St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC SKIN SUB GRAFT TRNK/ARM/LEG, CHILD

Facility

$9,017.00

Service Code	CPT 15273
Hospital Charge Code	3611527301
Hospital Revenue Code	361
Min. Negotiated Rate	$223.95
Max. Negotiated Rate	$6,762.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,473.05
Rate for Payer: Aetna Government	$4,473.05
Rate for Payer: Affinity Essential Plan 1&2	$3,131.14
Rate for Payer: Affinity Essential Plan 3&4	$3,131.14
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,131.14
Rate for Payer: Brighton Health Commercial	$6,762.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4,473.05
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	$4,473.05
Rate for Payer: EmblemHealth Commercial	$4,473.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4,025.74
Rate for Payer: Fidelis Essential Plan Aliesa	$3,802.09
Rate for Payer: Fidelis Essential Plan QHP	$3,981.01
Rate for Payer: Fidelis Medicare Advantage	$4,473.05
Rate for Payer: Fidelis Qualified Health Plan	$3,981.01
Rate for Payer: Group Health Inc Commercial	$4,473.05
Rate for Payer: Group Health Inc Medicare	$4,473.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,473.05
Rate for Payer: Hamaspik Choice Inc Medicare	$1,957.33
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$223.95
Rate for Payer: Healthfirst Medicare Advantage	$3,802.09
Rate for Payer: Healthfirst QHP	$4,473.05
Rate for Payer: Humana Medicare	$4,562.51
Rate for Payer: Senior Whole Health Medicare Advantage	$4,473.05
Rate for Payer: United Healthcare Commercial	$1,835.00
Rate for Payer: United Healthcare Medicare Advantage	$4,473.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,473.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4,249.40
Rate for Payer: Wellcare Medicare	$4,249.40

HC SKIN SUB GRAFT TRNK/ARM/LEG, CHILD

Facility

$9,017.00

Service Code	CPT 15273
Hospital Charge Code	3611527301
Hospital Revenue Code	361
Min. Negotiated Rate	$4,508.50
Max. Negotiated Rate	$4,508.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,508.50

HC SKIN SUB GRAFT TRNK/ARM/LEG, CHILD (ADDON)

Facility

$261.00

Service Code	CPT 15274
Hospital Charge Code	3611527401
Hospital Revenue Code	361
Min. Negotiated Rate	$40.83
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.83
Rate for Payer: Aetna Government	$40.83
Rate for Payer: Brighton Health Commercial	$195.75
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	$130.50
Rate for Payer: Group Health Inc Commercial	$130.50
Rate for Payer: Group Health Inc Medicare	$91.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.50
Rate for Payer: Hamaspik Choice Inc Medicare	$130.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$51.04
Rate for Payer: United Healthcare Commercial	$1,113.00

HC SKIN SUB GRAFT TRNK/ARM/LEG, CHILD (ADDON)

Facility

$261.00

Service Code	CPT 15274
Hospital Charge Code	3611527401
Hospital Revenue Code	361
Min. Negotiated Rate	$130.50
Max. Negotiated Rate	$130.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.50

HC SKIN SUBSTITUE, NOS

Facility

$3,544.00

Service Code	CPT Q4100
Hospital Charge Code	636Q410001
Hospital Revenue Code	636
Min. Negotiated Rate	$1,772.00
Max. Negotiated Rate	$1,772.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,772.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,772.00

HC SKIN SUBSTITUE, NOS

Facility

$3,544.00

Service Code	CPT Q4100
Hospital Charge Code	636Q410001
Hospital Revenue Code	636
Min. Negotiated Rate	$9.74
Max. Negotiated Rate	$2,303.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,949.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.74
Rate for Payer: Aetna Government	$9.74
Rate for Payer: Brighton Health Commercial	$2,126.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,772.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,037.80
Rate for Payer: EmblemHealth Commercial	$1,772.00
Rate for Payer: Group Health Inc Commercial	$1,772.00
Rate for Payer: Group Health Inc Medicare	$1,240.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,772.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,772.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,303.60

HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BILAT

Facility

$8,393.00

Service Code	CPT 36252 TC
Hospital Charge Code	3203625201
Hospital Revenue Code	320
Min. Negotiated Rate	$4,196.50
Max. Negotiated Rate	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50

HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BILAT

Facility

$8,393.00

Service Code	CPT 36252 TC
Hospital Charge Code	3203625201
Hospital Revenue Code	320
Min. Negotiated Rate	$1,680.79
Max. Negotiated Rate	$6,714.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,680.79
Rate for Payer: Aetna Government	$1,680.79
Rate for Payer: Brighton Health Commercial	$6,294.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,714.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,707.24
Rate for Payer: EmblemHealth Commercial	$4,196.50
Rate for Payer: Group Health Inc Commercial	$4,196.50
Rate for Payer: Group Health Inc Medicare	$2,937.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,196.50

HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I UNI

Facility

$8,818.00

Service Code	CPT 36251 TC
Hospital Charge Code	3203625101
Hospital Revenue Code	320
Min. Negotiated Rate	$4,409.00
Max. Negotiated Rate	$4,409.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,409.00

HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I UNI

Facility

$8,818.00

Service Code	CPT 36251 TC
Hospital Charge Code	3203625101
Hospital Revenue Code	320
Min. Negotiated Rate	$1,546.38
Max. Negotiated Rate	$7,054.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,546.38
Rate for Payer: Aetna Government	$1,546.38
Rate for Payer: Brighton Health Commercial	$6,613.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,054.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,996.24
Rate for Payer: EmblemHealth Commercial	$4,409.00
Rate for Payer: Group Health Inc Commercial	$4,409.00
Rate for Payer: Group Health Inc Medicare	$3,086.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,409.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,409.00

HC SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART

Facility

$13,920.00

Service Code	CPT 36223 TC
Hospital Charge Code	3613622301
Hospital Revenue Code	361
Min. Negotiated Rate	$6,960.00
Max. Negotiated Rate	$6,960.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,960.00

HC SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART

Facility

$13,920.00

Service Code	CPT 36223 TC
Hospital Charge Code	3613622301
Hospital Revenue Code	361
Min. Negotiated Rate	$1,671.68
Max. Negotiated Rate	$10,440.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,065.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,671.68
Rate for Payer: Aetna Government	$1,671.68
Rate for Payer: Brighton Health Commercial	$10,440.00
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	$6,960.00
Rate for Payer: Group Health Inc Commercial	$6,960.00
Rate for Payer: Group Health Inc Medicare	$4,872.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,960.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,960.00
Rate for Payer: United Healthcare Commercial	$2,546.00

HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART

Facility

$8,393.00

Service Code	CPT 36222 TC
Hospital Charge Code	3613622201
Hospital Revenue Code	361
Min. Negotiated Rate	$1,429.48
Max. Negotiated Rate	$6,294.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,065.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,429.48
Rate for Payer: Aetna Government	$1,429.48
Rate for Payer: Brighton Health Commercial	$6,294.75
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	$4,196.50
Rate for Payer: Group Health Inc Commercial	$4,196.50
Rate for Payer: Group Health Inc Medicare	$2,937.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,196.50
Rate for Payer: United Healthcare Commercial	$1,835.00

HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART

Facility

$8,393.00

Service Code	CPT 36222 TC
Hospital Charge Code	3613622201
Hospital Revenue Code	361
Min. Negotiated Rate	$4,196.50
Max. Negotiated Rate	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50

HC SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT

Facility

$1,147.00

Service Code	CPT 36228 TC
Hospital Charge Code	3613622801
Hospital Revenue Code	361
Min. Negotiated Rate	$401.45
Max. Negotiated Rate	$4,065.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,065.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,321.78
Rate for Payer: Aetna Government	$1,321.78
Rate for Payer: Brighton Health Commercial	$860.25
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	$573.50
Rate for Payer: Group Health Inc Commercial	$573.50
Rate for Payer: Group Health Inc Medicare	$401.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$573.50
Rate for Payer: Hamaspik Choice Inc Medicare	$573.50
Rate for Payer: United Healthcare Commercial	$1,113.00

