St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC ULTRASONIC GUIDANCE, INTRAOPERATIVE - US PROSTATE WITH BIOPSY

Facility

$348.00

Service Code	CPT 76998 TC
Hospital Charge Code	4027699801
Hospital Revenue Code	402
Min. Negotiated Rate	$50.29
Max. Negotiated Rate	$278.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$191.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.29
Rate for Payer: Aetna Government	$50.29
Rate for Payer: Brighton Health Commercial	$261.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$278.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$236.64
Rate for Payer: EmblemHealth Commercial	$174.00
Rate for Payer: Group Health Inc Commercial	$174.00
Rate for Payer: Group Health Inc Medicare	$121.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$174.00
Rate for Payer: Hamaspik Choice Inc Medicare	$174.00
Rate for Payer: Healthfirst Essential Plan	$249.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$110.94

HC ULTRASONIC GUIDANCE, INTRAOPERATIVE - US PROSTATE WITH BIOPSY

Facility

$348.00

Service Code	CPT 76998 TC
Hospital Charge Code	4027699801
Hospital Revenue Code	402
Min. Negotiated Rate	$174.00
Max. Negotiated Rate	$174.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$174.00

HC ULTRASOUND BREAST COMPLETE - US BREAST BILATERAL COMPLETE

Facility

$339.00

Service Code	CPT 76641 50,TC
Hospital Charge Code	4027664101
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC ULTRASOUND BREAST COMPLETE - US BREAST BILATERAL COMPLETE

Facility

$339.00

Service Code	CPT 76641 50,TC
Hospital Charge Code	4027664101
Hospital Revenue Code	402
Min. Negotiated Rate	$55.93
Max. Negotiated Rate	$271.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$55.93
Rate for Payer: Aetna Government	$55.93
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.52
Rate for Payer: EmblemHealth Commercial	$169.50
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 Essential Plan	$166.43
Rate for Payer: United Healthcare Commercial	$73.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$73.97

HC ULTRASOUND BREAST COMPLETE - US BREAST COMPLETE

Facility

$339.00

Service Code	CPT 76641 TC
Hospital Charge Code	4027664102
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC ULTRASOUND BREAST COMPLETE - US BREAST COMPLETE

Facility

$339.00

Service Code	CPT 76641 TC
Hospital Charge Code	4027664102
Hospital Revenue Code	402
Min. Negotiated Rate	$55.93
Max. Negotiated Rate	$271.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$55.93
Rate for Payer: Aetna Government	$55.93
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.52
Rate for Payer: EmblemHealth Commercial	$70.78
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	$70.78
Rate for Payer: Healthfirst Essential Plan	$166.43
Rate for Payer: United Healthcare Commercial	$73.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$73.97

HC ULTRASOUND BREAST COMPLETE - US BREAST RIGHT COMPLETE

Facility

$339.00

Service Code	CPT 76641 TC
Hospital Charge Code	4027664103
Hospital Revenue Code	402
Min. Negotiated Rate	$55.93
Max. Negotiated Rate	$271.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$55.93
Rate for Payer: Aetna Government	$55.93
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.52
Rate for Payer: EmblemHealth Commercial	$70.78
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	$70.78
Rate for Payer: Healthfirst Essential Plan	$166.43
Rate for Payer: United Healthcare Commercial	$73.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$73.97

HC ULTRASOUND BREAST COMPLETE - US BREAST RIGHT COMPLETE

Facility

$339.00

Service Code	CPT 76641 TC
Hospital Charge Code	4027664103
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC ULTRASOUND BREAST LIMITED - US BREAST BILATERAL LIMITED

Facility

$241.00

Service Code	CPT 76642 TC
Hospital Charge Code	4027664203
Hospital Revenue Code	402
Min. Negotiated Rate	$42.82
Max. Negotiated Rate	$192.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.82
Rate for Payer: Aetna Government	$42.82
Rate for Payer: Brighton Health Commercial	$180.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$192.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.88
Rate for Payer: EmblemHealth Commercial	$55.05
Rate for Payer: Group Health Inc Commercial	$120.50
Rate for Payer: Group Health Inc Medicare	$84.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50
Rate for Payer: Hamaspik Choice Inc Medicare	$120.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$55.05
Rate for Payer: Healthfirst Essential Plan	$136.53
Rate for Payer: United Healthcare Commercial	$73.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$60.68

HC ULTRASOUND BREAST LIMITED - US BREAST BILATERAL LIMITED

Facility

$241.00

Service Code	CPT 76642 TC
Hospital Charge Code	4027664203
Hospital Revenue Code	402
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$120.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50

