Facility

$155.00

Service Code	CPT 80358
Hospital Charge Code	3018035801
Hospital Revenue Code	301
Min. Negotiated Rate	$77.50
Max. Negotiated Rate	$77.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.50

HC DRUG SCREENING METHADONE - METHADONE & METABOLITE LEVEL

Facility

$155.00

Service Code	CPT 80358
Hospital Charge Code	3018035801
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$124.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$116.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$124.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.40
Rate for Payer: EmblemHealth Commercial	$77.50
Rate for Payer: Group Health Inc Commercial	$77.50
Rate for Payer: Group Health Inc Medicare	$54.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.50
Rate for Payer: Hamaspik Choice Inc Medicare	$77.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.05
Rate for Payer: Healthfirst Essential Plan	$11.36
Rate for Payer: United Healthcare Commercial	$20.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.05

HC DRUG SCREENING OPIATES 1 OR MORE, 10 DRUG-SCRN,QUANTITATIVE,UR

Facility

$155.00

Service Code	CPT 80361
Hospital Charge Code	3018036102
Hospital Revenue Code	301
Min. Negotiated Rate	$77.50
Max. Negotiated Rate	$77.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.50

HC DRUG SCREENING OPIATES 1 OR MORE, 10 DRUG-SCRN,QUANTITATIVE,UR

Facility

$155.00

Service Code	CPT 80361
Hospital Charge Code	3018036102
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$124.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$116.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$124.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.40
Rate for Payer: EmblemHealth Commercial	$77.50
Rate for Payer: Group Health Inc Commercial	$77.50
Rate for Payer: Group Health Inc Medicare	$54.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.50
Rate for Payer: Hamaspik Choice Inc Medicare	$77.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.05
Rate for Payer: Healthfirst Essential Plan	$11.36
Rate for Payer: United Healthcare Commercial	$31.48
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.05

HC DRUG SCREENING OPIATES 1 OR MORE, 5 DRUG-SCRN,QUANTITATIVE,UR

Facility

$155.00

Service Code	CPT 80361
Hospital Charge Code	3018036101
Hospital Revenue Code	301
Min. Negotiated Rate	$77.50
Max. Negotiated Rate	$77.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.50

HC DRUG SCREENING OPIATES 1 OR MORE, 5 DRUG-SCRN,QUANTITATIVE,UR

Facility

$155.00

Service Code	CPT 80361
Hospital Charge Code	3018036101
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$124.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$116.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$124.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.40
Rate for Payer: EmblemHealth Commercial	$77.50
Rate for Payer: Group Health Inc Commercial	$77.50
Rate for Payer: Group Health Inc Medicare	$54.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.50
Rate for Payer: Hamaspik Choice Inc Medicare	$77.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.05
Rate for Payer: Healthfirst Essential Plan	$11.36
Rate for Payer: United Healthcare Commercial	$31.48
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.05

HC DRUG SCREENING OPIATES 1 OR MORE, HYDROCODONE & METABOLITE,QUANTITATIVE,UR

Facility

$155.00

Service Code	CPT 80361
Hospital Charge Code	3018036103
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$124.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$116.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$124.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.40
Rate for Payer: EmblemHealth Commercial	$77.50
Rate for Payer: Group Health Inc Commercial	$77.50
Rate for Payer: Group Health Inc Medicare	$54.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.50
Rate for Payer: Hamaspik Choice Inc Medicare	$77.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.05
Rate for Payer: Healthfirst Essential Plan	$11.36
Rate for Payer: United Healthcare Commercial	$31.48
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.05

HC DRUG SCREENING OPIATES 1 OR MORE, HYDROCODONE & METABOLITE,QUANTITATIVE,UR

Facility

$155.00

Service Code	CPT 80361
Hospital Charge Code	3018036103
Hospital Revenue Code	301
Min. Negotiated Rate	$77.50
Max. Negotiated Rate	$77.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.50

HC DRUG SCREENING OPIATES 1 OR MORE - OPIATE,QUANTITATIVE,UR CONF

Facility

$155.00

Service Code	CPT 80361
Hospital Charge Code	3018036104
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$124.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$116.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$124.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.40
Rate for Payer: EmblemHealth Commercial	$77.50
Rate for Payer: Group Health Inc Commercial	$77.50
Rate for Payer: Group Health Inc Medicare	$54.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.50
Rate for Payer: Hamaspik Choice Inc Medicare	$77.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.05
Rate for Payer: Healthfirst Essential Plan	$11.36
Rate for Payer: United Healthcare Commercial	$31.48
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.05

HC DRUG SCREENING OPIATES 1 OR MORE - OPIATE,QUANTITATIVE,UR CONF

Facility

$155.00

Service Code	CPT 80361
Hospital Charge Code	3018036104
Hospital Revenue Code	301
Min. Negotiated Rate	$77.50
Max. Negotiated Rate	$77.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.50

HC DRUG SCREENING OPIATES 1 OR MORE, OXYCODONE AND METABOLITE,URINE

Facility

$155.00

Service Code	CPT 80361
Hospital Charge Code	3018036105
Hospital Revenue Code	301
Min. Negotiated Rate	$77.50
Max. Negotiated Rate	$77.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.50

