St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC OB US DETAILED ADDL FETUS - US OB DETAIL FETAL ANAT EA ADDL GEST

Facility

$595.00

Service Code	CPT 76812 TC
Hospital Charge Code	4027681201
Hospital Revenue Code	402
Min. Negotiated Rate	$49.80
Max. Negotiated Rate	$446.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$327.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$90.52
Rate for Payer: Aetna Government	$90.52
Rate for Payer: Brighton Health Commercial	$446.25
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	$110.81
Rate for Payer: Group Health Inc Commercial	$297.50
Rate for Payer: Group Health Inc Medicare	$208.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$297.50
Rate for Payer: Hamaspik Choice Inc Medicare	$297.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$110.81
Rate for Payer: Healthfirst Essential Plan	$345.78
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$153.68

HC OB US DETAILED SNGL FETUS - US OB DETAIL FETAL ANAT SING OR 1ST GEST

Facility

$705.00

Service Code	CPT 76811 TC
Hospital Charge Code	4027681101
Hospital Revenue Code	402
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC OB US DETAILED SNGL FETUS - US OB DETAIL FETAL ANAT SING OR 1ST GEST

Facility

$705.00

Service Code	CPT 76811 TC
Hospital Charge Code	4027681101
Hospital Revenue Code	402
Min. Negotiated Rate	$66.39
Max. Negotiated Rate	$530.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$66.39
Rate for Payer: Aetna Government	$66.39
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$327.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$275.58
Rate for Payer: EmblemHealth Commercial	$93.19
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 CHP/FHP/Medicaid	$93.19
Rate for Payer: Healthfirst Essential Plan	$530.12
Rate for Payer: United Healthcare Commercial	$122.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$235.61

HC OB US FOLLOW-UP PER FETUS - US OB FOLLOW UP TRANSABDOMINAL APPROACH

Facility

$339.00

Service Code	CPT 76816 TC
Hospital Charge Code	4027681601
Hospital Revenue Code	402
Min. Negotiated Rate	$49.80
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.49
Rate for Payer: Aetna Government	$56.49
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	$71.82
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	$71.82
Rate for Payer: Healthfirst Essential Plan	$243.97
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$108.43

HC OB US FOLLOW-UP PER FETUS - US OB FOLLOW UP TRANSABDOMINAL APPROACH

Facility

$339.00

Service Code	CPT 76816 TC
Hospital Charge Code	4027681601
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC OB US LIMITED FETUS(S) - US OB LIMITED 1+ FETUSES

Facility

$339.00

Service Code	CPT 76815 TC
Hospital Charge Code	4027681501
Hospital Revenue Code	402
Min. Negotiated Rate	$40.87
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.87
Rate for Payer: Aetna Government	$40.87
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	$52.60
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	$52.60
Rate for Payer: Healthfirst Essential Plan	$219.74
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$97.66

HC OB US LIMITED FETUS(S) - US OB LIMITED 1+ FETUSES

Facility

$339.00

Service Code	CPT 76815 TC
Hospital Charge Code	4027681501
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC OCCULT BLOOD FECES - POCT OCCULT BLOOD STOOL

Facility

$10.00

Service Code	CPT 82270
Hospital Charge Code	3018227003
Hospital Revenue Code	301
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$7.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.38
Rate for Payer: Aetna Government	$4.38
Rate for Payer: Affinity Essential Plan 1&2	$3.07
Rate for Payer: Affinity Essential Plan 3&4	$3.07
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.07
Rate for Payer: Brighton Health Commercial	$7.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.67
Rate for Payer: Elderplan Medicare Advantage	$4.38
Rate for Payer: EmblemHealth Commercial	$4.38
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.94
Rate for Payer: Fidelis Essential Plan Aliesa	$3.72
Rate for Payer: Fidelis Essential Plan QHP	$3.90
Rate for Payer: Fidelis Medicare Advantage	$4.38
Rate for Payer: Fidelis Qualified Health Plan	$3.90
Rate for Payer: Group Health Inc Commercial	$4.38
Rate for Payer: Group Health Inc Medicare	$4.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.38
Rate for Payer: Hamaspik Choice Inc Medicare	$4.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.43
Rate for Payer: Healthfirst Essential Plan	$7.72
Rate for Payer: Healthfirst Medicare Advantage	$4.38
Rate for Payer: Healthfirst QHP	$4.38
Rate for Payer: Humana Medicare	$4.47
Rate for Payer: Senior Whole Health Medicare Advantage	$4.38
Rate for Payer: United Healthcare Commercial	$4.12
Rate for Payer: United Healthcare Medicare Advantage	$4.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.43
Rate for Payer: Wellcare Medicare	$3.94

