St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC ECHO EXAM OF EYE - QUANTITATIVE A-SCAN ULTRASOUND - OD - RIGHT EYE

Facility

$339.00

Service Code	CPT 76516 TC
Hospital Charge Code	4027651602
Hospital Revenue Code	402
Min. Negotiated Rate	$25.71
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.52
Rate for Payer: Aetna Government	$37.52
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	$25.71
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	$25.71
Rate for Payer: Healthfirst Essential Plan	$103.84
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$46.15

HC ECHO EXAM OF EYE - QUANTITATIVE A-SCAN ULTRASOUND - OD - RIGHT EYE

Facility

$339.00

Service Code	CPT 76516 TC
Hospital Charge Code	4027651602
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC ECHO EXAM OF EYE - QUANTITATIVE A-SCAN ULTRASOUND - OS - LEFT EYE

Facility

$339.00

Service Code	CPT 76516 TC
Hospital Charge Code	4027651603
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC ECHO EXAM OF EYE - QUANTITATIVE A-SCAN ULTRASOUND - OS - LEFT EYE

Facility

$339.00

Service Code	CPT 76516 TC
Hospital Charge Code	4027651603
Hospital Revenue Code	402
Min. Negotiated Rate	$25.71
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.52
Rate for Payer: Aetna Government	$37.52
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	$25.71
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	$25.71
Rate for Payer: Healthfirst Essential Plan	$103.84
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$46.15

HC ECHO EXAM OF EYE - QUANTITATIVE A-SCAN ULTRASOUND - OU - BOTH EYES

Facility

$339.00

Service Code	CPT 76516 TC
Hospital Charge Code	4027651604
Hospital Revenue Code	402
Min. Negotiated Rate	$25.71
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.52
Rate for Payer: Aetna Government	$37.52
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	$25.71
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	$25.71
Rate for Payer: Healthfirst Essential Plan	$103.84
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$46.15

HC ECHO EXAM OF EYE - QUANTITATIVE A-SCAN ULTRASOUND - OU - BOTH EYES

Facility

$339.00

Service Code	CPT 76516 TC
Hospital Charge Code	4027651604
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC ECHO EXAM OF EYE - ULTRASOUND BIOMETRY - OD - RIGHT EYE

Facility

$339.00

Service Code	CPT 76516 TC
Hospital Charge Code	4027651605
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC ECHO EXAM OF EYE - ULTRASOUND BIOMETRY - OD - RIGHT EYE

Facility

$339.00

Service Code	CPT 76516 TC
Hospital Charge Code	4027651605
Hospital Revenue Code	402
Min. Negotiated Rate	$25.71
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.52
Rate for Payer: Aetna Government	$37.52
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	$25.71
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	$25.71
Rate for Payer: Healthfirst Essential Plan	$103.84
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$46.15

HC ECHO EXAM OF EYE - ULTRASOUND BIOMETRY - OS - LEFT EYE

Facility

$339.00

Service Code	CPT 76516 TC
Hospital Charge Code	4027651606
Hospital Revenue Code	402
Min. Negotiated Rate	$25.71
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.52
Rate for Payer: Aetna Government	$37.52
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	$25.71
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	$25.71
Rate for Payer: Healthfirst Essential Plan	$103.84
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$46.15

HC ECHO EXAM OF EYE - ULTRASOUND BIOMETRY - OS - LEFT EYE

Facility

$339.00

Service Code	CPT 76516 TC
Hospital Charge Code	4027651606
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC ECHO EXAM OF EYE - ULTRASOUND BIOMETRY - OU - BOTH EYES

Facility

$339.00

Service Code	CPT 76516 TC
Hospital Charge Code	4027651607
Hospital Revenue Code	402
Min. Negotiated Rate	$25.71
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.52
Rate for Payer: Aetna Government	$37.52
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	$25.71
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	$25.71
Rate for Payer: Healthfirst Essential Plan	$103.84
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$46.15

HC ECHO EXAM OF EYE - ULTRASOUND BIOMETRY - OU - BOTH EYES

Facility

$339.00

Service Code	CPT 76516 TC
Hospital Charge Code	4027651607
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC ECHO EXAM OF EYE - ULTRASOUND BIOMETRY W IOL CAL - OD - RIGHT EYE