HC ULTRASOUND BREAST LIMITED - US BREAST LIMITED

Facility

$241.00

Service Code	CPT 76642 TC
Hospital Charge Code	4027664201
Hospital Revenue Code	402
Min. Negotiated Rate	$42.82
Max. Negotiated Rate	$192.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.82
Rate for Payer: Aetna Government	$42.82
Rate for Payer: Brighton Health Commercial	$180.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$192.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.88
Rate for Payer: EmblemHealth Commercial	$55.05
Rate for Payer: Group Health Inc Commercial	$120.50
Rate for Payer: Group Health Inc Medicare	$84.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50
Rate for Payer: Hamaspik Choice Inc Medicare	$120.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$55.05
Rate for Payer: Healthfirst Essential Plan	$136.53
Rate for Payer: United Healthcare Commercial	$73.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$60.68

HC ULTRASOUND BREAST LIMITED - US BREAST LIMITED

Facility

$241.00

Service Code	CPT 76642 TC
Hospital Charge Code	4027664201
Hospital Revenue Code	402
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$120.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50

HC ULTRASOUND BREAST LIMITED - US BREAST RIGHT LIMITED

Facility

$241.00

Service Code	CPT 76642 TC
Hospital Charge Code	4027664202
Hospital Revenue Code	402
Min. Negotiated Rate	$42.82
Max. Negotiated Rate	$192.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.82
Rate for Payer: Aetna Government	$42.82
Rate for Payer: Brighton Health Commercial	$180.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$192.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.88
Rate for Payer: EmblemHealth Commercial	$55.05
Rate for Payer: Group Health Inc Commercial	$120.50
Rate for Payer: Group Health Inc Medicare	$84.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50
Rate for Payer: Hamaspik Choice Inc Medicare	$120.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$55.05
Rate for Payer: Healthfirst Essential Plan	$136.53
Rate for Payer: United Healthcare Commercial	$73.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$60.68

HC ULTRASOUND BREAST LIMITED - US BREAST RIGHT LIMITED

Facility

$241.00

Service Code	CPT 76642 TC
Hospital Charge Code	4027664202
Hospital Revenue Code	402
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$120.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50

HC UNLISTED ABDOM-PERITONEUM/OMENTUM

Facility

$2,380.00

Service Code	CPT 49999
Hospital Charge Code	3614999901
Hospital Revenue Code	361
Min. Negotiated Rate	$1,190.00
Max. Negotiated Rate	$1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,190.00

HC UNLISTED ABDOM-PERITONEUM/OMENTUM

Facility

$2,380.00

Service Code	CPT 49999
Hospital Charge Code	3614999901
Hospital Revenue Code	361
Min. Negotiated Rate	$801.87
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,145.53
Rate for Payer: Aetna Government	$1,145.53
Rate for Payer: Affinity Essential Plan 1&2	$801.87
Rate for Payer: Affinity Essential Plan 3&4	$801.87
Rate for Payer: Affinity Medicaid/CHP/HARP	$801.87
Rate for Payer: Brighton Health Commercial	$1,785.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,145.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,092.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,628.64
Rate for Payer: Elderplan Medicare Advantage	$1,145.53
Rate for Payer: EmblemHealth Commercial	$1,145.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,030.98
Rate for Payer: Fidelis Essential Plan Aliesa	$973.70
Rate for Payer: Fidelis Essential Plan QHP	$1,019.52
Rate for Payer: Fidelis Medicare Advantage	$1,145.53
Rate for Payer: Fidelis Qualified Health Plan	$1,019.52
Rate for Payer: Group Health Inc Commercial	$1,145.53
Rate for Payer: Group Health Inc Medicare	$1,145.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,145.53
Rate for Payer: Hamaspik Choice Inc Medicare	$1,145.53
Rate for Payer: Healthfirst Medicare Advantage	$973.70
Rate for Payer: Healthfirst QHP	$1,145.53
Rate for Payer: Humana Medicare	$1,168.44
Rate for Payer: Senior Whole Health Medicare Advantage	$1,145.53
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$1,145.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,145.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,088.25
Rate for Payer: Wellcare Medicare	$1,088.25

HC UNLISTED DX RADIOGRAPHIC PROCEDURE - XR BRONCHOGRAM

Facility

$241.00

Service Code	CPT 76499 TC
Hospital Charge Code	3207649901
Hospital Revenue Code	320
Min. Negotiated Rate	$81.13
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$120.50
Rate for Payer: Aetna Government	$120.50
Rate for Payer: Brighton Health Commercial	$180.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.13
Rate for Payer: EmblemHealth Commercial	$120.50
Rate for Payer: Group Health Inc Commercial	$120.50
Rate for Payer: Group Health Inc Medicare	$84.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50
Rate for Payer: Hamaspik Choice Inc Medicare	$120.50

