St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC MAXILLA FX-CLOSED REDUCT (TEETH I

Facility

$1,087.00

Service Code	CPT D7620
Hospital Charge Code	361D762001
Hospital Revenue Code	361
Min. Negotiated Rate	$380.45
Max. Negotiated Rate	$902.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$597.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$902.02
Rate for Payer: Aetna Government	$902.02
Rate for Payer: Brighton Health Commercial	$815.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$869.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$739.16
Rate for Payer: EmblemHealth Commercial	$543.50
Rate for Payer: Group Health Inc Commercial	$543.50
Rate for Payer: Group Health Inc Medicare	$380.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$543.50
Rate for Payer: Hamaspik Choice Inc Medicare	$543.50

HC MCHNICL THRMBCTMY AND/OR INFUSION FOR THROMBOLYSIS

Facility

$15,004.00

Service Code	CPT 36904 TC
Hospital Charge Code	3613690401
Hospital Revenue Code	361
Min. Negotiated Rate	$7,502.00
Max. Negotiated Rate	$7,502.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,502.00

HC MCHNICL THRMBCTMY AND/OR INFUSION FOR THROMBOLYSIS

Facility

$15,004.00

Service Code	CPT 36904 TC
Hospital Charge Code	3613690401
Hospital Revenue Code	361
Min. Negotiated Rate	$342.00
Max. Negotiated Rate	$11,253.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,915.48
Rate for Payer: Aetna Government	$1,915.48
Rate for Payer: Brighton Health Commercial	$11,253.00
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	$7,502.00
Rate for Payer: Group Health Inc Commercial	$7,502.00
Rate for Payer: Group Health Inc Medicare	$5,251.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,502.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,515.82
Rate for Payer: United Healthcare Commercial	$2,546.00

HC MCHNICL THRMBCTMY AND/OR INFUSION FOR THROMBOLYSIS W/ BALLOON ANGIO

Facility

$30,010.00

Service Code	CPT 36905 TC
Hospital Charge Code	3613690501
Hospital Revenue Code	361
Min. Negotiated Rate	$15,005.00
Max. Negotiated Rate	$15,005.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,005.00

HC MCHNICL THRMBCTMY AND/OR INFUSION FOR THROMBOLYSIS W/ BALLOON ANGIO

Facility

$30,010.00

Service Code	CPT 36905 TC
Hospital Charge Code	3613690501
Hospital Revenue Code	361
Min. Negotiated Rate	$2,451.40
Max. Negotiated Rate	$22,507.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,593.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,451.40
Rate for Payer: Aetna Government	$2,451.40
Rate for Payer: Brighton Health Commercial	$22,507.50
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	$15,005.00
Rate for Payer: Group Health Inc Commercial	$15,005.00
Rate for Payer: Group Health Inc Medicare	$10,503.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,005.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,491.10
Rate for Payer: United Healthcare Commercial	$3,190.00

HC MCHNICL THRMBCTMY AND/OR INFUSION FOR THROMBOLYSIS W/ STENT PLCMNT

Facility

$48,278.00

Service Code	CPT 36906 TC
Hospital Charge Code	3613690601
Hospital Revenue Code	361
Min. Negotiated Rate	$24,139.00
Max. Negotiated Rate	$24,139.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,139.00

HC MCHNICL THRMBCTMY AND/OR INFUSION FOR THROMBOLYSIS W/ STENT PLCMNT

Facility

$48,278.00

Service Code	CPT 36906 TC
Hospital Charge Code	3613690601
Hospital Revenue Code	361
Min. Negotiated Rate	$342.00
Max. Negotiated Rate	$36,208.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7,324.89
Rate for Payer: Aetna Government	$7,324.89
Rate for Payer: Brighton Health Commercial	$36,208.50
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	$24,139.00
Rate for Payer: Group Health Inc Commercial	$24,139.00
Rate for Payer: Group Health Inc Medicare	$16,897.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,139.00
Rate for Payer: Hamaspik Choice Inc Medicare	$11,783.21
Rate for Payer: United Healthcare Commercial	$4,446.00

