St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC PET IMAGING - SKULL BASE - MID. THIGH

Facility

$4,370.00

Service Code	CPT 78812 TC
Hospital Charge Code	4047881201
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 - SKULL BASE - MID. THIGH

Facility

$4,370.00

Service Code	CPT 78812 TC
Hospital Charge Code	4047881201
Hospital Revenue Code	404
Min. Negotiated Rate	$257.55
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	$579.49
Rate for Payer: United Healthcare Commercial	$833.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$257.55

HC PET IMAGING - WHOLE BODY

Facility

$4,370.00

Service Code	CPT 78813 TC
Hospital Charge Code	4047881301
Hospital Revenue Code	404
Min. Negotiated Rate	$833.59
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	$1,924.81
Rate for Payer: United Healthcare Commercial	$833.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$855.47

HC PET IMAGING - WHOLE BODY

Facility

$4,370.00

Service Code	CPT 78813 TC
Hospital Charge Code	4047881301
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 PFIZERCOVID19 VAC ADMIN 1ST DOSE 6MONS-5YRS

Facility

$102.00

Service Code	CPT 0081A
Hospital Charge Code	7710081A01
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 PFIZERCOVID19 VAC ADMIN 1ST DOSE 6MONS-5YRS

Facility

$102.00

Service Code	CPT 0081A
Hospital Charge Code	7710081A01
Hospital Revenue Code	771
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00

HC PFIZERCOVID19 VAC ADMIN 2ND DOSE 6MONS-5YRS

Facility

$102.00

Service Code	CPT 0082A
Hospital Charge Code	7710082A01
Hospital Revenue Code	771
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00

HC PFIZERCOVID19 VAC ADMIN 2ND DOSE 6MONS-5YRS

Facility

$102.00

Service Code	CPT 0082A
Hospital Charge Code	7710082A01
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 PFIZER COVID19 VAC ADMIN BOOSTER DOSE

Facility

$102.00

Service Code	CPT 0124A
Hospital Charge Code	7710124A01
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 PFIZER COVID19 VAC ADMIN BOOSTER DOSE

Facility

$102.00

Service Code	CPT 0124A
Hospital Charge Code	7710124A01
Hospital Revenue Code	771
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00

HC PFIZER COVID19 VAC PEDS ADMIN 1ST DOSE

Facility

$102.00

Service Code	CPT 0071A
Hospital Charge Code	7710071A01
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 PFIZER COVID19 VAC PEDS ADMIN 1ST DOSE

Facility

$102.00

Service Code	CPT 0071A
Hospital Charge Code	7710071A01
Hospital Revenue Code	771
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00

HC PFIZER COVID19 VAC PEDS ADMIN 2ND DOSE

Facility

$102.00

Service Code	CPT 0072A
Hospital Charge Code	7710072A01
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 PFIZER COVID19 VAC PEDS ADMIN 2ND DOSE

Facility

$102.00

Service Code	CPT 0072A
Hospital Charge Code	7710072A01
Hospital Revenue Code	771
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00

HC PFIZER COVID19 VAC PEDS ADMIN 3RD DOSE

Facility

$102.00

Service Code	CPT 0073A
Hospital Charge Code	7710073A01
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 PFIZER COVID19 VAC PEDS ADMIN 3RD DOSE

Facility

$102.00

Service Code	CPT 0073A
Hospital Charge Code	7710073A01
Hospital Revenue Code	771
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00

HC PHARMACOLOGIC MGMT W/PSYCH TX

Facility

$453.00

Service Code	CPT 90863
Hospital Charge Code	9139086301
Hospital Revenue Code	913
Min. Negotiated Rate	$226.50
Max. Negotiated Rate	$226.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$226.50

HC PHARMACOLOGIC MGMT W/PSYCH TX

Facility

$453.00

Service Code	CPT 90863
Hospital Charge Code	9139086301
Hospital Revenue Code	913
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$362.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$249.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.00
Rate for Payer: Aetna Government	$30.00
Rate for Payer: Brighton Health Commercial	$339.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$362.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$308.04
Rate for Payer: EmblemHealth Commercial	$226.50
Rate for Payer: Group Health Inc Commercial	$226.50
Rate for Payer: Group Health Inc Medicare	$158.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$226.50
Rate for Payer: Hamaspik Choice Inc Medicare	$226.50

HC PH BODY FLUID NOS - PH BODY FLUID

Facility

$8.00

Service Code	CPT 83986
Hospital Charge Code	3018398601
Hospital Revenue Code	301
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$6.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.58
Rate for Payer: Aetna Government	$3.58
Rate for Payer: Affinity Essential Plan 1&2	$2.51
Rate for Payer: Affinity Essential Plan 3&4	$2.51
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.51
Rate for Payer: Brighton Health Commercial	$6.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.14
Rate for Payer: Elderplan Medicare Advantage	$3.58
Rate for Payer: EmblemHealth Commercial	$3.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.22
Rate for Payer: Fidelis Essential Plan Aliesa	$3.04
Rate for Payer: Fidelis Essential Plan QHP	$3.19
Rate for Payer: Fidelis Medicare Advantage	$3.58
Rate for Payer: Fidelis Qualified Health Plan	$3.19
Rate for Payer: Group Health Inc Commercial	$3.58
Rate for Payer: Group Health Inc Medicare	$3.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.58
Rate for Payer: Hamaspik Choice Inc Medicare	$3.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.58
Rate for Payer: Healthfirst Medicare Advantage	$3.58
Rate for Payer: Healthfirst QHP	$3.58
Rate for Payer: Humana Medicare	$3.65
Rate for Payer: Senior Whole Health Medicare Advantage	$3.58
Rate for Payer: United Healthcare Commercial	$4.54
Rate for Payer: United Healthcare Medicare Advantage	$3.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.40
Rate for Payer: Wellcare Medicare	$3.22

