St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&

Professional

Both

$101.57

Service Code	HCPCS 75893 26
Min. Negotiated Rate	$76.18
Max. Negotiated Rate	$76.18
Rate for Payer: Cash Price	$28.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$76.18
Rate for Payer: SOMOS Essential	$76.18

CHG VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&

Professional

Both

$343.28

Service Code	HCPCS 75893 TC
Min. Negotiated Rate	$257.46
Max. Negotiated Rate	$257.46
Rate for Payer: Cash Price	$94.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$257.46
Rate for Payer: SOMOS Essential	$257.46

CHG VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL

Professional

Both

$834.68

Service Code	HCPCS 78458
Min. Negotiated Rate	$626.01
Max. Negotiated Rate	$626.01
Rate for Payer: Cash Price	$225.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$626.01
Rate for Payer: SOMOS Essential	$626.01

CHG VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL

Professional

Both

$171.12

Service Code	HCPCS 78458 26
Min. Negotiated Rate	$128.34
Max. Negotiated Rate	$128.34
Rate for Payer: Cash Price	$47.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$128.34
Rate for Payer: SOMOS Essential	$128.34

CHG VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL

Professional

Both

$663.57

Service Code	HCPCS 78458 TC
Min. Negotiated Rate	$497.68
Max. Negotiated Rate	$497.68
Rate for Payer: Cash Price	$178.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$497.68
Rate for Payer: SOMOS Essential	$497.68

CHG VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL

Professional

Both

$684.74

Service Code	HCPCS 78457
Min. Negotiated Rate	$513.56
Max. Negotiated Rate	$513.56
Rate for Payer: Cash Price	$183.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$513.56
Rate for Payer: SOMOS Essential	$513.56

CHG VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL

Professional

Both

$527.00

Service Code	HCPCS 78457 TC
Min. Negotiated Rate	$395.25
Max. Negotiated Rate	$395.25
Rate for Payer: Cash Price	$141.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$395.25
Rate for Payer: SOMOS Essential	$395.25

CHG VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL

Professional

Both

$157.75

Service Code	HCPCS 78457 26
Min. Negotiated Rate	$118.31
Max. Negotiated Rate	$118.31
Rate for Payer: Cash Price	$41.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$118.31
Rate for Payer: SOMOS Essential	$118.31

CHG VERTEBRAL FRACTURE ASSESSMENT VIA DXA

Professional

Both

$141.75

Service Code	HCPCS 77086
Min. Negotiated Rate	$106.31
Max. Negotiated Rate	$106.31
Rate for Payer: Cash Price	$39.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$106.31
Rate for Payer: SOMOS Essential	$106.31

CHG VERTEBRAL FRACTURE ASSESSMENT VIA DXA

Professional

Both

$32.66

Service Code	HCPCS 77086 26
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$24.50
Rate for Payer: Cash Price	$8.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24.50
Rate for Payer: SOMOS Essential	$24.50

CHG VERTEBRAL FRACTURE ASSESSMENT VIA DXA

Professional

Both

$109.10

Service Code	HCPCS 77086 TC
Min. Negotiated Rate	$81.82
Max. Negotiated Rate	$81.82
Rate for Payer: Cash Price	$30.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$81.82
Rate for Payer: SOMOS Essential	$81.82

CHG WHOLE BLOOD VOLUME DETERM PLASMA&RED CELL VOLU

Professional

Both

$343.00

Service Code	HCPCS 78122 TC
Min. Negotiated Rate	$257.25
Max. Negotiated Rate	$257.25
Rate for Payer: Cash Price	$92.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$257.25
Rate for Payer: SOMOS Essential	$257.25

CHG WHOLE BLOOD VOLUME DETERM PLASMA&RED CELL VOLU

Professional

Both

$424.97

Service Code	HCPCS 78122
Min. Negotiated Rate	$318.73
Max. Negotiated Rate	$318.73
Rate for Payer: Cash Price	$114.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$318.73
Rate for Payer: SOMOS Essential	$318.73

CHG WHOLE BLOOD VOLUME DETERM PLASMA&RED CELL VOLU

Professional

Both

$81.97

Service Code	HCPCS 78122 26
Min. Negotiated Rate	$61.48
Max. Negotiated Rate	$61.48
Rate for Payer: Cash Price	$22.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$61.48
Rate for Payer: SOMOS Essential	$61.48