HC DRUG SCREENING OPIATES 1 OR MORE, OXYCODONE AND METABOLITE,URINE

Facility

$155.00

Service Code	CPT 80361
Hospital Charge Code	3018036105
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$124.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$116.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$124.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.40
Rate for Payer: EmblemHealth Commercial	$77.50
Rate for Payer: Group Health Inc Commercial	$77.50
Rate for Payer: Group Health Inc Medicare	$54.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.50
Rate for Payer: Hamaspik Choice Inc Medicare	$77.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.05
Rate for Payer: Healthfirst Essential Plan	$11.36
Rate for Payer: United Healthcare Commercial	$31.48
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.05

HC DRUG SCREENING OPIATES 1 OR MORE, TRAMADOL & METABOLITES, URINE

Facility

$49.00

Service Code	CPT 80361
Hospital Charge Code	3018036106
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$39.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$36.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.32
Rate for Payer: EmblemHealth Commercial	$24.50
Rate for Payer: Group Health Inc Commercial	$24.50
Rate for Payer: Group Health Inc Medicare	$17.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.50
Rate for Payer: Hamaspik Choice Inc Medicare	$24.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.05
Rate for Payer: Healthfirst Essential Plan	$11.36
Rate for Payer: United Healthcare Commercial	$31.48
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.05

HC DRUG SCREENING OPIATES 1 OR MORE, TRAMADOL & METABOLITES, URINE

Facility

$49.00

Service Code	CPT 80361
Hospital Charge Code	3018036106
Hospital Revenue Code	301
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$24.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.50

HC DRUG SCREENING PROPOXYPHENE - PROPOXYPHENE SCREEN URINE

Facility

$49.00

Service Code	CPT 80367
Hospital Charge Code	3018036701
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$39.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$36.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.32
Rate for Payer: EmblemHealth Commercial	$24.50
Rate for Payer: Group Health Inc Commercial	$24.50
Rate for Payer: Group Health Inc Medicare	$17.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.50
Rate for Payer: Hamaspik Choice Inc Medicare	$24.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.05
Rate for Payer: Healthfirst Essential Plan	$11.36
Rate for Payer: United Healthcare Commercial	$21.99
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.05

HC DRUG SCREENING PROPOXYPHENE - PROPOXYPHENE SCREEN URINE

Facility

$49.00

Service Code	CPT 80367
Hospital Charge Code	3018036701
Hospital Revenue Code	301
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$24.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.50

HC DRUG SCREENING, QUANTITATIVE, OXYCODONE/OXYMORPHONE, URINE

Facility

$49.00

Service Code	CPT 80365
Hospital Charge Code	3018036501
Hospital Revenue Code	301
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$24.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.50

HC DRUG SCREENING, QUANTITATIVE, OXYCODONE/OXYMORPHONE, URINE

Facility

$49.00

Service Code	CPT 80365
Hospital Charge Code	3018036501
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$39.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$36.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.32
Rate for Payer: EmblemHealth Commercial	$24.50
Rate for Payer: Group Health Inc Commercial	$24.50
Rate for Payer: Group Health Inc Medicare	$17.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.50
Rate for Payer: Hamaspik Choice Inc Medicare	$24.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.05
Rate for Payer: Healthfirst Essential Plan	$11.36
Rate for Payer: United Healthcare Commercial	$23.93
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.05

HC DRUG SCREENING SKELETAL MUSCLE RELAXANTS 1 OR 2 - BUNDLED CHARGE

Facility

$99.00

Service Code	CPT 80369
Hospital Charge Code	3018036902
Hospital Revenue Code	301
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$49.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.50

HC DRUG SCREENING SKELETAL MUSCLE RELAXANTS 1 OR 2 - BUNDLED CHARGE

Facility

$99.00

Service Code	CPT 80369
Hospital Charge Code	3018036902
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$79.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$54.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
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: United Healthcare Commercial	$21.58

HC DRUG SCREENING SKEL MUSCLE RELAXANTS 3 OR MORE - BUNDLED CHARGE

Facility

$149.00

Service Code	CPT 80370
Hospital Charge Code	3018037001
Hospital Revenue Code	301
Min. Negotiated Rate	$74.50
Max. Negotiated Rate	$74.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.50

HC DRUG SCREENING SKEL MUSCLE RELAXANTS 3 OR MORE - BUNDLED CHARGE

Facility

$149.00

Service Code	CPT 80370
Hospital Charge Code	3018037001
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$119.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$81.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$111.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$119.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$101.32
Rate for Payer: EmblemHealth Commercial	$74.50
Rate for Payer: Group Health Inc Commercial	$74.50
Rate for Payer: Group Health Inc Medicare	$52.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.50
Rate for Payer: Hamaspik Choice Inc Medicare	$74.50
Rate for Payer: United Healthcare Commercial	$21.58

HC DRUG SCREENING, TRAMADOL, QUANTITATIVE

Facility

$49.00

Service Code	CPT 80373
Hospital Charge Code	3018037301
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$39.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$36.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.32
Rate for Payer: EmblemHealth Commercial	$24.50
Rate for Payer: Group Health Inc Commercial	$24.50
Rate for Payer: Group Health Inc Medicare	$17.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.50
Rate for Payer: Hamaspik Choice Inc Medicare	$24.50
Rate for Payer: United Healthcare Commercial	$19.40

Know your out-of-pocket cost for care.

All Charges