St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC NEW PT AGE 18-39

Facility

$358.00

Service Code	CPT 99385
Hospital Charge Code	5109938501
Hospital Revenue Code	510
Min. Negotiated Rate	$72.57
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$196.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$72.57
Rate for Payer: Aetna Government	$72.57
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
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	$179.00
Rate for Payer: Hamaspik Choice Inc Medicare	$179.00
Rate for Payer: United Healthcare Commercial	$222.00

HC NEW PT AGE 18-39

Facility

$358.00

Service Code	CPT 99385
Hospital Charge Code	5109938501
Hospital Revenue Code	510
Min. Negotiated Rate	$179.00
Max. Negotiated Rate	$179.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00

HC NEW PT AGE 40-64

Facility

$358.00

Service Code	CPT 99386
Hospital Charge Code	5109938601
Hospital Revenue Code	510
Min. Negotiated Rate	$179.00
Max. Negotiated Rate	$179.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00

HC NEW PT AGE 40-64

Facility

$358.00

Service Code	CPT 99386
Hospital Charge Code	5109938601
Hospital Revenue Code	510
Min. Negotiated Rate	$88.46
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$196.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$88.46
Rate for Payer: Aetna Government	$88.46
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
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	$179.00
Rate for Payer: Hamaspik Choice Inc Medicare	$179.00
Rate for Payer: United Healthcare Commercial	$222.00

HC NEW PT AGE 65-OVER

Facility

$358.00

Service Code	CPT 99387
Hospital Charge Code	5109938701
Hospital Revenue Code	510
Min. Negotiated Rate	$95.04
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$196.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$95.04
Rate for Payer: Aetna Government	$95.04
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
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	$179.00
Rate for Payer: Hamaspik Choice Inc Medicare	$179.00
Rate for Payer: United Healthcare Commercial	$222.00

HC NEW PT AGE 65-OVER

Facility

$358.00

Service Code	CPT 99387
Hospital Charge Code	5109938701
Hospital Revenue Code	510
Min. Negotiated Rate	$179.00
Max. Negotiated Rate	$179.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00

HC NEW PT PRE AGE 12-17

Facility

$358.00

Service Code	CPT 99384
Hospital Charge Code	5109938401
Hospital Revenue Code	510
Min. Negotiated Rate	$123.04
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$196.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$123.04
Rate for Payer: Aetna Government	$123.04
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
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	$179.00
Rate for Payer: Hamaspik Choice Inc Medicare	$179.00
Rate for Payer: United Healthcare Commercial	$222.00

HC NEW PT PRE AGE 12-17

Facility

$358.00

Service Code	CPT 99384
Hospital Charge Code	5109938401
Hospital Revenue Code	510
Min. Negotiated Rate	$179.00
Max. Negotiated Rate	$179.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00

HC NEW PT WELL CHILD CARE 1-4 YEAR

Facility

$358.00

Service Code	CPT 99382
Hospital Charge Code	5109938201
Hospital Revenue Code	510
Min. Negotiated Rate	$71.44
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$196.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$71.44
Rate for Payer: Aetna Government	$71.44
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
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	$179.00
Rate for Payer: Hamaspik Choice Inc Medicare	$179.00
Rate for Payer: United Healthcare Commercial	$222.00

HC NEW PT WELL CHILD CARE 1-4 YEAR

Facility

$358.00

Service Code	CPT 99382
Hospital Charge Code	5109938201
Hospital Revenue Code	510
Min. Negotiated Rate	$179.00
Max. Negotiated Rate	$179.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00

HC NEW PT WELL CHILD CARE <1 YEAR

Facility

$146.00

Service Code	CPT 99381
Hospital Charge Code	5109938101
Hospital Revenue Code	510
Min. Negotiated Rate	$73.00
Max. Negotiated Rate	$73.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.00

HC NEW PT WELL CHILD CARE <1 YEAR

Facility

$146.00

Service Code	CPT 99381
Hospital Charge Code	5109938101
Hospital Revenue Code	510
Min. Negotiated Rate	$62.88
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$62.88
Rate for Payer: Aetna Government	$62.88
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
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	$73.00
Rate for Payer: Hamaspik Choice Inc Medicare	$73.00
Rate for Payer: United Healthcare Commercial	$222.00

HC NEW PT WELL CHILD CARE 5-11 YEAR

Facility

$294.00

Service Code	CPT 99383
Hospital Charge Code	5109938301
Hospital Revenue Code	510
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$147.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$147.00

HC NEW PT WELL CHILD CARE 5-11 YEAR

Facility

$294.00

Service Code	CPT 99383
Hospital Charge Code	5109938301
Hospital Revenue Code	510
Min. Negotiated Rate	$71.44
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$161.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$71.44
Rate for Payer: Aetna Government	$71.44
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
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	$147.00
Rate for Payer: Hamaspik Choice Inc Medicare	$147.00
Rate for Payer: United Healthcare Commercial	$222.00

HC N.GONORRHOEAE, DNA, AMP PROB - GC DNA PCR

Facility

$87.00

Service Code	CPT 87591
Hospital Charge Code	3068759101
Hospital Revenue Code	306
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$43.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.50

