St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC RMVL SUBQ CAR RHYTHM MNTR

Facility

$1,847.00

Service Code	CPT 33286
Hospital Charge Code	3613328601
Hospital Revenue Code	361
Min. Negotiated Rate	$923.50
Max. Negotiated Rate	$923.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.50

HC RMVL SUBQ CAR RHYTHM MNTR

Facility

$1,847.00

Service Code	CPT 33286
Hospital Charge Code	3613328601
Hospital Revenue Code	361
Min. Negotiated Rate	$99.47
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
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	$377.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$99.47
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 RMV & RPL IMPLANTABLE DEFRIB PULSE GEN, DUAL LEAD

Facility

$68,791.00

Service Code	CPT 33263
Hospital Charge Code	3613326301
Hospital Revenue Code	361
Min. Negotiated Rate	$34,395.50
Max. Negotiated Rate	$34,395.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,395.50

HC RMV & RPL IMPLANTABLE DEFRIB PULSE GEN, DUAL LEAD

Facility

$68,791.00

Service Code	CPT 33263
Hospital Charge Code	3613326301
Hospital Revenue Code	361
Min. Negotiated Rate	$450.02
Max. Negotiated Rate	$51,593.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44,507.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27,425.20
Rate for Payer: Aetna Government	$27,425.20
Rate for Payer: Affinity Essential Plan 1&2	$19,197.64
Rate for Payer: Affinity Essential Plan 3&4	$19,197.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,197.64
Rate for Payer: Brighton Health Commercial	$51,593.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$27,425.20
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	$27,425.20
Rate for Payer: EmblemHealth Commercial	$27,425.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,682.68
Rate for Payer: Fidelis Essential Plan Aliesa	$23,311.42
Rate for Payer: Fidelis Essential Plan QHP	$24,408.43
Rate for Payer: Fidelis Medicare Advantage	$27,425.20
Rate for Payer: Fidelis Qualified Health Plan	$24,408.43
Rate for Payer: Group Health Inc Commercial	$27,425.20
Rate for Payer: Group Health Inc Medicare	$27,425.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,425.20
Rate for Payer: Hamaspik Choice Inc Medicare	$18,855.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$450.02
Rate for Payer: Healthfirst Medicare Advantage	$23,311.42
Rate for Payer: Healthfirst QHP	$27,425.20
Rate for Payer: Humana Medicare	$27,973.70
Rate for Payer: Senior Whole Health Medicare Advantage	$27,425.20
Rate for Payer: United Healthcare Commercial	$4,446.00
Rate for Payer: United Healthcare Medicare Advantage	$27,425.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27,425.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,053.94
Rate for Payer: Wellcare Medicare	$26,053.94

HC RMV & RPL IMPLANTABLE DEFRIB PULSE GEN, MULTI LEAD

Facility

$97,776.00

Service Code	CPT 33264
Hospital Charge Code	3613326401
Hospital Revenue Code	361
Min. Negotiated Rate	$469.08
Max. Negotiated Rate	$73,332.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44,507.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$39,173.48
Rate for Payer: Aetna Government	$39,173.48
Rate for Payer: Affinity Essential Plan 1&2	$27,421.44
Rate for Payer: Affinity Essential Plan 3&4	$27,421.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$27,421.44
Rate for Payer: Brighton Health Commercial	$73,332.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$39,173.48
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	$39,173.48
Rate for Payer: EmblemHealth Commercial	$39,173.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$35,256.13
Rate for Payer: Fidelis Essential Plan Aliesa	$33,297.46
Rate for Payer: Fidelis Essential Plan QHP	$34,864.40
Rate for Payer: Fidelis Medicare Advantage	$39,173.48
Rate for Payer: Fidelis Qualified Health Plan	$34,864.40
Rate for Payer: Group Health Inc Commercial	$39,173.48
Rate for Payer: Group Health Inc Medicare	$39,173.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$39,173.48
Rate for Payer: Hamaspik Choice Inc Medicare	$25,154.33
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$469.08
Rate for Payer: Healthfirst Medicare Advantage	$33,297.46
Rate for Payer: Healthfirst QHP	$39,173.48
Rate for Payer: Humana Medicare	$39,956.95
Rate for Payer: Senior Whole Health Medicare Advantage	$39,173.48
Rate for Payer: United Healthcare Commercial	$4,446.00
Rate for Payer: United Healthcare Medicare Advantage	$39,173.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39,173.48
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37,214.81
Rate for Payer: Wellcare Medicare	$37,214.81

