St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC MOBILE CRISIS RESPONSE-2 PERSON RESPONSE-LICENSED+UNLICENSED(<90 MIN)

Facility

$356.00

Service Code	CPT H2011 HK
Hospital Charge Code	911H201107
Hospital Revenue Code	911
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$284.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$195.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.79
Rate for Payer: Aetna Government	$7.79
Rate for Payer: Affinity Essential Plan 1&2	$208.29
Rate for Payer: Affinity Essential Plan 3&4	$208.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$92.57
Rate for Payer: Amida Care Medicaid	$92.57
Rate for Payer: Brighton Health Commercial	$267.00
Rate for Payer: Carelon Behavioral Health HARP/QHP	$92.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$284.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$242.08
Rate for Payer: EmblemHealth Commercial	$178.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$208.29
Rate for Payer: EmblemHealth Essential Plan 3&4	$92.57
Rate for Payer: Fidelis CHP/HARP/Medicaid	$92.57
Rate for Payer: Fidelis Essential Plan Aliesa	$208.29
Rate for Payer: Fidelis Essential Plan QHP	$208.29
Rate for Payer: Fidelis Qualified Health Plan	$97.20
Rate for Payer: Group Health Inc Commercial	$178.00
Rate for Payer: Group Health Inc Medicare	$124.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.57
Rate for Payer: Hamaspik Choice Inc Medicare	$92.57
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$92.57
Rate for Payer: Healthfirst Essential Plan	$208.29
Rate for Payer: Healthfirst QHP	$150.89
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$92.57
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$208.29
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$208.29
Rate for Payer: Optum Medicaid	$0.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$92.57
Rate for Payer: SOMOS Essential	$208.29
Rate for Payer: United Healthcare Essential Plan 1&2	$208.29
Rate for Payer: United Healthcare Essential Plan 3&4	$101.83
Rate for Payer: United Healthcare Medicaid	$92.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$92.57

HC MOBILE CRISIS RESPONSE-2 PERSON RESPONSE-LICENSED+UNLICENSED(91-180 MIN)

Facility

$3,205.00

Service Code	CPT S9485 HE,U5
Hospital Charge Code	905S948504
Hospital Revenue Code	905
Min. Negotiated Rate	$1,602.50
Max. Negotiated Rate	$1,602.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,602.50

HC MOBILE CRISIS RESPONSE-2 PERSON RESPONSE-LICENSED+UNLICENSED(91-180 MIN)

Facility

$3,205.00

Service Code	CPT S9485 HE,U5
Hospital Charge Code	905S948504
Hospital Revenue Code	905
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$3,016.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,762.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.28
Rate for Payer: Aetna Government	$63.28
Rate for Payer: Affinity Essential Plan 1&2	$3,016.37
Rate for Payer: Affinity Essential Plan 3&4	$3,016.37
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,340.60
Rate for Payer: Amida Care Medicaid	$1,340.60
Rate for Payer: Brighton Health Commercial	$2,403.75
Rate for Payer: Carelon Behavioral Health HARP/QHP	$1,340.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,564.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,179.40
Rate for Payer: EmblemHealth Commercial	$1,602.50
Rate for Payer: EmblemHealth Essential Plan 1&2	$3,016.37
Rate for Payer: EmblemHealth Essential Plan 3&4	$1,340.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,340.60
Rate for Payer: Fidelis Essential Plan Aliesa	$3,016.37
Rate for Payer: Fidelis Essential Plan QHP	$3,016.37
Rate for Payer: Fidelis Qualified Health Plan	$1,407.63
Rate for Payer: Group Health Inc Commercial	$1,602.50
Rate for Payer: Group Health Inc Medicare	$1,121.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,340.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,340.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,340.60
Rate for Payer: Healthfirst Essential Plan	$3,016.37
Rate for Payer: Healthfirst QHP	$2,185.18
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1,340.60
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$3,016.37
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$3,016.37
Rate for Payer: Optum Commercial/Medicare	$143.00
Rate for Payer: Optum Medicaid	$5.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,340.60
Rate for Payer: SOMOS Essential	$3,016.37
Rate for Payer: United Healthcare Essential Plan 1&2	$3,016.37
Rate for Payer: United Healthcare Essential Plan 3&4	$1,474.65
Rate for Payer: United Healthcare Medicaid	$1,340.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,340.60

