St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC INJX PROC FOR TMJ ARTHOGRAPHY

Facility

$122.00

Service Code	CPT 21116 TC
Hospital Charge Code	3612111601
Hospital Revenue Code	361
Min. Negotiated Rate	$61.00
Max. Negotiated Rate	$61.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.00

HC INJX PROC, HIP ARTHOGRAM W/ANESTHESIA

Facility

$1,027.00

Service Code	CPT 27095 TC
Hospital Charge Code	3612709501
Hospital Revenue Code	361
Min. Negotiated Rate	$513.50
Max. Negotiated Rate	$513.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$513.50

HC INJX PROC, HIP ARTHOGRAM W/ANESTHESIA

Facility

$1,027.00

Service Code	CPT 27095 TC
Hospital Charge Code	3612709501
Hospital Revenue Code	361
Min. Negotiated Rate	$244.07
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$244.07
Rate for Payer: Aetna Government	$244.07
Rate for Payer: Brighton Health Commercial	$770.25
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	$513.50
Rate for Payer: Group Health Inc Commercial	$513.50
Rate for Payer: Group Health Inc Medicare	$359.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$513.50
Rate for Payer: Hamaspik Choice Inc Medicare	$513.50
Rate for Payer: United Healthcare Commercial	$1,113.00

HC INJX SCLEROSANT MULTIPLE INCMPTNT VEINS

Facility

$967.00

Service Code	CPT 36471 TC
Hospital Charge Code	3613647101
Hospital Revenue Code	361
Min. Negotiated Rate	$133.91
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$176.99
Rate for Payer: Aetna Government	$176.99
Rate for Payer: Brighton Health Commercial	$725.25
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	$483.50
Rate for Payer: Group Health Inc Commercial	$483.50
Rate for Payer: Group Health Inc Medicare	$338.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$483.50
Rate for Payer: Hamaspik Choice Inc Medicare	$133.91
Rate for Payer: United Healthcare Commercial	$1,113.00

HC INJX SCLEROSANT MULTIPLE INCMPTNT VEINS

Facility

$967.00

Service Code	CPT 36471 TC
Hospital Charge Code	3613647101
Hospital Revenue Code	361
Min. Negotiated Rate	$483.50
Max. Negotiated Rate	$483.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$483.50

HC INJX SCLEROSANT SINGLE INCMPTNT VEIN

Facility

$967.00

Service Code	CPT 36470 TC
Hospital Charge Code	3613647001
Hospital Revenue Code	361
Min. Negotiated Rate	$82.48
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$151.53
Rate for Payer: Aetna Government	$151.53
Rate for Payer: Brighton Health Commercial	$725.25
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	$483.50
Rate for Payer: Group Health Inc Commercial	$483.50
Rate for Payer: Group Health Inc Medicare	$338.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$483.50
Rate for Payer: Hamaspik Choice Inc Medicare	$82.48
Rate for Payer: United Healthcare Commercial	$1,113.00

HC INJX SCLEROSANT SINGLE INCMPTNT VEIN

Facility

$967.00

Service Code	CPT 36470 TC
Hospital Charge Code	3613647001
Hospital Revenue Code	361
Min. Negotiated Rate	$483.50
Max. Negotiated Rate	$483.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$483.50

HC INJX SCLEROSANT SPIDER VEINS

Facility

$529.00

Service Code	CPT 36468 TC
Hospital Charge Code	3613646801
Hospital Revenue Code	361
Min. Negotiated Rate	$264.50
Max. Negotiated Rate	$264.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.50

HC INJX SCLEROSANT SPIDER VEINS

Facility

$529.00

Service Code	CPT 36468 TC
Hospital Charge Code	3613646801
Hospital Revenue Code	361
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.00
Rate for Payer: Aetna Government	$51.00
Rate for Payer: Brighton Health Commercial	$396.75
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	$264.50
Rate for Payer: Group Health Inc Commercial	$264.50
Rate for Payer: Group Health Inc Medicare	$185.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.50
Rate for Payer: Hamaspik Choice Inc Medicare	$264.50
Rate for Payer: United Healthcare Commercial	$1,113.00

HC INPT CONSLT MOD. COMPLEX>40MIN

Facility

$294.00

Service Code	CPT 99252 TC
Hospital Charge Code	6579925201
Hospital Revenue Code	657
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$147.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$147.00

