St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC SNRPN/UBE3A METHYLATION ANALYSIS - PRADER-WILLI PANEL

Facility

$127.00

Service Code	CPT 81331
Hospital Charge Code	3108133101
Hospital Revenue Code	310
Min. Negotiated Rate	$63.50
Max. Negotiated Rate	$63.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.50

HC SNRPN/UBE3A METHYLATION ANALYSIS - PRADER-WILLI PANEL

Facility

$127.00

Service Code	CPT 81331
Hospital Charge Code	3108133101
Hospital Revenue Code	310
Min. Negotiated Rate	$35.75
Max. Negotiated Rate	$101.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$69.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.07
Rate for Payer: Aetna Government	$51.07
Rate for Payer: Affinity Essential Plan 1&2	$35.75
Rate for Payer: Affinity Essential Plan 3&4	$35.75
Rate for Payer: Affinity Medicaid/CHP/HARP	$35.75
Rate for Payer: Brighton Health Commercial	$51.07
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$51.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$101.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.36
Rate for Payer: Elderplan Medicare Advantage	$51.07
Rate for Payer: EmblemHealth Commercial	$51.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$45.96
Rate for Payer: Fidelis Essential Plan Aliesa	$43.41
Rate for Payer: Fidelis Essential Plan QHP	$45.45
Rate for Payer: Fidelis Medicare Advantage	$51.07
Rate for Payer: Fidelis Qualified Health Plan	$45.45
Rate for Payer: Group Health Inc Commercial	$51.07
Rate for Payer: Group Health Inc Medicare	$51.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.07
Rate for Payer: Hamaspik Choice Inc Medicare	$51.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$51.07
Rate for Payer: Healthfirst Medicare Advantage	$51.07
Rate for Payer: Healthfirst QHP	$51.07
Rate for Payer: Humana Medicare	$52.09
Rate for Payer: Senior Whole Health Medicare Advantage	$51.07
Rate for Payer: United Healthcare Medicare Advantage	$51.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$51.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$48.52
Rate for Payer: Wellcare Medicare	$45.96

HC SO NEO GSAP DNA/DNA&RNA

Facility

$420.00

Service Code	CPT 81459
Hospital Charge Code	3108145901
Hospital Revenue Code	310
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$210.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.00

HC SO NEO GSAP DNA/DNA&RNA

Facility

$420.00

Service Code	CPT 81459
Hospital Charge Code	3108145901
Hospital Revenue Code	310
Min. Negotiated Rate	$231.00
Max. Negotiated Rate	$3,049.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$231.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,989.55
Rate for Payer: Aetna Government	$2,989.55
Rate for Payer: Affinity Essential Plan 1&2	$2,092.68
Rate for Payer: Affinity Essential Plan 3&4	$2,092.68
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,092.68
Rate for Payer: Brighton Health Commercial	$2,989.55
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,989.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$336.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$285.60
Rate for Payer: Elderplan Medicare Advantage	$2,989.55
Rate for Payer: EmblemHealth Commercial	$2,989.55
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,690.59
Rate for Payer: Fidelis Essential Plan Aliesa	$2,541.12
Rate for Payer: Fidelis Essential Plan QHP	$2,660.70
Rate for Payer: Fidelis Medicare Advantage	$2,989.55
Rate for Payer: Fidelis Qualified Health Plan	$2,660.70
Rate for Payer: Group Health Inc Commercial	$2,989.55
Rate for Payer: Group Health Inc Medicare	$2,989.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,989.55
Rate for Payer: Hamaspik Choice Inc Medicare	$2,989.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,989.55
Rate for Payer: Healthfirst Medicare Advantage	$2,989.55
Rate for Payer: Healthfirst QHP	$2,989.55
Rate for Payer: Humana Medicare	$3,049.34
Rate for Payer: Senior Whole Health Medicare Advantage	$2,989.55
Rate for Payer: United Healthcare Medicare Advantage	$2,989.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,989.55
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,840.07
Rate for Payer: Wellcare Medicare	$2,690.59

HC SONO EXAM, HYSTEROSONOGRAPHY - US PELVIS HYSTEROSONOGRAPHY DOPPLER

Facility

$705.00

Service Code	CPT 76831 TC
Hospital Charge Code	4027683101
Hospital Revenue Code	402
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC SONO EXAM, HYSTEROSONOGRAPHY - US PELVIS HYSTEROSONOGRAPHY DOPPLER