HC MODERNA COVID19 VAC ADMIN BOOSTER DOSE

Facility

$102.00

Service Code	CPT 0094A
Hospital Charge Code	7710094A01
Hospital Revenue Code	771
Min. Negotiated Rate	$44.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.00
Rate for Payer: Aetna Government	$51.00
Rate for Payer: Brighton Health Commercial	$76.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.36
Rate for Payer: EmblemHealth Commercial	$250.00
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	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: United Healthcare Commercial	$44.00

HC MODERNA COVID19 VAC ADMIN BOOSTER DOSE

Facility

$102.00

Service Code	CPT 0094A
Hospital Charge Code	7710094A01
Hospital Revenue Code	771
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00

HC MODERNA COVID-19 VACCINE ADMIN - BOOSTER

Facility

$102.00

Service Code	CPT 0064A
Hospital Charge Code	7710064A01
Hospital Revenue Code	771
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00

HC MODERNA COVID-19 VACCINE ADMIN - BOOSTER

Facility

$102.00

Service Code	CPT 0064A
Hospital Charge Code	7710064A01
Hospital Revenue Code	771
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.00
Rate for Payer: Aetna Government	$40.00
Rate for Payer: Brighton Health Commercial	$76.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.36
Rate for Payer: EmblemHealth Commercial	$250.00
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	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: United Healthcare Commercial	$44.00

HC MODERNA COVID-19 VACCINE ADMIN - FIRST DOSE- 6-11YRS

Facility

$102.00

Service Code	CPT 0091A
Hospital Charge Code	7710091A01
Hospital Revenue Code	771
Min. Negotiated Rate	$44.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.00
Rate for Payer: Aetna Government	$51.00
Rate for Payer: Brighton Health Commercial	$76.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.36
Rate for Payer: EmblemHealth Commercial	$250.00
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	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: United Healthcare Commercial	$44.00

HC MODERNA COVID-19 VACCINE ADMIN - FIRST DOSE- 6-11YRS

Facility

$102.00

Service Code	CPT 0091A
Hospital Charge Code	7710091A01
Hospital Revenue Code	771
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00

HC MODERNA COVID-19 VACCINE ADMIN - FIRST DOSE - 6MON-5YRS

Facility

$102.00

Service Code	CPT 0111A
Hospital Charge Code	7710111A01
Hospital Revenue Code	771
Min. Negotiated Rate	$44.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.00
Rate for Payer: Aetna Government	$51.00
Rate for Payer: Brighton Health Commercial	$76.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.36
Rate for Payer: EmblemHealth Commercial	$250.00
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	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: United Healthcare Commercial	$44.00

HC MODERNA COVID-19 VACCINE ADMIN - FIRST DOSE - 6MON-5YRS

Facility

$102.00

Service Code	CPT 0111A
Hospital Charge Code	7710111A01
Hospital Revenue Code	771
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00

HC MODERNA COVID-19 VACCINE ADMIN -SECOND DOSE- 6-11YRS

Facility

$102.00

Service Code	CPT 0092A
Hospital Charge Code	7710092A01
Hospital Revenue Code	771
Min. Negotiated Rate	$44.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.00
Rate for Payer: Aetna Government	$51.00
Rate for Payer: Brighton Health Commercial	$76.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.36
Rate for Payer: EmblemHealth Commercial	$250.00
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	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: United Healthcare Commercial	$44.00

HC MODERNA COVID-19 VACCINE ADMIN -SECOND DOSE- 6-11YRS

Facility

$102.00

Service Code	CPT 0092A
Hospital Charge Code	7710092A01
Hospital Revenue Code	771
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00

HC MODERNA COVID-19 VACCINE ADMIN - SECOND DOSE - 6MON-5YRS

Facility

$102.00

Service Code	CPT 0112A
Hospital Charge Code	7710112A01
Hospital Revenue Code	771
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00