HC INPT CONSLT MOD. COMPLEX>40MIN

Facility

$294.00

Service Code	CPT 99252 TC
Hospital Charge Code	6579925201
Hospital Revenue Code	657
Min. Negotiated Rate	$54.97
Max. Negotiated Rate	$235.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$161.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.97
Rate for Payer: Aetna Government	$54.97
Rate for Payer: Brighton Health Commercial	$220.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$199.92
Rate for Payer: EmblemHealth Commercial	$147.00
Rate for Payer: Group Health Inc Commercial	$147.00
Rate for Payer: Group Health Inc Medicare	$102.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$147.00
Rate for Payer: Hamaspik Choice Inc Medicare	$147.00

HC INPT CONSULT COMPREHENS.>80MIN

Facility

$462.00

Service Code	CPT 99254 TC
Hospital Charge Code	6579925401
Hospital Revenue Code	657
Min. Negotiated Rate	$231.00
Max. Negotiated Rate	$231.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$231.00

HC INPT CONSULT COMPREHENS.>80MIN

Facility

$462.00

Service Code	CPT 99254 TC
Hospital Charge Code	6579925401
Hospital Revenue Code	657
Min. Negotiated Rate	$122.72
Max. Negotiated Rate	$369.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$254.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$122.72
Rate for Payer: Aetna Government	$122.72
Rate for Payer: Brighton Health Commercial	$346.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$369.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$314.16
Rate for Payer: EmblemHealth Commercial	$231.00
Rate for Payer: Group Health Inc Commercial	$231.00
Rate for Payer: Group Health Inc Medicare	$161.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$231.00
Rate for Payer: Hamaspik Choice Inc Medicare	$231.00

HC INPT CONSULT MOST COMPLX>55MIN

Facility

$358.00

Service Code	CPT 99253 TC
Hospital Charge Code	6579925301
Hospital Revenue Code	657
Min. Negotiated Rate	$179.00
Max. Negotiated Rate	$179.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00

HC INPT CONSULT MOST COMPLX>55MIN

Facility

$358.00

Service Code	CPT 99253 TC
Hospital Charge Code	6579925301
Hospital Revenue Code	657
Min. Negotiated Rate	$84.39
Max. Negotiated Rate	$286.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$196.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$84.39
Rate for Payer: Aetna Government	$84.39
Rate for Payer: Brighton Health Commercial	$268.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$286.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$243.44
Rate for Payer: EmblemHealth Commercial	$179.00
Rate for Payer: Group Health Inc Commercial	$179.00
Rate for Payer: Group Health Inc Medicare	$125.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00
Rate for Payer: Hamaspik Choice Inc Medicare	$179.00

HC INPT CONSULT, PROBLEM FOCUSED>20MIN

Facility

$358.00

Service Code	CPT 99251 TC
Hospital Charge Code	6579925101
Hospital Revenue Code	657
Min. Negotiated Rate	$35.92
Max. Negotiated Rate	$286.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$196.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.92
Rate for Payer: Aetna Government	$35.92
Rate for Payer: Brighton Health Commercial	$268.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$286.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$243.44
Rate for Payer: EmblemHealth Commercial	$179.00
Rate for Payer: Group Health Inc Commercial	$179.00
Rate for Payer: Group Health Inc Medicare	$125.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00
Rate for Payer: Hamaspik Choice Inc Medicare	$179.00

HC INPT CONSULT, PROBLEM FOCUSED>20MIN

Facility

$358.00

Service Code	CPT 99251 TC
Hospital Charge Code	6579925101
Hospital Revenue Code	657
Min. Negotiated Rate	$179.00
Max. Negotiated Rate	$179.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00

HC INSERT ABDOMEN-VENOUS SHUNT

Facility

$2,425.00

Service Code	CPT 49425 TC
Hospital Charge Code	3614942501
Hospital Revenue Code	361
Min. Negotiated Rate	$848.75
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,333.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$860.90
Rate for Payer: Aetna Government	$860.90
Rate for Payer: Brighton Health Commercial	$1,818.75
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	$1,212.50
Rate for Payer: Group Health Inc Commercial	$1,212.50
Rate for Payer: Group Health Inc Medicare	$848.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,212.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,212.50
Rate for Payer: United Healthcare Commercial	$1,409.00

HC INSERT ABDOMEN-VENOUS SHUNT

Facility

$2,425.00

Service Code	CPT 49425 TC
Hospital Charge Code	3614942501
Hospital Revenue Code	361
Min. Negotiated Rate	$1,212.50
Max. Negotiated Rate	$1,212.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,212.50

