St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC ENDOCRINE NUCLEAR PROCEDURE - NM INTERPRETATION OF OUTSIDE FILMS

Facility

$1,165.00

Service Code	CPT 78099 TC
Hospital Charge Code	3417809901
Hospital Revenue Code	341
Min. Negotiated Rate	$106.23
Max. Negotiated Rate	$873.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$640.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$582.50
Rate for Payer: Aetna Government	$582.50
Rate for Payer: Brighton Health Commercial	$873.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$284.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$239.19
Rate for Payer: EmblemHealth Commercial	$582.50
Rate for Payer: Group Health Inc Commercial	$582.50
Rate for Payer: Group Health Inc Medicare	$407.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$582.50
Rate for Payer: Hamaspik Choice Inc Medicare	$582.50
Rate for Payer: United Healthcare Commercial	$106.23

HC ENDOCRINE NUCLEAR PROCEDURE - NM INTERPRETATION OF OUTSIDE FILMS

Facility

$1,165.00

Service Code	CPT 78099 TC
Hospital Charge Code	3417809901
Hospital Revenue Code	341
Min. Negotiated Rate	$582.50
Max. Negotiated Rate	$582.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$582.50

HC END OF LIFE COUNSELING

Facility

$10.00

Service Code	CPT S0257
Hospital Charge Code	940S025701
Hospital Revenue Code	940
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$8.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.09
Rate for Payer: Aetna Government	$2.09
Rate for Payer: Brighton Health Commercial	$7.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.80
Rate for Payer: EmblemHealth Commercial	$5.00
Rate for Payer: Group Health Inc Commercial	$5.00
Rate for Payer: Group Health Inc Medicare	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5.00
Rate for Payer: United Healthcare Commercial	$5.00

HC END OF LIFE COUNSELING

Facility

$10.00

Service Code	CPT S0257
Hospital Charge Code	940S025701
Hospital Revenue Code	940
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$5.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00

HC ENDOLUMINAL BX URTR &/RNL PELVIS NONENDOSCOPIC

Facility

$2,804.00

Service Code	CPT 50606
Hospital Charge Code	3615060601
Hospital Revenue Code	361
Min. Negotiated Rate	$154.70
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$192.44
Rate for Payer: Aetna Government	$192.44
Rate for Payer: Brighton Health Commercial	$2,103.00
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	$1,402.00
Rate for Payer: Group Health Inc Commercial	$1,402.00
Rate for Payer: Group Health Inc Medicare	$981.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,402.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,402.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$154.70
Rate for Payer: United Healthcare Commercial	$1,113.00

HC ENDOLUMINAL BX URTR &/RNL PELVIS NONENDOSCOPIC

Facility

$2,804.00

Service Code	CPT 50606
Hospital Charge Code	3615060601
Hospital Revenue Code	361
Min. Negotiated Rate	$1,402.00
Max. Negotiated Rate	$1,402.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,402.00

HC ENDOMETRIAL ABLATION, THEMAL

Facility

$12,937.00

Service Code	CPT 58353
Hospital Charge Code	5105835301
Hospital Revenue Code	510
Min. Negotiated Rate	$184.48
Max. Negotiated Rate	$6,333.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,031.45
Rate for Payer: Aetna Government	$6,031.45
Rate for Payer: Affinity Essential Plan 1&2	$4,222.02
Rate for Payer: Affinity Essential Plan 3&4	$4,222.02
Rate for Payer: Affinity Medicaid/CHP/HARP	$4,222.02
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6,031.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: Elderplan Medicare Advantage	$6,031.45
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$5,428.31
Rate for Payer: Fidelis Essential Plan Aliesa	$5,126.73
Rate for Payer: Fidelis Essential Plan QHP	$5,367.99
Rate for Payer: Fidelis Medicare Advantage	$6,031.45
Rate for Payer: Fidelis Qualified Health Plan	$5,367.99
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,031.45
Rate for Payer: Hamaspik Choice Inc Medicare	$2,225.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$267.85
Rate for Payer: Healthfirst Medicare Advantage	$5,126.73
Rate for Payer: Healthfirst QHP	$6,031.45
Rate for Payer: Humana Medicare	$6,152.08
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$6,333.02
Rate for Payer: Senior Whole Health Medicare Advantage	$6,031.45
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$6,031.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,031.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5,729.88
Rate for Payer: Wellcare Medicare	$5,729.88

