St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC NUCLEAR ANTIGEN ANTIBODY - SCLERODERMA (SCL-70) ANTIBODY

Facility

$44.00

Service Code	CPT 86235
Hospital Charge Code	3028623504
Hospital Revenue Code	302
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$33.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.93
Rate for Payer: Aetna Government	$17.93
Rate for Payer: Affinity Essential Plan 1&2	$12.55
Rate for Payer: Affinity Essential Plan 3&4	$12.55
Rate for Payer: Affinity Medicaid/CHP/HARP	$12.55
Rate for Payer: Brighton Health Commercial	$33.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$17.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.65
Rate for Payer: Elderplan Medicare Advantage	$17.93
Rate for Payer: EmblemHealth Commercial	$17.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16.14
Rate for Payer: Fidelis Essential Plan Aliesa	$15.24
Rate for Payer: Fidelis Essential Plan QHP	$15.96
Rate for Payer: Fidelis Medicare Advantage	$17.93
Rate for Payer: Fidelis Qualified Health Plan	$15.96
Rate for Payer: Group Health Inc Commercial	$17.93
Rate for Payer: Group Health Inc Medicare	$17.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.93
Rate for Payer: Hamaspik Choice Inc Medicare	$17.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.25
Rate for Payer: Healthfirst Essential Plan	$11.81
Rate for Payer: Healthfirst Medicare Advantage	$17.93
Rate for Payer: Healthfirst QHP	$17.93
Rate for Payer: Humana Medicare	$18.29
Rate for Payer: Senior Whole Health Medicare Advantage	$17.93
Rate for Payer: United Healthcare Commercial	$22.71
Rate for Payer: United Healthcare Medicare Advantage	$17.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.93
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.25
Rate for Payer: Wellcare Medicare	$16.14

HC NUCLEAR ANTIGEN ANTIBODY - SCLERODERMA (SCL-70) ANTIBODY

Facility

$44.00

Service Code	CPT 86235
Hospital Charge Code	3028623504
Hospital Revenue Code	302
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$22.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.00

HC NUCLEAR ANTIGEN ANTIBODY - SJOGRENS SYNDROME-A EXT NU AB

Facility

$44.00

Service Code	CPT 86235
Hospital Charge Code	3028623501
Hospital Revenue Code	302
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$22.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.00

HC NUCLEAR ANTIGEN ANTIBODY - SJOGRENS SYNDROME-A EXT NU AB

Facility

$44.00

Service Code	CPT 86235
Hospital Charge Code	3028623501
Hospital Revenue Code	302
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$33.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.93
Rate for Payer: Aetna Government	$17.93
Rate for Payer: Affinity Essential Plan 1&2	$12.55
Rate for Payer: Affinity Essential Plan 3&4	$12.55
Rate for Payer: Affinity Medicaid/CHP/HARP	$12.55
Rate for Payer: Brighton Health Commercial	$33.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$17.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.65
Rate for Payer: Elderplan Medicare Advantage	$17.93
Rate for Payer: EmblemHealth Commercial	$17.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16.14
Rate for Payer: Fidelis Essential Plan Aliesa	$15.24
Rate for Payer: Fidelis Essential Plan QHP	$15.96
Rate for Payer: Fidelis Medicare Advantage	$17.93
Rate for Payer: Fidelis Qualified Health Plan	$15.96
Rate for Payer: Group Health Inc Commercial	$17.93
Rate for Payer: Group Health Inc Medicare	$17.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.93
Rate for Payer: Hamaspik Choice Inc Medicare	$17.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.25
Rate for Payer: Healthfirst Essential Plan	$11.81
Rate for Payer: Healthfirst Medicare Advantage	$17.93
Rate for Payer: Healthfirst QHP	$17.93
Rate for Payer: Humana Medicare	$18.29
Rate for Payer: Senior Whole Health Medicare Advantage	$17.93
Rate for Payer: United Healthcare Commercial	$22.71
Rate for Payer: United Healthcare Medicare Advantage	$17.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.93
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.25
Rate for Payer: Wellcare Medicare	$16.14

HC NUCLEAR MEDICINE - RADIOPHARM TUMOR LOCALIZATION SPECT - 2 AREAS

Facility

$3,980.00

Service Code	CPT 78831 TC
Hospital Charge Code	3417883101
Hospital Revenue Code	341
Min. Negotiated Rate	$482.65
Max. Negotiated Rate	$3,184.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,189.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$513.70
Rate for Payer: Aetna Government	$513.70
Rate for Payer: Brighton Health Commercial	$2,985.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,184.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,706.40
Rate for Payer: EmblemHealth Commercial	$576.67
Rate for Payer: Group Health Inc Commercial	$1,990.00
Rate for Payer: Group Health Inc Medicare	$1,393.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,990.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,990.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$576.67
Rate for Payer: Healthfirst Essential Plan	$1,085.96
Rate for Payer: United Healthcare Commercial	$1,017.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$482.65

