St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC DURAGEN PLUS 1X1 DURAL REGENER

Facility

$717.00

Service Code	CPT Q4100
Hospital Charge Code	636Q410003
Hospital Revenue Code	636
Min. Negotiated Rate	$358.50
Max. Negotiated Rate	$358.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$358.50
Rate for Payer: Hamaspik Choice Inc Medicare	$358.50

HC DURAGEN PLUS 1X1 DURAL REGENER

Facility

$717.00

Service Code	CPT Q4100
Hospital Charge Code	636Q410003
Hospital Revenue Code	636
Min. Negotiated Rate	$9.74
Max. Negotiated Rate	$466.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$394.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.74
Rate for Payer: Aetna Government	$9.74
Rate for Payer: Brighton Health Commercial	$430.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$358.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$412.27
Rate for Payer: EmblemHealth Commercial	$358.50
Rate for Payer: Group Health Inc Commercial	$358.50
Rate for Payer: Group Health Inc Medicare	$250.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$358.50
Rate for Payer: Hamaspik Choice Inc Medicare	$358.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$466.05

HC DURAGEN PLUS 1X3 DURAL REGENER

Facility

$1,271.00

Service Code	CPT Q4100
Hospital Charge Code	636Q410002
Hospital Revenue Code	636
Min. Negotiated Rate	$9.74
Max. Negotiated Rate	$826.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$699.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.74
Rate for Payer: Aetna Government	$9.74
Rate for Payer: Brighton Health Commercial	$762.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$635.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$730.83
Rate for Payer: EmblemHealth Commercial	$635.50
Rate for Payer: Group Health Inc Commercial	$635.50
Rate for Payer: Group Health Inc Medicare	$444.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$635.50
Rate for Payer: Hamaspik Choice Inc Medicare	$635.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$826.15

HC DURAGEN PLUS 1X3 DURAL REGENER

Facility

$1,271.00

Service Code	CPT Q4100
Hospital Charge Code	636Q410002
Hospital Revenue Code	636
Min. Negotiated Rate	$635.50
Max. Negotiated Rate	$635.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$635.50
Rate for Payer: Hamaspik Choice Inc Medicare	$635.50

HC DURAGEN PLUS 2X2 DURAL REGENER

Facility

$1,207.00

Service Code	CPT Q4100
Hospital Charge Code	636Q410004
Hospital Revenue Code	636
Min. Negotiated Rate	$9.74
Max. Negotiated Rate	$784.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$663.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.74
Rate for Payer: Aetna Government	$9.74
Rate for Payer: Brighton Health Commercial	$724.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$603.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$694.02
Rate for Payer: EmblemHealth Commercial	$603.50
Rate for Payer: Group Health Inc Commercial	$603.50
Rate for Payer: Group Health Inc Medicare	$422.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$603.50
Rate for Payer: Hamaspik Choice Inc Medicare	$603.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$784.55

HC DURAGEN PLUS 2X2 DURAL REGENER

Facility

$1,207.00

Service Code	CPT Q4100
Hospital Charge Code	636Q410004
Hospital Revenue Code	636
Min. Negotiated Rate	$603.50
Max. Negotiated Rate	$603.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$603.50
Rate for Payer: Hamaspik Choice Inc Medicare	$603.50

HC DURAGEN PLUS 4 X 5

Facility

$3,998.00

Service Code	CPT Q4100
Hospital Charge Code	636Q410005
Hospital Revenue Code	636
Min. Negotiated Rate	$9.74
Max. Negotiated Rate	$2,598.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,198.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.74
Rate for Payer: Aetna Government	$9.74
Rate for Payer: Brighton Health Commercial	$2,398.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,999.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,298.85
Rate for Payer: EmblemHealth Commercial	$1,999.00
Rate for Payer: Group Health Inc Commercial	$1,999.00
Rate for Payer: Group Health Inc Medicare	$1,399.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,999.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,999.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,598.70

HC DURAGEN PLUS 4 X 5

Facility

$3,998.00

Service Code	CPT Q4100
Hospital Charge Code	636Q410005
Hospital Revenue Code	636
Min. Negotiated Rate	$1,999.00
Max. Negotiated Rate	$1,999.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,999.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,999.00

HC DXA BONE DENSITY AXIAL - DEXA BONE DENSITY

Facility

$339.00

Service Code	CPT 77080 TC
Hospital Charge Code	3207708002
Hospital Revenue Code	320
Min. Negotiated Rate	$24.41
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.41
Rate for Payer: Aetna Government	$24.41
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$150.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$127.03
Rate for Payer: EmblemHealth Commercial	$31.64
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31.64
Rate for Payer: Healthfirst Essential Plan	$141.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$62.80