HC RMV & RPL IMPLANTABLE DEFRIB PULSE GEN, MULTI LEAD

Facility

$97,776.00

Service Code	CPT 33264
Hospital Charge Code	3613326401
Hospital Revenue Code	361
Min. Negotiated Rate	$48,888.00
Max. Negotiated Rate	$48,888.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$48,888.00

HC RMV & RPL IMPLANTABLE DEFRIB PULSE GEN, SINGLE LEAD

Facility

$68,791.00

Service Code	CPT 33262
Hospital Charge Code	3613326201
Hospital Revenue Code	361
Min. Negotiated Rate	$432.28
Max. Negotiated Rate	$51,593.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44,507.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27,425.20
Rate for Payer: Aetna Government	$27,425.20
Rate for Payer: Affinity Essential Plan 1&2	$19,197.64
Rate for Payer: Affinity Essential Plan 3&4	$19,197.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,197.64
Rate for Payer: Brighton Health Commercial	$51,593.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$27,425.20
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	$27,425.20
Rate for Payer: EmblemHealth Commercial	$27,425.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,682.68
Rate for Payer: Fidelis Essential Plan Aliesa	$23,311.42
Rate for Payer: Fidelis Essential Plan QHP	$24,408.43
Rate for Payer: Fidelis Medicare Advantage	$27,425.20
Rate for Payer: Fidelis Qualified Health Plan	$24,408.43
Rate for Payer: Group Health Inc Commercial	$27,425.20
Rate for Payer: Group Health Inc Medicare	$27,425.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,425.20
Rate for Payer: Hamaspik Choice Inc Medicare	$18,722.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$432.28
Rate for Payer: Healthfirst Medicare Advantage	$23,311.42
Rate for Payer: Healthfirst QHP	$27,425.20
Rate for Payer: Humana Medicare	$27,973.70
Rate for Payer: Senior Whole Health Medicare Advantage	$27,425.20
Rate for Payer: United Healthcare Commercial	$4,446.00
Rate for Payer: United Healthcare Medicare Advantage	$27,425.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27,425.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,053.94
Rate for Payer: Wellcare Medicare	$26,053.94

HC RMV & RPL IMPLANTABLE DEFRIB PULSE GEN, SINGLE LEAD

Facility

$68,791.00

Service Code	CPT 33262
Hospital Charge Code	3613326201
Hospital Revenue Code	361
Min. Negotiated Rate	$34,395.50
Max. Negotiated Rate	$34,395.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,395.50

HC ROOM & BOARD ER FLOAT BED

Facility

$4,093.00

Hospital Charge Code	1200000003
Hospital Revenue Code	120
Min. Negotiated Rate	$2,046.50
Max. Negotiated Rate	$2,046.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,046.50

HC ROOM & BOARD INTENSIVE CARE UNIT

Facility

$6,198.00

Hospital Charge Code	2000000001
Hospital Revenue Code	200
Min. Negotiated Rate	$3,099.00
Max. Negotiated Rate	$3,099.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,099.00

HC ROOM & BOARD ISOLATION

Facility

$5,457.00

Hospital Charge Code	1400000001
Hospital Revenue Code	140
Min. Negotiated Rate	$2,728.50
Max. Negotiated Rate	$2,728.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,728.50

HC ROOM & BOARD PRIVATE

Facility

$4,209.00

Hospital Charge Code	1100000001
Hospital Revenue Code	110
Min. Negotiated Rate	$2,104.50
Max. Negotiated Rate	$2,104.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,104.50

HC ROOM & BOARD PSYCH ER FLOAT BED

Facility

$4,093.00

Hospital Charge Code	1240000003
Hospital Revenue Code	124
Min. Negotiated Rate	$760.00
Max. Negotiated Rate	$2,046.50
Rate for Payer: Amida Care Medicaid	$800.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$760.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$860.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,085.00
Rate for Payer: Fidelis Essential Plan QHP	$1,085.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,046.50
Rate for Payer: Optum Commercial/Medicare	$776.00
Rate for Payer: Optum Medicaid	$761.00

HC ROOM & BOARD RESPIRATORY UNIT SEMI-PRIVATE

Facility

$5,302.00

Hospital Charge Code	1200000002
Hospital Revenue Code	120
Min. Negotiated Rate	$2,651.00
Max. Negotiated Rate	$2,651.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,651.00

HC ROOM & BOARD SEMI-PRIVATE

Facility

$4,093.00

Hospital Charge Code	1200000001
Hospital Revenue Code	120
Min. Negotiated Rate	$2,046.50
Max. Negotiated Rate	$2,046.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,046.50

