St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC PULM FUNCT TST PLETHYSMOGRAP - BODY PLETHYSMOGRAPHIC LUNG VOLUMES

Facility

$766.00

Service Code	CPT 94726
Hospital Charge Code	4609472602
Hospital Revenue Code	460
Min. Negotiated Rate	$383.00
Max. Negotiated Rate	$383.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.00

HC PULM FUNCT TST PLETHYSMOGRAP - PLETHYSMOGRAPHY

Facility

$766.00

Service Code	CPT 94726
Hospital Charge Code	4609472601
Hospital Revenue Code	460
Min. Negotiated Rate	$65.54
Max. Negotiated Rate	$612.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$380.47
Rate for Payer: Aetna Government	$380.47
Rate for Payer: Affinity Essential Plan 1&2	$266.33
Rate for Payer: Affinity Essential Plan 3&4	$266.33
Rate for Payer: Affinity Medicaid/CHP/HARP	$266.33
Rate for Payer: Brighton Health Commercial	$574.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$380.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$612.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$520.88
Rate for Payer: Elderplan Medicare Advantage	$380.47
Rate for Payer: EmblemHealth Commercial	$380.47
Rate for Payer: Fidelis CHP/HARP/Medicaid	$342.42
Rate for Payer: Fidelis Essential Plan Aliesa	$323.40
Rate for Payer: Fidelis Essential Plan QHP	$338.62
Rate for Payer: Fidelis Medicare Advantage	$380.47
Rate for Payer: Fidelis Qualified Health Plan	$338.62
Rate for Payer: Group Health Inc Commercial	$380.47
Rate for Payer: Group Health Inc Medicare	$380.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$380.47
Rate for Payer: Hamaspik Choice Inc Medicare	$380.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$65.54
Rate for Payer: Healthfirst Medicare Advantage	$323.40
Rate for Payer: Healthfirst QHP	$380.47
Rate for Payer: Humana Medicare	$388.08
Rate for Payer: Senior Whole Health Medicare Advantage	$380.47
Rate for Payer: United Healthcare Commercial	$383.00
Rate for Payer: United Healthcare Medicare Advantage	$380.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$380.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$361.45
Rate for Payer: Wellcare Medicare	$361.45

HC PULM FUNCT TST PLETHYSMOGRAP - PLETHYSMOGRAPHY

Facility

$766.00

Service Code	CPT 94726
Hospital Charge Code	4609472601
Hospital Revenue Code	460
Min. Negotiated Rate	$383.00
Max. Negotiated Rate	$383.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.00

HC PULMONARY STRESS TESTING

Facility

$330.00

Service Code	CPT 94618 TC
Hospital Charge Code	4609461801
Hospital Revenue Code	460
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$165.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.00

HC PULMONARY STRESS TESTING

Facility

$330.00

Service Code	CPT 94618 TC
Hospital Charge Code	4609461801
Hospital Revenue Code	460
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$264.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$181.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.45
Rate for Payer: Aetna Government	$10.45
Rate for Payer: Brighton Health Commercial	$247.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$264.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$224.40
Rate for Payer: EmblemHealth Commercial	$165.00
Rate for Payer: Group Health Inc Commercial	$165.00
Rate for Payer: Group Health Inc Medicare	$115.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.00
Rate for Payer: Hamaspik Choice Inc Medicare	$165.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$14.98
Rate for Payer: United Healthcare Commercial	$165.00

HC PUNC ASPIRATION ABSCESS/HEMOTOMA/BUKKA/CYST

Facility

$967.00

Service Code	CPT 10160 TC
Hospital Charge Code	3611016001
Hospital Revenue Code	361
Min. Negotiated Rate	$80.87
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$111.35
Rate for Payer: Aetna Government	$111.35
Rate for Payer: Brighton Health Commercial	$725.25
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	$483.50
Rate for Payer: Group Health Inc Commercial	$483.50
Rate for Payer: Group Health Inc Medicare	$338.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$483.50
Rate for Payer: Hamaspik Choice Inc Medicare	$80.87
Rate for Payer: United Healthcare Commercial	$1,113.00

HC PUNC ASPIRATION ABSCESS/HEMOTOMA/BUKKA/CYST

Facility

$967.00

Service Code	CPT 10160 TC
Hospital Charge Code	3611016001
Hospital Revenue Code	361
Min. Negotiated Rate	$483.50
Max. Negotiated Rate	$483.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$483.50

HC PUNCH BIOPSY, SKIN, EACH ADD'L LESION (ADDON)