HC MODERNA COVID-19 VACCINE ADMIN - SECOND DOSE - 6MON-5YRS

Facility

$102.00

Service Code	CPT 0112A
Hospital Charge Code	7710112A01
Hospital Revenue Code	771
Min. Negotiated Rate	$44.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.00
Rate for Payer: Aetna Government	$51.00
Rate for Payer: Brighton Health Commercial	$76.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.36
Rate for Payer: EmblemHealth Commercial	$250.00
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	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: United Healthcare Commercial	$44.00

HC MODERNA COVID-19 VACCINE ADMIN - THIRD DOSE

Facility

$102.00

Service Code	CPT 0013A
Hospital Charge Code	7710013A01
Hospital Revenue Code	771
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00

HC MODERNA COVID-19 VACCINE ADMIN - THIRD DOSE

Facility

$102.00

Service Code	CPT 0013A
Hospital Charge Code	7710013A01
Hospital Revenue Code	771
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.00
Rate for Payer: Aetna Government	$40.00
Rate for Payer: Brighton Health Commercial	$76.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.36
Rate for Payer: EmblemHealth Commercial	$250.00
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	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: United Healthcare Commercial	$44.00

HC MODERNA COVID-19 VACCINE ADMIN -THIRD DOSE- 6-11YRS

Facility

$102.00

Service Code	CPT 0093A
Hospital Charge Code	7710093A01
Hospital Revenue Code	771
Min. Negotiated Rate	$44.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.00
Rate for Payer: Aetna Government	$51.00
Rate for Payer: Brighton Health Commercial	$76.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.36
Rate for Payer: EmblemHealth Commercial	$250.00
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	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: United Healthcare Commercial	$44.00

HC MODERNA COVID-19 VACCINE ADMIN -THIRD DOSE- 6-11YRS

Facility

$102.00

Service Code	CPT 0093A
Hospital Charge Code	7710093A01
Hospital Revenue Code	771
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00

HC MODERNA COVID-19 VACCINE ADMIN - THIRD DOSE - 6MON-5YRS

Facility

$102.00

Service Code	CPT 0113A
Hospital Charge Code	7710113A01
Hospital Revenue Code	771
Min. Negotiated Rate	$44.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.00
Rate for Payer: Aetna Government	$51.00
Rate for Payer: Brighton Health Commercial	$76.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.36
Rate for Payer: EmblemHealth Commercial	$250.00
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	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: United Healthcare Commercial	$44.00

HC MODERNA COVID-19 VACCINE ADMIN - THIRD DOSE - 6MON-5YRS

Facility

$102.00

Service Code	CPT 0113A
Hospital Charge Code	7710113A01
Hospital Revenue Code	771
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00

HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS

Facility

$42.00

Service Code	CPT 99157
Hospital Charge Code	3709915701
Hospital Revenue Code	370
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.00

HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS

Facility

$42.00

Service Code	CPT 99157
Hospital Charge Code	3709915701
Hospital Revenue Code	370
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$63.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$49.58
Rate for Payer: Aetna Government	$49.58
Rate for Payer: Brighton Health Commercial	$31.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.56
Rate for Payer: EmblemHealth Commercial	$21.00
Rate for Payer: Group Health Inc Commercial	$21.00
Rate for Payer: Group Health Inc Medicare	$14.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.00
Rate for Payer: Hamaspik Choice Inc Medicare	$21.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$63.91

HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS

Facility

$135.00

Service Code	CPT 99155
Hospital Charge Code	3709915501
Hospital Revenue Code	370
Min. Negotiated Rate	$47.25
Max. Negotiated Rate	$108.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$80.29
Rate for Payer: Aetna Government	$80.29
Rate for Payer: Brighton Health Commercial	$101.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$108.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$91.80
Rate for Payer: EmblemHealth Commercial	$67.50
Rate for Payer: Group Health Inc Commercial	$67.50
Rate for Payer: Group Health Inc Medicare	$47.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.50
Rate for Payer: Hamaspik Choice Inc Medicare	$67.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$92.02

HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS

Facility

$135.00

Service Code	CPT 99155
Hospital Charge Code	3709915501
Hospital Revenue Code	370
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.50

Know your out-of-pocket cost for care.

All Charges