St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC LYMPHANGIO ABD/PELV UNILAT - IR LYMPHANGIOGRAM ABDOMEN PELVIS

Facility

$4,940.00

Service Code	CPT 75805 TC
Hospital Charge Code	3207580501
Hospital Revenue Code	320
Min. Negotiated Rate	$2,470.00
Max. Negotiated Rate	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.00

HC LYMPHANGIO EXTREM BILAT - IR LYMPHANGIOGRAM EXTREMITY BILATERAL

Facility

$4,940.00

Service Code	CPT 75803 TC
Hospital Charge Code	3207580301
Hospital Revenue Code	320
Min. Negotiated Rate	$2,470.00
Max. Negotiated Rate	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.00

HC LYMPHANGIO EXTREM BILAT - IR LYMPHANGIOGRAM EXTREMITY BILATERAL

Facility

$4,940.00

Service Code	CPT 75803 TC
Hospital Charge Code	3207580301
Hospital Revenue Code	320
Min. Negotiated Rate	$221.57
Max. Negotiated Rate	$3,705.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,717.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$518.96
Rate for Payer: Aetna Government	$518.96
Rate for Payer: Brighton Health Commercial	$3,705.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$871.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$733.32
Rate for Payer: EmblemHealth Commercial	$2,470.00
Rate for Payer: Group Health Inc Commercial	$2,470.00
Rate for Payer: Group Health Inc Medicare	$1,729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,470.00
Rate for Payer: Healthfirst Essential Plan	$498.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$221.57

HC LYMPHANGIO EXTREM UNILAT - IR LYMPHANGIOGRAM EXTREMITY

Facility

$1,909.00

Service Code	CPT 75801 TC
Hospital Charge Code	3207580101
Hospital Revenue Code	320
Min. Negotiated Rate	$149.09
Max. Negotiated Rate	$1,431.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,049.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$149.09
Rate for Payer: Aetna Government	$149.09
Rate for Payer: Brighton Health Commercial	$1,431.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$871.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$733.32
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	$954.50
Rate for Payer: Healthfirst Essential Plan	$472.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$210.10

HC LYMPHANGIO EXTREM UNILAT - IR LYMPHANGIOGRAM EXTREMITY

Facility

$1,909.00

Service Code	CPT 75801 TC
Hospital Charge Code	3207580101
Hospital Revenue Code	320
Min. Negotiated Rate	$954.50
Max. Negotiated Rate	$954.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.50

HC LYMPHANGIOTOMY

Facility

$9,175.00

Service Code	CPT 38308 TC
Hospital Charge Code	3613830801
Hospital Revenue Code	361
Min. Negotiated Rate	$467.89
Max. Negotiated Rate	$6,881.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$467.89
Rate for Payer: Aetna Government	$467.89
Rate for Payer: Brighton Health Commercial	$6,881.25
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	$4,587.50
Rate for Payer: Group Health Inc Commercial	$4,587.50
Rate for Payer: Group Health Inc Medicare	$3,211.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,587.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,538.05
Rate for Payer: United Healthcare Commercial	$1,468.00

HC LYMPHANGIOTOMY

Facility

$9,175.00

Service Code	CPT 38308 TC
Hospital Charge Code	3613830801
Hospital Revenue Code	361
Min. Negotiated Rate	$4,587.50
Max. Negotiated Rate	$4,587.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,587.50

HC LYMPHATICS & LYMPH GLANDS IMAGING - NM LYMPHOSCINTIGRAM

Facility

$1,429.00

Service Code	CPT 78195 TC
Hospital Charge Code	3417819502
Hospital Revenue Code	341
Min. Negotiated Rate	$714.50
Max. Negotiated Rate	$714.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$714.50