HC N.GONORRHOEAE, DNA, AMP PROB - GC DNA PCR

Facility

$87.00

Service Code	CPT 87591
Hospital Charge Code	3068759101
Hospital Revenue Code	306
Min. Negotiated Rate	$21.64
Max. Negotiated Rate	$65.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.09
Rate for Payer: Aetna Government	$35.09
Rate for Payer: Affinity Essential Plan 1&2	$24.56
Rate for Payer: Affinity Essential Plan 3&4	$24.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$24.56
Rate for Payer: Brighton Health Commercial	$65.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$35.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$59.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$50.20
Rate for Payer: Elderplan Medicare Advantage	$35.09
Rate for Payer: EmblemHealth Commercial	$35.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31.58
Rate for Payer: Fidelis Essential Plan Aliesa	$29.83
Rate for Payer: Fidelis Essential Plan QHP	$31.23
Rate for Payer: Fidelis Medicare Advantage	$35.09
Rate for Payer: Fidelis Qualified Health Plan	$31.23
Rate for Payer: Group Health Inc Commercial	$35.09
Rate for Payer: Group Health Inc Medicare	$35.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.09
Rate for Payer: Hamaspik Choice Inc Medicare	$35.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21.64
Rate for Payer: Healthfirst Essential Plan	$48.69
Rate for Payer: Healthfirst Medicare Advantage	$35.09
Rate for Payer: Healthfirst QHP	$35.09
Rate for Payer: Humana Medicare	$35.79
Rate for Payer: Senior Whole Health Medicare Advantage	$35.09
Rate for Payer: United Healthcare Commercial	$44.45
Rate for Payer: United Healthcare Medicare Advantage	$35.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$35.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21.64
Rate for Payer: Wellcare Medicare	$31.58

HC NIPPLE/AREOLA RECONSTRUCTION

Facility

$9,720.00

Service Code	CPT 19350
Hospital Charge Code	3611935001
Hospital Revenue Code	361
Min. Negotiated Rate	$4,860.00
Max. Negotiated Rate	$4,860.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,860.00

HC NIPPLE/AREOLA RECONSTRUCTION

Facility

$9,720.00

Service Code	CPT 19350
Hospital Charge Code	3611935001
Hospital Revenue Code	361
Min. Negotiated Rate	$795.04
Max. Negotiated Rate	$7,290.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,678.69
Rate for Payer: Aetna Government	$4,678.69
Rate for Payer: Affinity Essential Plan 1&2	$3,275.08
Rate for Payer: Affinity Essential Plan 3&4	$3,275.08
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,275.08
Rate for Payer: Brighton Health Commercial	$7,290.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4,678.69
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	$4,678.69
Rate for Payer: EmblemHealth Commercial	$4,678.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4,210.82
Rate for Payer: Fidelis Essential Plan Aliesa	$3,976.89
Rate for Payer: Fidelis Essential Plan QHP	$4,164.03
Rate for Payer: Fidelis Medicare Advantage	$4,678.69
Rate for Payer: Fidelis Qualified Health Plan	$4,164.03
Rate for Payer: Group Health Inc Commercial	$4,678.69
Rate for Payer: Group Health Inc Medicare	$4,678.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,678.69
Rate for Payer: Hamaspik Choice Inc Medicare	$1,538.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$795.04
Rate for Payer: Healthfirst Medicare Advantage	$3,976.89
Rate for Payer: Healthfirst QHP	$4,678.69
Rate for Payer: Humana Medicare	$4,772.26
Rate for Payer: Senior Whole Health Medicare Advantage	$4,678.69
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$4,678.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,678.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4,444.76
Rate for Payer: Wellcare Medicare	$4,444.76

HC NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS

Facility

$9,417.00

Service Code	CPT 47531 TC
Hospital Charge Code	3614753101
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 NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS

Facility

$9,417.00

Service Code	CPT 47531 TC
Hospital Charge Code	3614753101
Hospital Revenue Code	361
Min. Negotiated Rate	$342.00
Max. Negotiated Rate	$7,062.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$424.97
Rate for Payer: Aetna Government	$424.97
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	$4,708.50
Rate for Payer: United Healthcare Commercial	$1,835.00

HC NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS

Facility

$9,417.00

Service Code	CPT 47532 TC
Hospital Charge Code	3614753201
Hospital Revenue Code	361
Min. Negotiated Rate	$342.00
Max. Negotiated Rate	$7,062.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$935.62
Rate for Payer: Aetna Government	$935.62
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	$4,708.50
Rate for Payer: United Healthcare Commercial	$1,835.00

HC NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS

Facility

$9,417.00

Service Code	CPT 47532 TC
Hospital Charge Code	3614753201
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 NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS

Facility

$1,685.00

Service Code	CPT 50431 TC
Hospital Charge Code	3615043101
Hospital Revenue Code	361
Min. Negotiated Rate	$842.50
Max. Negotiated Rate	$842.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$842.50

HC NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS

Facility

$1,685.00

Service Code	CPT 50431 TC
Hospital Charge Code	3615043101
Hospital Revenue Code	361
Min. Negotiated Rate	$197.97
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$197.97
Rate for Payer: Aetna Government	$197.97
Rate for Payer: Brighton Health Commercial	$1,263.75
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	$842.50
Rate for Payer: Group Health Inc Commercial	$842.50
Rate for Payer: Group Health Inc Medicare	$589.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$842.50
Rate for Payer: Hamaspik Choice Inc Medicare	$842.50
Rate for Payer: United Healthcare Commercial	$1,188.00

HC NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS

Facility

$1,685.00

Service Code	CPT 50430 TC
Hospital Charge Code	3615043001
Hospital Revenue Code	361
Min. Negotiated Rate	$842.50
Max. Negotiated Rate	$842.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$842.50

Know your out-of-pocket cost for care.

All Charges