St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HSPC PRO DETAILED HX & EXAM (MOD-HIGH) 40 MIN

Facility

$248.00

Service Code	CPT 99349
Hospital Charge Code	6579934901
Hospital Revenue Code	657
Min. Negotiated Rate	$86.80
Max. Negotiated Rate	$198.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$136.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$95.65
Rate for Payer: Aetna Government	$95.65
Rate for Payer: Brighton Health Commercial	$186.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$198.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$168.64
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: Healthfirst CHP/FHP/Medicaid	$140.14

HSPC PRO HOME VISIT NEW PATIENT LEVEL 2

Facility

$429.00

Service Code	CPT 99342
Hospital Charge Code	6579934201
Hospital Revenue Code	657
Min. Negotiated Rate	$58.88
Max. Negotiated Rate	$343.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$235.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$58.88
Rate for Payer: Aetna Government	$58.88
Rate for Payer: Brighton Health Commercial	$321.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$343.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$291.72
Rate for Payer: EmblemHealth Commercial	$214.50
Rate for Payer: Group Health Inc Commercial	$214.50
Rate for Payer: Group Health Inc Medicare	$150.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$214.50
Rate for Payer: Hamaspik Choice Inc Medicare	$214.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$85.23

HSPC PRO HOME VISIT NEW PATIENT LEVEL 2

Facility

$429.00

Service Code	CPT 99342
Hospital Charge Code	6579934201
Hospital Revenue Code	657
Min. Negotiated Rate	$214.50
Max. Negotiated Rate	$214.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$214.50

HSPC PRO HOME VISIT NEW PATIENT LEVEL 4

Facility

$429.00

Service Code	CPT 99344
Hospital Charge Code	6579934401
Hospital Revenue Code	657
Min. Negotiated Rate	$135.77
Max. Negotiated Rate	$343.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$235.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$135.77
Rate for Payer: Aetna Government	$135.77
Rate for Payer: Brighton Health Commercial	$321.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$343.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$291.72
Rate for Payer: EmblemHealth Commercial	$214.50
Rate for Payer: Group Health Inc Commercial	$214.50
Rate for Payer: Group Health Inc Medicare	$150.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$214.50
Rate for Payer: Hamaspik Choice Inc Medicare	$214.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$155.34

HSPC PRO HOME VISIT NEW PATIENT LEVEL 4

Facility

$429.00

Service Code	CPT 99344
Hospital Charge Code	6579934401
Hospital Revenue Code	657
Min. Negotiated Rate	$214.50
Max. Negotiated Rate	$214.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$214.50

HSPC PRO INITIAL HOSPITAL CARE 30 MIN

Facility

$296.00

Service Code	CPT 99221
Hospital Charge Code	6579922101
Hospital Revenue Code	657
Min. Negotiated Rate	$76.47
Max. Negotiated Rate	$236.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$162.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$76.47
Rate for Payer: Aetna Government	$76.47
Rate for Payer: Brighton Health Commercial	$222.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$236.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.28
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	$92.28

HSPC PRO INITIAL HOSPITAL CARE 30 MIN

Facility

$296.00

Service Code	CPT 99221
Hospital Charge Code	6579922101
Hospital Revenue Code	657
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$148.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00

HSPC PRO INITIAL HOSPITAL CARE 50 MIN

Facility

$296.00

Service Code	CPT 99222
Hospital Charge Code	6579922201
Hospital Revenue Code	657
Min. Negotiated Rate	$102.50
Max. Negotiated Rate	$236.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$162.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$102.50
Rate for Payer: Aetna Government	$102.50
Rate for Payer: Brighton Health Commercial	$222.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$236.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.28
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	$144.31

HSPC PRO INITIAL HOSPITAL CARE 50 MIN

Facility

$296.00

Service Code	CPT 99222
Hospital Charge Code	6579922201
Hospital Revenue Code	657
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$148.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.00

HSPC PRO PROBLEM FOCUSED (MINOR) 15 MIN

Facility

$332.00

Service Code	CPT 99347
Hospital Charge Code	6579934701
Hospital Revenue Code	657
Min. Negotiated Rate	$41.36
Max. Negotiated Rate	$265.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$182.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.36
Rate for Payer: Aetna Government	$41.36
Rate for Payer: Brighton Health Commercial	$249.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$265.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$225.76
Rate for Payer: EmblemHealth Commercial	$166.00
Rate for Payer: Group Health Inc Commercial	$166.00
Rate for Payer: Group Health Inc Medicare	$116.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$166.00
Rate for Payer: Hamaspik Choice Inc Medicare	$166.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$49.39

HSPC PRO PROBLEM FOCUSED (MINOR) 15 MIN

Facility

$332.00

Service Code	CPT 99347
Hospital Charge Code	6579934701
Hospital Revenue Code	657
Min. Negotiated Rate	$166.00
Max. Negotiated Rate	$166.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$166.00

