St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC DTAP IMMUNIZATION, IM, <7 YO

Facility

$275.00

Service Code	CPT 90700
Hospital Charge Code	6369070001
Hospital Revenue Code	636
Min. Negotiated Rate	$137.50
Max. Negotiated Rate	$137.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.50
Rate for Payer: Hamaspik Choice Inc Medicare	$137.50

HC DTAP IMMUNIZATION, IM, <7 YO

Facility

$275.00

Service Code	CPT 90700
Hospital Charge Code	6369070001
Hospital Revenue Code	636
Min. Negotiated Rate	$27.70
Max. Negotiated Rate	$178.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$151.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.70
Rate for Payer: Aetna Government	$27.70
Rate for Payer: Brighton Health Commercial	$165.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$137.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$158.12
Rate for Payer: EmblemHealth Commercial	$137.50
Rate for Payer: Group Health Inc Commercial	$137.50
Rate for Payer: Group Health Inc Medicare	$96.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.50
Rate for Payer: Hamaspik Choice Inc Medicare	$137.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$178.75

HC DTAP-IPV-HIB-HEPB VACCINE INTRAMUSCULAR

Facility

$769.00

Service Code	CPT 90697
Hospital Charge Code	6369069701
Hospital Revenue Code	636
Min. Negotiated Rate	$384.50
Max. Negotiated Rate	$384.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$384.50
Rate for Payer: Hamaspik Choice Inc Medicare	$384.50

HC DTAP-IPV-HIB-HEPB VACCINE INTRAMUSCULAR

Facility

$769.00

Service Code	CPT 90697
Hospital Charge Code	6369069701
Hospital Revenue Code	636
Min. Negotiated Rate	$139.41
Max. Negotiated Rate	$499.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$422.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$139.41
Rate for Payer: Aetna Government	$139.41
Rate for Payer: Brighton Health Commercial	$461.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$384.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$442.18
Rate for Payer: EmblemHealth Commercial	$384.50
Rate for Payer: Group Health Inc Commercial	$384.50
Rate for Payer: Group Health Inc Medicare	$269.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$384.50
Rate for Payer: Hamaspik Choice Inc Medicare	$384.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$499.85

HC DTAP--IPV/HIP(PENTACEL)

Facility

$103.00

Service Code	CPT 90698
Hospital Charge Code	6369069801
Hospital Revenue Code	636
Min. Negotiated Rate	$51.50
Max. Negotiated Rate	$51.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.50
Rate for Payer: Hamaspik Choice Inc Medicare	$51.50

HC DTAP--IPV/HIP(PENTACEL)

Facility

$103.00

Service Code	CPT 90698
Hospital Charge Code	6369069801
Hospital Revenue Code	636
Min. Negotiated Rate	$36.05
Max. Negotiated Rate	$105.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$105.11
Rate for Payer: Aetna Government	$105.11
Rate for Payer: Brighton Health Commercial	$61.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$51.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.23
Rate for Payer: EmblemHealth Commercial	$51.50
Rate for Payer: Group Health Inc Commercial	$51.50
Rate for Payer: Group Health Inc Medicare	$36.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.50
Rate for Payer: Hamaspik Choice Inc Medicare	$51.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.95

HC DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE

Facility

$733.00

Service Code	CPT 90696
Hospital Charge Code	6369069601
Hospital Revenue Code	636
Min. Negotiated Rate	$56.24
Max. Negotiated Rate	$476.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$403.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.24
Rate for Payer: Aetna Government	$56.24
Rate for Payer: Brighton Health Commercial	$439.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$366.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$421.48
Rate for Payer: EmblemHealth Commercial	$366.50
Rate for Payer: Group Health Inc Commercial	$366.50
Rate for Payer: Group Health Inc Medicare	$256.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.50
Rate for Payer: Hamaspik Choice Inc Medicare	$366.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$476.45

