St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC X-RAY URETHROCYSTOGRAM - XR CYSTOURETHROGRAM

Facility

$705.00

Service Code	CPT 74450 TC
Hospital Charge Code	3207445001
Hospital Revenue Code	320
Min. Negotiated Rate	$50.24
Max. Negotiated Rate	$528.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$149.09
Rate for Payer: Aetna Government	$149.09
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$376.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$317.25
Rate for Payer: EmblemHealth Commercial	$352.50
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 Essential Plan	$113.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50.24

HC X-RAY URETHROCYSTOGRAM - XR CYSTOURETHROGRAM

Facility

$705.00

Service Code	CPT 74450 TC
Hospital Charge Code	3207445001
Hospital Revenue Code	320
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC X-RAY WRIST 2 VW - XR WRIST 1-2 VIEWS

Facility

$241.00

Service Code	CPT 73100 TC
Hospital Charge Code	3207310001
Hospital Revenue Code	320
Min. Negotiated Rate	$16.04
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.04
Rate for Payer: Aetna Government	$16.04
Rate for Payer: Brighton Health Commercial	$180.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.13
Rate for Payer: EmblemHealth Commercial	$27.11
Rate for Payer: Group Health Inc Commercial	$120.50
Rate for Payer: Group Health Inc Medicare	$84.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50
Rate for Payer: Hamaspik Choice Inc Medicare	$120.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27.11
Rate for Payer: Healthfirst Essential Plan	$45.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.04

HC X-RAY WRIST 2 VW - XR WRIST 1-2 VIEWS

Facility

$241.00

Service Code	CPT 73100 TC
Hospital Charge Code	3207310001
Hospital Revenue Code	320
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$120.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50

HC X-RAY WRIST 2 VW - XR WRIST 1-2 VIEWS BILATERAL

Facility

$241.00

Service Code	CPT 73100 TC
Hospital Charge Code	3207310003
Hospital Revenue Code	320
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$120.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50

HC X-RAY WRIST 2 VW - XR WRIST 1-2 VIEWS BILATERAL

Facility

$241.00

Service Code	CPT 73100 TC
Hospital Charge Code	3207310003
Hospital Revenue Code	320
Min. Negotiated Rate	$16.04
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.04
Rate for Payer: Aetna Government	$16.04
Rate for Payer: Brighton Health Commercial	$180.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.13
Rate for Payer: EmblemHealth Commercial	$27.11
Rate for Payer: Group Health Inc Commercial	$120.50
Rate for Payer: Group Health Inc Medicare	$84.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50
Rate for Payer: Hamaspik Choice Inc Medicare	$120.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27.11
Rate for Payer: Healthfirst Essential Plan	$45.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.04

HC X-RAY WRIST 2 VW - XR WRIST 1-2 VIEWS RIGHT

Facility

$241.00

Service Code	CPT 73100 TC
Hospital Charge Code	3207310002
Hospital Revenue Code	320
Min. Negotiated Rate	$16.04
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.04
Rate for Payer: Aetna Government	$16.04
Rate for Payer: Brighton Health Commercial	$180.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.13
Rate for Payer: EmblemHealth Commercial	$27.11
Rate for Payer: Group Health Inc Commercial	$120.50
Rate for Payer: Group Health Inc Medicare	$84.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50
Rate for Payer: Hamaspik Choice Inc Medicare	$120.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27.11
Rate for Payer: Healthfirst Essential Plan	$45.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.04

HC X-RAY WRIST 2 VW - XR WRIST 1-2 VIEWS RIGHT

Facility

$241.00

Service Code	CPT 73100 TC
Hospital Charge Code	3207310002
Hospital Revenue Code	320
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$120.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50

HC X-RAY WRIST 3+ VW - XR WRIST 3+ VIEWS

Facility

$241.00

Service Code	CPT 73110 TC
Hospital Charge Code	3207311001
Hospital Revenue Code	320
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$120.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50

