St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$567.38
Max. Negotiated Rate	$3,749.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$567.38
Rate for Payer: Aetna Government	$567.38
Rate for Payer: Brighton Health Commercial	$3,749.25
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	$2,499.50
Rate for Payer: Group Health Inc Commercial	$2,499.50
Rate for Payer: Group Health Inc Medicare	$1,749.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,499.50
Rate for Payer: Hamaspik Choice Inc Medicare	$864.15
Rate for Payer: United Healthcare Commercial	$1,409.00

HC PERQ RADIOFREQ ABLATION TX, PUL TUMOR

Facility

$14,640.00

Service Code	CPT 32998 TC
Hospital Charge Code	3613299801
Hospital Revenue Code	361
Min. Negotiated Rate	$2,520.72
Max. Negotiated Rate	$10,980.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,387.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,520.72
Rate for Payer: Aetna Government	$2,520.72
Rate for Payer: Brighton Health Commercial	$10,980.00
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	$7,320.00
Rate for Payer: Group Health Inc Commercial	$7,320.00
Rate for Payer: Group Health Inc Medicare	$5,124.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,320.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,860.32
Rate for Payer: United Healthcare Commercial	$2,546.00

HC PERQ RADIOFREQ ABLATION TX, PUL TUMOR

Facility

$14,640.00

Service Code	CPT 32998 TC
Hospital Charge Code	3613299801
Hospital Revenue Code	361
Min. Negotiated Rate	$7,320.00
Max. Negotiated Rate	$7,320.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,320.00

HC PERQ SFT TISS LOC DEVICE PLMT 1ST LES W/GDNCE

Facility

$1,946.00

Service Code	CPT 10035
Hospital Charge Code	3611003501
Hospital Revenue Code	361
Min. Negotiated Rate	$92.52
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$859.66
Rate for Payer: Aetna Government	$859.66
Rate for Payer: Affinity Essential Plan 1&2	$601.76
Rate for Payer: Affinity Essential Plan 3&4	$601.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$601.76
Rate for Payer: Brighton Health Commercial	$1,459.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$859.66
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	$859.66
Rate for Payer: EmblemHealth Commercial	$859.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$773.69
Rate for Payer: Fidelis Essential Plan Aliesa	$730.71
Rate for Payer: Fidelis Essential Plan QHP	$765.10
Rate for Payer: Fidelis Medicare Advantage	$859.66
Rate for Payer: Fidelis Qualified Health Plan	$765.10
Rate for Payer: Group Health Inc Commercial	$859.66
Rate for Payer: Group Health Inc Medicare	$859.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$859.66
Rate for Payer: Hamaspik Choice Inc Medicare	$859.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$92.52
Rate for Payer: Healthfirst Medicare Advantage	$730.71
Rate for Payer: Healthfirst QHP	$859.66
Rate for Payer: Humana Medicare	$876.85
Rate for Payer: Senior Whole Health Medicare Advantage	$859.66
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$859.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$859.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$816.68
Rate for Payer: Wellcare Medicare	$816.68

HC PERQ SFT TISS LOC DEVICE PLMT 1ST LES W/GDNCE

Facility

$1,946.00

Service Code	CPT 10035
Hospital Charge Code	3611003501
Hospital Revenue Code	361
Min. Negotiated Rate	$973.00
Max. Negotiated Rate	$973.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$973.00

HC PERQ TRLUML CORONRY LITHOTRP

Facility

$31,452.00

Service Code	CPT 92972
Hospital Charge Code	3619297201
Hospital Revenue Code	361
Min. Negotiated Rate	$160.77
Max. Negotiated Rate	$25,161.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17,298.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15,726.00
Rate for Payer: Aetna Government	$15,726.00
Rate for Payer: Brighton Health Commercial	$23,589.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25,161.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$21,387.36
Rate for Payer: EmblemHealth Commercial	$15,726.00
Rate for Payer: Group Health Inc Commercial	$15,726.00
Rate for Payer: Group Health Inc Medicare	$11,008.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,726.00
Rate for Payer: Hamaspik Choice Inc Medicare	$15,726.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$160.77

HC PERQ TRLUML CORONRY LITHOTRP

Facility

$31,452.00

Service Code	CPT 92972
Hospital Charge Code	3619297201
Hospital Revenue Code	361
Min. Negotiated Rate	$15,726.00
Max. Negotiated Rate	$15,726.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,726.00

HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION

Facility

$18,618.00

Service Code	CPT 22513 TC
Hospital Charge Code	3612251301
Hospital Revenue Code	361
Min. Negotiated Rate	$2,546.00
Max. Negotiated Rate	$13,963.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,593.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7,469.27
Rate for Payer: Aetna Government	$7,469.27
Rate for Payer: Brighton Health Commercial	$13,963.50
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	$9,309.00
Rate for Payer: Group Health Inc Commercial	$9,309.00
Rate for Payer: Group Health Inc Medicare	$6,516.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,309.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,510.84
Rate for Payer: United Healthcare Commercial	$2,546.00

HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION

Facility

$18,618.00

Service Code	CPT 22513 TC
Hospital Charge Code	3612251301
Hospital Revenue Code	361
Min. Negotiated Rate	$9,309.00
Max. Negotiated Rate	$9,309.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,309.00

HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH

Facility

$13,964.00

Service Code	CPT 22515 TC
Hospital Charge Code	3612251501
Hospital Revenue Code	361
Min. Negotiated Rate	$6,982.00
Max. Negotiated Rate	$6,982.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,982.00

HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH

Facility

$13,964.00

Service Code	CPT 22515 TC
Hospital Charge Code	3612251501
Hospital Revenue Code	361
Min. Negotiated Rate	$1,113.00
Max. Negotiated Rate	$40,313.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,593.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,518.40
Rate for Payer: Aetna Government	$4,518.40
Rate for Payer: Affinity Essential Plan 1&2	$40,313.62
Rate for Payer: Affinity Essential Plan 3&4	$40,313.62
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,917.08
Rate for Payer: Amida Care Medicaid	$17,917.08
Rate for Payer: Brighton Health Commercial	$10,473.00
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	$6,982.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$40,313.62
Rate for Payer: EmblemHealth Essential Plan 3&4	$17,917.08
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,917.08
Rate for Payer: Fidelis Essential Plan Aliesa	$40,313.62
Rate for Payer: Fidelis Essential Plan QHP	$40,313.62
Rate for Payer: Fidelis Qualified Health Plan	$18,812.82
Rate for Payer: Group Health Inc Commercial	$6,982.00
Rate for Payer: Group Health Inc Medicare	$4,887.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,917.08
Rate for Payer: Hamaspik Choice Inc Medicare	$17,917.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,917.08
Rate for Payer: Healthfirst Essential Plan	$40,313.62
Rate for Payer: Healthfirst QHP	$29,204.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,917.08
Rate for Payer: SOMOS Essential	$40,313.62
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Essential Plan 1&2	$40,313.62
Rate for Payer: United Healthcare Essential Plan 3&4	$19,708.55
Rate for Payer: United Healthcare Medicaid	$17,917.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,917.08

HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR

Facility

$18,618.00

Service Code	CPT 22514 TC
Hospital Charge Code	3612251401
Hospital Revenue Code	361
Min. Negotiated Rate	$9,309.00
Max. Negotiated Rate	$9,309.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,309.00

HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR

Facility

$18,618.00

Service Code	CPT 22514 TC
Hospital Charge Code	3612251401
Hospital Revenue Code	361
Min. Negotiated Rate	$2,546.00
Max. Negotiated Rate	$13,963.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,593.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7,459.75
Rate for Payer: Aetna Government	$7,459.75
Rate for Payer: Brighton Health Commercial	$13,963.50
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	$9,309.00
Rate for Payer: Group Health Inc Commercial	$9,309.00
Rate for Payer: Group Health Inc Medicare	$6,516.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,309.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,510.84
Rate for Payer: United Healthcare Commercial	$2,546.00

HC PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL

Facility

$8,291.00

Service Code	CPT 22511 TC
Hospital Charge Code	3612251101
Hospital Revenue Code	361
Min. Negotiated Rate	$4,145.50
Max. Negotiated Rate	$4,145.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,145.50

HC PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL

Facility

$8,291.00

Service Code	CPT 22511 TC
Hospital Charge Code	3612251101
Hospital Revenue Code	361
Min. Negotiated Rate	$1,579.16
Max. Negotiated Rate	$6,218.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,593.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,775.44
Rate for Payer: Aetna Government	$1,775.44
Rate for Payer: Brighton Health Commercial	$6,218.25
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	$4,145.50
Rate for Payer: Group Health Inc Commercial	$4,145.50
Rate for Payer: Group Health Inc Medicare	$2,901.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,145.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,579.16
Rate for Payer: United Healthcare Commercial	$1,835.00

HC PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC

Facility

$8,291.00

Service Code	CPT 22510 TC
Hospital Charge Code	3612251001
Hospital Revenue Code	361
Min. Negotiated Rate	$4,145.50
Max. Negotiated Rate	$4,145.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,145.50

HC PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC

Facility

$8,291.00

Service Code	CPT 22510 TC
Hospital Charge Code	3612251001
Hospital Revenue Code	361
Min. Negotiated Rate	$1,579.16
Max. Negotiated Rate	$6,218.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,593.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,792.94
Rate for Payer: Aetna Government	$1,792.94
Rate for Payer: Brighton Health Commercial	$6,218.25
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	$4,145.50
Rate for Payer: Group Health Inc Commercial	$4,145.50
Rate for Payer: Group Health Inc Medicare	$2,901.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,145.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,579.16
Rate for Payer: United Healthcare Commercial	$1,835.00