HC NUCLEAR MEDICINE - RADIOPHARM TUMOR LOCALIZATION SPECT - 2 AREAS

Facility

$3,980.00

Service Code	CPT 78831 TC
Hospital Charge Code	3417883101
Hospital Revenue Code	341
Min. Negotiated Rate	$1,990.00
Max. Negotiated Rate	$1,990.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,990.00

HC NUCLEAR MEDICINE - UNLISTED MISC PROCEDURE

Facility

$1,114.00

Service Code	CPT 78999 TC
Hospital Charge Code	3417899901
Hospital Revenue Code	341
Min. Negotiated Rate	$557.00
Max. Negotiated Rate	$557.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$557.00

HC NUCLEAR MEDICINE - UNLISTED MISC PROCEDURE

Facility

$1,114.00

Service Code	CPT 78999 TC
Hospital Charge Code	3417899901
Hospital Revenue Code	341
Min. Negotiated Rate	$80.62
Max. Negotiated Rate	$835.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$612.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$557.00
Rate for Payer: Aetna Government	$557.00
Rate for Payer: Brighton Health Commercial	$835.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$215.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$181.51
Rate for Payer: EmblemHealth Commercial	$557.00
Rate for Payer: Group Health Inc Commercial	$557.00
Rate for Payer: Group Health Inc Medicare	$389.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$557.00
Rate for Payer: Hamaspik Choice Inc Medicare	$557.00
Rate for Payer: United Healthcare Commercial	$80.62

HC NUCLEAR THERAPY, ORAL - NM THYROID THERAPY ABLATION BASIC

Facility

$719.00

Service Code	CPT 79005 TC
Hospital Charge Code	3427900502
Hospital Revenue Code	342
Min. Negotiated Rate	$359.50
Max. Negotiated Rate	$359.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$359.50

HC NUCLEAR THERAPY, ORAL - NM THYROID THERAPY ABLATION BASIC

Facility

$719.00

Service Code	CPT 79005 TC
Hospital Charge Code	3427900502
Hospital Revenue Code	342
Min. Negotiated Rate	$32.79
Max. Negotiated Rate	$539.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$395.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.79
Rate for Payer: Aetna Government	$32.79
Rate for Payer: Brighton Health Commercial	$539.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$479.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$403.70
Rate for Payer: EmblemHealth Commercial	$54.56
Rate for Payer: Group Health Inc Commercial	$359.50
Rate for Payer: Group Health Inc Medicare	$251.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$359.50
Rate for Payer: Hamaspik Choice Inc Medicare	$359.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$54.56
Rate for Payer: Healthfirst Essential Plan	$203.42
Rate for Payer: United Healthcare Commercial	$179.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$90.41

HC NUCLEAR THERAPY, ORAL - NM THYROID THERAPY I 131

Facility

$749.00

Service Code	CPT 79005 TC
Hospital Charge Code	3427900501
Hospital Revenue Code	342
Min. Negotiated Rate	$32.79
Max. Negotiated Rate	$561.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$411.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.79
Rate for Payer: Aetna Government	$32.79
Rate for Payer: Brighton Health Commercial	$561.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$479.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$403.70
Rate for Payer: EmblemHealth Commercial	$54.56
Rate for Payer: Group Health Inc Commercial	$374.50
Rate for Payer: Group Health Inc Medicare	$262.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$374.50
Rate for Payer: Hamaspik Choice Inc Medicare	$374.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$54.56
Rate for Payer: Healthfirst Essential Plan	$203.42
Rate for Payer: United Healthcare Commercial	$179.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$90.41

HC NUCLEAR THERAPY, ORAL - NM THYROID THERAPY I 131

Facility

$749.00

Service Code	CPT 79005 TC
Hospital Charge Code	3427900501
Hospital Revenue Code	342
Min. Negotiated Rate	$374.50
Max. Negotiated Rate	$374.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$374.50

HC NUDT15 (NUDIX HYDROLASE 15) GENE ANALYSIS

Facility

$136.00

Service Code	CPT 81306
Hospital Charge Code	3108130601
Hospital Revenue Code	310
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$68.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.00

