St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LEVEL I PERIODONTICS

Facility

$259.30

Service Code	EAPG 00352
Min. Negotiated Rate	$187.46
Max. Negotiated Rate	$259.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$187.46
Rate for Payer: Healthfirst Commercial	$259.30

LEVEL I PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES

Facility

$2,795.67

Service Code	EAPG 00077
Min. Negotiated Rate	$2,795.67
Max. Negotiated Rate	$2,795.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,795.67

LEVEL I PERIPHERAL VASCULAR REPAIR, LIGATION OR RECONSTRUCTION

Facility

$3,228.45

Service Code	EAPG 00078
Min. Negotiated Rate	$3,228.45
Max. Negotiated Rate	$3,228.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,228.45

LEVEL I POSTERIOR SEGMENT EYE PROCEDURES

Facility

$1,010.86

Service Code	EAPG 00237
Min. Negotiated Rate	$733.63
Max. Negotiated Rate	$1,010.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$733.63
Rate for Payer: Healthfirst Commercial	$1,010.86

LEVEL I PROSTATE PROCEDURES

Facility

$2,515.64

Service Code	EAPG 00176
Min. Negotiated Rate	$2,515.64
Max. Negotiated Rate	$2,515.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,515.64

LEVEL I PROSTHODONTICS, FIXED

Facility

$145.05

Service Code	EAPG 00353
Min. Negotiated Rate	$106.46
Max. Negotiated Rate	$145.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$106.46
Rate for Payer: Healthfirst Commercial	$145.05

LEVEL I PROSTHODONTICS, REMOVABLE

Facility

$293.99

Service Code	EAPG 00356
Min. Negotiated Rate	$212.92
Max. Negotiated Rate	$293.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$212.92
Rate for Payer: Healthfirst Commercial	$293.99

LEVEL I RADIATION THERAPY

Facility

$606.64

Service Code	EAPG 00343
Min. Negotiated Rate	$439.72
Max. Negotiated Rate	$606.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$439.72
Rate for Payer: Healthfirst Commercial	$606.64

LEVEL I RADIATION TREATMENT PREPARATION & PLANNING

Facility

$813.01

Service Code	EAPG 00476
Min. Negotiated Rate	$590.15
Max. Negotiated Rate	$813.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$590.15
Rate for Payer: Healthfirst Commercial	$813.01

LEVEL I REPAIR AND PLASTIC PROCEDURES OF EYE

Facility

$1,331.55

Service Code	EAPG 00240
Min. Negotiated Rate	$967.38
Max. Negotiated Rate	$1,331.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$967.38
Rate for Payer: Healthfirst Commercial	$1,331.55

LEVEL I SKIN EXCISIONS, BIOPSIES, AND REPAIRS

Facility

$1,095.46

Service Code	EAPG 00009
Min. Negotiated Rate	$796.12
Max. Negotiated Rate	$1,095.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$796.12
Rate for Payer: Healthfirst Commercial	$1,095.46

LEVEL I SKIN INCISION AND DRAINAGE, DEBRIDEMENT, DESTRUCTION, OTHER RELATED PX

Facility

$559.99

Service Code	EAPG 00003
Min. Negotiated Rate	$407.32
Max. Negotiated Rate	$559.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$407.32
Rate for Payer: Healthfirst Commercial	$559.99

LEVEL I SMALL AND LARGE INTESTINE SURGICAL PROCEDURES

Facility

$2,904.45

Service Code	EAPG 00127
Min. Negotiated Rate	$2,904.45
Max. Negotiated Rate	$2,904.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,904.45

LEVEL I SPINE PROCEDURES

Facility

$4,075.48

Service Code	EAPG 00028
Min. Negotiated Rate	$4,075.48
Max. Negotiated Rate	$4,075.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$4,075.48

LEVEL I SURGICAL PATHOLOGY TESTS

Facility

$71.74

Service Code	EAPG 00305
Min. Negotiated Rate	$71.74
Max. Negotiated Rate	$71.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$71.74

LEVEL I THORACIC AND CHEST PROCEDURES

Facility

$2,268.01

Service Code	EAPG 00069
Min. Negotiated Rate	$2,268.01
Max. Negotiated Rate	$2,268.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,268.01

LEVEL I UPPER GI ENDOSCOPY

Facility

$1,401.34

Service Code	EAPG 00134
Min. Negotiated Rate	$1,018.29
Max. Negotiated Rate	$1,401.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,018.29
Rate for Payer: Healthfirst Commercial	$1,401.34

LEVEL I URETHRAL PROCEDURES

Facility

$1,745.84

Service Code	EAPG 00166
Min. Negotiated Rate	$1,268.24
Max. Negotiated Rate	$1,745.84
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,268.24
Rate for Payer: Healthfirst Commercial	$1,745.84

LEVEL I VARICOSE VEIN AND RELATED PROCEDURES

Facility

$1,822.55

Service Code	EAPG 00090
Min. Negotiated Rate	$1,323.78
Max. Negotiated Rate	$1,822.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,323.78
Rate for Payer: Healthfirst Commercial	$1,822.55

LEVEL I VASCULAR RADIOLOGICAL PROCEDURES

Facility

$402.69

Service Code	EAPG 00277
Min. Negotiated Rate	$402.69
Max. Negotiated Rate	$402.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$402.69

LEVEL IV EAR, NOSE, MOUTH AND THROAT PROCEDURES

Facility

$5,947.89

Service Code	EAPG 00255
Min. Negotiated Rate	$4,318.48
Max. Negotiated Rate	$5,947.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$4,318.48
Rate for Payer: Healthfirst Commercial	$5,947.89

LEVEL IV NERVE PROCEDURE W OR W/O NEUROLOGICAL DEVICE

Facility

$24,682.08

Service Code	EAPG 00224
Min. Negotiated Rate	$23,867.38
Max. Negotiated Rate	$24,682.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,867.38
Rate for Payer: Healthfirst Commercial	$24,682.08

LEVEL IV ORAL AND MAXILLOFACIAL PROCEDURES

Facility

$661.55

Service Code	EAPG 00370
Min. Negotiated Rate	$481.37
Max. Negotiated Rate	$661.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$481.37
Rate for Payer: Healthfirst Commercial	$661.55

LEVETIRACETAM 100 MG/ML PO SOLN

Facility

$0.65

Service Code	NDC 0121079916
Hospital Charge Code	0121079916
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.44
Rate for Payer: EmblemHealth Commercial	$0.33
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.42

LEVETIRACETAM 100 MG/ML PO SOLN

Facility

$1.38

Service Code	NDC 6933915705
Hospital Charge Code	6933915705
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.69

Know your out-of-pocket cost for care.

All Charges