HC PET IMAGE W/CT SKULL-THIGH - PT/CT BONE SKULL BASE TO MID THIGH

Facility

$4,370.00

Service Code	CPT 78815 TC
Hospital Charge Code	4047881501
Hospital Revenue Code	404
Min. Negotiated Rate	$546.41
Max. Negotiated Rate	$3,277.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,403.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$875.00
Rate for Payer: Aetna Government	$875.00
Rate for Payer: Brighton Health Commercial	$3,277.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,229.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,876.93
Rate for Payer: EmblemHealth Commercial	$2,185.00
Rate for Payer: Group Health Inc Commercial	$2,185.00
Rate for Payer: Group Health Inc Medicare	$1,529.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,185.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,185.00
Rate for Payer: Healthfirst Essential Plan	$1,229.42
Rate for Payer: United Healthcare Commercial	$833.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$546.41

HC PET IMAGE W/CT SKULL-THIGH - PT/CT BONE SKULL BASE TO MID THIGH

Facility

$4,370.00

Service Code	CPT 78815 TC
Hospital Charge Code	4047881501
Hospital Revenue Code	404
Min. Negotiated Rate	$2,185.00
Max. Negotiated Rate	$2,185.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,185.00

HC PET IMAGING CT FOR ATTENUATION LIMITED AREA - PT/CT LOWER EXTREMITY

Facility

$4,370.00

Service Code	CPT 78814 TC
Hospital Charge Code	4047881401
Hospital Revenue Code	404
Min. Negotiated Rate	$313.10
Max. Negotiated Rate	$3,277.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,403.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$875.00
Rate for Payer: Aetna Government	$875.00
Rate for Payer: Brighton Health Commercial	$3,277.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,229.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,876.93
Rate for Payer: EmblemHealth Commercial	$2,185.00
Rate for Payer: Group Health Inc Commercial	$2,185.00
Rate for Payer: Group Health Inc Medicare	$1,529.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,185.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,185.00
Rate for Payer: Healthfirst Essential Plan	$704.48
Rate for Payer: United Healthcare Commercial	$833.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$313.10

HC PET IMAGING CT FOR ATTENUATION LIMITED AREA - PT/CT LOWER EXTREMITY

Facility

$4,370.00

Service Code	CPT 78814 TC
Hospital Charge Code	4047881401
Hospital Revenue Code	404
Min. Negotiated Rate	$2,185.00
Max. Negotiated Rate	$2,185.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,185.00

HC PET IMAGING FOR CT ATTENUATION WHOLE BODY - PT/CT BONE WHOLE BODY

Facility

$4,370.00

Service Code	CPT 78816 TC
Hospital Charge Code	4047881601
Hospital Revenue Code	404
Min. Negotiated Rate	$702.96
Max. Negotiated Rate	$3,277.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,403.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$875.00
Rate for Payer: Aetna Government	$875.00
Rate for Payer: Brighton Health Commercial	$3,277.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,229.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,876.93
Rate for Payer: EmblemHealth Commercial	$2,185.00
Rate for Payer: Group Health Inc Commercial	$2,185.00
Rate for Payer: Group Health Inc Medicare	$1,529.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,185.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,185.00
Rate for Payer: Healthfirst Essential Plan	$1,581.66
Rate for Payer: United Healthcare Commercial	$833.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$702.96

HC PET IMAGING FOR CT ATTENUATION WHOLE BODY - PT/CT BONE WHOLE BODY

Facility

$4,370.00

Service Code	CPT 78816 TC
Hospital Charge Code	4047881601
Hospital Revenue Code	404
Min. Negotiated Rate	$2,185.00
Max. Negotiated Rate	$2,185.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,185.00

HC PET IMAGING - LIMITED AREA

Facility

$3,853.00

Service Code	CPT 78811 TC
Hospital Charge Code	4047881101
Hospital Revenue Code	404
Min. Negotiated Rate	$574.69
Max. Negotiated Rate	$2,889.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,119.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$875.00
Rate for Payer: Aetna Government	$875.00
Rate for Payer: Brighton Health Commercial	$2,889.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,229.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,876.93
Rate for Payer: EmblemHealth Commercial	$1,926.50
Rate for Payer: Group Health Inc Commercial	$1,926.50
Rate for Payer: Group Health Inc Medicare	$1,348.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,926.50
Rate for Payer: Healthfirst Essential Plan	$1,293.05
Rate for Payer: United Healthcare Commercial	$833.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$574.69

HC PET IMAGING - LIMITED AREA

Facility

$3,853.00

Service Code	CPT 78811 TC
Hospital Charge Code	4047881101
Hospital Revenue Code	404
Min. Negotiated Rate	$1,926.50
Max. Negotiated Rate	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50

Know your out-of-pocket cost for care.

All Charges