St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC INJECTION, ANESTHETIC AGENT, SYMPH GANGLION

Facility

$792.00

Service Code	CPT 64505
Hospital Charge Code	5106450501
Hospital Revenue Code	510
Min. Negotiated Rate	$85.39
Max. Negotiated Rate	$378.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$360.67
Rate for Payer: Aetna Government	$360.67
Rate for Payer: Affinity Essential Plan 1&2	$252.47
Rate for Payer: Affinity Essential Plan 3&4	$252.47
Rate for Payer: Affinity Medicaid/CHP/HARP	$252.47
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$360.67
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	$360.67
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$324.60
Rate for Payer: Fidelis Essential Plan Aliesa	$306.57
Rate for Payer: Fidelis Essential Plan QHP	$321.00
Rate for Payer: Fidelis Medicare Advantage	$360.67
Rate for Payer: Fidelis Qualified Health Plan	$321.00
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	$360.67
Rate for Payer: Hamaspik Choice Inc Medicare	$85.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$127.63
Rate for Payer: Healthfirst Medicare Advantage	$306.57
Rate for Payer: Healthfirst QHP	$360.67
Rate for Payer: Humana Medicare	$367.88
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$378.70
Rate for Payer: Senior Whole Health Medicare Advantage	$360.67
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$360.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$360.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$342.64
Rate for Payer: Wellcare Medicare	$342.64

HC INJECTION, ANESTHETIC AGENT, SYMPH GANGLION

Facility

$792.00

Service Code	CPT 64505
Hospital Charge Code	5106450501
Hospital Revenue Code	510
Min. Negotiated Rate	$396.00
Max. Negotiated Rate	$396.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.00

HC INJECTION EYE DRUG

Facility

$937.00

Service Code	CPT 67028
Hospital Charge Code	5106702801
Hospital Revenue Code	510
Min. Negotiated Rate	$58.55
Max. Negotiated Rate	$780.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$405.27
Rate for Payer: Aetna Government	$405.27
Rate for Payer: Affinity Essential Plan 1&2	$283.69
Rate for Payer: Affinity Essential Plan 3&4	$283.69
Rate for Payer: Affinity Medicaid/CHP/HARP	$283.69
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$405.27
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	$405.27
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$364.74
Rate for Payer: Fidelis Essential Plan Aliesa	$344.48
Rate for Payer: Fidelis Essential Plan QHP	$360.69
Rate for Payer: Fidelis Medicare Advantage	$405.27
Rate for Payer: Fidelis Qualified Health Plan	$360.69
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	$405.27
Rate for Payer: Hamaspik Choice Inc Medicare	$58.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$102.83
Rate for Payer: Healthfirst Medicare Advantage	$344.48
Rate for Payer: Healthfirst QHP	$405.27
Rate for Payer: Humana Medicare	$413.38
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$425.53
Rate for Payer: Senior Whole Health Medicare Advantage	$405.27
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$405.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$405.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$385.01
Rate for Payer: Wellcare Medicare	$385.01

HC INJECTION EYE DRUG

Facility

$937.00

Service Code	CPT 67028
Hospital Charge Code	5106702801
Hospital Revenue Code	510
Min. Negotiated Rate	$468.50
Max. Negotiated Rate	$468.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$468.50

HC INJECTION FOR ELBOW ARTHROGRAM

Facility

$478.00

Service Code	CPT 24220 TC
Hospital Charge Code	3612422001
Hospital Revenue Code	361
Min. Negotiated Rate	$239.00
Max. Negotiated Rate	$239.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$239.00

HC INJECTION FOR ELBOW ARTHROGRAM

Facility

$478.00

Service Code	CPT 24220 TC
Hospital Charge Code	3612422001
Hospital Revenue Code	361
Min. Negotiated Rate	$160.95
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$160.95
Rate for Payer: Aetna Government	$160.95
Rate for Payer: Brighton Health Commercial	$358.50
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	$239.00
Rate for Payer: Group Health Inc Commercial	$239.00
Rate for Payer: Group Health Inc Medicare	$167.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$239.00
Rate for Payer: Hamaspik Choice Inc Medicare	$239.00
Rate for Payer: United Healthcare Commercial	$1,113.00

HC INJECTION FOR LYMPHATIC XRAY

Facility

$238.00

Service Code	CPT 38790 TC
Hospital Charge Code	3613879001
Hospital Revenue Code	361
Min. Negotiated Rate	$83.30
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$85.65
Rate for Payer: Aetna Government	$85.65
Rate for Payer: Brighton Health Commercial	$178.50
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	$119.00
Rate for Payer: Group Health Inc Commercial	$119.00
Rate for Payer: Group Health Inc Medicare	$83.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.00
Rate for Payer: Hamaspik Choice Inc Medicare	$119.00
Rate for Payer: United Healthcare Commercial	$1,113.00

