St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC DRUG SCREENING, TRAMADOL, QUANTITATIVE

Facility

$49.00

Service Code	CPT 80373
Hospital Charge Code	3018037301
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 SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2 - BUNDLED CHARGE

Facility

$32.00

Service Code	CPT 80321
Hospital Charge Code	3018032101
Hospital Revenue Code	301
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$16.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.00

HC DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2 - BUNDLED CHARGE

Facility

$32.00

Service Code	CPT 80321
Hospital Charge Code	3018032101
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$25.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$24.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.76
Rate for Payer: EmblemHealth Commercial	$16.00
Rate for Payer: Group Health Inc Commercial	$16.00
Rate for Payer: Group Health Inc Medicare	$11.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.00
Rate for Payer: Hamaspik Choice Inc Medicare	$16.00
Rate for Payer: United Healthcare Commercial	$13.23

HC DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 - AMPHETAMINE, URINE

Facility

$107.00

Service Code	CPT 80324
Hospital Charge Code	3018032401
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$85.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$80.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$85.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$72.76
Rate for Payer: EmblemHealth Commercial	$53.50
Rate for Payer: Group Health Inc Commercial	$53.50
Rate for Payer: Group Health Inc Medicare	$37.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.50
Rate for Payer: Hamaspik Choice Inc Medicare	$53.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.05
Rate for Payer: Healthfirst Essential Plan	$11.36
Rate for Payer: United Healthcare Commercial	$19.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.05

HC DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 - AMPHETAMINE, URINE

Facility

$107.00

Service Code	CPT 80324
Hospital Charge Code	3018032401
Hospital Revenue Code	301
Min. Negotiated Rate	$53.50
Max. Negotiated Rate	$53.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.50

HC DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 - BUNDLED CHARGE

Facility

$107.00

Service Code	CPT 80324
Hospital Charge Code	3018032402
Hospital Revenue Code	301
Min. Negotiated Rate	$53.50
Max. Negotiated Rate	$53.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.50

HC DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 - BUNDLED CHARGE

Facility

$107.00

Service Code	CPT 80324
Hospital Charge Code	3018032402
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$85.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$80.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$85.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$72.76
Rate for Payer: EmblemHealth Commercial	$53.50
Rate for Payer: Group Health Inc Commercial	$53.50
Rate for Payer: Group Health Inc Medicare	$37.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.50
Rate for Payer: Hamaspik Choice Inc Medicare	$53.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.05
Rate for Payer: Healthfirst Essential Plan	$11.36
Rate for Payer: United Healthcare Commercial	$19.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.05

HC DRUG SCREEN QUANT AMPHETAMINES 3 OR 4 - BUNDLED CHARGE

Facility

$215.00

Service Code	CPT 80325
Hospital Charge Code	3018032501
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$172.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$118.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$161.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$172.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$146.20
Rate for Payer: EmblemHealth Commercial	$107.50
Rate for Payer: Group Health Inc Commercial	$107.50
Rate for Payer: Group Health Inc Medicare	$75.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.50
Rate for Payer: Hamaspik Choice Inc Medicare	$107.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.05
Rate for Payer: Healthfirst Essential Plan	$11.36
Rate for Payer: United Healthcare Commercial	$19.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.05

HC DRUG SCREEN QUANT AMPHETAMINES 3 OR 4 - BUNDLED CHARGE

Facility

$215.00

Service Code	CPT 80325
Hospital Charge Code	3018032501
Hospital Revenue Code	301
Min. Negotiated Rate	$107.50
Max. Negotiated Rate	$107.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.50

HC DRUG SCREEN QUANT AMPHETAMINES 5 OR MORE - BUNDLED CHARGE

Facility

$322.00

Service Code	CPT 80326
Hospital Charge Code	3018032601
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$257.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$177.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$241.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$257.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$218.96
Rate for Payer: EmblemHealth Commercial	$161.00
Rate for Payer: Group Health Inc Commercial	$161.00
Rate for Payer: Group Health Inc Medicare	$112.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$161.00
Rate for Payer: Hamaspik Choice Inc Medicare	$161.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.05
Rate for Payer: Healthfirst Essential Plan	$11.36
Rate for Payer: United Healthcare Commercial	$19.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.05

