St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC INSERT EMERGENCY ENDOTRACH AIRWAY

Facility

$623.00

Service Code	CPT 31500
Hospital Charge Code	3613150001
Hospital Revenue Code	361
Min. Negotiated Rate	$124.13
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$283.73
Rate for Payer: Aetna Government	$283.73
Rate for Payer: Affinity Essential Plan 1&2	$198.61
Rate for Payer: Affinity Essential Plan 3&4	$198.61
Rate for Payer: Affinity Medicaid/CHP/HARP	$198.61
Rate for Payer: Brighton Health Commercial	$467.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$283.73
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	$283.73
Rate for Payer: EmblemHealth Commercial	$283.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$255.36
Rate for Payer: Fidelis Essential Plan Aliesa	$241.17
Rate for Payer: Fidelis Essential Plan QHP	$252.52
Rate for Payer: Fidelis Medicare Advantage	$283.73
Rate for Payer: Fidelis Qualified Health Plan	$252.52
Rate for Payer: Group Health Inc Commercial	$283.73
Rate for Payer: Group Health Inc Medicare	$283.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$283.73
Rate for Payer: Hamaspik Choice Inc Medicare	$124.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$161.90
Rate for Payer: Healthfirst Medicare Advantage	$241.17
Rate for Payer: Healthfirst QHP	$283.73
Rate for Payer: Humana Medicare	$289.40
Rate for Payer: Senior Whole Health Medicare Advantage	$283.73
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$283.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$283.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$269.54
Rate for Payer: Wellcare Medicare	$269.54

HC INSERT EMERGENCY ENDOTRACH AIRWAY

Facility

$623.00

Service Code	CPT 31500
Hospital Charge Code	3613150001
Hospital Revenue Code	361
Min. Negotiated Rate	$311.50
Max. Negotiated Rate	$311.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$311.50

HC INSERT GASTROSTOMY TUBE PERCUTANEOUS

Facility

$4,716.00

Service Code	CPT 49440 TC
Hospital Charge Code	3614944001
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

HC INSERT GASTROSTOMY TUBE PERCUTANEOUS

Facility

$4,716.00

Service Code	CPT 49440 TC
Hospital Charge Code	3614944001
Hospital Revenue Code	361
Min. Negotiated Rate	$864.15
Max. Negotiated Rate	$3,537.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,190.51
Rate for Payer: Aetna Government	$1,190.51
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 INSERTINO GRAFT, AORTA OR GRTR VESSELS W/O SHUNT

Facility

$4,544.00

Service Code	CPT 33330 TC
Hospital Charge Code	3613333001
Hospital Revenue Code	361
Min. Negotiated Rate	$1,496.00
Max. Negotiated Rate	$3,408.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,499.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,592.90
Rate for Payer: Aetna Government	$1,592.90
Rate for Payer: Brighton Health Commercial	$3,408.00
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	$2,272.00
Rate for Payer: Group Health Inc Commercial	$2,272.00
Rate for Payer: Group Health Inc Medicare	$1,590.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,272.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,272.00
Rate for Payer: United Healthcare Commercial	$1,496.00

HC INSERTINO GRAFT, AORTA OR GRTR VESSELS W/O SHUNT

Facility

$4,544.00

Service Code	CPT 33330 TC
Hospital Charge Code	3613333001
Hospital Revenue Code	361
Min. Negotiated Rate	$2,272.00
Max. Negotiated Rate	$2,272.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,272.00

HC INSERT INTRAUTERINE DEVICE

Facility

$98.00

Service Code	CPT 58300
Hospital Charge Code	3615830003
Hospital Revenue Code	361
Min. Negotiated Rate	$34.30
Max. Negotiated Rate	$21,008.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$67.24
Rate for Payer: Aetna Government	$67.24
Rate for Payer: Affinity Essential Plan 1&2	$472.68
Rate for Payer: Affinity Essential Plan 3&4	$472.68
Rate for Payer: Affinity Medicaid/CHP/HARP	$210.08
Rate for Payer: Amida Care Medicaid	$210.08
Rate for Payer: Brighton Health Commercial	$73.50
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	$49.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$472.68
Rate for Payer: EmblemHealth Essential Plan 3&4	$210.08
Rate for Payer: Fidelis CHP/HARP/Medicaid	$210.08
Rate for Payer: Fidelis Essential Plan Aliesa	$472.68
Rate for Payer: Fidelis Essential Plan QHP	$472.68
Rate for Payer: Fidelis Qualified Health Plan	$220.58
Rate for Payer: Group Health Inc Commercial	$49.00
Rate for Payer: Group Health Inc Medicare	$34.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.08
Rate for Payer: Hamaspik Choice Inc Medicare	$49.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,008.00
Rate for Payer: Healthfirst Essential Plan	$472.68
Rate for Payer: Healthfirst QHP	$342.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$210.08
Rate for Payer: SOMOS Essential	$472.68
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Essential Plan 1&2	$472.68
Rate for Payer: United Healthcare Essential Plan 3&4	$231.09
Rate for Payer: United Healthcare Medicaid	$210.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$210.08