HC DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE

Facility

$733.00

Service Code	CPT 90696
Hospital Charge Code	6369069601
Hospital Revenue Code	636
Min. Negotiated Rate	$366.50
Max. Negotiated Rate	$366.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.50
Rate for Payer: Hamaspik Choice Inc Medicare	$366.50

HC DUPLEX ABD/PEL VASC STUDY,COMPLETE

Facility

$705.00

Service Code	CPT 93975
Hospital Charge Code	9219397505
Hospital Revenue Code	921
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC DUPLEX ABD/PEL VASC STUDY,COMPLETE

Facility

$705.00

Service Code	CPT 93975
Hospital Charge Code	9219397505
Hospital Revenue Code	921
Min. Negotiated Rate	$206.74
Max. Negotiated Rate	$564.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$295.34
Rate for Payer: Aetna Government	$295.34
Rate for Payer: Affinity Essential Plan 1&2	$206.74
Rate for Payer: Affinity Essential Plan 3&4	$206.74
Rate for Payer: Affinity Medicaid/CHP/HARP	$206.74
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$295.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.40
Rate for Payer: Elderplan Medicare Advantage	$295.34
Rate for Payer: EmblemHealth Commercial	$295.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$265.81
Rate for Payer: Fidelis Essential Plan Aliesa	$251.04
Rate for Payer: Fidelis Essential Plan QHP	$262.85
Rate for Payer: Fidelis Medicare Advantage	$295.34
Rate for Payer: Fidelis Qualified Health Plan	$262.85
Rate for Payer: Group Health Inc Commercial	$295.34
Rate for Payer: Group Health Inc Medicare	$295.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$295.34
Rate for Payer: Hamaspik Choice Inc Medicare	$295.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$300.85
Rate for Payer: Healthfirst Medicare Advantage	$251.04
Rate for Payer: Healthfirst QHP	$295.34
Rate for Payer: Humana Medicare	$301.25
Rate for Payer: Senior Whole Health Medicare Advantage	$295.34
Rate for Payer: United Healthcare Commercial	$352.50
Rate for Payer: United Healthcare Medicare Advantage	$295.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$295.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$280.57
Rate for Payer: Wellcare Medicare	$280.57

HC DUPLEX ABD/PEL VASC STUDY,LIMITD

Facility

$339.00

Service Code	CPT 93976
Hospital Charge Code	9219397601
Hospital Revenue Code	921
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC DUPLEX ABD/PEL VASC STUDY,LIMITD

Facility

$339.00

Service Code	CPT 93976
Hospital Charge Code	9219397601
Hospital Revenue Code	921
Min. Negotiated Rate	$90.95
Max. Negotiated Rate	$271.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$129.93
Rate for Payer: Aetna Government	$129.93
Rate for Payer: Affinity Essential Plan 1&2	$90.95
Rate for Payer: Affinity Essential Plan 3&4	$90.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$90.95
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$129.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.52
Rate for Payer: Elderplan Medicare Advantage	$129.93
Rate for Payer: EmblemHealth Commercial	$129.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$116.94
Rate for Payer: Fidelis Essential Plan Aliesa	$110.44
Rate for Payer: Fidelis Essential Plan QHP	$115.64
Rate for Payer: Fidelis Medicare Advantage	$129.93
Rate for Payer: Fidelis Qualified Health Plan	$115.64
Rate for Payer: Group Health Inc Commercial	$129.93
Rate for Payer: Group Health Inc Medicare	$129.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.93
Rate for Payer: Hamaspik Choice Inc Medicare	$129.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$181.72
Rate for Payer: Healthfirst Medicare Advantage	$110.44
Rate for Payer: Healthfirst QHP	$129.93
Rate for Payer: Humana Medicare	$132.53
Rate for Payer: Senior Whole Health Medicare Advantage	$129.93
Rate for Payer: United Healthcare Commercial	$169.50
Rate for Payer: United Healthcare Medicare Advantage	$129.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$129.93
Rate for Payer: Wellcare CHP/FHP/Medicaid	$123.43
Rate for Payer: Wellcare Medicare	$123.43