HC MCHNICL THRMBCTMY VEIN, INITIAL

Facility

$15,004.00

Service Code	CPT 37187 TC
Hospital Charge Code	3613718701
Hospital Revenue Code	361
Min. Negotiated Rate	$7,502.00
Max. Negotiated Rate	$7,502.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,502.00

HC MCHNICL THRMBCTMY VEIN, INITIAL

Facility

$15,004.00

Service Code	CPT 37187 TC
Hospital Charge Code	3613718701
Hospital Revenue Code	361
Min. Negotiated Rate	$2,235.43
Max. Negotiated Rate	$11,253.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,387.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,235.43
Rate for Payer: Aetna Government	$2,235.43
Rate for Payer: Brighton Health Commercial	$11,253.00
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	$7,502.00
Rate for Payer: Group Health Inc Commercial	$7,502.00
Rate for Payer: Group Health Inc Medicare	$5,251.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,502.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7,800.37
Rate for Payer: United Healthcare Commercial	$2,546.00

HC MCHNICL THRMBCTMY VEIN, SUBSEQUENT

Facility

$8,393.00

Service Code	CPT 37188 TC
Hospital Charge Code	3613718801
Hospital Revenue Code	361
Min. Negotiated Rate	$4,196.50
Max. Negotiated Rate	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50

HC MCHNICL THRMBCTMY VEIN, SUBSEQUENT

Facility

$8,393.00

Service Code	CPT 37188 TC
Hospital Charge Code	3613718801
Hospital Revenue Code	361
Min. Negotiated Rate	$1,835.00
Max. Negotiated Rate	$6,294.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,387.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,923.77
Rate for Payer: Aetna Government	$1,923.77
Rate for Payer: Brighton Health Commercial	$6,294.75
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	$4,196.50
Rate for Payer: Group Health Inc Commercial	$4,196.50
Rate for Payer: Group Health Inc Medicare	$2,937.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,665.67
Rate for Payer: United Healthcare Commercial	$1,835.00

HC MCOLN1 GENE ANALYSIS - MUCOLIPIDOSIS TYPE IV MUTATION

Facility

$98.00

Service Code	CPT 81290
Hospital Charge Code	3108129001
Hospital Revenue Code	310
Min. Negotiated Rate	$27.52
Max. Negotiated Rate	$78.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$39.31
Rate for Payer: Aetna Government	$39.31
Rate for Payer: Affinity Essential Plan 1&2	$27.52
Rate for Payer: Affinity Essential Plan 3&4	$27.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$27.52
Rate for Payer: Brighton Health Commercial	$39.31
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$39.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$66.64
Rate for Payer: Elderplan Medicare Advantage	$39.31
Rate for Payer: EmblemHealth Commercial	$39.31
Rate for Payer: Fidelis CHP/HARP/Medicaid	$35.38
Rate for Payer: Fidelis Essential Plan Aliesa	$33.41
Rate for Payer: Fidelis Essential Plan QHP	$34.99
Rate for Payer: Fidelis Medicare Advantage	$39.31
Rate for Payer: Fidelis Qualified Health Plan	$34.99
Rate for Payer: Group Health Inc Commercial	$39.31
Rate for Payer: Group Health Inc Medicare	$39.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.31
Rate for Payer: Hamaspik Choice Inc Medicare	$39.31
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39.31
Rate for Payer: Healthfirst Medicare Advantage	$39.31
Rate for Payer: Healthfirst QHP	$39.31
Rate for Payer: Humana Medicare	$40.10
Rate for Payer: Senior Whole Health Medicare Advantage	$39.31
Rate for Payer: United Healthcare Medicare Advantage	$39.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.31
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37.34
Rate for Payer: Wellcare Medicare	$35.38

HC MCOLN1 GENE ANALYSIS - MUCOLIPIDOSIS TYPE IV MUTATION

Facility

$98.00

Service Code	CPT 81290
Hospital Charge Code	3108129001
Hospital Revenue Code	310
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$49.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.00