HC X-RAY WRIST 3+ VW - XR WRIST 3+ VIEWS

Facility

$241.00

Service Code	CPT 73110 TC
Hospital Charge Code	3207311001
Hospital Revenue Code	320
Min. Negotiated Rate	$20.78
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.78
Rate for Payer: Aetna Government	$20.78
Rate for Payer: Brighton Health Commercial	$180.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.13
Rate for Payer: EmblemHealth Commercial	$34.79
Rate for Payer: Group Health Inc Commercial	$120.50
Rate for Payer: Group Health Inc Medicare	$84.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50
Rate for Payer: Hamaspik Choice Inc Medicare	$120.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34.79
Rate for Payer: Healthfirst Essential Plan	$53.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23.61

HC X-RAY WRIST 3+ VW - XR WRIST 3+ VIEWS BILATERAL

Facility

$241.00

Service Code	CPT 73110 TC
Hospital Charge Code	3207311003
Hospital Revenue Code	320
Min. Negotiated Rate	$20.78
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.78
Rate for Payer: Aetna Government	$20.78
Rate for Payer: Brighton Health Commercial	$180.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.13
Rate for Payer: EmblemHealth Commercial	$34.79
Rate for Payer: Group Health Inc Commercial	$120.50
Rate for Payer: Group Health Inc Medicare	$84.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50
Rate for Payer: Hamaspik Choice Inc Medicare	$120.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34.79
Rate for Payer: Healthfirst Essential Plan	$53.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23.61

HC X-RAY WRIST 3+ VW - XR WRIST 3+ VIEWS BILATERAL

Facility

$241.00

Service Code	CPT 73110 TC
Hospital Charge Code	3207311003
Hospital Revenue Code	320
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$120.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50

HC X-RAY WRIST 3+ VW - XR WRIST 3+ VIEWS RIGHT

Facility

$241.00

Service Code	CPT 73110 TC
Hospital Charge Code	3207311002
Hospital Revenue Code	320
Min. Negotiated Rate	$20.78
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.78
Rate for Payer: Aetna Government	$20.78
Rate for Payer: Brighton Health Commercial	$180.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.13
Rate for Payer: EmblemHealth Commercial	$34.79
Rate for Payer: Group Health Inc Commercial	$120.50
Rate for Payer: Group Health Inc Medicare	$84.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50
Rate for Payer: Hamaspik Choice Inc Medicare	$120.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34.79
Rate for Payer: Healthfirst Essential Plan	$53.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23.61

HC X-RAY WRIST 3+ VW - XR WRIST 3+ VIEWS RIGHT

Facility

$241.00

Service Code	CPT 73110 TC
Hospital Charge Code	3207311002
Hospital Revenue Code	320
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$120.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50

HC XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I

Facility

$714.00

Service Code	CPT 93224
Hospital Charge Code	7319322401
Hospital Revenue Code	731
Min. Negotiated Rate	$357.00
Max. Negotiated Rate	$357.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$357.00

HC XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I

Facility

$714.00

Service Code	CPT 93224
Hospital Charge Code	7319322401
Hospital Revenue Code	731
Min. Negotiated Rate	$80.69
Max. Negotiated Rate	$571.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$392.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$80.69
Rate for Payer: Aetna Government	$80.69
Rate for Payer: Brighton Health Commercial	$535.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$571.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$485.52
Rate for Payer: EmblemHealth Commercial	$357.00
Rate for Payer: Group Health Inc Commercial	$357.00
Rate for Payer: Group Health Inc Medicare	$249.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$357.00
Rate for Payer: Hamaspik Choice Inc Medicare	$357.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$80.89
Rate for Payer: United Healthcare Commercial	$253.00

HC YELLOW FEVER IMMUNIZATN,LIVE,SUB-Q

Facility

$427.00

Service Code	CPT 90717
Hospital Charge Code	6369071701
Hospital Revenue Code	636
Min. Negotiated Rate	$213.50
Max. Negotiated Rate	$213.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.50
Rate for Payer: Hamaspik Choice Inc Medicare	$213.50