Facility

$339.00

Service Code	CPT 76519 TC
Hospital Charge Code	4027651903
Hospital Revenue Code	402
Min. Negotiated Rate	$40.03
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.70
Rate for Payer: Aetna Government	$41.70
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$206.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.43
Rate for Payer: EmblemHealth Commercial	$40.03
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	$40.03
Rate for Payer: Healthfirst Essential Plan	$112.66
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50.07

HC ECHO EXAM OF EYE - ULTRASOUND BIOMETRY W IOL CAL - OD - RIGHT EYE

Facility

$339.00

Service Code	CPT 76519 TC
Hospital Charge Code	4027651903
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC ECHO EXAM OF EYE - ULTRASOUND BIOMETRY W IOL CAL - OS - LEFT EYE

Facility

$339.00

Service Code	CPT 76519 TC
Hospital Charge Code	4027651904
Hospital Revenue Code	402
Min. Negotiated Rate	$40.03
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.70
Rate for Payer: Aetna Government	$41.70
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$206.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.43
Rate for Payer: EmblemHealth Commercial	$40.03
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	$40.03
Rate for Payer: Healthfirst Essential Plan	$112.66
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50.07

HC ECHO EXAM OF EYE - ULTRASOUND BIOMETRY W IOL CAL - OS - LEFT EYE

Facility

$339.00

Service Code	CPT 76519 TC
Hospital Charge Code	4027651904
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC ECHO EXAM OF EYE - ULTRASOUND BIOMETRY W IOL CAL - OU - BOTH EYES

Facility

$339.00

Service Code	CPT 76519 TC
Hospital Charge Code	4027651905
Hospital Revenue Code	402
Min. Negotiated Rate	$40.03
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.70
Rate for Payer: Aetna Government	$41.70
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$206.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.43
Rate for Payer: EmblemHealth Commercial	$40.03
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	$40.03
Rate for Payer: Healthfirst Essential Plan	$112.66
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50.07

HC ECHO EXAM OF EYE - ULTRASOUND BIOMETRY W IOL CAL - OU - BOTH EYES

Facility

$339.00

Service Code	CPT 76519 TC
Hospital Charge Code	4027651905
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC ECHO EXAM OF EYE - US EYE BIOMETRY W INTRAOCULAR LENS CALCULATION

Facility

$339.00

Service Code	CPT 76519 TC
Hospital Charge Code	4027651901
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC ECHO EXAM OF EYE - US EYE BIOMETRY W INTRAOCULAR LENS CALCULATION

Facility

$339.00

Service Code	CPT 76519 TC
Hospital Charge Code	4027651901
Hospital Revenue Code	402
Min. Negotiated Rate	$40.03
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.70
Rate for Payer: Aetna Government	$41.70
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$206.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.43
Rate for Payer: EmblemHealth Commercial	$40.03
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	$40.03
Rate for Payer: Healthfirst Essential Plan	$112.66
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50.07

HC ECHOGRAPHY,TRANSVAGINAL

Facility

$339.00

Service Code	CPT 76830 TC
Hospital Charge Code	4027683002
Hospital Revenue Code	402
Min. Negotiated Rate	$69.04
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.04
Rate for Payer: Aetna Government	$69.04
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$206.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.43
Rate for Payer: EmblemHealth Commercial	$89.50
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	$89.50
Rate for Payer: Healthfirst Essential Plan	$181.91
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$80.85

HC ECHOGRAPHY,TRANSVAGINAL

Facility

$339.00

Service Code	CPT 76830 TC
Hospital Charge Code	4027683002
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC ECHOGRAPHY,TRANSVAGINAL - US PELVIS TRANSVAGINAL

Facility

$339.00

Service Code	CPT 76830 TC
Hospital Charge Code	4027683001
Hospital Revenue Code	402
Min. Negotiated Rate	$69.04
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.04
Rate for Payer: Aetna Government	$69.04
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$206.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.43
Rate for Payer: EmblemHealth Commercial	$89.50
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	$89.50
Rate for Payer: Healthfirst Essential Plan	$181.91
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$80.85

HC ECHOGRAPHY,TRANSVAGINAL - US PELVIS TRANSVAGINAL

Facility

$339.00

Service Code	CPT 76830 TC
Hospital Charge Code	4027683001
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC ECHO GUIDE FOR BIOPSY - US GUIDANCE NEEDLE PLACEMENT

Facility

$1,144.00

Service Code	CPT 76942 TC
Hospital Charge Code	4027694232
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

Know your out-of-pocket cost for care.

All Charges