HC OCCULT BLOOD FECES - POCT OCCULT BLOOD STOOL

Facility

$10.00

Service Code	CPT 82270
Hospital Charge Code	3018227003
Hospital Revenue Code	301
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$5.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00

HC OCCULT BLOOD OTHER SOURCES - POCT GASTRIC OCCULT BLOOD

Facility

$48.00

Service Code	CPT 82271
Hospital Charge Code	3018227101
Hospital Revenue Code	301
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$36.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.32
Rate for Payer: Aetna Government	$5.32
Rate for Payer: Affinity Essential Plan 1&2	$3.72
Rate for Payer: Affinity Essential Plan 3&4	$3.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.72
Rate for Payer: Brighton Health Commercial	$36.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.67
Rate for Payer: Elderplan Medicare Advantage	$5.32
Rate for Payer: EmblemHealth Commercial	$5.32
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4.79
Rate for Payer: Fidelis Essential Plan Aliesa	$4.52
Rate for Payer: Fidelis Essential Plan QHP	$4.73
Rate for Payer: Fidelis Medicare Advantage	$5.32
Rate for Payer: Fidelis Qualified Health Plan	$4.73
Rate for Payer: Group Health Inc Commercial	$5.32
Rate for Payer: Group Health Inc Medicare	$5.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.32
Rate for Payer: Hamaspik Choice Inc Medicare	$5.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.32
Rate for Payer: Healthfirst Medicare Advantage	$5.32
Rate for Payer: Healthfirst QHP	$5.32
Rate for Payer: Humana Medicare	$5.43
Rate for Payer: Senior Whole Health Medicare Advantage	$5.32
Rate for Payer: United Healthcare Commercial	$4.12
Rate for Payer: United Healthcare Medicare Advantage	$5.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.05
Rate for Payer: Wellcare Medicare	$4.79

HC OCCULT BLOOD OTHER SOURCES - POCT GASTRIC OCCULT BLOOD

Facility

$48.00

Service Code	CPT 82271
Hospital Charge Code	3018227101
Hospital Revenue Code	301
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.00

HC OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN

Facility

$358.00

Service Code	CPT 99241 TC
Hospital Charge Code	5109924101
Hospital Revenue Code	510
Min. Negotiated Rate	$179.00
Max. Negotiated Rate	$179.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00

HC OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN

Facility

$358.00

Service Code	CPT 99241 TC
Hospital Charge Code	5109924101
Hospital Revenue Code	510
Min. Negotiated Rate	$35.52
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$196.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.52
Rate for Payer: Aetna Government	$35.52
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00
Rate for Payer: Hamaspik Choice Inc Medicare	$179.00
Rate for Payer: United Healthcare Commercial	$222.00

HC OFFICE CONSULTATION NEW/ESTAB PATIENT 30 MIN

Facility

$395.00

Service Code	CPT 99242 TC
Hospital Charge Code	5109924201
Hospital Revenue Code	510
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$217.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$66.50
Rate for Payer: Aetna Government	$66.50
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$197.50
Rate for Payer: Hamaspik Choice Inc Medicare	$197.50
Rate for Payer: United Healthcare Commercial	$222.00