HC YELLOW FEVER IMMUNIZATN,LIVE,SUB-Q

Facility

$427.00

Service Code	CPT 90717
Hospital Charge Code	6369071701
Hospital Revenue Code	636
Min. Negotiated Rate	$143.47
Max. Negotiated Rate	$277.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$234.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$143.47
Rate for Payer: Aetna Government	$143.47
Rate for Payer: Brighton Health Commercial	$256.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$213.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$245.53
Rate for Payer: EmblemHealth Commercial	$213.50
Rate for Payer: Group Health Inc Commercial	$213.50
Rate for Payer: Group Health Inc Medicare	$149.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$213.50
Rate for Payer: Hamaspik Choice Inc Medicare	$213.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$277.55

HC ZOSTER (SHINGLES) VACCINE (HZV), RECOMBINANT, SUBUNIT, ADJUVANTED

Facility

$94.00

Service Code	CPT 90750
Hospital Charge Code	6369075001
Hospital Revenue Code	636
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$14,140.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$165.25
Rate for Payer: Aetna Government	$165.25
Rate for Payer: Affinity Essential Plan 1&2	$318.15
Rate for Payer: Affinity Essential Plan 3&4	$318.15
Rate for Payer: Affinity Medicaid/CHP/HARP	$141.40
Rate for Payer: Amida Care Medicaid	$141.40
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: EmblemHealth Essential Plan 1&2	$318.15
Rate for Payer: EmblemHealth Essential Plan 3&4	$141.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$141.40
Rate for Payer: Fidelis Essential Plan Aliesa	$318.15
Rate for Payer: Fidelis Essential Plan QHP	$318.15
Rate for Payer: Fidelis Qualified Health Plan	$148.47
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	$141.40
Rate for Payer: Hamaspik Choice Inc Medicare	$47.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$14,140.00
Rate for Payer: Healthfirst Essential Plan	$318.15
Rate for Payer: Healthfirst QHP	$230.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$141.40
Rate for Payer: SOMOS Essential	$318.15
Rate for Payer: United Healthcare Essential Plan 1&2	$318.15
Rate for Payer: United Healthcare Essential Plan 3&4	$155.54
Rate for Payer: United Healthcare Medicaid	$141.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$61.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$141.40

HC ZOSTER (SHINGLES) VACCINE (HZV), RECOMBINANT, SUBUNIT, ADJUVANTED

Facility

$94.00

Service Code	CPT 90750
Hospital Charge Code	6369075001
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 ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE

Facility

$94.00

Service Code	CPT 90736
Hospital Charge Code	6369073601
Hospital Revenue Code	636
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$216.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$216.92
Rate for Payer: Aetna Government	$216.92
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 ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE

Facility

$94.00

Service Code	CPT 90736
Hospital Charge Code	6369073601
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 ZZ TECH., TIME 1ST HALF HOUR

Facility

$309.00

Hospital Charge Code	3600000006
Hospital Revenue Code	360
Min. Negotiated Rate	$108.15
Max. Negotiated Rate	$247.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$169.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$154.50
Rate for Payer: Aetna Government	$154.50
Rate for Payer: Brighton Health Commercial	$231.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$247.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$210.12
Rate for Payer: EmblemHealth Commercial	$154.50
Rate for Payer: Group Health Inc Commercial	$154.50
Rate for Payer: Group Health Inc Medicare	$108.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$154.50
Rate for Payer: Hamaspik Choice Inc Medicare	$154.50

HC ZZ TECH., TIME 1ST HALF HOUR

Facility

$309.00

Hospital Charge Code	3600000006
Hospital Revenue Code	360
Min. Negotiated Rate	$154.50
Max. Negotiated Rate	$154.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$154.50

HC ZZ TECH. TIME ADD'L HALF HOUR

Facility

$285.00

Hospital Charge Code	3600000007
Hospital Revenue Code	360
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$228.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$156.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$142.50
Rate for Payer: Aetna Government	$142.50
Rate for Payer: Brighton Health Commercial	$213.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$228.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$193.80
Rate for Payer: EmblemHealth Commercial	$142.50
Rate for Payer: Group Health Inc Commercial	$142.50
Rate for Payer: Group Health Inc Medicare	$99.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50

Know your out-of-pocket cost for care.

All Charges