HC INSERT INTRAUTERINE DEVICE

Facility

$98.00

Service Code	CPT 58300
Hospital Charge Code	3615830003
Hospital Revenue Code	361
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$49.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.00

HC INSERTION INDWELLING TUNNELED PLEURAL CATHETER

Facility

$9,417.00

Service Code	CPT 32550 TC
Hospital Charge Code	3613255001
Hospital Revenue Code	361
Min. Negotiated Rate	$825.05
Max. Negotiated Rate	$7,062.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,880.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$825.05
Rate for Payer: Aetna Government	$825.05
Rate for Payer: Brighton Health Commercial	$7,062.75
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	$4,708.50
Rate for Payer: Group Health Inc Commercial	$4,708.50
Rate for Payer: Group Health Inc Medicare	$3,295.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,708.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,207.28
Rate for Payer: United Healthcare Commercial	$1,835.00

HC INSERTION INDWELLING TUNNELED PLEURAL CATHETER

Facility

$9,417.00

Service Code	CPT 32550 TC
Hospital Charge Code	3613255001
Hospital Revenue Code	361
Min. Negotiated Rate	$4,708.50
Max. Negotiated Rate	$4,708.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,708.50

HC INSERTION IVC FILTER, ENDOVASCULAR APPROACH

Facility

$13,920.00

Service Code	CPT 37191 TC
Hospital Charge Code	3613719101
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 INSERTION IVC FILTER, ENDOVASCULAR APPROACH

Facility

$13,920.00

Service Code	CPT 37191 TC
Hospital Charge Code	3613719101
Hospital Revenue Code	361
Min. Negotiated Rate	$2,546.00
Max. Negotiated Rate	$10,440.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,880.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,851.48
Rate for Payer: Aetna Government	$2,851.48
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 INSERTION OF IUD

Facility

$98.00

Service Code	CPT 58300
Hospital Charge Code	3615830001
Hospital Revenue Code	361
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$49.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.00

HC INSERTION OF IUD

Facility

$98.00

Service Code	CPT 58300
Hospital Charge Code	3615830001
Hospital Revenue Code	361
Min. Negotiated Rate	$34.30
Max. Negotiated Rate	$21,008.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$67.24
Rate for Payer: Aetna Government	$67.24
Rate for Payer: Affinity Essential Plan 1&2	$472.68
Rate for Payer: Affinity Essential Plan 3&4	$472.68
Rate for Payer: Affinity Medicaid/CHP/HARP	$210.08
Rate for Payer: Amida Care Medicaid	$210.08
Rate for Payer: Brighton Health Commercial	$73.50
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	$49.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$472.68
Rate for Payer: EmblemHealth Essential Plan 3&4	$210.08
Rate for Payer: Fidelis CHP/HARP/Medicaid	$210.08
Rate for Payer: Fidelis Essential Plan Aliesa	$472.68
Rate for Payer: Fidelis Essential Plan QHP	$472.68
Rate for Payer: Fidelis Qualified Health Plan	$220.58
Rate for Payer: Group Health Inc Commercial	$49.00
Rate for Payer: Group Health Inc Medicare	$34.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.08
Rate for Payer: Hamaspik Choice Inc Medicare	$49.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,008.00
Rate for Payer: Healthfirst Essential Plan	$472.68
Rate for Payer: Healthfirst QHP	$342.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$210.08
Rate for Payer: SOMOS Essential	$472.68
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Essential Plan 1&2	$472.68
Rate for Payer: United Healthcare Essential Plan 3&4	$231.09
Rate for Payer: United Healthcare Medicaid	$210.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$210.08

HC INSERTION PERQ LT HRT VAD, ARTL ACCESS

Facility

$1,255.00

Service Code	CPT 33990
Hospital Charge Code	3613399001
Hospital Revenue Code	361
Min. Negotiated Rate	$415.61
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$690.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$494.35
Rate for Payer: Aetna Government	$494.35
Rate for Payer: Brighton Health Commercial	$941.25
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	$627.50
Rate for Payer: Group Health Inc Commercial	$627.50
Rate for Payer: Group Health Inc Medicare	$439.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$627.50
Rate for Payer: Hamaspik Choice Inc Medicare	$627.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$415.61
Rate for Payer: United Healthcare Commercial	$1,496.00

HC INSERTION PERQ LT HRT VAD, ARTL ACCESS

Facility

$1,255.00

Service Code	CPT 33990
Hospital Charge Code	3613399001
Hospital Revenue Code	361
Min. Negotiated Rate	$627.50
Max. Negotiated Rate	$627.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$627.50

HC INSERTION PERQ LT HRT VAD, ARTL&VEN ACCESS

Facility

$1,829.00

Service Code	CPT 33991
Hospital Charge Code	3613399101
Hospital Revenue Code	361
Min. Negotiated Rate	$523.33
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,005.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$719.78
Rate for Payer: Aetna Government	$719.78
Rate for Payer: Brighton Health Commercial	$1,371.75
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	$914.50
Rate for Payer: Group Health Inc Commercial	$914.50
Rate for Payer: Group Health Inc Medicare	$640.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$914.50
Rate for Payer: Hamaspik Choice Inc Medicare	$914.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$523.33
Rate for Payer: United Healthcare Commercial	$1,496.00