Facility

$356.00

Service Code	CPT 11105
Hospital Charge Code	3611110501
Hospital Revenue Code	361
Min. Negotiated Rate	$23.39
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.39
Rate for Payer: Aetna Government	$23.39
Rate for Payer: Brighton Health Commercial	$267.00
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	$178.00
Rate for Payer: Group Health Inc Commercial	$178.00
Rate for Payer: Group Health Inc Medicare	$124.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$178.00
Rate for Payer: Hamaspik Choice Inc Medicare	$178.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28.91
Rate for Payer: United Healthcare Commercial	$1,113.00

HC PUNCH BIOPSY, SKIN, EACH ADD'L LESION (ADDON)

Facility

$356.00

Service Code	CPT 11105
Hospital Charge Code	3611110501
Hospital Revenue Code	361
Min. Negotiated Rate	$178.00
Max. Negotiated Rate	$178.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$178.00

HC PUNCH BIOPSY, SKIN, SINGLE LESION

Facility

$529.00

Service Code	CPT 11104
Hospital Charge Code	3611110401
Hospital Revenue Code	361
Min. Negotiated Rate	$264.50
Max. Negotiated Rate	$264.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.50

HC PUNCH BIOPSY, SKIN, SINGLE LESION

Facility

$529.00

Service Code	CPT 11104
Hospital Charge Code	3611110401
Hospital Revenue Code	361
Min. Negotiated Rate	$53.02
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$488.15
Rate for Payer: Aetna Government	$488.15
Rate for Payer: Affinity Essential Plan 1&2	$341.70
Rate for Payer: Affinity Essential Plan 3&4	$341.70
Rate for Payer: Affinity Medicaid/CHP/HARP	$341.70
Rate for Payer: Brighton Health Commercial	$396.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$488.15
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	$488.15
Rate for Payer: EmblemHealth Commercial	$488.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$439.33
Rate for Payer: Fidelis Essential Plan Aliesa	$414.93
Rate for Payer: Fidelis Essential Plan QHP	$434.45
Rate for Payer: Fidelis Medicare Advantage	$488.15
Rate for Payer: Fidelis Qualified Health Plan	$434.45
Rate for Payer: Group Health Inc Commercial	$488.15
Rate for Payer: Group Health Inc Medicare	$488.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$488.15
Rate for Payer: Hamaspik Choice Inc Medicare	$89.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$53.02
Rate for Payer: Healthfirst Medicare Advantage	$414.93
Rate for Payer: Healthfirst QHP	$488.15
Rate for Payer: Humana Medicare	$497.91
Rate for Payer: Senior Whole Health Medicare Advantage	$488.15
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$488.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$488.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$463.74
Rate for Payer: Wellcare Medicare	$463.74

HC PUNCT ASPIRATION OF BREAST CYST

Facility

$1,847.00

Service Code	CPT 19000 TC
Hospital Charge Code	3611900001
Hospital Revenue Code	361
Min. Negotiated Rate	$63.08
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$97.16
Rate for Payer: Aetna Government	$97.16
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	$63.08
Rate for Payer: United Healthcare Commercial	$1,188.00

HC PUNCT ASPIRATION OF BREAST CYST

Facility

$1,847.00

Service Code	CPT 19000 TC
Hospital Charge Code	3611900001
Hospital Revenue Code	361
Min. Negotiated Rate	$923.50
Max. Negotiated Rate	$923.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.50

HC PUNCT ASPIRATION OF BREAST CYST, EACH ADD'L (ADDON)

Facility

$248.00

Service Code	CPT 19001 TC
Hospital Charge Code	3611900101
Hospital Revenue Code	361
Min. Negotiated Rate	$23.01
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.01
Rate for Payer: Aetna Government	$23.01
Rate for Payer: Brighton Health Commercial	$186.00
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	$124.00
Rate for Payer: Group Health Inc Commercial	$124.00
Rate for Payer: Group Health Inc Medicare	$86.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$124.00
Rate for Payer: Hamaspik Choice Inc Medicare	$124.00
Rate for Payer: United Healthcare Commercial	$1,113.00

HC PUNCT ASPIRATION OF BREAST CYST, EACH ADD'L (ADDON)

Facility

$248.00

Service Code	CPT 19001 TC
Hospital Charge Code	3611900101
Hospital Revenue Code	361
Min. Negotiated Rate	$124.00
Max. Negotiated Rate	$124.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$124.00

HC PUNCTURE ASP OF HYDROCELE

Facility

$1,847.00

Service Code	CPT 55000
Hospital Charge Code	3615500001
Hospital Revenue Code	361
Min. Negotiated Rate	$64.69
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	$1,385.25
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	$64.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$96.26
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 PUNCTURE ASP OF HYDROCELE