HC DUPLEX EXTREM VENOUS,BILAT - CV US DOPPLER VENOUS LEGS BILATERAL

Facility

$705.00

Service Code	CPT 93970 50
Hospital Charge Code	9219397001
Hospital Revenue Code	921
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC DUPLEX EXTREM VENOUS,BILAT - CV US DOPPLER VENOUS LEGS BILATERAL

Facility

$705.00

Service Code	CPT 93970 50
Hospital Charge Code	9219397001
Hospital Revenue Code	921
Min. Negotiated Rate	$136.35
Max. Negotiated Rate	$564.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$136.35
Rate for Payer: Aetna Government	$136.35
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.40
Rate for Payer: EmblemHealth Commercial	$352.50
Rate for Payer: Group Health Inc Commercial	$352.50
Rate for Payer: Group Health Inc Medicare	$246.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50
Rate for Payer: Hamaspik Choice Inc Medicare	$352.50
Rate for Payer: United Healthcare Commercial	$352.50

HC DUPLEX EXTREM VENOUS,BILAT - LOWER EXTREMITY DVT

Facility

$705.00

Service Code	CPT 93970 50
Hospital Charge Code	9219397004
Hospital Revenue Code	921
Min. Negotiated Rate	$136.35
Max. Negotiated Rate	$564.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$136.35
Rate for Payer: Aetna Government	$136.35
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.40
Rate for Payer: EmblemHealth Commercial	$352.50
Rate for Payer: Group Health Inc Commercial	$352.50
Rate for Payer: Group Health Inc Medicare	$246.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50
Rate for Payer: Hamaspik Choice Inc Medicare	$352.50
Rate for Payer: United Healthcare Commercial	$352.50

HC DUPLEX EXTREM VENOUS,BILAT - LOWER EXTREMITY DVT

Facility

$705.00

Service Code	CPT 93970 50
Hospital Charge Code	9219397004
Hospital Revenue Code	921
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC DUPLEX EXTREM VENOUS,BILAT - UPPER EXTREMITY DVT

Facility

$705.00

Service Code	CPT 93970 50
Hospital Charge Code	9219397005
Hospital Revenue Code	921
Min. Negotiated Rate	$136.35
Max. Negotiated Rate	$564.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$136.35
Rate for Payer: Aetna Government	$136.35
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.40
Rate for Payer: EmblemHealth Commercial	$352.50
Rate for Payer: Group Health Inc Commercial	$352.50
Rate for Payer: Group Health Inc Medicare	$246.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50
Rate for Payer: Hamaspik Choice Inc Medicare	$352.50
Rate for Payer: United Healthcare Commercial	$352.50

HC DUPLEX EXTREM VENOUS,BILAT - UPPER EXTREMITY DVT

Facility

$705.00

Service Code	CPT 93970 50
Hospital Charge Code	9219397005
Hospital Revenue Code	921
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC DUPLEX EXTREM VENOUS,BILAT - US DOPPLER VENOUS ARMS BILATERAL

Facility

$705.00

Service Code	CPT 93970 50
Hospital Charge Code	9219397002
Hospital Revenue Code	921
Min. Negotiated Rate	$136.35
Max. Negotiated Rate	$564.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$136.35
Rate for Payer: Aetna Government	$136.35
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.40
Rate for Payer: EmblemHealth Commercial	$352.50
Rate for Payer: Group Health Inc Commercial	$352.50
Rate for Payer: Group Health Inc Medicare	$246.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50
Rate for Payer: Hamaspik Choice Inc Medicare	$352.50
Rate for Payer: United Healthcare Commercial	$352.50

HC DUPLEX EXTREM VENOUS,BILAT - US DOPPLER VENOUS ARMS BILATERAL

Facility

$705.00

Service Code	CPT 93970 50
Hospital Charge Code	9219397002
Hospital Revenue Code	921
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC DUPLEX EXTREM VENOUS,UNI OR LTD

Facility

$339.00

Service Code	CPT 93971
Hospital Charge Code	9219397101
Hospital Revenue Code	921
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC DUPLEX EXTREM VENOUS,UNI OR LTD