HC DXA BONE DENSITY AXIAL - DEXA BONE DENSITY

Facility

$339.00

Service Code	CPT 77080 TC
Hospital Charge Code	3207708002
Hospital Revenue Code	320
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC DXA BONE DENSITY AXIAL - XR BONE DENSITY WITH SPECT LUMBAR

Facility

$339.00

Service Code	CPT 77080 TC
Hospital Charge Code	3207708001
Hospital Revenue Code	320
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC DXA BONE DENSITY AXIAL - XR BONE DENSITY WITH SPECT LUMBAR

Facility

$339.00

Service Code	CPT 77080 TC
Hospital Charge Code	3207708001
Hospital Revenue Code	320
Min. Negotiated Rate	$24.41
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.41
Rate for Payer: Aetna Government	$24.41
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$150.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$127.03
Rate for Payer: EmblemHealth Commercial	$31.64
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31.64
Rate for Payer: Healthfirst Essential Plan	$141.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$62.80

HC DXA BONE DENSITY/PERIPHERAL - DEXA BONE DENSITY EXTREMITY

Facility

$241.00

Service Code	CPT 77081 TC
Hospital Charge Code	3207708101
Hospital Revenue Code	320
Min. Negotiated Rate	$13.53
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.53
Rate for Payer: Aetna Government	$13.53
Rate for Payer: Brighton Health Commercial	$180.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$68.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.84
Rate for Payer: EmblemHealth Commercial	$23.96
Rate for Payer: Group Health Inc Commercial	$120.50
Rate for Payer: Group Health Inc Medicare	$84.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50
Rate for Payer: Hamaspik Choice Inc Medicare	$120.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23.96
Rate for Payer: Healthfirst Essential Plan	$41.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18.46

HC DXA BONE DENSITY/PERIPHERAL - DEXA BONE DENSITY EXTREMITY

Facility

$241.00

Service Code	CPT 77081 TC
Hospital Charge Code	3207708101
Hospital Revenue Code	320
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$120.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50

HC DXA BONE DENSITY STUDY - DEXA BONE DENSITY AXIAL SKELETON W VFA

Facility

$366.00

Service Code	CPT 77085 TC
Hospital Charge Code	3207708501
Hospital Revenue Code	320
Min. Negotiated Rate	$183.00
Max. Negotiated Rate	$183.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$183.00

HC DXA BONE DENSITY STUDY - DEXA BONE DENSITY AXIAL SKELETON W VFA

Facility

$366.00

Service Code	CPT 77085 TC
Hospital Charge Code	3207708501
Hospital Revenue Code	320
Min. Negotiated Rate	$32.22
Max. Negotiated Rate	$292.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$201.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.22
Rate for Payer: Aetna Government	$32.22
Rate for Payer: Brighton Health Commercial	$274.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$292.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$248.88
Rate for Payer: EmblemHealth Commercial	$42.34
Rate for Payer: Group Health Inc Commercial	$183.00
Rate for Payer: Group Health Inc Medicare	$128.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$183.00
Rate for Payer: Hamaspik Choice Inc Medicare	$183.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42.34

HC DX MAMMO INCL CAD BI - MAMMO BREAST DIAGNOSTIC BILATERAL

Facility

$502.00

Service Code	CPT 77066 TC
Hospital Charge Code	4017706602
Hospital Revenue Code	401
Min. Negotiated Rate	$95.39
Max. Negotiated Rate	$401.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$276.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$95.39
Rate for Payer: Aetna Government	$95.39
Rate for Payer: Brighton Health Commercial	$376.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$401.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$341.36
Rate for Payer: EmblemHealth Commercial	$117.44
Rate for Payer: Group Health Inc Commercial	$251.00
Rate for Payer: Group Health Inc Medicare	$175.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.00
Rate for Payer: Hamaspik Choice Inc Medicare	$251.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$117.44
Rate for Payer: Healthfirst Essential Plan	$286.25
Rate for Payer: United Healthcare Commercial	$100.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$127.22

HC DX MAMMO INCL CAD BI - MAMMO BREAST DIAGNOSTIC BILATERAL

Facility

$502.00

Service Code	CPT 77066 TC
Hospital Charge Code	4017706602
Hospital Revenue Code	401
Min. Negotiated Rate	$251.00
Max. Negotiated Rate	$251.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.00