Facility

$705.00

Service Code	CPT 76831 TC
Hospital Charge Code	4027683101
Hospital Revenue Code	402
Min. Negotiated Rate	$64.58
Max. Negotiated Rate	$528.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.58
Rate for Payer: Aetna Government	$64.58
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$327.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$275.58
Rate for Payer: EmblemHealth Commercial	$84.26
Rate for Payer: Group Health Inc Commercial	$352.50
Rate for Payer: Group Health Inc Medicare	$246.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50
Rate for Payer: Hamaspik Choice Inc Medicare	$352.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$84.26
Rate for Payer: Healthfirst Essential Plan	$182.32
Rate for Payer: United Healthcare Commercial	$122.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$81.03

HC SONO FETAL HEART - US FETAL HEART

Facility

$1,458.00

Service Code	CPT 76825 TC
Hospital Charge Code	4027682501
Hospital Revenue Code	402
Min. Negotiated Rate	$140.14
Max. Negotiated Rate	$1,203.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$801.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$152.30
Rate for Payer: Aetna Government	$152.30
Rate for Payer: Brighton Health Commercial	$1,093.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,203.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,012.60
Rate for Payer: EmblemHealth Commercial	$187.17
Rate for Payer: Group Health Inc Commercial	$729.00
Rate for Payer: Group Health Inc Medicare	$510.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00
Rate for Payer: Hamaspik Choice Inc Medicare	$729.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$187.17
Rate for Payer: Healthfirst Essential Plan	$315.31
Rate for Payer: United Healthcare Commercial	$449.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$140.14

HC SONO FETAL HEART - US FETAL HEART

Facility

$1,458.00

Service Code	CPT 76825 TC
Hospital Charge Code	4027682501
Hospital Revenue Code	402
Min. Negotiated Rate	$729.00
Max. Negotiated Rate	$729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00

HC SONO GUIDE AMNIOCENTESIS

Facility

$453.00

Service Code	CPT 76946 TC
Hospital Charge Code	4027694601
Hospital Revenue Code	402
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$362.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$249.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.46
Rate for Payer: Aetna Government	$10.46
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	$16.28
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
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16.28
Rate for Payer: Healthfirst Essential Plan	$54.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24.23

HC SONO GUIDE AMNIOCENTESIS

Facility

$453.00

Service Code	CPT 76946 TC
Hospital Charge Code	4027694601
Hospital Revenue Code	402
Min. Negotiated Rate	$226.50
Max. Negotiated Rate	$226.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$226.50

HC SONO GUIDE NEEDLE BIOPSY

Facility

$1,144.00

Service Code	CPT 76942 TC
Hospital Charge Code	4027694243
Hospital Revenue Code	402
Min. Negotiated Rate	$21.62
Max. Negotiated Rate	$915.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$629.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.62
Rate for Payer: Aetna Government	$21.62
Rate for Payer: Brighton Health Commercial	$858.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$915.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$777.92
Rate for Payer: EmblemHealth Commercial	$30.60
Rate for Payer: Group Health Inc Commercial	$572.00
Rate for Payer: Group Health Inc Medicare	$400.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$572.00
Rate for Payer: Hamaspik Choice Inc Medicare	$572.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30.60
Rate for Payer: Healthfirst Essential Plan	$287.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$127.95

HC SONO GUIDE NEEDLE BIOPSY

Facility

$1,144.00

Service Code	CPT 76942 TC
Hospital Charge Code	4027694243
Hospital Revenue Code	402
Min. Negotiated Rate	$572.00
Max. Negotiated Rate	$572.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$572.00

HC SONO PELVIS LIMITED

Facility

$339.00

Service Code	CPT 76857 TC
Hospital Charge Code	4027685704
Hospital Revenue Code	402
Min. Negotiated Rate	$17.99
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.99
Rate for Payer: Aetna Government	$17.99
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$112.12
Rate for Payer: EmblemHealth Commercial	$28.15
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28.15
Rate for Payer: Healthfirst Essential Plan	$143.64
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$63.84

HC SONO PELVIS LIMITED

Facility

$339.00

Service Code	CPT 76857 TC
Hospital Charge Code	4027685704
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC SONO PELVIS LIMITED - US PELVIS LIMITED

Facility

$339.00

Service Code	CPT 76857 TC
Hospital Charge Code	4027685703
Hospital Revenue Code	402
Min. Negotiated Rate	$17.99
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.99
Rate for Payer: Aetna Government	$17.99
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$112.12
Rate for Payer: EmblemHealth Commercial	$28.15
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28.15
Rate for Payer: Healthfirst Essential Plan	$143.64
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$63.84

HC SONO PELVIS LIMITED - US PELVIS LIMITED

Facility

$339.00

Service Code	CPT 76857 TC
Hospital Charge Code	4027685703
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC SONO PELVIS LIMITED - US PELVIS LIMITED BLADDER

Facility

$339.00

Service Code	CPT 76857 TC
Hospital Charge Code	4027685701
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC SONO PELVIS LIMITED - US PELVIS LIMITED BLADDER