HC PH BODY FLUID NOS - PH BODY FLUID

Facility

$8.00

Service Code	CPT 83986
Hospital Charge Code	3018398601
Hospital Revenue Code	301
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00

HC PH BODY FLUID NOS - PH STOOL

Facility

$8.00

Service Code	CPT 83986
Hospital Charge Code	3018398603
Hospital Revenue Code	301
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00

HC PH BODY FLUID NOS - PH STOOL

Facility

$8.00

Service Code	CPT 83986
Hospital Charge Code	3018398603
Hospital Revenue Code	301
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$6.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.58
Rate for Payer: Aetna Government	$3.58
Rate for Payer: Affinity Essential Plan 1&2	$2.51
Rate for Payer: Affinity Essential Plan 3&4	$2.51
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.51
Rate for Payer: Brighton Health Commercial	$6.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.14
Rate for Payer: Elderplan Medicare Advantage	$3.58
Rate for Payer: EmblemHealth Commercial	$3.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.22
Rate for Payer: Fidelis Essential Plan Aliesa	$3.04
Rate for Payer: Fidelis Essential Plan QHP	$3.19
Rate for Payer: Fidelis Medicare Advantage	$3.58
Rate for Payer: Fidelis Qualified Health Plan	$3.19
Rate for Payer: Group Health Inc Commercial	$3.58
Rate for Payer: Group Health Inc Medicare	$3.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.58
Rate for Payer: Hamaspik Choice Inc Medicare	$3.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.58
Rate for Payer: Healthfirst Medicare Advantage	$3.58
Rate for Payer: Healthfirst QHP	$3.58
Rate for Payer: Humana Medicare	$3.65
Rate for Payer: Senior Whole Health Medicare Advantage	$3.58
Rate for Payer: United Healthcare Commercial	$4.54
Rate for Payer: United Healthcare Medicare Advantage	$3.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.40
Rate for Payer: Wellcare Medicare	$3.22

HC PH BODY FLUID NOS - POCT GASTRIC PH

Facility

$8.00

Service Code	CPT 83986
Hospital Charge Code	3018398604
Hospital Revenue Code	301
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00

HC PH BODY FLUID NOS - POCT GASTRIC PH

Facility

$8.00

Service Code	CPT 83986
Hospital Charge Code	3018398604
Hospital Revenue Code	301
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$6.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.58
Rate for Payer: Aetna Government	$3.58
Rate for Payer: Affinity Essential Plan 1&2	$2.51
Rate for Payer: Affinity Essential Plan 3&4	$2.51
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.51
Rate for Payer: Brighton Health Commercial	$6.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.14
Rate for Payer: Elderplan Medicare Advantage	$3.58
Rate for Payer: EmblemHealth Commercial	$3.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.22
Rate for Payer: Fidelis Essential Plan Aliesa	$3.04
Rate for Payer: Fidelis Essential Plan QHP	$3.19
Rate for Payer: Fidelis Medicare Advantage	$3.58
Rate for Payer: Fidelis Qualified Health Plan	$3.19
Rate for Payer: Group Health Inc Commercial	$3.58
Rate for Payer: Group Health Inc Medicare	$3.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.58
Rate for Payer: Hamaspik Choice Inc Medicare	$3.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.58
Rate for Payer: Healthfirst Medicare Advantage	$3.58
Rate for Payer: Healthfirst QHP	$3.58
Rate for Payer: Humana Medicare	$3.65
Rate for Payer: Senior Whole Health Medicare Advantage	$3.58
Rate for Payer: United Healthcare Commercial	$4.54
Rate for Payer: United Healthcare Medicare Advantage	$3.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.40
Rate for Payer: Wellcare Medicare	$3.22

HC PH BODY FLUID NOS - POCT VAGINAL PH

Facility

$8.00

Service Code	CPT 83986
Hospital Charge Code	3018398605
Hospital Revenue Code	301
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$6.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.58
Rate for Payer: Aetna Government	$3.58
Rate for Payer: Affinity Essential Plan 1&2	$2.51
Rate for Payer: Affinity Essential Plan 3&4	$2.51
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.51
Rate for Payer: Brighton Health Commercial	$6.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.14
Rate for Payer: Elderplan Medicare Advantage	$3.58
Rate for Payer: EmblemHealth Commercial	$3.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.22
Rate for Payer: Fidelis Essential Plan Aliesa	$3.04
Rate for Payer: Fidelis Essential Plan QHP	$3.19
Rate for Payer: Fidelis Medicare Advantage	$3.58
Rate for Payer: Fidelis Qualified Health Plan	$3.19
Rate for Payer: Group Health Inc Commercial	$3.58
Rate for Payer: Group Health Inc Medicare	$3.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.58
Rate for Payer: Hamaspik Choice Inc Medicare	$3.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.58
Rate for Payer: Healthfirst Medicare Advantage	$3.58
Rate for Payer: Healthfirst QHP	$3.58
Rate for Payer: Humana Medicare	$3.65
Rate for Payer: Senior Whole Health Medicare Advantage	$3.58
Rate for Payer: United Healthcare Commercial	$4.54
Rate for Payer: United Healthcare Medicare Advantage	$3.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.40
Rate for Payer: Wellcare Medicare	$3.22

Know your out-of-pocket cost for care.

All Charges