Facility

$339.00

Service Code	CPT 93971
Hospital Charge Code	9219397101
Hospital Revenue Code	921
Min. Negotiated Rate	$90.95
Max. Negotiated Rate	$271.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$129.93
Rate for Payer: Aetna Government	$129.93
Rate for Payer: Affinity Essential Plan 1&2	$90.95
Rate for Payer: Affinity Essential Plan 3&4	$90.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$90.95
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$129.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.52
Rate for Payer: Elderplan Medicare Advantage	$129.93
Rate for Payer: EmblemHealth Commercial	$129.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$116.94
Rate for Payer: Fidelis Essential Plan Aliesa	$110.44
Rate for Payer: Fidelis Essential Plan QHP	$115.64
Rate for Payer: Fidelis Medicare Advantage	$129.93
Rate for Payer: Fidelis Qualified Health Plan	$115.64
Rate for Payer: Group Health Inc Commercial	$129.93
Rate for Payer: Group Health Inc Medicare	$129.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.93
Rate for Payer: Hamaspik Choice Inc Medicare	$129.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$136.59
Rate for Payer: Healthfirst Medicare Advantage	$110.44
Rate for Payer: Healthfirst QHP	$129.93
Rate for Payer: Humana Medicare	$132.53
Rate for Payer: Senior Whole Health Medicare Advantage	$129.93
Rate for Payer: United Healthcare Commercial	$169.50
Rate for Payer: United Healthcare Medicare Advantage	$129.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$129.93
Rate for Payer: Wellcare CHP/FHP/Medicaid	$123.43
Rate for Payer: Wellcare Medicare	$123.43

HC DUPLEX EXTREM VENOUS,UNI OR LTD - LOWER EXTREM SUPERFICIAL VEIN MAP

Facility

$339.00

Service Code	CPT 93971
Hospital Charge Code	9219397108
Hospital Revenue Code	921
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC DUPLEX EXTREM VENOUS,UNI OR LTD - LOWER EXTREM SUPERFICIAL VEIN MAP

Facility

$339.00

Service Code	CPT 93971
Hospital Charge Code	9219397108
Hospital Revenue Code	921
Min. Negotiated Rate	$90.95
Max. Negotiated Rate	$271.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$129.93
Rate for Payer: Aetna Government	$129.93
Rate for Payer: Affinity Essential Plan 1&2	$90.95
Rate for Payer: Affinity Essential Plan 3&4	$90.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$90.95
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$129.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.52
Rate for Payer: Elderplan Medicare Advantage	$129.93
Rate for Payer: EmblemHealth Commercial	$129.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$116.94
Rate for Payer: Fidelis Essential Plan Aliesa	$110.44
Rate for Payer: Fidelis Essential Plan QHP	$115.64
Rate for Payer: Fidelis Medicare Advantage	$129.93
Rate for Payer: Fidelis Qualified Health Plan	$115.64
Rate for Payer: Group Health Inc Commercial	$129.93
Rate for Payer: Group Health Inc Medicare	$129.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.93
Rate for Payer: Hamaspik Choice Inc Medicare	$129.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$136.59
Rate for Payer: Healthfirst Medicare Advantage	$110.44
Rate for Payer: Healthfirst QHP	$129.93
Rate for Payer: Humana Medicare	$132.53
Rate for Payer: Senior Whole Health Medicare Advantage	$129.93
Rate for Payer: United Healthcare Commercial	$169.50
Rate for Payer: United Healthcare Medicare Advantage	$129.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$129.93
Rate for Payer: Wellcare CHP/FHP/Medicaid	$123.43
Rate for Payer: Wellcare Medicare	$123.43

HC DUPLEX EXTREM VENOUS,UNI OR LTD - UPPER EXTREM SUPERFICIAL VEIN MAP

Facility

$339.00

Service Code	CPT 93971
Hospital Charge Code	9219397107
Hospital Revenue Code	921
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

Know your out-of-pocket cost for care.

All Charges