HC MDI WITH VENTILATION, INITIAL

Facility

$557.00

Service Code	CPT 94640
Hospital Charge Code	4109464005
Hospital Revenue Code	410
Min. Negotiated Rate	$278.50
Max. Negotiated Rate	$278.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.50

HC MDI WITH VENTILATION, INITIAL

Facility

$557.00

Service Code	CPT 94640
Hospital Charge Code	4109464005
Hospital Revenue Code	410
Min. Negotiated Rate	$9.55
Max. Negotiated Rate	$417.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$248.51
Rate for Payer: Aetna Government	$248.51
Rate for Payer: Affinity Essential Plan 1&2	$173.96
Rate for Payer: Affinity Essential Plan 3&4	$173.96
Rate for Payer: Affinity Medicaid/CHP/HARP	$173.96
Rate for Payer: Brighton Health Commercial	$417.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$248.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$165.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$140.51
Rate for Payer: Elderplan Medicare Advantage	$248.51
Rate for Payer: EmblemHealth Commercial	$248.51
Rate for Payer: Fidelis CHP/HARP/Medicaid	$223.66
Rate for Payer: Fidelis Essential Plan Aliesa	$211.23
Rate for Payer: Fidelis Essential Plan QHP	$221.17
Rate for Payer: Fidelis Medicare Advantage	$248.51
Rate for Payer: Fidelis Qualified Health Plan	$221.17
Rate for Payer: Group Health Inc Commercial	$248.51
Rate for Payer: Group Health Inc Medicare	$248.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$248.51
Rate for Payer: Hamaspik Choice Inc Medicare	$248.51
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$9.55
Rate for Payer: Healthfirst Medicare Advantage	$211.23
Rate for Payer: Healthfirst QHP	$248.51
Rate for Payer: Humana Medicare	$253.48
Rate for Payer: Senior Whole Health Medicare Advantage	$248.51
Rate for Payer: United Healthcare Commercial	$278.50
Rate for Payer: United Healthcare Medicare Advantage	$248.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$248.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$236.08
Rate for Payer: Wellcare Medicare	$236.08

HC MECH REMOV INTRALUM OBSTR CV DEV THRU LUMEN

Facility

$4,940.00

Service Code	CPT 36596 TC
Hospital Charge Code	3613659601
Hospital Revenue Code	361
Min. Negotiated Rate	$143.72
Max. Negotiated Rate	$3,705.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$143.72
Rate for Payer: Aetna Government	$143.72
Rate for Payer: Brighton Health Commercial	$3,705.00
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	$2,470.00
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	$632.40
Rate for Payer: United Healthcare Commercial	$1,188.00

HC MECH REMOV INTRALUM OBSTR CV DEV THRU LUMEN

Facility

$4,940.00

Service Code	CPT 36596 TC
Hospital Charge Code	3613659601
Hospital Revenue Code	361
Min. Negotiated Rate	$2,470.00
Max. Negotiated Rate	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.00

HC MECH REMOV PERICATH OBSTR CV DEV VIA VEN ACCESS

Facility

$8,393.00

Service Code	CPT 36595 TC
Hospital Charge Code	3613659501
Hospital Revenue Code	361
Min. Negotiated Rate	$421.15
Max. Negotiated Rate	$6,294.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$629.53
Rate for Payer: Aetna Government	$629.53
Rate for Payer: Brighton Health Commercial	$6,294.75
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	$4,196.50
Rate for Payer: Group Health Inc Commercial	$4,196.50
Rate for Payer: Group Health Inc Medicare	$2,937.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicare	$421.15
Rate for Payer: United Healthcare Commercial	$1,835.00

HC MECH REMOV PERICATH OBSTR CV DEV VIA VEN ACCESS

Facility

$8,393.00

Service Code	CPT 36595 TC
Hospital Charge Code	3613659501
Hospital Revenue Code	361
Min. Negotiated Rate	$4,196.50
Max. Negotiated Rate	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50