CHICKEN POX VACCINE

Facility

$25.63

Service Code	HCPCS 90716
Hospital Charge Code	30301178
Hospital Revenue Code	636
Min. Negotiated Rate	$12.82
Max. Negotiated Rate	$12.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.82
Rate for Payer: Hamaspik Choice Inc Medicare	$12.82

CHICKEN POX VACCINE

Facility

$25.63

Service Code	HCPCS 90716
Hospital Charge Code	30301178
Hospital Revenue Code	636
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$153.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$153.87
Rate for Payer: Aetna Government	$153.87
Rate for Payer: Brighton Health Commercial	$15.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.74
Rate for Payer: Group Health Inc Commercial	$12.82
Rate for Payer: Group Health Inc Medicare	$8.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.82
Rate for Payer: Hamaspik Choice Inc Medicare	$12.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.66

CHIKUNGUNYA ABS, IGG/IGM

Facility

$32.20

Service Code	HCPCS 86790
Hospital Charge Code	40729387
Hospital Revenue Code	300
Rate for Payer: Cash Price	$12.88

CHIKUNGUNYA ABS, IGG/IGM

Facility

$32.20

Service Code	HCPCS 86790
Hospital Charge Code	40729387
Hospital Revenue Code	300
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$24.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.88
Rate for Payer: Aetna Government	$12.88
Rate for Payer: Affinity Essential Plan 1&2	$9.02
Rate for Payer: Affinity Essential Plan 3&4	$9.02
Rate for Payer: Affinity Medicaid/CHP/HARP	$9.02
Rate for Payer: Brighton Health Commercial	$24.15
Rate for Payer: Cash Price	$12.88
Rate for Payer: Cash Price	$12.88
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.32
Rate for Payer: Elderplan Medicare Advantage	$12.88
Rate for Payer: EmblemHealth Commercial	$12.88
Rate for Payer: Fidelis Essential Plan Aliesa	$10.95
Rate for Payer: Fidelis Essential Plan QHP	$11.46
Rate for Payer: Fidelis Medicare Advantage	$12.88
Rate for Payer: Fidelis Qualified Health Plan	$11.46
Rate for Payer: Group Health Inc Commercial	$12.88
Rate for Payer: Group Health Inc Medicare	$12.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.10
Rate for Payer: Hamaspik Choice Inc Medicare	$12.88
Rate for Payer: Healthfirst Medicare Advantage	$12.88
Rate for Payer: Healthfirst QHP	$12.88
Rate for Payer: Humana Medicare	$13.14
Rate for Payer: Senior Whole Health Medicare Advantage	$12.88
Rate for Payer: United Healthcare Commercial	$16.32
Rate for Payer: United Healthcare Medicare Advantage	$12.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.30
Rate for Payer: Wellcare Medicare	$11.59

CHILDHOOD ALLERGY PROFILE

Facility

$41.15

Service Code	HCPCS 82785
Hospital Charge Code	40728347
Hospital Revenue Code	301
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$30.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.46
Rate for Payer: Aetna Government	$16.46
Rate for Payer: Affinity Essential Plan 1&2	$11.52
Rate for Payer: Affinity Essential Plan 3&4	$11.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$11.52
Rate for Payer: Brighton Health Commercial	$30.86
Rate for Payer: Cash Price	$16.46
Rate for Payer: Cash Price	$16.46
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.15
Rate for Payer: Elderplan Medicare Advantage	$16.46
Rate for Payer: EmblemHealth Commercial	$16.46
Rate for Payer: Fidelis Essential Plan Aliesa	$13.99
Rate for Payer: Fidelis Essential Plan QHP	$14.65
Rate for Payer: Fidelis Medicare Advantage	$16.46
Rate for Payer: Fidelis Qualified Health Plan	$14.65
Rate for Payer: Group Health Inc Commercial	$16.46
Rate for Payer: Group Health Inc Medicare	$16.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.58
Rate for Payer: Hamaspik Choice Inc Medicare	$16.46
Rate for Payer: Healthfirst Medicare Advantage	$16.46
Rate for Payer: Healthfirst QHP	$16.46
Rate for Payer: Humana Medicare	$16.79
Rate for Payer: Senior Whole Health Medicare Advantage	$16.46
Rate for Payer: United Healthcare Commercial	$20.86
Rate for Payer: United Healthcare Medicare Advantage	$16.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13.17
Rate for Payer: Wellcare Medicare	$14.81