HC INSERTION PERQ LT HRT VAD, ARTL&VEN ACCESS

Facility

$1,829.00

Service Code	CPT 33991
Hospital Charge Code	3613399101
Hospital Revenue Code	361
Min. Negotiated Rate	$914.50
Max. Negotiated Rate	$914.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$914.50

HC INSERTION TUNNELED INTRAPERITONEAL CATHETER, OPEN

Facility

$9,417.00

Service Code	CPT 49421 TC
Hospital Charge Code	3614942101
Hospital Revenue Code	361
Min. Negotiated Rate	$274.13
Max. Negotiated Rate	$7,062.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$274.13
Rate for Payer: Aetna Government	$274.13
Rate for Payer: Brighton Health Commercial	$7,062.75
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	$4,708.50
Rate for Payer: Group Health Inc Commercial	$4,708.50
Rate for Payer: Group Health Inc Medicare	$3,295.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,708.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,685.17
Rate for Payer: United Healthcare Commercial	$1,835.00

HC INSERTION TUNNELED INTRAPERITONEAL CATHETER, OPEN

Facility

$9,417.00

Service Code	CPT 49421 TC
Hospital Charge Code	3614942101
Hospital Revenue Code	361
Min. Negotiated Rate	$4,708.50
Max. Negotiated Rate	$4,708.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,708.50

HC INSERTION TUNNELED INTRAPERITONEAL CATHETER, PERCU

Facility

$9,417.00

Service Code	CPT 49418 TC
Hospital Charge Code	3614941801
Hospital Revenue Code	361
Min. Negotiated Rate	$4,708.50
Max. Negotiated Rate	$4,708.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,708.50

HC INSERTION TUNNELED INTRAPERITONEAL CATHETER, PERCU

Facility

$9,417.00

Service Code	CPT 49418 TC
Hospital Charge Code	3614941801
Hospital Revenue Code	361
Min. Negotiated Rate	$1,647.84
Max. Negotiated Rate	$7,062.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,880.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,647.84
Rate for Payer: Aetna Government	$1,647.84
Rate for Payer: Brighton Health Commercial	$7,062.75
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	$4,708.50
Rate for Payer: Group Health Inc Commercial	$4,708.50
Rate for Payer: Group Health Inc Medicare	$3,295.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,708.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,685.17
Rate for Payer: United Healthcare Commercial	$1,835.00

HC INSERTN IMPL DEFRIB PULSE GEN ONLY, EXSTG DUAL LEADS

Facility

$68,791.00

Service Code	CPT 33230
Hospital Charge Code	3613323001
Hospital Revenue Code	361
Min. Negotiated Rate	$34,395.50
Max. Negotiated Rate	$34,395.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,395.50

HC INSERTN IMPL DEFRIB PULSE GEN ONLY, EXSTG DUAL LEADS

Facility

$68,791.00

Service Code	CPT 33230
Hospital Charge Code	3613323001
Hospital Revenue Code	361
Min. Negotiated Rate	$435.15
Max. Negotiated Rate	$51,593.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44,507.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27,425.20
Rate for Payer: Aetna Government	$27,425.20
Rate for Payer: Affinity Essential Plan 1&2	$19,197.64
Rate for Payer: Affinity Essential Plan 3&4	$19,197.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,197.64
Rate for Payer: Brighton Health Commercial	$51,593.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$27,425.20
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	$27,425.20
Rate for Payer: EmblemHealth Commercial	$27,425.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,682.68
Rate for Payer: Fidelis Essential Plan Aliesa	$23,311.42
Rate for Payer: Fidelis Essential Plan QHP	$24,408.43
Rate for Payer: Fidelis Medicare Advantage	$27,425.20
Rate for Payer: Fidelis Qualified Health Plan	$24,408.43
Rate for Payer: Group Health Inc Commercial	$27,425.20
Rate for Payer: Group Health Inc Medicare	$27,425.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,425.20
Rate for Payer: Hamaspik Choice Inc Medicare	$19,249.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$435.15
Rate for Payer: Healthfirst Medicare Advantage	$23,311.42
Rate for Payer: Healthfirst QHP	$27,425.20
Rate for Payer: Humana Medicare	$27,973.70
Rate for Payer: Senior Whole Health Medicare Advantage	$27,425.20
Rate for Payer: United Healthcare Commercial	$4,446.00
Rate for Payer: United Healthcare Medicare Advantage	$27,425.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27,425.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,053.94
Rate for Payer: Wellcare Medicare	$26,053.94

HC INSERTN IMPL DEFRIB PULSE GEN ONLY, EXSTG SING LEAD

Facility

$68,791.00

Service Code	CPT 33240
Hospital Charge Code	3613324001
Hospital Revenue Code	361
Min. Negotiated Rate	$34,395.50
Max. Negotiated Rate	$34,395.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,395.50

Know your out-of-pocket cost for care.

All Charges