HC ROOM & BOARD TELEMETRY

Facility

$5,302.00

Hospital Charge Code	2000000002
Hospital Revenue Code	200
Min. Negotiated Rate	$2,651.00
Max. Negotiated Rate	$2,651.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,651.00

HC RPLC GTUBE, PERC, NO REVSN REQ

Facility

$711.00

Service Code	CPT 43762 TC
Hospital Charge Code	3614376201
Hospital Revenue Code	361
Min. Negotiated Rate	$130.70
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$258.07
Rate for Payer: Aetna Government	$258.07
Rate for Payer: Brighton Health Commercial	$533.25
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	$355.50
Rate for Payer: Group Health Inc Commercial	$355.50
Rate for Payer: Group Health Inc Medicare	$248.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$355.50
Rate for Payer: Hamaspik Choice Inc Medicare	$130.70
Rate for Payer: United Healthcare Commercial	$1,113.00

HC RPLC GTUBE, PERC, NO REVSN REQ

Facility

$711.00

Service Code	CPT 43762 TC
Hospital Charge Code	3614376201
Hospital Revenue Code	361
Min. Negotiated Rate	$355.50
Max. Negotiated Rate	$355.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$355.50

HC RPLC GTUBE, PERC, REVSN REQ

Facility

$711.00

Service Code	CPT 43763 TC
Hospital Charge Code	3614376301
Hospital Revenue Code	361
Min. Negotiated Rate	$130.70
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$382.46
Rate for Payer: Aetna Government	$382.46
Rate for Payer: Brighton Health Commercial	$533.25
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	$355.50
Rate for Payer: Group Health Inc Commercial	$355.50
Rate for Payer: Group Health Inc Medicare	$248.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$355.50
Rate for Payer: Hamaspik Choice Inc Medicare	$130.70
Rate for Payer: United Healthcare Commercial	$1,113.00

HC RPLC GTUBE, PERC, REVSN REQ

Facility

$711.00

Service Code	CPT 43762 TC
Hospital Charge Code	3614376202
Hospital Revenue Code	361
Min. Negotiated Rate	$355.50
Max. Negotiated Rate	$355.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$355.50

HC RPLC GTUBE, PERC, REVSN REQ

Facility

$711.00

Service Code	CPT 43762 TC
Hospital Charge Code	3614376202
Hospital Revenue Code	361
Min. Negotiated Rate	$130.70
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$258.07
Rate for Payer: Aetna Government	$258.07
Rate for Payer: Brighton Health Commercial	$533.25
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	$355.50
Rate for Payer: Group Health Inc Commercial	$355.50
Rate for Payer: Group Health Inc Medicare	$248.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$355.50
Rate for Payer: Hamaspik Choice Inc Medicare	$130.70
Rate for Payer: United Healthcare Commercial	$1,113.00

HC RPLC GTUBE, PERC, REVSN REQ

Facility

$711.00

Service Code	CPT 43763 TC
Hospital Charge Code	3614376301
Hospital Revenue Code	361
Min. Negotiated Rate	$355.50
Max. Negotiated Rate	$355.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$355.50

HC RSV MONOC ANTB SEASN 1 ML IM

Facility

$94.00

Service Code	CPT 90381
Hospital Charge Code	6369038101
Hospital Revenue Code	636
Min. Negotiated Rate	$47.00
Max. Negotiated Rate	$47.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.00
Rate for Payer: Hamaspik Choice Inc Medicare	$47.00

HC RSV MONOC ANTB SEASN 1 ML IM

Facility

$94.00

Service Code	CPT 90381
Hospital Charge Code	6369038101
Hospital Revenue Code	636
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$61.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.00
Rate for Payer: Aetna Government	$47.00
Rate for Payer: Brighton Health Commercial	$56.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$54.05
Rate for Payer: EmblemHealth Commercial	$47.00
Rate for Payer: Group Health Inc Commercial	$47.00
Rate for Payer: Group Health Inc Medicare	$32.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.00
Rate for Payer: Hamaspik Choice Inc Medicare	$47.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$61.10

HC RSV MONOC ANTB SEASN .5ML IM

Facility

$94.00

Service Code	CPT 90380
Hospital Charge Code	6369038001
Hospital Revenue Code	636
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$61.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.00
Rate for Payer: Aetna Government	$47.00
Rate for Payer: Brighton Health Commercial	$56.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$54.05
Rate for Payer: EmblemHealth Commercial	$47.00
Rate for Payer: Group Health Inc Commercial	$47.00
Rate for Payer: Group Health Inc Medicare	$32.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.00
Rate for Payer: Hamaspik Choice Inc Medicare	$47.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$61.10

Know your out-of-pocket cost for care.

All Charges