St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC EEG,COMA/SLEEP RECORD ONLY

Facility

$766.00

Service Code	CPT 95822 TC
Hospital Charge Code	7409582201
Hospital Revenue Code	740
Min. Negotiated Rate	$383.00
Max. Negotiated Rate	$383.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.00

HC EEG CONT REC W/VID EEG TECH

Facility

$766.00

Service Code	CPT 95700
Hospital Charge Code	7409570001
Hospital Revenue Code	740
Min. Negotiated Rate	$133.82
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$191.17
Rate for Payer: Aetna Government	$191.17
Rate for Payer: Affinity Essential Plan 1&2	$133.82
Rate for Payer: Affinity Essential Plan 3&4	$133.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$133.82
Rate for Payer: Brighton Health Commercial	$574.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$191.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$612.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$520.88
Rate for Payer: Elderplan Medicare Advantage	$191.17
Rate for Payer: EmblemHealth Commercial	$191.17
Rate for Payer: Fidelis CHP/HARP/Medicaid	$172.05
Rate for Payer: Fidelis Essential Plan Aliesa	$162.49
Rate for Payer: Fidelis Essential Plan QHP	$170.14
Rate for Payer: Fidelis Medicare Advantage	$191.17
Rate for Payer: Fidelis Qualified Health Plan	$170.14
Rate for Payer: Group Health Inc Commercial	$191.17
Rate for Payer: Group Health Inc Medicare	$191.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.17
Rate for Payer: Hamaspik Choice Inc Medicare	$191.17
Rate for Payer: Healthfirst Medicare Advantage	$162.49
Rate for Payer: Healthfirst QHP	$191.17
Rate for Payer: Humana Medicare	$194.99
Rate for Payer: Senior Whole Health Medicare Advantage	$191.17
Rate for Payer: United Healthcare Commercial	$822.00
Rate for Payer: United Healthcare Medicare Advantage	$191.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$191.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$181.61
Rate for Payer: Wellcare Medicare	$181.61

HC EEG CONT REC W/VID EEG TECH

Facility

$766.00

Service Code	CPT 95700
Hospital Charge Code	7409570001
Hospital Revenue Code	740
Min. Negotiated Rate	$383.00
Max. Negotiated Rate	$383.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.00

HC EEG EVAL CEREBRAL DEATH - EEG CEREBRAL DEATH EVAL ONLY

Facility

$1,470.00

Service Code	CPT 95824 TC
Hospital Charge Code	7409582401
Hospital Revenue Code	740
Min. Negotiated Rate	$57.08
Max. Negotiated Rate	$1,176.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$808.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$57.08
Rate for Payer: Aetna Government	$57.08
Rate for Payer: Brighton Health Commercial	$1,102.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,176.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$999.60
Rate for Payer: EmblemHealth Commercial	$735.00
Rate for Payer: Group Health Inc Commercial	$735.00
Rate for Payer: Group Health Inc Medicare	$514.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$735.00
Rate for Payer: Hamaspik Choice Inc Medicare	$735.00
Rate for Payer: United Healthcare Commercial	$822.00

HC EEG EVAL CEREBRAL DEATH - EEG CEREBRAL DEATH EVAL ONLY

Facility

$1,470.00

Service Code	CPT 95824 TC
Hospital Charge Code	7409582401
Hospital Revenue Code	740
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$735.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$735.00

HC EEG,EXTENDED MONITORING,41-60 MINUTES - EEG

Facility

$766.00

Service Code	CPT 95812 TC
Hospital Charge Code	7409581201
Hospital Revenue Code	740
Min. Negotiated Rate	$261.74
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$261.74
Rate for Payer: Aetna Government	$261.74
Rate for Payer: Brighton Health Commercial	$574.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$612.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$520.88
Rate for Payer: EmblemHealth Commercial	$383.00
Rate for Payer: Group Health Inc Commercial	$383.00
Rate for Payer: Group Health Inc Medicare	$268.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.00
Rate for Payer: Hamaspik Choice Inc Medicare	$383.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$340.95
Rate for Payer: United Healthcare Commercial	$822.00

HC EEG,EXTENDED MONITORING,41-60 MINUTES - EEG

Facility

$766.00

Service Code	CPT 95812 TC
Hospital Charge Code	7409581201
Hospital Revenue Code	740
Min. Negotiated Rate	$383.00
Max. Negotiated Rate	$383.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.00

