St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC PERI-PX PACEMAKER DEVICE EVL - CARD DEVICE IMPLANT/POST-PROC PCMKR

Facility

$81.00

Service Code	CPT 93286
Hospital Charge Code	4809328602
Hospital Revenue Code	480
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.50

HC PERI-PX PACEMAKER DEVICE EVL - CARD DEVICE IMPLANT/POST-PROC PCMKR

Facility

$81.00

Service Code	CPT 93286
Hospital Charge Code	4809328602
Hospital Revenue Code	480
Min. Negotiated Rate	$23.85
Max. Negotiated Rate	$342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.85
Rate for Payer: Aetna Government	$23.85
Rate for Payer: Brighton Health Commercial	$60.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$64.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.08
Rate for Payer: EmblemHealth Commercial	$40.50
Rate for Payer: Group Health Inc Commercial	$40.50
Rate for Payer: Group Health Inc Medicare	$28.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.50
Rate for Payer: Hamaspik Choice Inc Medicare	$40.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$50.77
Rate for Payer: United Healthcare Commercial	$316.00

HC PERITONEAL LAVAGE W/WO IMAGING GUIDANCE

Facility

$2,380.00

Service Code	CPT 49084 TC
Hospital Charge Code	3614908401
Hospital Revenue Code	361
Min. Negotiated Rate	$1,190.00
Max. Negotiated Rate	$1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,190.00

HC PERITONEAL LAVAGE W/WO IMAGING GUIDANCE

Facility

$2,380.00

Service Code	CPT 49084 TC
Hospital Charge Code	3614908401
Hospital Revenue Code	361
Min. Negotiated Rate	$128.36
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$128.36
Rate for Payer: Aetna Government	$128.36
Rate for Payer: Brighton Health Commercial	$1,785.00
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	$1,190.00
Rate for Payer: Group Health Inc Commercial	$1,190.00
Rate for Payer: Group Health Inc Medicare	$833.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,190.00
Rate for Payer: Hamaspik Choice Inc Medicare	$503.39
Rate for Payer: United Healthcare Commercial	$1,409.00

HC PERQ ARTERIAL M-THROMBECTOMY &/INFSN

Facility

$5,361.00

Service Code	CPT 61645 TC
Hospital Charge Code	3616164501
Hospital Revenue Code	361
Min. Negotiated Rate	$928.33
Max. Negotiated Rate	$4,020.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,948.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$928.33
Rate for Payer: Aetna Government	$928.33
Rate for Payer: Brighton Health Commercial	$4,020.75
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	$2,680.50
Rate for Payer: Group Health Inc Commercial	$2,680.50
Rate for Payer: Group Health Inc Medicare	$1,876.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,680.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,680.50
Rate for Payer: United Healthcare Commercial	$1,496.00

HC PERQ ARTERIAL M-THROMBECTOMY &/INFSN

Facility

$5,361.00

Service Code	CPT 61645 TC
Hospital Charge Code	3616164501
Hospital Revenue Code	361
Min. Negotiated Rate	$2,680.50
Max. Negotiated Rate	$2,680.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,680.50

HC PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID

Facility

$1,847.00

Service Code	CPT 19287 TC
Hospital Charge Code	3611928701
Hospital Revenue Code	361
Min. Negotiated Rate	$923.50
Max. Negotiated Rate	$923.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.50

HC PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID

Facility

$1,847.00

Service Code	CPT 19287 TC
Hospital Charge Code	3611928701
Hospital Revenue Code	361
Min. Negotiated Rate	$342.00
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$742.27
Rate for Payer: Aetna Government	$742.27
Rate for Payer: Brighton Health Commercial	$1,385.25
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	$923.50
Rate for Payer: Group Health Inc Commercial	$923.50
Rate for Payer: Group Health Inc Medicare	$646.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.50
Rate for Payer: Hamaspik Choice Inc Medicare	$923.50
Rate for Payer: United Healthcare Commercial	$1,188.00

HC PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG

Facility

$1,847.00

Service Code	CPT 19285 TC
Hospital Charge Code	3611928501
Hospital Revenue Code	361
Min. Negotiated Rate	$923.50
Max. Negotiated Rate	$923.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.50

HC PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG

Facility

$1,847.00

Service Code	CPT 19285 TC
Hospital Charge Code	3611928501
Hospital Revenue Code	361
Min. Negotiated Rate	$342.00
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$443.82
Rate for Payer: Aetna Government	$443.82
Rate for Payer: Brighton Health Commercial	$1,385.25
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	$923.50
Rate for Payer: Group Health Inc Commercial	$923.50
Rate for Payer: Group Health Inc Medicare	$646.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.50
Rate for Payer: Hamaspik Choice Inc Medicare	$923.50
Rate for Payer: United Healthcare Commercial	$1,188.00

HC PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GUID

Facility

$1,847.00

Service Code	CPT 19283 TC
Hospital Charge Code	3611928301
Hospital Revenue Code	361
Min. Negotiated Rate	$230.75
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$230.75
Rate for Payer: Aetna Government	$230.75
Rate for Payer: Brighton Health Commercial	$1,385.25
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	$923.50
Rate for Payer: Group Health Inc Commercial	$923.50
Rate for Payer: Group Health Inc Medicare	$646.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.50
Rate for Payer: Hamaspik Choice Inc Medicare	$923.50
Rate for Payer: United Healthcare Commercial	$1,188.00

HC PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GUID

Facility

$1,847.00

Service Code	CPT 19283 TC
Hospital Charge Code	3611928301
Hospital Revenue Code	361
Min. Negotiated Rate	$923.50
Max. Negotiated Rate	$923.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.50