HC LYMPHATICS & LYMPH GLANDS IMAGING - NM LYMPHOSCINTIGRAM

Facility

$1,429.00

Service Code	CPT 78195 TC
Hospital Charge Code	3417819502
Hospital Revenue Code	341
Min. Negotiated Rate	$203.99
Max. Negotiated Rate	$1,071.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$785.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$203.99
Rate for Payer: Aetna Government	$203.99
Rate for Payer: Brighton Health Commercial	$1,071.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$550.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$462.97
Rate for Payer: EmblemHealth Commercial	$275.97
Rate for Payer: Group Health Inc Commercial	$714.50
Rate for Payer: Group Health Inc Medicare	$500.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$714.50
Rate for Payer: Hamaspik Choice Inc Medicare	$714.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$275.97
Rate for Payer: Healthfirst Essential Plan	$547.67
Rate for Payer: United Healthcare Commercial	$205.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$243.41

HC LYMPH CHORIOMENINGITIS - LYMPHOCYTIC CHORIOMENINGITIS ANTIBODY

Facility

$32.00

Service Code	CPT 86727
Hospital Charge Code	3028672701
Hospital Revenue Code	302
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$24.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.87
Rate for Payer: Aetna Government	$12.87
Rate for Payer: Affinity Essential Plan 1&2	$9.01
Rate for Payer: Affinity Essential Plan 3&4	$9.01
Rate for Payer: Affinity Medicaid/CHP/HARP	$9.01
Rate for Payer: Brighton Health Commercial	$24.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.40
Rate for Payer: Elderplan Medicare Advantage	$12.87
Rate for Payer: EmblemHealth Commercial	$12.87
Rate for Payer: Fidelis CHP/HARP/Medicaid	$11.58
Rate for Payer: Fidelis Essential Plan Aliesa	$10.94
Rate for Payer: Fidelis Essential Plan QHP	$11.45
Rate for Payer: Fidelis Medicare Advantage	$12.87
Rate for Payer: Fidelis Qualified Health Plan	$11.45
Rate for Payer: Group Health Inc Commercial	$12.87
Rate for Payer: Group Health Inc Medicare	$12.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.87
Rate for Payer: Hamaspik Choice Inc Medicare	$12.87
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$8.11
Rate for Payer: Healthfirst Essential Plan	$18.25
Rate for Payer: Healthfirst Medicare Advantage	$12.87
Rate for Payer: Healthfirst QHP	$12.87
Rate for Payer: Humana Medicare	$13.13
Rate for Payer: Senior Whole Health Medicare Advantage	$12.87
Rate for Payer: United Healthcare Commercial	$16.30
Rate for Payer: United Healthcare Medicare Advantage	$12.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$8.11
Rate for Payer: Wellcare Medicare	$11.58

HC LYMPH CHORIOMENINGITIS - LYMPHOCYTIC CHORIOMENINGITIS ANTIBODY

Facility

$32.00

Service Code	CPT 86727
Hospital Charge Code	3028672701
Hospital Revenue Code	302
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$16.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.00

HC LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS

Facility

$1,454.00

Service Code	CPT 54162
Hospital Charge Code	3615416201
Hospital Revenue Code	361
Min. Negotiated Rate	$727.00
Max. Negotiated Rate	$727.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$727.00

HC LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS

Facility

$1,454.00

Service Code	CPT 54162
Hospital Charge Code	3615416201
Hospital Revenue Code	361
Min. Negotiated Rate	$229.93
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,502.91
Rate for Payer: Aetna Government	$2,502.91
Rate for Payer: Affinity Essential Plan 1&2	$1,752.04
Rate for Payer: Affinity Essential Plan 3&4	$1,752.04
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,752.04
Rate for Payer: Brighton Health Commercial	$1,090.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,502.91
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	$2,502.91
Rate for Payer: EmblemHealth Commercial	$2,502.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,252.62
Rate for Payer: Fidelis Essential Plan Aliesa	$2,127.47
Rate for Payer: Fidelis Essential Plan QHP	$2,227.59
Rate for Payer: Fidelis Medicare Advantage	$2,502.91
Rate for Payer: Fidelis Qualified Health Plan	$2,227.59
Rate for Payer: Group Health Inc Commercial	$2,502.91
Rate for Payer: Group Health Inc Medicare	$2,502.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,502.91
Rate for Payer: Hamaspik Choice Inc Medicare	$959.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$229.93
Rate for Payer: Healthfirst Medicare Advantage	$2,127.47
Rate for Payer: Healthfirst QHP	$2,502.91
Rate for Payer: Humana Medicare	$2,552.97
Rate for Payer: Senior Whole Health Medicare Advantage	$2,502.91
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$2,502.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,502.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,377.76
Rate for Payer: Wellcare Medicare	$2,377.76