HC DX MAMMO INCL CAD BI - MG BREAST BILATERAL POST BIOPSY CLIP

Facility

$502.00

Service Code	CPT 77066 TC
Hospital Charge Code	4017706601
Hospital Revenue Code	401
Min. Negotiated Rate	$95.39
Max. Negotiated Rate	$401.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$276.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$95.39
Rate for Payer: Aetna Government	$95.39
Rate for Payer: Brighton Health Commercial	$376.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$401.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$341.36
Rate for Payer: EmblemHealth Commercial	$117.44
Rate for Payer: Group Health Inc Commercial	$251.00
Rate for Payer: Group Health Inc Medicare	$175.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.00
Rate for Payer: Hamaspik Choice Inc Medicare	$251.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$117.44
Rate for Payer: Healthfirst Essential Plan	$286.25
Rate for Payer: United Healthcare Commercial	$100.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$127.22

HC DX MAMMO INCL CAD BI - MG BREAST BILATERAL POST BIOPSY CLIP

Facility

$502.00

Service Code	CPT 77066 TC
Hospital Charge Code	4017706601
Hospital Revenue Code	401
Min. Negotiated Rate	$251.00
Max. Negotiated Rate	$251.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.00

HC DX MAMMO INCL CAD UNI - MAMMO ADDITIONAL VIEWS

Facility

$399.00

Service Code	CPT 77065 TC
Hospital Charge Code	4017706501
Hospital Revenue Code	401
Min. Negotiated Rate	$74.60
Max. Negotiated Rate	$319.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$219.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$74.60
Rate for Payer: Aetna Government	$74.60
Rate for Payer: Brighton Health Commercial	$299.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$319.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$271.32
Rate for Payer: EmblemHealth Commercial	$92.30
Rate for Payer: Group Health Inc Commercial	$199.50
Rate for Payer: Group Health Inc Medicare	$139.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$199.50
Rate for Payer: Hamaspik Choice Inc Medicare	$199.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$92.30
Rate for Payer: Healthfirst Essential Plan	$234.09
Rate for Payer: United Healthcare Commercial	$78.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$104.04

HC DX MAMMO INCL CAD UNI - MAMMO ADDITIONAL VIEWS

Facility

$399.00

Service Code	CPT 77065 TC
Hospital Charge Code	4017706501
Hospital Revenue Code	401
Min. Negotiated Rate	$199.50
Max. Negotiated Rate	$199.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$199.50

HC DX MAMMO INCL CAD UNI - MAMMO ADDITIONAL VIEWS RIGHT

Facility

$399.00

Service Code	CPT 77065 TC
Hospital Charge Code	4017706502
Hospital Revenue Code	401
Min. Negotiated Rate	$199.50
Max. Negotiated Rate	$199.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$199.50

HC DX MAMMO INCL CAD UNI - MAMMO ADDITIONAL VIEWS RIGHT

Facility

$399.00

Service Code	CPT 77065 TC
Hospital Charge Code	4017706502
Hospital Revenue Code	401
Min. Negotiated Rate	$74.60
Max. Negotiated Rate	$319.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$219.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$74.60
Rate for Payer: Aetna Government	$74.60
Rate for Payer: Brighton Health Commercial	$299.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$319.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$271.32
Rate for Payer: EmblemHealth Commercial	$92.30
Rate for Payer: Group Health Inc Commercial	$199.50
Rate for Payer: Group Health Inc Medicare	$139.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$199.50
Rate for Payer: Hamaspik Choice Inc Medicare	$199.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$92.30
Rate for Payer: Healthfirst Essential Plan	$234.09
Rate for Payer: United Healthcare Commercial	$78.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$104.04

HC DX MAMMO INCL CAD UNI - MAMMO BREAST DIAGNOSTIC

Facility

$399.00

Service Code	CPT 77065 TC
Hospital Charge Code	4017706505
Hospital Revenue Code	401
Min. Negotiated Rate	$74.60
Max. Negotiated Rate	$319.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$219.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$74.60
Rate for Payer: Aetna Government	$74.60
Rate for Payer: Brighton Health Commercial	$299.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$319.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$271.32
Rate for Payer: EmblemHealth Commercial	$92.30
Rate for Payer: Group Health Inc Commercial	$199.50
Rate for Payer: Group Health Inc Medicare	$139.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$199.50
Rate for Payer: Hamaspik Choice Inc Medicare	$199.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$92.30
Rate for Payer: Healthfirst Essential Plan	$234.09
Rate for Payer: United Healthcare Commercial	$78.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$104.04

Know your out-of-pocket cost for care.

All Charges