CHILDHOOD ALLERGY PROFILE

Facility

$41.15

Service Code	HCPCS 82785
Hospital Charge Code	40728347
Hospital Revenue Code	301
Rate for Payer: Cash Price	$16.46

CHILDHOOD ALLERGY PROFILE+IGE

Facility

$41.15

Service Code	HCPCS 82785
Hospital Charge Code	40609077
Hospital Revenue Code	300
Rate for Payer: Cash Price	$16.46

CHILDHOOD ALLERGY PROFILE+IGE

Facility

$41.15

Service Code	HCPCS 82785
Hospital Charge Code	40609077
Hospital Revenue Code	300
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$30.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.46
Rate for Payer: Aetna Government	$16.46
Rate for Payer: Affinity Essential Plan 1&2	$11.52
Rate for Payer: Affinity Essential Plan 3&4	$11.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$11.52
Rate for Payer: Brighton Health Commercial	$30.86
Rate for Payer: Cash Price	$16.46
Rate for Payer: Cash Price	$16.46
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.15
Rate for Payer: Elderplan Medicare Advantage	$16.46
Rate for Payer: EmblemHealth Commercial	$16.46
Rate for Payer: Fidelis Essential Plan Aliesa	$13.99
Rate for Payer: Fidelis Essential Plan QHP	$14.65
Rate for Payer: Fidelis Medicare Advantage	$16.46
Rate for Payer: Fidelis Qualified Health Plan	$14.65
Rate for Payer: Group Health Inc Commercial	$16.46
Rate for Payer: Group Health Inc Medicare	$16.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.58
Rate for Payer: Hamaspik Choice Inc Medicare	$16.46
Rate for Payer: Healthfirst Medicare Advantage	$16.46
Rate for Payer: Healthfirst QHP	$16.46
Rate for Payer: Humana Medicare	$16.79
Rate for Payer: Senior Whole Health Medicare Advantage	$16.46
Rate for Payer: United Healthcare Commercial	$20.86
Rate for Payer: United Healthcare Medicare Advantage	$16.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13.17
Rate for Payer: Wellcare Medicare	$14.81

CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES

Facility

$732,690.77

Service Code	MSDRG 018
Min. Negotiated Rate	$240,981.47
Max. Negotiated Rate	$732,690.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$543,245.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$518,239.73
Rate for Payer: Aetna Government	$518,239.73
Rate for Payer: Brighton Health Commercial	$534,219.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$528,604.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$636,236.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$525,049.74
Rate for Payer: Elderplan Medicare Advantage	$492,327.74
Rate for Payer: EmblemHealth Commercial	$315,926.00
Rate for Payer: Fidelis Medicare Advantage	$518,239.73
Rate for Payer: Group Health Inc Commercial	$518,239.73
Rate for Payer: Group Health Inc Medicare	$518,239.73
Rate for Payer: Hamaspik Choice Inc Medicare	$518,239.73
Rate for Payer: Healthfirst Medicare Advantage	$240,981.47
Rate for Payer: Humana Medicare	$712,579.63
Rate for Payer: Senior Whole Health Medicare Advantage	$518,239.73
Rate for Payer: United Healthcare Commercial	$732,690.77
Rate for Payer: United Healthcare Medicare Advantage	$518,239.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$518,239.73
Rate for Payer: Wellcare Medicare	$492,327.74

CHIN PLATE 4MM

Facility

$414.00

Service Code	HCPCS C1713
Hospital Charge Code	40200074
Hospital Revenue Code	278
Min. Negotiated Rate	$207.00
Max. Negotiated Rate	$207.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$207.00
Rate for Payer: Hamaspik Choice Inc Medicare	$207.00

CHIN PLATE 4MM

Facility

$414.00

Service Code	HCPCS C1713
Hospital Charge Code	40200074
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$434.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$227.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$248.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$207.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$238.05
Rate for Payer: EmblemHealth Commercial	$207.00
Rate for Payer: Fidelis Medicare Advantage	$434.70
Rate for Payer: Group Health Inc Commercial	$207.00
Rate for Payer: Group Health Inc Medicare	$144.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$207.00
Rate for Payer: Hamaspik Choice Inc Medicare	$207.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$269.10

Know your out-of-pocket cost for care.

All Charges