HC MACROSCOPIC EXAM, PARASITE - PARASITE IDENTIFICATION

Facility

$10.00

Service Code	CPT 87169
Hospital Charge Code	3068716901
Hospital Revenue Code	306
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$7.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.31
Rate for Payer: Aetna Government	$4.31
Rate for Payer: Affinity Essential Plan 1&2	$3.02
Rate for Payer: Affinity Essential Plan 3&4	$3.02
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.02
Rate for Payer: Brighton Health Commercial	$7.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.11
Rate for Payer: Elderplan Medicare Advantage	$4.31
Rate for Payer: EmblemHealth Commercial	$4.31
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.88
Rate for Payer: Fidelis Essential Plan Aliesa	$3.66
Rate for Payer: Fidelis Essential Plan QHP	$3.84
Rate for Payer: Fidelis Medicare Advantage	$4.31
Rate for Payer: Fidelis Qualified Health Plan	$3.84
Rate for Payer: Group Health Inc Commercial	$4.31
Rate for Payer: Group Health Inc Medicare	$4.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.31
Rate for Payer: Hamaspik Choice Inc Medicare	$4.31
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.02
Rate for Payer: Healthfirst Essential Plan	$4.54
Rate for Payer: Healthfirst Medicare Advantage	$4.31
Rate for Payer: Healthfirst QHP	$4.31
Rate for Payer: Humana Medicare	$4.40
Rate for Payer: Senior Whole Health Medicare Advantage	$4.31
Rate for Payer: United Healthcare Commercial	$5.41
Rate for Payer: United Healthcare Medicare Advantage	$4.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.31
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.02
Rate for Payer: Wellcare Medicare	$3.88

HC MACROSCOPIC EXAM, PARASITE - PARASITE IDENTIFICATION

Facility

$10.00

Service Code	CPT 87169
Hospital Charge Code	3068716901
Hospital Revenue Code	306
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$5.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00

HC MALAR AND/OR ZYGOMATIC ARCH OPEN

Facility

$4,638.00

Service Code	CPT D7750
Hospital Charge Code	361D775001
Hospital Revenue Code	361
Min. Negotiated Rate	$1,286.95
Max. Negotiated Rate	$3,710.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,550.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,286.95
Rate for Payer: Aetna Government	$1,286.95
Rate for Payer: Brighton Health Commercial	$3,478.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,710.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,153.84
Rate for Payer: EmblemHealth Commercial	$2,319.00
Rate for Payer: Group Health Inc Commercial	$2,319.00
Rate for Payer: Group Health Inc Medicare	$1,623.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,319.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,319.00

HC MALAR AND/OR ZYGOMATIC ARCH OPEN

Facility

$4,638.00

Service Code	CPT D7750
Hospital Charge Code	361D775001
Hospital Revenue Code	361
Min. Negotiated Rate	$2,319.00
Max. Negotiated Rate	$2,319.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,319.00

HC MALAR/ZYGOMAT ARCH-OPEN REDUC

Facility

$1,812.00

Service Code	CPT D7650
Hospital Charge Code	361D765001
Hospital Revenue Code	361
Min. Negotiated Rate	$634.20
Max. Negotiated Rate	$1,449.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$996.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$751.80
Rate for Payer: Aetna Government	$751.80
Rate for Payer: Brighton Health Commercial	$1,359.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,449.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,232.16
Rate for Payer: EmblemHealth Commercial	$906.00
Rate for Payer: Group Health Inc Commercial	$906.00
Rate for Payer: Group Health Inc Medicare	$634.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$906.00
Rate for Payer: Hamaspik Choice Inc Medicare	$906.00