Facility

$339.00

Service Code	CPT 76857 TC
Hospital Charge Code	4027685701
Hospital Revenue Code	402
Min. Negotiated Rate	$17.99
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.99
Rate for Payer: Aetna Government	$17.99
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$112.12
Rate for Payer: EmblemHealth Commercial	$28.15
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28.15
Rate for Payer: Healthfirst Essential Plan	$143.64
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$63.84

HC SONO PELVIS LIMITED - US PELVIS LIMITED FOLLICLES

Facility

$339.00

Service Code	CPT 76857 TC
Hospital Charge Code	4027685702
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC SONO PELVIS LIMITED - US PELVIS LIMITED FOLLICLES

Facility

$339.00

Service Code	CPT 76857 TC
Hospital Charge Code	4027685702
Hospital Revenue Code	402
Min. Negotiated Rate	$17.99
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.99
Rate for Payer: Aetna Government	$17.99
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$112.12
Rate for Payer: EmblemHealth Commercial	$28.15
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28.15
Rate for Payer: Healthfirst Essential Plan	$143.64
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$63.84

HC SOTROVIMAB INFUSION ADMINISTRATION

Facility

$1,357.00

Service Code	CPT M0247
Hospital Charge Code	260M024701
Hospital Revenue Code	260
Min. Negotiated Rate	$76.00
Max. Negotiated Rate	$1,085.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$746.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$450.00
Rate for Payer: Aetna Government	$450.00
Rate for Payer: Brighton Health Commercial	$1,017.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,085.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$922.76
Rate for Payer: EmblemHealth Commercial	$678.50
Rate for Payer: Group Health Inc Commercial	$678.50
Rate for Payer: Group Health Inc Medicare	$474.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$678.50
Rate for Payer: Hamaspik Choice Inc Medicare	$678.50
Rate for Payer: United Healthcare Commercial	$76.00

HC SOTROVIMAB INFUSION ADMINISTRATION

Facility

$1,357.00

Service Code	CPT M0247
Hospital Charge Code	260M024701
Hospital Revenue Code	260
Min. Negotiated Rate	$678.50
Max. Negotiated Rate	$678.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$678.50

HC SP AORTA TRANSLUMBAR

Facility

$30,010.00

Service Code	CPT 0236T
Hospital Charge Code	3610236T01
Hospital Revenue Code	361
Min. Negotiated Rate	$15,005.00
Max. Negotiated Rate	$15,005.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,005.00

HC SP AORTA TRANSLUMBAR

Facility

$30,010.00

Service Code	CPT 0236T
Hospital Charge Code	3610236T01
Hospital Revenue Code	361
Min. Negotiated Rate	$3,190.00
Max. Negotiated Rate	$24,008.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,065.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13,856.14
Rate for Payer: Aetna Government	$13,856.14
Rate for Payer: Affinity Essential Plan 1&2	$9,699.30
Rate for Payer: Affinity Essential Plan 3&4	$9,699.30
Rate for Payer: Affinity Medicaid/CHP/HARP	$9,699.30
Rate for Payer: Brighton Health Commercial	$22,507.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$13,856.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24,008.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$20,406.80
Rate for Payer: Elderplan Medicare Advantage	$13,856.14
Rate for Payer: EmblemHealth Commercial	$13,856.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$12,470.53
Rate for Payer: Fidelis Essential Plan Aliesa	$11,777.72
Rate for Payer: Fidelis Essential Plan QHP	$12,331.96
Rate for Payer: Fidelis Medicare Advantage	$13,856.14
Rate for Payer: Fidelis Qualified Health Plan	$12,331.96
Rate for Payer: Group Health Inc Commercial	$13,856.14
Rate for Payer: Group Health Inc Medicare	$13,856.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$13,856.14
Rate for Payer: Hamaspik Choice Inc Medicare	$13,856.14
Rate for Payer: Healthfirst Medicare Advantage	$11,777.72
Rate for Payer: Healthfirst QHP	$13,856.14
Rate for Payer: Humana Medicare	$14,133.26
Rate for Payer: Senior Whole Health Medicare Advantage	$13,856.14
Rate for Payer: United Healthcare Commercial	$3,190.00
Rate for Payer: United Healthcare Medicare Advantage	$13,856.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13,856.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13,163.33
Rate for Payer: Wellcare Medicare	$13,163.33

HC SP CONTRAST INJ CK VEN ACCESS

Facility

$556.00

Service Code	CPT 36598 TC
Hospital Charge Code	3613659801
Hospital Revenue Code	361
Min. Negotiated Rate	$278.00
Max. Negotiated Rate	$278.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.00

Know your out-of-pocket cost for care.

All Charges