HC SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT

Facility

$1,147.00

Service Code	CPT 36228 TC
Hospital Charge Code	3613622801
Hospital Revenue Code	361
Min. Negotiated Rate	$573.50
Max. Negotiated Rate	$573.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$573.50

HC SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART

Facility

$13,920.00

Service Code	CPT 36224 TC
Hospital Charge Code	3613622401
Hospital Revenue Code	361
Min. Negotiated Rate	$6,960.00
Max. Negotiated Rate	$6,960.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,960.00

HC SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART

Facility

$13,920.00

Service Code	CPT 36224 TC
Hospital Charge Code	3613622401
Hospital Revenue Code	361
Min. Negotiated Rate	$1,971.08
Max. Negotiated Rate	$10,440.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,065.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,971.08
Rate for Payer: Aetna Government	$1,971.08
Rate for Payer: Brighton Health Commercial	$10,440.00
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	$6,960.00
Rate for Payer: Group Health Inc Commercial	$6,960.00
Rate for Payer: Group Health Inc Medicare	$4,872.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,960.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,960.00
Rate for Payer: United Healthcare Commercial	$2,546.00

HC SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY

Facility

$8,818.00

Service Code	CPT 36225 TC
Hospital Charge Code	3613622501
Hospital Revenue Code	361
Min. Negotiated Rate	$1,632.84
Max. Negotiated Rate	$6,613.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,065.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,632.84
Rate for Payer: Aetna Government	$1,632.84
Rate for Payer: Brighton Health Commercial	$6,613.50
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	$4,409.00
Rate for Payer: Group Health Inc Commercial	$4,409.00
Rate for Payer: Group Health Inc Medicare	$3,086.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,409.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,409.00
Rate for Payer: United Healthcare Commercial	$1,835.00

HC SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY

Facility

$8,818.00

Service Code	CPT 36225 TC
Hospital Charge Code	3613622501
Hospital Revenue Code	361
Min. Negotiated Rate	$4,409.00
Max. Negotiated Rate	$4,409.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,409.00

HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY

Facility

$13,920.00

Service Code	CPT 36226 TC
Hospital Charge Code	3613622601
Hospital Revenue Code	361
Min. Negotiated Rate	$2,001.15
Max. Negotiated Rate	$10,440.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,065.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,001.15
Rate for Payer: Aetna Government	$2,001.15
Rate for Payer: Brighton Health Commercial	$10,440.00
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	$6,960.00
Rate for Payer: Group Health Inc Commercial	$6,960.00
Rate for Payer: Group Health Inc Medicare	$4,872.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,960.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,960.00
Rate for Payer: United Healthcare Commercial	$2,546.00

HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY

Facility

$13,920.00

Service Code	CPT 36226 TC
Hospital Charge Code	3613622601
Hospital Revenue Code	361
Min. Negotiated Rate	$6,960.00
Max. Negotiated Rate	$6,960.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,960.00

HC SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC

Facility

$1,872.00

Service Code	CPT 36227 TC
Hospital Charge Code	3613622701
Hospital Revenue Code	361
Min. Negotiated Rate	$274.65
Max. Negotiated Rate	$4,065.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,065.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$274.65
Rate for Payer: Aetna Government	$274.65
Rate for Payer: Brighton Health Commercial	$1,404.00
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	$936.00
Rate for Payer: Group Health Inc Commercial	$936.00
Rate for Payer: Group Health Inc Medicare	$655.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$936.00
Rate for Payer: Hamaspik Choice Inc Medicare	$936.00
Rate for Payer: United Healthcare Commercial	$1,113.00

HC SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC

Facility

$1,872.00

Service Code	CPT 36227 TC
Hospital Charge Code	3613622701
Hospital Revenue Code	361
Min. Negotiated Rate	$936.00
Max. Negotiated Rate	$936.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$936.00

HC SLEEP STUDY, ATTENDED

Facility

$1,470.00

Service Code	CPT 95807 TC
Hospital Charge Code	9209580701
Hospital Revenue Code	920
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$735.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$735.00

Know your out-of-pocket cost for care.

All Charges