HC INSERT CERVICAL DILATOR - SEPERATE PROCEDURE

Facility

$814.00

Service Code	CPT 59200
Hospital Charge Code	7205920001
Hospital Revenue Code	510
Min. Negotiated Rate	$78.60
Max. Negotiated Rate	$390.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$371.67
Rate for Payer: Aetna Government	$371.67
Rate for Payer: Affinity Essential Plan 1&2	$260.17
Rate for Payer: Affinity Essential Plan 3&4	$260.17
Rate for Payer: Affinity Medicaid/CHP/HARP	$260.17
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$371.67
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	$371.67
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$334.50
Rate for Payer: Fidelis Essential Plan Aliesa	$315.92
Rate for Payer: Fidelis Essential Plan QHP	$330.79
Rate for Payer: Fidelis Medicare Advantage	$371.67
Rate for Payer: Fidelis Qualified Health Plan	$330.79
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	$371.67
Rate for Payer: Hamaspik Choice Inc Medicare	$78.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$81.22
Rate for Payer: Healthfirst Medicare Advantage	$315.92
Rate for Payer: Healthfirst QHP	$371.67
Rate for Payer: Humana Medicare	$379.10
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$390.25
Rate for Payer: Senior Whole Health Medicare Advantage	$371.67
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$371.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$371.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$353.09
Rate for Payer: Wellcare Medicare	$353.09

HC INSERT CERVICAL DILATOR - SEPERATE PROCEDURE

Facility

$814.00

Service Code	CPT 59200
Hospital Charge Code	7205920001
Hospital Revenue Code	510
Min. Negotiated Rate	$407.00
Max. Negotiated Rate	$407.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$407.00

HC INSERT DRUG IMPLANT DEVICE

Facility

$330.00

Service Code	CPT 11981
Hospital Charge Code	3611198101
Hospital Revenue Code	361
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$165.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.00

HC INSERT DRUG IMPLANT DEVICE

Facility

$330.00

Service Code	CPT 11981
Hospital Charge Code	3611198101
Hospital Revenue Code	361
Min. Negotiated Rate	$73.21
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$157.49
Rate for Payer: Aetna Government	$157.49
Rate for Payer: Affinity Essential Plan 1&2	$110.24
Rate for Payer: Affinity Essential Plan 3&4	$110.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$110.24
Rate for Payer: Brighton Health Commercial	$247.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$157.49
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	$157.49
Rate for Payer: EmblemHealth Commercial	$157.49
Rate for Payer: Fidelis CHP/HARP/Medicaid	$141.74
Rate for Payer: Fidelis Essential Plan Aliesa	$133.87
Rate for Payer: Fidelis Essential Plan QHP	$140.17
Rate for Payer: Fidelis Medicare Advantage	$157.49
Rate for Payer: Fidelis Qualified Health Plan	$140.17
Rate for Payer: Group Health Inc Commercial	$157.49
Rate for Payer: Group Health Inc Medicare	$157.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.49
Rate for Payer: Hamaspik Choice Inc Medicare	$157.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$73.21
Rate for Payer: Healthfirst Medicare Advantage	$133.87
Rate for Payer: Healthfirst QHP	$157.49
Rate for Payer: Humana Medicare	$160.64
Rate for Payer: Senior Whole Health Medicare Advantage	$157.49
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$157.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$157.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$149.62
Rate for Payer: Wellcare Medicare	$149.62

HC INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERCUTANEOUS

Facility

$4,716.00

Service Code	CPT 49441 TC
Hospital Charge Code	3614944101
Hospital Revenue Code	361
Min. Negotiated Rate	$780.00
Max. Negotiated Rate	$3,537.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,345.29
Rate for Payer: Aetna Government	$1,345.29
Rate for Payer: Brighton Health Commercial	$3,537.00
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	$2,358.00
Rate for Payer: Group Health Inc Commercial	$2,358.00
Rate for Payer: Group Health Inc Medicare	$1,650.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,358.00
Rate for Payer: Hamaspik Choice Inc Medicare	$864.15
Rate for Payer: United Healthcare Commercial	$1,409.00

HC INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERCUTANEOUS

Facility

$4,716.00

Service Code	CPT 49441 TC
Hospital Charge Code	3614944101
Hospital Revenue Code	361
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$2,358.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,358.00

Know your out-of-pocket cost for care.

All Charges