HC EEG PHY/QHP>36<60 HR W/O VID

Facility

$2,831.00

Service Code	CPT 95721
Hospital Charge Code	7409572101
Hospital Revenue Code	740
Min. Negotiated Rate	$1,415.50
Max. Negotiated Rate	$1,415.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,415.50

HC EEG PHY/QHP>36<60 HR W/O VID

Facility

$2,831.00

Service Code	CPT 95721
Hospital Charge Code	7409572101
Hospital Revenue Code	740
Min. Negotiated Rate	$183.76
Max. Negotiated Rate	$2,264.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,557.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$183.76
Rate for Payer: Aetna Government	$183.76
Rate for Payer: Brighton Health Commercial	$2,123.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,264.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,925.08
Rate for Payer: EmblemHealth Commercial	$1,415.50
Rate for Payer: Group Health Inc Commercial	$1,415.50
Rate for Payer: Group Health Inc Medicare	$990.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,415.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,415.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$225.81
Rate for Payer: United Healthcare Commercial	$822.00

HC EEG PHY/QHP>36<60 HR W/VEEG

Facility

$2,831.00

Service Code	CPT 95722
Hospital Charge Code	7409572201
Hospital Revenue Code	740
Min. Negotiated Rate	$223.63
Max. Negotiated Rate	$2,264.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,557.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$223.63
Rate for Payer: Aetna Government	$223.63
Rate for Payer: Brighton Health Commercial	$2,123.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,264.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,925.08
Rate for Payer: EmblemHealth Commercial	$1,415.50
Rate for Payer: Group Health Inc Commercial	$1,415.50
Rate for Payer: Group Health Inc Medicare	$990.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,415.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,415.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$275.45
Rate for Payer: United Healthcare Commercial	$822.00

HC EEG PHY/QHP>36<60 HR W/VEEG

Facility

$2,831.00

Service Code	CPT 95722
Hospital Charge Code	7409572201
Hospital Revenue Code	740
Min. Negotiated Rate	$1,415.50
Max. Negotiated Rate	$1,415.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,415.50

HC EEG PHY/QHP>60<84 HR W/O VID

Facility

$2,831.00

Service Code	CPT 95723
Hospital Charge Code	7409572301
Hospital Revenue Code	740
Min. Negotiated Rate	$228.04
Max. Negotiated Rate	$2,264.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,557.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$228.04
Rate for Payer: Aetna Government	$228.04
Rate for Payer: Brighton Health Commercial	$2,123.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,264.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,925.08
Rate for Payer: EmblemHealth Commercial	$1,415.50
Rate for Payer: Group Health Inc Commercial	$1,415.50
Rate for Payer: Group Health Inc Medicare	$990.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,415.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,415.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$277.95
Rate for Payer: United Healthcare Commercial	$822.00

HC EEG PHY/QHP>60<84 HR W/O VID

Facility

$2,831.00

Service Code	CPT 95723
Hospital Charge Code	7409572301
Hospital Revenue Code	740
Min. Negotiated Rate	$1,415.50
Max. Negotiated Rate	$1,415.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,415.50

HC EEG PHY/QHP>60<84 HR W/VEEG

Facility

$2,831.00

Service Code	CPT 95724
Hospital Charge Code	7409572401
Hospital Revenue Code	740
Min. Negotiated Rate	$284.99
Max. Negotiated Rate	$2,264.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,557.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$284.99
Rate for Payer: Aetna Government	$284.99
Rate for Payer: Brighton Health Commercial	$2,123.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,264.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,925.08
Rate for Payer: EmblemHealth Commercial	$1,415.50
Rate for Payer: Group Health Inc Commercial	$1,415.50
Rate for Payer: Group Health Inc Medicare	$990.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,415.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,415.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$349.32
Rate for Payer: United Healthcare Commercial	$822.00

HC EEG PHY/QHP>60<84 HR W/VEEG

Facility

$2,831.00

Service Code	CPT 95724
Hospital Charge Code	7409572401
Hospital Revenue Code	740
Min. Negotiated Rate	$1,415.50
Max. Negotiated Rate	$1,415.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,415.50

HC EEG PHY/QHP>84 HR W/O VID

Facility

$2,831.00

Service Code	CPT 95725
Hospital Charge Code	7409572501
Hospital Revenue Code	740
Min. Negotiated Rate	$1,415.50
Max. Negotiated Rate	$1,415.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,415.50