HC MALAR/ZYGOMAT ARCH-OPEN REDUC

Facility

$1,812.00

Service Code	CPT D7650
Hospital Charge Code	361D765001
Hospital Revenue Code	361
Min. Negotiated Rate	$906.00
Max. Negotiated Rate	$906.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$906.00

HC MA MAMMO TOMO THREE DIMENSIONAL

Facility

$160.00

Service Code	CPT G0279 TC
Hospital Charge Code	401G027901
Hospital Revenue Code	401
Min. Negotiated Rate	$80.00
Max. Negotiated Rate	$80.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.00

HC MA MAMMO TOMO THREE DIMENSIONAL

Facility

$160.00

Service Code	CPT G0279 TC
Hospital Charge Code	401G027901
Hospital Revenue Code	401
Min. Negotiated Rate	$15.74
Max. Negotiated Rate	$128.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$88.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.74
Rate for Payer: Aetna Government	$15.74
Rate for Payer: Brighton Health Commercial	$120.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$128.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$108.80
Rate for Payer: EmblemHealth Commercial	$16.42
Rate for Payer: Group Health Inc Commercial	$80.00
Rate for Payer: Group Health Inc Medicare	$56.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.00
Rate for Payer: Hamaspik Choice Inc Medicare	$80.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18.24
Rate for Payer: United Healthcare Commercial	$20.62

HC MAMMARY DUCTOGRAM, MULTIPLE - MAMMO BREAST DUCTOGRAM MULTIPLE

Facility

$705.00

Service Code	CPT 77054 TC
Hospital Charge Code	4017705401
Hospital Revenue Code	401
Min. Negotiated Rate	$42.26
Max. Negotiated Rate	$528.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.26
Rate for Payer: Aetna Government	$42.26
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$492.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$414.22
Rate for Payer: EmblemHealth Commercial	$50.86
Rate for Payer: Group Health Inc Commercial	$352.50
Rate for Payer: Group Health Inc Medicare	$246.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50
Rate for Payer: Hamaspik Choice Inc Medicare	$352.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$50.86
Rate for Payer: Healthfirst Essential Plan	$308.38
Rate for Payer: United Healthcare Commercial	$183.97
Rate for Payer: Wellcare CHP/FHP/Medicaid	$137.06

HC MAMMARY DUCTOGRAM, MULTIPLE - MAMMO BREAST DUCTOGRAM MULTIPLE

Facility

$705.00

Service Code	CPT 77054 TC
Hospital Charge Code	4017705401
Hospital Revenue Code	401
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC MAMMARY DUCTOGRAM, SINGLE - MAMMO BREAST DUCTOGRAM

Facility

$705.00

Service Code	CPT 77053 TC
Hospital Charge Code	4017705301
Hospital Revenue Code	401
Min. Negotiated Rate	$31.66
Max. Negotiated Rate	$528.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.66
Rate for Payer: Aetna Government	$31.66
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$492.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$414.22
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Group Health Inc Commercial	$352.50
Rate for Payer: Group Health Inc Medicare	$246.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50
Rate for Payer: Hamaspik Choice Inc Medicare	$352.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38.64
Rate for Payer: Healthfirst Essential Plan	$227.21
Rate for Payer: United Healthcare Commercial	$183.97
Rate for Payer: Wellcare CHP/FHP/Medicaid	$100.98

HC MAMMARY DUCTOGRAM, SINGLE - MAMMO BREAST DUCTOGRAM

Facility

$705.00

Service Code	CPT 77053 TC
Hospital Charge Code	4017705301
Hospital Revenue Code	401
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

Know your out-of-pocket cost for care.

All Charges