HC DRUG SCREEN QUANT AMPHETAMINES 5 OR MORE - BUNDLED CHARGE

Facility

$322.00

Service Code	CPT 80326
Hospital Charge Code	3018032601
Hospital Revenue Code	301
Min. Negotiated Rate	$161.00
Max. Negotiated Rate	$161.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$161.00

HC DRUG SCREEN QUANT ANABOLIC STEROID 1 OR 2 - BUNDLED CHARGE

Facility

$107.00

Service Code	CPT 80327
Hospital Charge Code	3018032702
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$85.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$80.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$85.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$72.76
Rate for Payer: EmblemHealth Commercial	$53.50
Rate for Payer: Group Health Inc Commercial	$53.50
Rate for Payer: Group Health Inc Medicare	$37.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.50
Rate for Payer: Hamaspik Choice Inc Medicare	$53.50
Rate for Payer: United Healthcare Commercial	$31.62

HC DRUG SCREEN QUANT ANABOLIC STEROID 1 OR 2 - BUNDLED CHARGE

Facility

$107.00

Service Code	CPT 80327
Hospital Charge Code	3018032702
Hospital Revenue Code	301
Min. Negotiated Rate	$53.50
Max. Negotiated Rate	$53.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.50

HC DRUG SCREEN QUANT ANABOLIC STEROID 3 OR MORE - BUNDLED CHARGE

Facility

$215.00

Service Code	CPT 80328
Hospital Charge Code	3018032801
Hospital Revenue Code	301
Min. Negotiated Rate	$107.50
Max. Negotiated Rate	$107.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.50

HC DRUG SCREEN QUANT ANABOLIC STEROID 3 OR MORE - BUNDLED CHARGE

Facility

$215.00

Service Code	CPT 80328
Hospital Charge Code	3018032801
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$172.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$118.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$161.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$172.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$146.20
Rate for Payer: EmblemHealth Commercial	$107.50
Rate for Payer: Group Health Inc Commercial	$107.50
Rate for Payer: Group Health Inc Medicare	$75.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.50
Rate for Payer: Hamaspik Choice Inc Medicare	$107.50
Rate for Payer: United Healthcare Commercial	$31.62

HC DRUG SCREEN QUANT DIPROPYLACETIC ACID TOTAL - VALPROIC ACID TOTAL

Facility

$33.00

Service Code	CPT 80164
Hospital Charge Code	3018016402
Hospital Revenue Code	301
Min. Negotiated Rate	$9.48
Max. Negotiated Rate	$24.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.54
Rate for Payer: Aetna Government	$13.54
Rate for Payer: Affinity Essential Plan 1&2	$9.48
Rate for Payer: Affinity Essential Plan 3&4	$9.48
Rate for Payer: Affinity Medicaid/CHP/HARP	$9.48
Rate for Payer: Brighton Health Commercial	$24.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$13.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.38
Rate for Payer: Elderplan Medicare Advantage	$13.54
Rate for Payer: EmblemHealth Commercial	$13.54
Rate for Payer: Fidelis CHP/HARP/Medicaid	$12.19
Rate for Payer: Fidelis Essential Plan Aliesa	$11.51
Rate for Payer: Fidelis Essential Plan QHP	$12.05
Rate for Payer: Fidelis Medicare Advantage	$13.54
Rate for Payer: Fidelis Qualified Health Plan	$12.05
Rate for Payer: Group Health Inc Commercial	$13.54
Rate for Payer: Group Health Inc Medicare	$13.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.54
Rate for Payer: Hamaspik Choice Inc Medicare	$13.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$10.61
Rate for Payer: Healthfirst Essential Plan	$23.87
Rate for Payer: Healthfirst Medicare Advantage	$13.54
Rate for Payer: Healthfirst QHP	$13.54
Rate for Payer: Humana Medicare	$13.81
Rate for Payer: Senior Whole Health Medicare Advantage	$13.54
Rate for Payer: United Healthcare Commercial	$17.15
Rate for Payer: United Healthcare Medicare Advantage	$13.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.54
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.61
Rate for Payer: Wellcare Medicare	$12.19