HC ENDOMETRIAL ABLATION, THEMAL

Facility

$12,937.00

Service Code	CPT 58353
Hospital Charge Code	5105835301
Hospital Revenue Code	510
Min. Negotiated Rate	$6,468.50
Max. Negotiated Rate	$6,468.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,468.50

HC ENDOMETRIAL SAMPLING IN CONJ W/ COLPOSCOPY (ADD ON)

Facility

$134.00

Service Code	CPT 58110
Hospital Charge Code	5105811001
Hospital Revenue Code	510
Min. Negotiated Rate	$67.00
Max. Negotiated Rate	$67.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.00

HC ENDOMETRIAL SAMPLING IN CONJ W/ COLPOSCOPY (ADD ON)

Facility

$134.00

Service Code	CPT 58110
Hospital Charge Code	5105811001
Hospital Revenue Code	510
Min. Negotiated Rate	$46.59
Max. Negotiated Rate	$342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.26
Rate for Payer: Aetna Government	$50.26
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.00
Rate for Payer: Hamaspik Choice Inc Medicare	$67.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$46.59
Rate for Payer: United Healthcare Commercial	$222.00

HC ENDOMETRIAL SAMPLING W/ OR W/O ENDOCERVICAL SAMPLING

Facility

$502.00

Service Code	CPT 58100
Hospital Charge Code	3615810001
Hospital Revenue Code	361
Min. Negotiated Rate	$251.00
Max. Negotiated Rate	$251.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.00

HC ENDOMETRIAL SAMPLING W/ OR W/O ENDOCERVICAL SAMPLING

Facility

$502.00

Service Code	CPT 58100
Hospital Charge Code	3615810001
Hospital Revenue Code	361
Min. Negotiated Rate	$51.75
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$245.79
Rate for Payer: Aetna Government	$245.79
Rate for Payer: Affinity Essential Plan 1&2	$172.05
Rate for Payer: Affinity Essential Plan 3&4	$172.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$172.05
Rate for Payer: Brighton Health Commercial	$376.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$245.79
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	$245.79
Rate for Payer: EmblemHealth Commercial	$245.79
Rate for Payer: Fidelis CHP/HARP/Medicaid	$221.21
Rate for Payer: Fidelis Essential Plan Aliesa	$208.92
Rate for Payer: Fidelis Essential Plan QHP	$218.75
Rate for Payer: Fidelis Medicare Advantage	$245.79
Rate for Payer: Fidelis Qualified Health Plan	$218.75
Rate for Payer: Group Health Inc Commercial	$245.79
Rate for Payer: Group Health Inc Medicare	$245.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$245.79
Rate for Payer: Hamaspik Choice Inc Medicare	$51.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$72.68
Rate for Payer: Healthfirst Medicare Advantage	$208.92
Rate for Payer: Healthfirst QHP	$245.79
Rate for Payer: Humana Medicare	$250.71
Rate for Payer: Senior Whole Health Medicare Advantage	$245.79
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$245.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$245.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$233.50
Rate for Payer: Wellcare Medicare	$233.50

HC ENDOVASC REPAIR INFRARENAL AORTA AND/OR ILIAC ART W/ENDOGRAFT

Facility

$13,920.00

Service Code	CPT 34203 TC
Hospital Charge Code	3613420301
Hospital Revenue Code	361
Min. Negotiated Rate	$1,088.53
Max. Negotiated Rate	$10,440.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,387.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,088.53
Rate for Payer: Aetna Government	$1,088.53
Rate for Payer: Brighton Health Commercial	$10,440.00
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	$6,960.00
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: United Healthcare Commercial	$2,546.00

HC ENDOVASC REPAIR INFRARENAL AORTA AND/OR ILIAC ART W/ENDOGRAFT

Facility

$13,920.00

Service Code	CPT 34203 TC
Hospital Charge Code	3613420301
Hospital Revenue Code	361
Min. Negotiated Rate	$6,960.00
Max. Negotiated Rate	$6,960.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,960.00

HC ENDOVASC REPAIR INFRARENAL AORTA W/ENDOGRAFT

Facility

$4,627.00

Service Code	CPT 34701 TC
Hospital Charge Code	3613470101
Hospital Revenue Code	361
Min. Negotiated Rate	$1,351.35
Max. Negotiated Rate	$3,470.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,544.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,351.35
Rate for Payer: Aetna Government	$1,351.35
Rate for Payer: Brighton Health Commercial	$3,470.25
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	$2,313.50
Rate for Payer: Group Health Inc Commercial	$2,313.50
Rate for Payer: Group Health Inc Medicare	$1,619.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,313.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,313.50
Rate for Payer: United Healthcare Commercial	$1,496.00