HC UNLISTED DX RADIOGRAPHIC PROCEDURE - XR BRONCHOGRAM

Facility

$241.00

Service Code	CPT 76499 TC
Hospital Charge Code	3207649901
Hospital Revenue Code	320
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$120.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50

HC UNLISTED E/M SERVICE

Facility

$57.00

Service Code	CPT 99499
Hospital Charge Code	5109949901
Hospital Revenue Code	510
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.50
Rate for Payer: Aetna Government	$28.50
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	$28.50
Rate for Payer: Hamaspik Choice Inc Medicare	$28.50
Rate for Payer: United Healthcare Commercial	$222.00

HC UNLISTED E/M SERVICE

Facility

$57.00

Service Code	CPT 99499
Hospital Charge Code	5109949901
Hospital Revenue Code	510
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$28.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.50

HC UNLISTED IV OR INTRA ARTERIAL INJ

Facility

$115.00

Service Code	CPT 96379
Hospital Charge Code	2609637901
Hospital Revenue Code	260
Min. Negotiated Rate	$39.46
Max. Negotiated Rate	$92.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$63.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.37
Rate for Payer: Aetna Government	$56.37
Rate for Payer: Affinity Essential Plan 1&2	$39.46
Rate for Payer: Affinity Essential Plan 3&4	$39.46
Rate for Payer: Affinity Medicaid/CHP/HARP	$39.46
Rate for Payer: Brighton Health Commercial	$86.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$56.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$92.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$78.20
Rate for Payer: Elderplan Medicare Advantage	$56.37
Rate for Payer: EmblemHealth Commercial	$56.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$50.73
Rate for Payer: Fidelis Essential Plan Aliesa	$47.91
Rate for Payer: Fidelis Essential Plan QHP	$50.17
Rate for Payer: Fidelis Medicare Advantage	$56.37
Rate for Payer: Fidelis Qualified Health Plan	$50.17
Rate for Payer: Group Health Inc Commercial	$56.37
Rate for Payer: Group Health Inc Medicare	$56.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.37
Rate for Payer: Hamaspik Choice Inc Medicare	$56.37
Rate for Payer: Healthfirst Medicare Advantage	$47.91
Rate for Payer: Healthfirst QHP	$56.37
Rate for Payer: Humana Medicare	$57.50
Rate for Payer: Senior Whole Health Medicare Advantage	$56.37
Rate for Payer: United Healthcare Commercial	$76.00
Rate for Payer: United Healthcare Medicare Advantage	$56.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$56.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$53.55
Rate for Payer: Wellcare Medicare	$53.55

HC UNLISTED IV OR INTRA ARTERIAL INJ

Facility

$115.00

Service Code	CPT 96379
Hospital Charge Code	2609637901
Hospital Revenue Code	260
Min. Negotiated Rate	$57.50
Max. Negotiated Rate	$57.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.50

HC UNLISTED MR PROCEDURE - MR INTERPRETATION OF OUTSIDE FILMS

Facility

$260.00

Service Code	CPT 76498 TC
Hospital Charge Code	6107649801
Hospital Revenue Code	610
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$733.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$143.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$195.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$733.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$617.72
Rate for Payer: EmblemHealth Commercial	$130.00
Rate for Payer: Group Health Inc Commercial	$130.00
Rate for Payer: Group Health Inc Medicare	$91.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.00
Rate for Payer: Hamaspik Choice Inc Medicare	$130.00
Rate for Payer: United Healthcare Commercial	$274.34

HC UNLISTED MR PROCEDURE - MR INTERPRETATION OF OUTSIDE FILMS

Facility

$260.00

Service Code	CPT 76498 TC
Hospital Charge Code	6107649801
Hospital Revenue Code	610
Min. Negotiated Rate	$130.00
Max. Negotiated Rate	$130.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.00

HC UNLISTED PREVENTIVE SERVICE

Facility

$126.00

Service Code	CPT 99429
Hospital Charge Code	5109942901
Hospital Revenue Code	510
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$69.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.00
Rate for Payer: Aetna Government	$63.00
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	$63.00
Rate for Payer: Hamaspik Choice Inc Medicare	$63.00
Rate for Payer: United Healthcare Commercial	$222.00

Know your out-of-pocket cost for care.

All Charges