HYALURONAN 88 MG/4ML IX SOSY

Facility

$450.00

Service Code	HCPCS J7327
Hospital Charge Code	5967682001
Hospital Revenue Code	250
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.00

HYALURONAN 88 MG/4ML IX SOSY

Facility

$450.00

Service Code	HCPCS J7327
Hospital Charge Code	5967682001
Hospital Revenue Code	250
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$649.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$247.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$636.59
Rate for Payer: Aetna Government	$636.59
Rate for Payer: Affinity Essential Plan 1&2	$445.61
Rate for Payer: Affinity Essential Plan 3&4	$445.61
Rate for Payer: Affinity Medicaid/CHP/HARP	$445.61
Rate for Payer: Brighton Health Commercial	$337.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$636.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$360.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$306.00
Rate for Payer: Elderplan Medicare Advantage	$636.59
Rate for Payer: EmblemHealth Commercial	$636.59
Rate for Payer: Fidelis CHP/HARP/Medicaid	$572.93
Rate for Payer: Fidelis Essential Plan Aliesa	$541.10
Rate for Payer: Fidelis Essential Plan QHP	$566.57
Rate for Payer: Fidelis Medicare Advantage	$636.59
Rate for Payer: Fidelis Qualified Health Plan	$566.57
Rate for Payer: Group Health Inc Commercial	$636.59
Rate for Payer: Group Health Inc Medicare	$636.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$636.59
Rate for Payer: Hamaspik Choice Inc Medicare	$636.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$636.59
Rate for Payer: Healthfirst Medicare Advantage	$541.10
Rate for Payer: Healthfirst QHP	$636.59
Rate for Payer: Humana Medicare	$649.32
Rate for Payer: Senior Whole Health Medicare Advantage	$636.59
Rate for Payer: United Healthcare Medicare Advantage	$636.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$292.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$604.76
Rate for Payer: Wellcare Medicare	$604.76

HYALURONIDASE OVINE 200 UNIT/ML IJ SOLN

Facility

$120.83

Service Code	HCPCS J3471
Hospital Charge Code	2420800202
Hospital Revenue Code	250
Min. Negotiated Rate	$60.41
Max. Negotiated Rate	$60.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.41

HYALURONIDASE OVINE 200 UNIT/ML IJ SOLN

Facility

$120.83

Service Code	HCPCS J3471
Hospital Charge Code	2420800202
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$96.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.47
Rate for Payer: Aetna Government	$0.47
Rate for Payer: Brighton Health Commercial	$90.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$82.16
Rate for Payer: EmblemHealth Commercial	$60.41
Rate for Payer: Group Health Inc Commercial	$60.41
Rate for Payer: Group Health Inc Medicare	$42.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.41
Rate for Payer: Hamaspik Choice Inc Medicare	$60.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$78.54

HYDRALAZINE HCL 10 MG PO TABS

Facility

$0.41

Service Code	NDC 2315500101
Hospital Charge Code	2315500101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.21
Rate for Payer: Aetna Government	$0.21
Rate for Payer: Brighton Health Commercial	$0.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.28
Rate for Payer: EmblemHealth Commercial	$0.21
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

HYDRALAZINE HCL 10 MG PO TABS

Facility

$0.41

Service Code	NDC 2315500101
Hospital Charge Code	2315500101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21

HYDRALAZINE HCL 10 MG PO TABS

Facility

$0.13

Service Code	NDC 0904644061
Hospital Charge Code	0904644061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: EmblemHealth Commercial	$0.06
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

HYDRALAZINE HCL 10 MG PO TABS

Facility

$0.13

Service Code	NDC 0904644061
Hospital Charge Code	0904644061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06

HYDRALAZINE HCL 10 MG PO TABS

Facility

$0.53

Service Code	NDC 6808444701
Hospital Charge Code	6808444701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27

HYDRALAZINE HCL 10 MG PO TABS

Facility

$0.16

Service Code	NDC 0904744761
Hospital Charge Code	0904744761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

HYDRALAZINE HCL 10 MG PO TABS

Facility

$0.41

Service Code	NDC 3172251901
Hospital Charge Code	3172251901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21

HYDRALAZINE HCL 10 MG PO TABS

Facility

$0.41

Service Code	NDC 3172251901
Hospital Charge Code	3172251901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.21
Rate for Payer: Aetna Government	$0.21
Rate for Payer: Brighton Health Commercial	$0.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.28
Rate for Payer: EmblemHealth Commercial	$0.21
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

HYDRALAZINE HCL 10 MG PO TABS

Facility

$0.16

Service Code	NDC 0904744761
Hospital Charge Code	0904744761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Brighton Health Commercial	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.11
Rate for Payer: EmblemHealth Commercial	$0.08
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.10

HYDRALAZINE HCL 10 MG PO TABS

Facility

$0.53

Service Code	NDC 6808444701
Hospital Charge Code	6808444701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Brighton Health Commercial	$0.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.36
Rate for Payer: EmblemHealth Commercial	$0.27
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.35

Know your out-of-pocket cost for care.

All Charges