HC ENDOVASC REPAIR INFRARENAL AORTA W/ENDOGRAFT

Facility

$4,627.00

Service Code	CPT 34701 TC
Hospital Charge Code	3613470101
Hospital Revenue Code	361
Min. Negotiated Rate	$2,313.50
Max. Negotiated Rate	$2,313.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,313.50

HC ENDOVASCULAR INTERCRANIAL ADMIN RX AGNT - ADD'L

Facility

$1,490.00

Service Code	CPT 61651 TC
Hospital Charge Code	3616165101
Hospital Revenue Code	361
Min. Negotiated Rate	$261.10
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$819.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$261.10
Rate for Payer: Aetna Government	$261.10
Rate for Payer: Brighton Health Commercial	$1,117.50
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	$745.00
Rate for Payer: Group Health Inc Commercial	$745.00
Rate for Payer: Group Health Inc Medicare	$521.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$745.00
Rate for Payer: Hamaspik Choice Inc Medicare	$745.00
Rate for Payer: United Healthcare Commercial	$1,496.00

HC ENDOVASCULAR INTERCRANIAL ADMIN RX AGNT - ADD'L

Facility

$1,490.00

Service Code	CPT 61651 TC
Hospital Charge Code	3616165101
Hospital Revenue Code	361
Min. Negotiated Rate	$745.00
Max. Negotiated Rate	$745.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$745.00

HC ENDOVASCULAR INTERCRANIAL ADMIN RX AGNT - FIRST

Facility

$3,499.00

Service Code	CPT 61650 TC
Hospital Charge Code	3616165001
Hospital Revenue Code	361
Min. Negotiated Rate	$1,749.50
Max. Negotiated Rate	$1,749.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,749.50

HC ENDOVASCULAR INTERCRANIAL ADMIN RX AGNT - FIRST

Facility

$3,499.00

Service Code	CPT 61650 TC
Hospital Charge Code	3616165001
Hospital Revenue Code	361
Min. Negotiated Rate	$614.76
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,924.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$614.76
Rate for Payer: Aetna Government	$614.76
Rate for Payer: Brighton Health Commercial	$2,624.25
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	$1,749.50
Rate for Payer: Group Health Inc Commercial	$1,749.50
Rate for Payer: Group Health Inc Medicare	$1,224.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,749.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,749.50
Rate for Payer: United Healthcare Commercial	$1,496.00

HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN

Facility

$8,393.00

Service Code	CPT 36473 TC
Hospital Charge Code	3613647301
Hospital Revenue Code	361
Min. Negotiated Rate	$960.37
Max. Negotiated Rate	$6,294.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,621.93
Rate for Payer: Aetna Government	$1,621.93
Rate for Payer: Brighton Health Commercial	$6,294.75
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	$4,196.50
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	$960.37
Rate for Payer: United Healthcare Commercial	$1,835.00

HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN

Facility

$8,393.00

Service Code	CPT 36473 TC
Hospital Charge Code	3613647301
Hospital Revenue Code	361
Min. Negotiated Rate	$4,196.50
Max. Negotiated Rate	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50

HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS

Facility

$2,077.00

Service Code	CPT 36474 TC
Hospital Charge Code	3613647401
Hospital Revenue Code	361
Min. Negotiated Rate	$1,038.50
Max. Negotiated Rate	$1,038.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,038.50

HC ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS

Facility

$2,077.00

Service Code	CPT 36474 TC
Hospital Charge Code	3613647401
Hospital Revenue Code	361
Min. Negotiated Rate	$295.66
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$295.66
Rate for Payer: Aetna Government	$295.66
Rate for Payer: Brighton Health Commercial	$1,557.75
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	$1,038.50
Rate for Payer: Group Health Inc Commercial	$1,038.50
Rate for Payer: Group Health Inc Medicare	$726.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,038.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,038.50
Rate for Payer: United Healthcare Commercial	$1,113.00

HC ENDOVENOUS LASER, 1ST VEIN

Facility

$8,393.00

Service Code	CPT 36478 TC
Hospital Charge Code	3613647801
Hospital Revenue Code	361
Min. Negotiated Rate	$4,196.50
Max. Negotiated Rate	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50

Know your out-of-pocket cost for care.

All Charges