HC MECP2 GENE ANALYSIS - RETT SYNDROME MUTATION

Facility

$1,319.00

Service Code	CPT 81302
Hospital Charge Code	3108130201
Hospital Revenue Code	310
Min. Negotiated Rate	$659.50
Max. Negotiated Rate	$659.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$659.50

HC MECP2 GENE ANALYSIS - RETT SYNDROME MUTATION

Facility

$1,319.00

Service Code	CPT 81302
Hospital Charge Code	3108130201
Hospital Revenue Code	310
Min. Negotiated Rate	$369.51
Max. Negotiated Rate	$1,055.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$725.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$527.87
Rate for Payer: Aetna Government	$527.87
Rate for Payer: Affinity Essential Plan 1&2	$369.51
Rate for Payer: Affinity Essential Plan 3&4	$369.51
Rate for Payer: Affinity Medicaid/CHP/HARP	$369.51
Rate for Payer: Brighton Health Commercial	$527.87
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$527.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,055.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$896.92
Rate for Payer: Elderplan Medicare Advantage	$527.87
Rate for Payer: EmblemHealth Commercial	$527.87
Rate for Payer: Fidelis CHP/HARP/Medicaid	$475.08
Rate for Payer: Fidelis Essential Plan Aliesa	$448.69
Rate for Payer: Fidelis Essential Plan QHP	$469.80
Rate for Payer: Fidelis Medicare Advantage	$527.87
Rate for Payer: Fidelis Qualified Health Plan	$469.80
Rate for Payer: Group Health Inc Commercial	$527.87
Rate for Payer: Group Health Inc Medicare	$527.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$527.87
Rate for Payer: Hamaspik Choice Inc Medicare	$527.87
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$527.87
Rate for Payer: Healthfirst Medicare Advantage	$527.87
Rate for Payer: Healthfirst QHP	$527.87
Rate for Payer: Humana Medicare	$538.43
Rate for Payer: Senior Whole Health Medicare Advantage	$527.87
Rate for Payer: United Healthcare Medicare Advantage	$527.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$527.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$501.48
Rate for Payer: Wellcare Medicare	$475.08

HC MED ASSTD TRMT, BUPRENORPHINE, IMP INSERTN, WKLY

Facility

$258.00

Service Code	CPT G2070
Hospital Charge Code	900G207001
Hospital Revenue Code	900
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$5,387.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$141.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,387.61
Rate for Payer: Aetna Government	$5,387.61
Rate for Payer: Brighton Health Commercial	$193.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$206.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$175.44
Rate for Payer: EmblemHealth Commercial	$129.00
Rate for Payer: Group Health Inc Commercial	$129.00
Rate for Payer: Group Health Inc Medicare	$90.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.00
Rate for Payer: Hamaspik Choice Inc Medicare	$129.00
Rate for Payer: United Healthcare Commercial	$129.00

HC MED ASSTD TRMT, BUPRENORPHINE, IMP INSERTN, WKLY

Facility

$258.00

Service Code	CPT G2070
Hospital Charge Code	900G207001
Hospital Revenue Code	900
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$129.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.00

HC MED ASSTD TRMT, BUPRENORPHINE, IMP REMOVAL, WKLY

Facility

$258.00

Service Code	CPT G2071
Hospital Charge Code	900G207101
Hospital Revenue Code	900
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$490.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$141.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$490.99
Rate for Payer: Aetna Government	$490.99
Rate for Payer: Brighton Health Commercial	$193.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$206.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$175.44
Rate for Payer: EmblemHealth Commercial	$129.00
Rate for Payer: Group Health Inc Commercial	$129.00
Rate for Payer: Group Health Inc Medicare	$90.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.00
Rate for Payer: Hamaspik Choice Inc Medicare	$129.00
Rate for Payer: United Healthcare Commercial	$129.00

HC MED ASSTD TRMT, BUPRENORPHINE, IMP REMOVAL, WKLY

Facility

$258.00

Service Code	CPT G2071
Hospital Charge Code	900G207101
Hospital Revenue Code	900
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$129.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.00

Know your out-of-pocket cost for care.

All Charges