HC DRUG SCREEN QUANT DIPROPYLACETIC ACID TOTAL - VALPROIC ACID TOTAL

Facility

$33.00

Service Code	CPT 80164
Hospital Charge Code	3018016402
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.50

HC DRUG SCREEN QUANTITATIVE ALCOHOLS - ETHANOL

Facility

$32.00

Service Code	CPT 80320
Hospital Charge Code	3018032002
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$25.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$24.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.76
Rate for Payer: EmblemHealth Commercial	$16.00
Rate for Payer: Group Health Inc Commercial	$16.00
Rate for Payer: Group Health Inc Medicare	$11.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.00
Rate for Payer: Hamaspik Choice Inc Medicare	$16.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.05
Rate for Payer: Healthfirst Essential Plan	$11.36
Rate for Payer: United Healthcare Commercial	$21.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.05

HC DRUG SCREEN QUANTITATIVE ALCOHOLS - ETHANOL

Facility

$32.00

Service Code	CPT 80320
Hospital Charge Code	3018032002
Hospital Revenue Code	301
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$16.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.00

HC DRUG SCREEN QUANTITATIVE ALCOHOLS - ETHANOL URINE

Facility

$49.00

Service Code	CPT 80320
Hospital Charge Code	3018032001
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 SCREEN QUANTITATIVE ALCOHOLS - ETHANOL URINE

Facility

$49.00

Service Code	CPT 80320
Hospital Charge Code	3018032001
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	$21.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.05

HC DRUG SCREEN QUANTITATIVE ALCOHOLS - METHANOL

Facility

$32.00

Service Code	CPT 80320
Hospital Charge Code	3018032003
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$25.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$24.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.76
Rate for Payer: EmblemHealth Commercial	$16.00
Rate for Payer: Group Health Inc Commercial	$16.00
Rate for Payer: Group Health Inc Medicare	$11.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.00
Rate for Payer: Hamaspik Choice Inc Medicare	$16.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.05
Rate for Payer: Healthfirst Essential Plan	$11.36
Rate for Payer: United Healthcare Commercial	$21.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.05

HC DRUG SCREEN QUANTITATIVE ALCOHOLS - METHANOL

Facility

$32.00

Service Code	CPT 80320
Hospital Charge Code	3018032003
Hospital Revenue Code	301
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$16.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.00

HC DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL - DIGOXIN

Facility

$33.00

Service Code	CPT 80162
Hospital Charge Code	3018016201
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.50

HC DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL - DIGOXIN

Facility

$33.00

Service Code	CPT 80162
Hospital Charge Code	3018016201
Hospital Revenue Code	301
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$24.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.28
Rate for Payer: Aetna Government	$13.28
Rate for Payer: Affinity Essential Plan 1&2	$9.30
Rate for Payer: Affinity Essential Plan 3&4	$9.30
Rate for Payer: Affinity Medicaid/CHP/HARP	$9.30
Rate for Payer: Brighton Health Commercial	$24.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$13.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.00
Rate for Payer: Elderplan Medicare Advantage	$13.28
Rate for Payer: EmblemHealth Commercial	$13.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$11.95
Rate for Payer: Fidelis Essential Plan Aliesa	$11.29
Rate for Payer: Fidelis Essential Plan QHP	$11.82
Rate for Payer: Fidelis Medicare Advantage	$13.28
Rate for Payer: Fidelis Qualified Health Plan	$11.82
Rate for Payer: Group Health Inc Commercial	$13.28
Rate for Payer: Group Health Inc Medicare	$13.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.28
Rate for Payer: Hamaspik Choice Inc Medicare	$13.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$10.61
Rate for Payer: Healthfirst Essential Plan	$23.87
Rate for Payer: Healthfirst Medicare Advantage	$13.28
Rate for Payer: Healthfirst QHP	$13.28
Rate for Payer: Humana Medicare	$13.55
Rate for Payer: Senior Whole Health Medicare Advantage	$13.28
Rate for Payer: United Healthcare Commercial	$16.82
Rate for Payer: United Healthcare Medicare Advantage	$13.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.61
Rate for Payer: Wellcare Medicare	$11.95

Know your out-of-pocket cost for care.

All Charges