HC OFFICE CONSULTATION NEW/ESTAB PATIENT 30 MIN

Facility

$395.00

Service Code	CPT 99242 TC
Hospital Charge Code	5109924201
Hospital Revenue Code	510
Min. Negotiated Rate	$197.50
Max. Negotiated Rate	$197.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$197.50

HC OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN

Facility

$479.00

Service Code	CPT 99243
Hospital Charge Code	5109924301
Hospital Revenue Code	510
Min. Negotiated Rate	$70.38
Max. Negotiated Rate	$263.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$263.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.38
Rate for Payer: Aetna Government	$70.38
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$239.50
Rate for Payer: Hamaspik Choice Inc Medicare	$239.50
Rate for Payer: United Healthcare Commercial	$222.00

HC OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN

Facility

$479.00

Service Code	CPT 99243
Hospital Charge Code	5109924301
Hospital Revenue Code	510
Min. Negotiated Rate	$239.50
Max. Negotiated Rate	$239.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$239.50

HC OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN

Facility

$528.00

Service Code	CPT 99244 TC
Hospital Charge Code	5109924401
Hospital Revenue Code	510
Min. Negotiated Rate	$264.00
Max. Negotiated Rate	$264.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.00

HC OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN

Facility

$528.00

Service Code	CPT 99244 TC
Hospital Charge Code	5109924401
Hospital Revenue Code	510
Min. Negotiated Rate	$135.64
Max. Negotiated Rate	$290.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$290.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$135.64
Rate for Payer: Aetna Government	$135.64
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.00
Rate for Payer: Hamaspik Choice Inc Medicare	$264.00
Rate for Payer: United Healthcare Commercial	$222.00

HC OFFICE CONSULTATION NEW/ESTAB PATIENT 80 MIN

Facility

$559.00

Service Code	CPT 99245
Hospital Charge Code	5109924501
Hospital Revenue Code	510
Min. Negotiated Rate	$139.91
Max. Negotiated Rate	$307.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$307.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$139.91
Rate for Payer: Aetna Government	$139.91
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$279.50
Rate for Payer: Hamaspik Choice Inc Medicare	$279.50
Rate for Payer: United Healthcare Commercial	$222.00

HC OFFICE CONSULTATION NEW/ESTAB PATIENT 80 MIN

Facility

$559.00

Service Code	CPT 99245
Hospital Charge Code	5109924501
Hospital Revenue Code	510
Min. Negotiated Rate	$279.50
Max. Negotiated Rate	$279.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$279.50

HC OFFICE OUTPATIENT NEW 20 MINUTES

Facility

$435.00

Service Code	CPT 99202
Hospital Charge Code	5109920201
Hospital Revenue Code	510
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$217.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$217.50

HC OFFICE OUTPATIENT NEW 20 MINUTES

Facility

$435.00

Service Code	CPT 99202
Hospital Charge Code	5109920201
Hospital Revenue Code	510
Min. Negotiated Rate	$37.08
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$239.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.08
Rate for Payer: Aetna Government	$37.08
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$217.50
Rate for Payer: Hamaspik Choice Inc Medicare	$217.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$51.89
Rate for Payer: United Healthcare Commercial	$222.00

HC OFFICE OUTPATIENT NEW 30-44 MINUTES

Facility

$479.00

Service Code	CPT 99203
Hospital Charge Code	5109920301
Hospital Revenue Code	510
Min. Negotiated Rate	$57.06
Max. Negotiated Rate	$263.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$263.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$57.06
Rate for Payer: Aetna Government	$57.06
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$239.50
Rate for Payer: Hamaspik Choice Inc Medicare	$239.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$91.79
Rate for Payer: United Healthcare Commercial	$222.00

HC OFFICE OUTPATIENT NEW 30-44 MINUTES

Facility

$479.00

Service Code	CPT 99203
Hospital Charge Code	5109920301
Hospital Revenue Code	510
Min. Negotiated Rate	$239.50
Max. Negotiated Rate	$239.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$239.50

Know your out-of-pocket cost for care.

All Charges