Facility

$1,847.00

Service Code	CPT 55000
Hospital Charge Code	3615500001
Hospital Revenue Code	361
Min. Negotiated Rate	$923.50
Max. Negotiated Rate	$923.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.50

HC PUNCTURE DRAINAGE OF LESION

Facility

$967.00

Service Code	CPT 10160 TC
Hospital Charge Code	3611016002
Hospital Revenue Code	361
Min. Negotiated Rate	$483.50
Max. Negotiated Rate	$483.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$483.50

HC PUNCTURE DRAINAGE OF LESION

Facility

$967.00

Service Code	CPT 10160 TC
Hospital Charge Code	3611016002
Hospital Revenue Code	361
Min. Negotiated Rate	$80.87
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$111.35
Rate for Payer: Aetna Government	$111.35
Rate for Payer: Brighton Health Commercial	$725.25
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	$483.50
Rate for Payer: Group Health Inc Commercial	$483.50
Rate for Payer: Group Health Inc Medicare	$338.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$483.50
Rate for Payer: Hamaspik Choice Inc Medicare	$80.87
Rate for Payer: United Healthcare Commercial	$1,113.00

HC PUNCTURE OF SHUNT TUBING/RESERVOIR

Facility

$1,932.00

Service Code	CPT 61070
Hospital Charge Code	3616107001
Hospital Revenue Code	361
Min. Negotiated Rate	$966.00
Max. Negotiated Rate	$966.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$966.00

HC PUNCTURE OF SHUNT TUBING/RESERVOIR

Facility

$1,932.00

Service Code	CPT 61070
Hospital Charge Code	3616107001
Hospital Revenue Code	361
Min. Negotiated Rate	$65.39
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$846.13
Rate for Payer: Aetna Government	$846.13
Rate for Payer: Affinity Essential Plan 1&2	$592.29
Rate for Payer: Affinity Essential Plan 3&4	$592.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$592.29
Rate for Payer: Brighton Health Commercial	$1,449.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$846.13
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	$846.13
Rate for Payer: EmblemHealth Commercial	$846.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$761.52
Rate for Payer: Fidelis Essential Plan Aliesa	$719.21
Rate for Payer: Fidelis Essential Plan QHP	$753.06
Rate for Payer: Fidelis Medicare Advantage	$846.13
Rate for Payer: Fidelis Qualified Health Plan	$753.06
Rate for Payer: Group Health Inc Commercial	$846.13
Rate for Payer: Group Health Inc Medicare	$846.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$846.13
Rate for Payer: Hamaspik Choice Inc Medicare	$371.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$65.39
Rate for Payer: Healthfirst Medicare Advantage	$719.21
Rate for Payer: Healthfirst QHP	$846.13
Rate for Payer: Humana Medicare	$863.05
Rate for Payer: Senior Whole Health Medicare Advantage	$846.13
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$846.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$846.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$803.82
Rate for Payer: Wellcare Medicare	$803.82

HC PURAPLY AM, PER SQ CM

Facility

$296.00

Service Code	CPT Q4196
Hospital Charge Code	636Q419601
Hospital Revenue Code	636
Min. Negotiated Rate	$101.03
Max. Negotiated Rate	$192.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$162.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$108.29
Rate for Payer: Aetna Government	$108.29
Rate for Payer: Brighton Health Commercial	$177.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$148.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.20
Rate for Payer: EmblemHealth Commercial	$148.00
Rate for Payer: Group Health Inc Commercial	$148.00
Rate for Payer: Group Health Inc Medicare	$103.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$101.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$192.40

HC PURAPLY AM, PER SQ CM

Facility

$296.00

Service Code	CPT Q4196
Hospital Charge Code	636Q419601
Hospital Revenue Code	636
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$148.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00

HC PURAPLY, PER SQ CM

Facility

$296.00

Service Code	CPT Q4195
Hospital Charge Code	636Q419501
Hospital Revenue Code	636
Min. Negotiated Rate	$97.94
Max. Negotiated Rate	$192.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$162.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$110.33
Rate for Payer: Aetna Government	$110.33
Rate for Payer: Brighton Health Commercial	$177.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$148.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.20
Rate for Payer: EmblemHealth Commercial	$148.00
Rate for Payer: Group Health Inc Commercial	$148.00
Rate for Payer: Group Health Inc Medicare	$103.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$97.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$192.40

HC PURAPLY, PER SQ CM

Facility

$296.00

Service Code	CPT Q4195
Hospital Charge Code	636Q419501
Hospital Revenue Code	636
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$148.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00
Rate for Payer: Hamaspik Choice Inc Medicare	$148.00

Know your out-of-pocket cost for care.

All Charges