HC INJECTION FOR LYMPHATIC XRAY

Facility

$238.00

Service Code	CPT 38790 TC
Hospital Charge Code	3613879001
Hospital Revenue Code	361
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$119.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.00

HC INJECTION FOR NERVE BLOCK

Facility

$1,893.00

Service Code	CPT 64450
Hospital Charge Code	5106445001
Hospital Revenue Code	510
Min. Negotiated Rate	$45.29
Max. Negotiated Rate	$888.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$846.13
Rate for Payer: Aetna Government	$846.13
Rate for Payer: Affinity Essential Plan 1&2	$592.29
Rate for Payer: Affinity Essential Plan 3&4	$592.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$592.29
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$846.13
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	$846.13
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$761.52
Rate for Payer: Fidelis Essential Plan Aliesa	$719.21
Rate for Payer: Fidelis Essential Plan QHP	$753.06
Rate for Payer: Fidelis Medicare Advantage	$846.13
Rate for Payer: Fidelis Qualified Health Plan	$753.06
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	$846.13
Rate for Payer: Hamaspik Choice Inc Medicare	$45.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$46.47
Rate for Payer: Healthfirst Medicare Advantage	$719.21
Rate for Payer: Healthfirst QHP	$846.13
Rate for Payer: Humana Medicare	$863.05
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$888.44
Rate for Payer: Senior Whole Health Medicare Advantage	$846.13
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$846.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$846.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$803.82
Rate for Payer: Wellcare Medicare	$803.82

HC INJECTION FOR NERVE BLOCK

Facility

$1,893.00

Service Code	CPT 64450
Hospital Charge Code	5106445001
Hospital Revenue Code	510
Min. Negotiated Rate	$946.50
Max. Negotiated Rate	$946.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$946.50

HC INJECTION FOR WRIST ARTHROGRAM

Facility

$525.00

Service Code	CPT 25246 TC
Hospital Charge Code	3612524601
Hospital Revenue Code	361
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50

HC INJECTION FOR WRIST ARTHROGRAM

Facility

$525.00

Service Code	CPT 25246 TC
Hospital Charge Code	3612524601
Hospital Revenue Code	361
Min. Negotiated Rate	$162.43
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$162.43
Rate for Payer: Aetna Government	$162.43
Rate for Payer: Brighton Health Commercial	$393.75
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	$262.50
Rate for Payer: Group Health Inc Commercial	$262.50
Rate for Payer: Group Health Inc Medicare	$183.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50
Rate for Payer: United Healthcare Commercial	$1,113.00

HC INJECTION HIP ARTHROGRAM

Facility

$864.00

Service Code	CPT 27093 TC
Hospital Charge Code	3612709301
Hospital Revenue Code	361
Min. Negotiated Rate	$432.00
Max. Negotiated Rate	$432.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$432.00

HC INJECTION HIP ARTHROGRAM

Facility

$864.00

Service Code	CPT 27093 TC
Hospital Charge Code	3612709301
Hospital Revenue Code	361
Min. Negotiated Rate	$189.09
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$189.09
Rate for Payer: Aetna Government	$189.09
Rate for Payer: Brighton Health Commercial	$648.00
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	$432.00
Rate for Payer: Group Health Inc Commercial	$432.00
Rate for Payer: Group Health Inc Medicare	$302.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$432.00
Rate for Payer: Hamaspik Choice Inc Medicare	$432.00
Rate for Payer: United Healthcare Commercial	$1,113.00

HC INJECTION INTO TURBINATE

Facility

$1,337.00

Service Code	CPT 30200
Hospital Charge Code	3613020001
Hospital Revenue Code	361
Min. Negotiated Rate	$668.50
Max. Negotiated Rate	$668.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$668.50

HC INJECTION INTO TURBINATE

Facility

$1,337.00

Service Code	CPT 30200
Hospital Charge Code	3613020001
Hospital Revenue Code	361
Min. Negotiated Rate	$70.39
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$622.21
Rate for Payer: Aetna Government	$622.21
Rate for Payer: Affinity Essential Plan 1&2	$435.55
Rate for Payer: Affinity Essential Plan 3&4	$435.55
Rate for Payer: Affinity Medicaid/CHP/HARP	$435.55
Rate for Payer: Brighton Health Commercial	$1,002.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$622.21
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	$622.21
Rate for Payer: EmblemHealth Commercial	$622.21
Rate for Payer: Fidelis CHP/HARP/Medicaid	$559.99
Rate for Payer: Fidelis Essential Plan Aliesa	$528.88
Rate for Payer: Fidelis Essential Plan QHP	$553.77
Rate for Payer: Fidelis Medicare Advantage	$622.21
Rate for Payer: Fidelis Qualified Health Plan	$553.77
Rate for Payer: Group Health Inc Commercial	$622.21
Rate for Payer: Group Health Inc Medicare	$622.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$622.21
Rate for Payer: Hamaspik Choice Inc Medicare	$76.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$70.39
Rate for Payer: Healthfirst Medicare Advantage	$528.88
Rate for Payer: Healthfirst QHP	$622.21
Rate for Payer: Humana Medicare	$634.65
Rate for Payer: Senior Whole Health Medicare Advantage	$622.21
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$622.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$622.21
Rate for Payer: Wellcare CHP/FHP/Medicaid	$591.10
Rate for Payer: Wellcare Medicare	$591.10