HC NUDT15 (NUDIX HYDROLASE 15) GENE ANALYSIS

Facility

$136.00

Service Code	CPT 81306
Hospital Charge Code	3108130601
Hospital Revenue Code	310
Min. Negotiated Rate	$74.80
Max. Negotiated Rate	$297.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$291.36
Rate for Payer: Aetna Government	$291.36
Rate for Payer: Affinity Essential Plan 1&2	$203.95
Rate for Payer: Affinity Essential Plan 3&4	$203.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$203.95
Rate for Payer: Brighton Health Commercial	$291.36
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$291.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$108.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$92.48
Rate for Payer: Elderplan Medicare Advantage	$291.36
Rate for Payer: EmblemHealth Commercial	$291.36
Rate for Payer: Fidelis CHP/HARP/Medicaid	$262.22
Rate for Payer: Fidelis Essential Plan Aliesa	$247.66
Rate for Payer: Fidelis Essential Plan QHP	$259.31
Rate for Payer: Fidelis Medicare Advantage	$291.36
Rate for Payer: Fidelis Qualified Health Plan	$259.31
Rate for Payer: Group Health Inc Commercial	$291.36
Rate for Payer: Group Health Inc Medicare	$291.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$291.36
Rate for Payer: Hamaspik Choice Inc Medicare	$291.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$291.36
Rate for Payer: Healthfirst Medicare Advantage	$291.36
Rate for Payer: Healthfirst QHP	$291.36
Rate for Payer: Humana Medicare	$297.19
Rate for Payer: Senior Whole Health Medicare Advantage	$291.36
Rate for Payer: United Healthcare Medicare Advantage	$291.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$291.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$276.79
Rate for Payer: Wellcare Medicare	$262.22

HC NURSERY-ISOLATION

Facility

$2,479.00

Hospital Charge Code	1700000002
Hospital Revenue Code	170
Min. Negotiated Rate	$1,239.50
Max. Negotiated Rate	$1,239.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,239.50

HC NURSERY NEONATAL ICU

Facility

$4,490.00

Hospital Charge Code	1710000001
Hospital Revenue Code	171
Min. Negotiated Rate	$2,245.00
Max. Negotiated Rate	$2,245.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,245.00

HC NURSERY NEONATAL ICU

Facility

$5,868.00

Hospital Charge Code	1740000004
Hospital Revenue Code	174
Min. Negotiated Rate	$2,934.00
Max. Negotiated Rate	$2,934.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,934.00

HC NURSERY NEONATAL ICU

Facility

$5,188.00

Hospital Charge Code	1730000003
Hospital Revenue Code	173
Min. Negotiated Rate	$2,594.00
Max. Negotiated Rate	$2,594.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,594.00

HC NURSERY NEONATAL ICU

Facility

$4,826.00

Hospital Charge Code	1720000002
Hospital Revenue Code	172
Min. Negotiated Rate	$2,413.00
Max. Negotiated Rate	$2,413.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,413.00

HC NURSERY-NEWBORN

Facility

$2,245.00

Hospital Charge Code	1700000001
Hospital Revenue Code	170
Min. Negotiated Rate	$1,122.50
Max. Negotiated Rate	$1,122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,122.50

HC NURSERY-OBSERVATION

Facility

$2,479.00

Hospital Charge Code	1700000003
Hospital Revenue Code	170
Min. Negotiated Rate	$1,239.50
Max. Negotiated Rate	$1,239.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,239.50

HC NUTRITIONAL COUNSELING, DIETITIAN VISIT

Facility

$20.00

Service Code	CPT S9470
Hospital Charge Code	942S947001
Hospital Revenue Code	942
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$10.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.00

HC NUTRITIONAL COUNSELING, DIETITIAN VISIT

Facility

$20.00

Service Code	CPT S9470
Hospital Charge Code	942S947001
Hospital Revenue Code	942
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.00
Rate for Payer: Aetna Government	$25.00
Rate for Payer: Brighton Health Commercial	$15.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.60
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	$10.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10.00
Rate for Payer: United Healthcare Commercial	$10.00

HC NUTRITION CLASS, NON PHYS PROVIDER

Facility

$20.00

Service Code	CPT S9452
Hospital Charge Code	942S945201
Hospital Revenue Code	942
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$10.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.00

HC NUTRITION CLASS, NON PHYS PROVIDER

Facility

$20.00

Service Code	CPT S9452
Hospital Charge Code	942S945201
Hospital Revenue Code	942
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.21
Rate for Payer: Aetna Government	$24.21
Rate for Payer: Brighton Health Commercial	$15.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.60
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	$10.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10.00
Rate for Payer: United Healthcare Commercial	$10.00

Know your out-of-pocket cost for care.

All Charges