HC PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID

Facility

$389.00

Service Code	CPT 19288 TC
Hospital Charge Code	3611928801
Hospital Revenue Code	361
Min. Negotiated Rate	$136.15
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$599.54
Rate for Payer: Aetna Government	$599.54
Rate for Payer: Brighton Health Commercial	$291.75
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	$194.50
Rate for Payer: Group Health Inc Commercial	$194.50
Rate for Payer: Group Health Inc Medicare	$136.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$194.50
Rate for Payer: Hamaspik Choice Inc Medicare	$194.50
Rate for Payer: United Healthcare Commercial	$1,113.00

HC PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID

Facility

$389.00

Service Code	CPT 19288 TC
Hospital Charge Code	3611928801
Hospital Revenue Code	361
Min. Negotiated Rate	$194.50
Max. Negotiated Rate	$194.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$194.50

HC PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE

Facility

$389.00

Service Code	CPT 19286 TC
Hospital Charge Code	3611928601
Hospital Revenue Code	361
Min. Negotiated Rate	$37.29
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.29
Rate for Payer: Aetna Government	$37.29
Rate for Payer: Brighton Health Commercial	$291.75
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	$194.50
Rate for Payer: Group Health Inc Commercial	$194.50
Rate for Payer: Group Health Inc Medicare	$136.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$194.50
Rate for Payer: Hamaspik Choice Inc Medicare	$194.50
Rate for Payer: United Healthcare Commercial	$1,113.00

HC PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE

Facility

$389.00

Service Code	CPT 19286 TC
Hospital Charge Code	3611928601
Hospital Revenue Code	361
Min. Negotiated Rate	$194.50
Max. Negotiated Rate	$194.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$194.50

HC PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC

Facility

$389.00

Service Code	CPT 19284 TC
Hospital Charge Code	3611928401
Hospital Revenue Code	361
Min. Negotiated Rate	$136.15
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$174.99
Rate for Payer: Aetna Government	$174.99
Rate for Payer: Brighton Health Commercial	$291.75
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	$194.50
Rate for Payer: Group Health Inc Commercial	$194.50
Rate for Payer: Group Health Inc Medicare	$136.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$194.50
Rate for Payer: Hamaspik Choice Inc Medicare	$194.50
Rate for Payer: United Healthcare Commercial	$1,113.00

HC PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC

Facility

$389.00

Service Code	CPT 19284 TC
Hospital Charge Code	3611928401
Hospital Revenue Code	361
Min. Negotiated Rate	$194.50
Max. Negotiated Rate	$194.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$194.50

HC PERQ DEVICE PLACEMT BREAST LOC 1ST LES W GUIDNCE

Facility

$1,847.00

Service Code	CPT 19281 TC
Hospital Charge Code	3611928101
Hospital Revenue Code	361
Min. Negotiated Rate	$204.33
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$204.33
Rate for Payer: Aetna Government	$204.33
Rate for Payer: Brighton Health Commercial	$1,385.25
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	$923.50
Rate for Payer: Group Health Inc Commercial	$923.50
Rate for Payer: Group Health Inc Medicare	$646.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.50
Rate for Payer: Hamaspik Choice Inc Medicare	$923.50
Rate for Payer: United Healthcare Commercial	$1,188.00

HC PERQ DEVICE PLACEMT BREAST LOC 1ST LES W GUIDNCE

Facility

$1,847.00

Service Code	CPT 19281 TC
Hospital Charge Code	3611928101
Hospital Revenue Code	361
Min. Negotiated Rate	$923.50
Max. Negotiated Rate	$923.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.50

HC PERQ DEVICE PLACEMT BREAST LOC EA LES W GUIDNCE

Facility

$389.00

Service Code	CPT 19282 TC
Hospital Charge Code	3611928201
Hospital Revenue Code	361
Min. Negotiated Rate	$136.15
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$143.84
Rate for Payer: Aetna Government	$143.84
Rate for Payer: Brighton Health Commercial	$291.75
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	$194.50
Rate for Payer: Group Health Inc Commercial	$194.50
Rate for Payer: Group Health Inc Medicare	$136.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$194.50
Rate for Payer: Hamaspik Choice Inc Medicare	$194.50
Rate for Payer: United Healthcare Commercial	$1,113.00

HC PERQ DEVICE PLACEMT BREAST LOC EA LES W GUIDNCE

Facility

$389.00

Service Code	CPT 19282 TC
Hospital Charge Code	3611928201
Hospital Revenue Code	361
Min. Negotiated Rate	$194.50
Max. Negotiated Rate	$194.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$194.50

HC PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING

Facility

$4,328.00

Service Code	CPT 32557 TC
Hospital Charge Code	3613255701
Hospital Revenue Code	361
Min. Negotiated Rate	$540.35
Max. Negotiated Rate	$3,246.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$540.35
Rate for Payer: Aetna Government	$540.35
Rate for Payer: Brighton Health Commercial	$3,246.00
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	$2,164.00
Rate for Payer: Group Health Inc Commercial	$2,164.00
Rate for Payer: Group Health Inc Medicare	$1,514.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,164.00
Rate for Payer: Hamaspik Choice Inc Medicare	$632.40
Rate for Payer: United Healthcare Commercial	$1,188.00

HC PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING

Facility

$4,328.00

Service Code	CPT 32557 TC
Hospital Charge Code	3613255701
Hospital Revenue Code	361
Min. Negotiated Rate	$2,164.00
Max. Negotiated Rate	$2,164.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,164.00

HC PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING

Facility

$4,999.00

Service Code	CPT 32556 TC
Hospital Charge Code	3613255601
Hospital Revenue Code	361
Min. Negotiated Rate	$2,499.50
Max. Negotiated Rate	$2,499.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,499.50

Know your out-of-pocket cost for care.

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