HC INJECTION PROC,EXTREMITY,VENOGRAPHY

Facility

$1,032.00

Service Code	CPT 36005 TC
Hospital Charge Code	3613600501
Hospital Revenue Code	361
Min. Negotiated Rate	$342.00
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$350.58
Rate for Payer: Aetna Government	$350.58
Rate for Payer: Brighton Health Commercial	$774.00
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	$516.00
Rate for Payer: Group Health Inc Commercial	$516.00
Rate for Payer: Group Health Inc Medicare	$361.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$516.00
Rate for Payer: Hamaspik Choice Inc Medicare	$516.00
Rate for Payer: United Healthcare Commercial	$1,113.00

HC INJECTION PROC,EXTREMITY,VENOGRAPHY

Facility

$1,032.00

Service Code	CPT 36005 TC
Hospital Charge Code	3613600501
Hospital Revenue Code	361
Min. Negotiated Rate	$516.00
Max. Negotiated Rate	$516.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$516.00

HC INJECTION PROC FOR SIALOGRAPHY

Facility

$419.00

Service Code	CPT 42550 TC
Hospital Charge Code	3614255001
Hospital Revenue Code	361
Min. Negotiated Rate	$209.50
Max. Negotiated Rate	$209.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.50

HC INJECTION PROC FOR SIALOGRAPHY

Facility

$419.00

Service Code	CPT 42550 TC
Hospital Charge Code	3614255001
Hospital Revenue Code	361
Min. Negotiated Rate	$146.65
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$153.91
Rate for Payer: Aetna Government	$153.91
Rate for Payer: Brighton Health Commercial	$314.25
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	$209.50
Rate for Payer: Group Health Inc Commercial	$209.50
Rate for Payer: Group Health Inc Medicare	$146.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.50
Rate for Payer: Hamaspik Choice Inc Medicare	$209.50
Rate for Payer: United Healthcare Commercial	$1,113.00

HC INJECTION PROC FOR SPLENOPORTOGRAPHY

Facility

$379.00

Service Code	CPT 38200 TC
Hospital Charge Code	3613820001
Hospital Revenue Code	361
Min. Negotiated Rate	$189.50
Max. Negotiated Rate	$189.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$189.50

HC INJECTION PROC FOR SPLENOPORTOGRAPHY

Facility

$379.00

Service Code	CPT 38200 TC
Hospital Charge Code	3613820001
Hospital Revenue Code	361
Min. Negotiated Rate	$115.86
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$115.86
Rate for Payer: Aetna Government	$115.86
Rate for Payer: Brighton Health Commercial	$284.25
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	$189.50
Rate for Payer: Group Health Inc Commercial	$189.50
Rate for Payer: Group Health Inc Medicare	$132.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$189.50
Rate for Payer: Hamaspik Choice Inc Medicare	$189.50
Rate for Payer: United Healthcare Commercial	$1,113.00

HC INJECTION RX EXTREMITY PSEUDOANEURYSM

Facility

$1,909.00

Service Code	CPT 36002 TC
Hospital Charge Code	3613600201
Hospital Revenue Code	361
Min. Negotiated Rate	$174.61
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$174.61
Rate for Payer: Aetna Government	$174.61
Rate for Payer: Brighton Health Commercial	$1,431.75
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	$954.50
Rate for Payer: Group Health Inc Commercial	$954.50
Rate for Payer: Group Health Inc Medicare	$668.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.50
Rate for Payer: Hamaspik Choice Inc Medicare	$332.31
Rate for Payer: United Healthcare Commercial	$1,188.00

HC INJECTION RX EXTREMITY PSEUDOANEURYSM

Facility

$1,909.00

Service Code	CPT 36002 TC
Hospital Charge Code	3613600201
Hospital Revenue Code	361
Min. Negotiated Rate	$954.50
Max. Negotiated Rate	$954.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.50

HC INJECTION,SACROILIAC JOINT

Facility

$1,027.00

Service Code	CPT 27096 TC
Hospital Charge Code	3612709601
Hospital Revenue Code	361
Min. Negotiated Rate	$513.50
Max. Negotiated Rate	$513.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$513.50

Know your out-of-pocket cost for care.

All Charges