HC EEG PHY/QHP>84 HR W/O VID

Facility

$2,831.00

Service Code	CPT 95725
Hospital Charge Code	7409572501
Hospital Revenue Code	740
Min. Negotiated Rate	$259.46
Max. Negotiated Rate	$2,264.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,557.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.46
Rate for Payer: Aetna Government	$259.46
Rate for Payer: Brighton Health Commercial	$2,123.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,264.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,925.08
Rate for Payer: EmblemHealth Commercial	$1,415.50
Rate for Payer: Group Health Inc Commercial	$1,415.50
Rate for Payer: Group Health Inc Medicare	$990.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,415.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,415.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$318.80
Rate for Payer: United Healthcare Commercial	$822.00

HC EEG PHY/QHP>84 HR W/VEEG

Facility

$2,831.00

Service Code	CPT 95726
Hospital Charge Code	7409572601
Hospital Revenue Code	740
Min. Negotiated Rate	$360.20
Max. Negotiated Rate	$2,264.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,557.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$360.20
Rate for Payer: Aetna Government	$360.20
Rate for Payer: Brighton Health Commercial	$2,123.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,264.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,925.08
Rate for Payer: EmblemHealth Commercial	$1,415.50
Rate for Payer: Group Health Inc Commercial	$1,415.50
Rate for Payer: Group Health Inc Medicare	$990.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,415.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,415.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$443.77
Rate for Payer: United Healthcare Commercial	$822.00

HC EEG PHY/QHP>84 HR W/VEEG

Facility

$2,831.00

Service Code	CPT 95726
Hospital Charge Code	7409572601
Hospital Revenue Code	740
Min. Negotiated Rate	$1,415.50
Max. Negotiated Rate	$1,415.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,415.50

HC EEG PHY/QHP EA INCR W/VEEG

Facility

$1,470.00

Service Code	CPT 95720
Hospital Charge Code	7409572001
Hospital Revenue Code	740
Min. Negotiated Rate	$183.10
Max. Negotiated Rate	$1,176.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$808.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$183.10
Rate for Payer: Aetna Government	$183.10
Rate for Payer: Brighton Health Commercial	$1,102.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,176.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$999.60
Rate for Payer: EmblemHealth Commercial	$735.00
Rate for Payer: Group Health Inc Commercial	$735.00
Rate for Payer: Group Health Inc Medicare	$514.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$735.00
Rate for Payer: Hamaspik Choice Inc Medicare	$735.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$226.82
Rate for Payer: United Healthcare Commercial	$822.00

HC EEG PHY/QHP EA INCR W/VEEG

Facility

$1,470.00

Service Code	CPT 95720
Hospital Charge Code	7409572001
Hospital Revenue Code	740
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$735.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$735.00

HC EEG PHYS/QHP 2-12 HR W/O VID

Facility

$766.00

Service Code	CPT 95717
Hospital Charge Code	7409571701
Hospital Revenue Code	740
Min. Negotiated Rate	$89.31
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$89.31
Rate for Payer: Aetna Government	$89.31
Rate for Payer: Brighton Health Commercial	$574.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$612.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$520.88
Rate for Payer: EmblemHealth Commercial	$383.00
Rate for Payer: Group Health Inc Commercial	$383.00
Rate for Payer: Group Health Inc Medicare	$268.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.00
Rate for Payer: Hamaspik Choice Inc Medicare	$383.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$117.60
Rate for Payer: United Healthcare Commercial	$822.00

HC EEG PHYS/QHP 2-12 HR W/O VID

Facility

$766.00

Service Code	CPT 95717
Hospital Charge Code	7409571701
Hospital Revenue Code	740
Min. Negotiated Rate	$383.00
Max. Negotiated Rate	$383.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.00

HC EEG PHYS/QHP 2-12 HR W/VEEG

Facility

$766.00

Service Code	CPT 95718
Hospital Charge Code	7409571801
Hospital Revenue Code	740
Min. Negotiated Rate	$383.00
Max. Negotiated Rate	$383.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.00

HC EEG PHYS/QHP 2-12 HR W/VEEG

Facility

$766.00

Service Code	CPT 95718
Hospital Charge Code	7409571801
Hospital Revenue Code	740
Min. Negotiated Rate	$118.20
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$118.20
Rate for Payer: Aetna Government	$118.20
Rate for Payer: Brighton Health Commercial	$574.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$612.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$520.88
Rate for Payer: EmblemHealth Commercial	$383.00
Rate for Payer: Group Health Inc Commercial	$383.00
Rate for Payer: Group Health Inc Medicare	$268.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.00
Rate for Payer: Hamaspik Choice Inc Medicare	$383.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$148.01
Rate for Payer: United Healthcare Commercial	$822.00

Know your out-of-pocket cost for care.

All Charges