St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC US ABDL AORTA SCREEN AAA - US ABDOMEN AORTIC ANEURYSM SCREENING

Facility

$339.00

Service Code	CPT 76706 TC
Hospital Charge Code	4027670601
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC US ABDL AORTA SCREEN AAA - US ABDOMEN AORTIC ANEURYSM SCREENING

Facility

$339.00

Service Code	CPT 76706 TC
Hospital Charge Code	4027670601
Hospital Revenue Code	402
Min. Negotiated Rate	$52.68
Max. Negotiated Rate	$271.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$52.68
Rate for Payer: Aetna Government	$52.68
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	$85.09
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	$85.09
Rate for Payer: Healthfirst Essential Plan	$173.23
Rate for Payer: United Healthcare Commercial	$90.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$76.99

HC US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE - US ABDOMEN

Facility

$320.00

Service Code	CPT 76700 TC
Hospital Charge Code	4027670001
Hospital Revenue Code	402
Min. Negotiated Rate	$64.86
Max. Negotiated Rate	$240.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$176.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.86
Rate for Payer: Aetna Government	$64.86
Rate for Payer: Brighton Health Commercial	$240.00
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	$81.46
Rate for Payer: Group Health Inc Commercial	$160.00
Rate for Payer: Group Health Inc Medicare	$112.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$81.46
Rate for Payer: Healthfirst Essential Plan	$240.19
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$106.75

HC US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE - US ABDOMEN

Facility

$320.00

Service Code	CPT 76700 TC
Hospital Charge Code	4027670001
Hospital Revenue Code	402
Min. Negotiated Rate	$160.00
Max. Negotiated Rate	$160.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00

HC US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE - US ABDOMEN COMPLETE

Facility

$339.00

Service Code	CPT 76700 TC
Hospital Charge Code	4027670002
Hospital Revenue Code	402
Min. Negotiated Rate	$64.86
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.86
Rate for Payer: Aetna Government	$64.86
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	$81.46
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	$81.46
Rate for Payer: Healthfirst Essential Plan	$240.19
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$106.75

HC US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE - US ABDOMEN COMPLETE

Facility

$339.00

Service Code	CPT 76700 TC
Hospital Charge Code	4027670002
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC US, ABDOMEN LIMITED - US ABDOMEN LIMITED

Facility

$302.00

Service Code	CPT 76705 TC
Hospital Charge Code	4027670506
Hospital Revenue Code	402
Min. Negotiated Rate	$151.00
Max. Negotiated Rate	$151.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$151.00

HC US, ABDOMEN LIMITED - US ABDOMEN LIMITED

Facility

$302.00

Service Code	CPT 76705 TC
Hospital Charge Code	4027670506
Hospital Revenue Code	402
Min. Negotiated Rate	$48.96
Max. Negotiated Rate	$226.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$166.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$48.96
Rate for Payer: Aetna Government	$48.96
Rate for Payer: Brighton Health Commercial	$226.50
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	$62.04
Rate for Payer: Group Health Inc Commercial	$151.00
Rate for Payer: Group Health Inc Medicare	$105.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$151.00
Rate for Payer: Hamaspik Choice Inc Medicare	$151.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$62.04
Rate for Payer: Healthfirst Essential Plan	$155.32
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$69.03

HC US, ABDOMEN LIMITED - US ABDOMEN LIMITED LIVER

Facility

$302.00

Service Code	CPT 76705 TC
Hospital Charge Code	4027670503
Hospital Revenue Code	402
Min. Negotiated Rate	$48.96
Max. Negotiated Rate	$226.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$166.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$48.96
Rate for Payer: Aetna Government	$48.96
Rate for Payer: Brighton Health Commercial	$226.50
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	$62.04
Rate for Payer: Group Health Inc Commercial	$151.00
Rate for Payer: Group Health Inc Medicare	$105.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$151.00
Rate for Payer: Hamaspik Choice Inc Medicare	$151.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$62.04
Rate for Payer: Healthfirst Essential Plan	$155.32
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$69.03

HC US, ABDOMEN LIMITED - US ABDOMEN LIMITED LIVER

Facility

$302.00

Service Code	CPT 76705 TC
Hospital Charge Code	4027670503
Hospital Revenue Code	402
Min. Negotiated Rate	$151.00
Max. Negotiated Rate	$151.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$151.00

HC US, ABDOMEN LIMITED - US ABDOMEN LIMITED SPLEEN

Facility

$302.00

Service Code	CPT 76705 TC
Hospital Charge Code	4027670501
Hospital Revenue Code	402
Min. Negotiated Rate	$48.96
Max. Negotiated Rate	$226.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$166.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$48.96
Rate for Payer: Aetna Government	$48.96
Rate for Payer: Brighton Health Commercial	$226.50
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	$62.04
Rate for Payer: Group Health Inc Commercial	$151.00
Rate for Payer: Group Health Inc Medicare	$105.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$151.00
Rate for Payer: Hamaspik Choice Inc Medicare	$151.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$62.04
Rate for Payer: Healthfirst Essential Plan	$155.32
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$69.03

HC US, ABDOMEN LIMITED - US ABDOMEN LIMITED SPLEEN

Facility

$302.00

Service Code	CPT 76705 TC
Hospital Charge Code	4027670501
Hospital Revenue Code	402
Min. Negotiated Rate	$151.00
Max. Negotiated Rate	$151.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$151.00

HC US, ABDOMEN LIMITED - US ENDOANAL

Facility

$302.00

Service Code	CPT 76705 TC
Hospital Charge Code	4027670502
Hospital Revenue Code	402
Min. Negotiated Rate	$151.00
Max. Negotiated Rate	$151.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$151.00

HC US, ABDOMEN LIMITED - US ENDOANAL

Facility

$302.00

Service Code	CPT 76705 TC
Hospital Charge Code	4027670502
Hospital Revenue Code	402
Min. Negotiated Rate	$48.96
Max. Negotiated Rate	$226.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$166.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$48.96
Rate for Payer: Aetna Government	$48.96
Rate for Payer: Brighton Health Commercial	$226.50
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	$62.04
Rate for Payer: Group Health Inc Commercial	$151.00
Rate for Payer: Group Health Inc Medicare	$105.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$151.00
Rate for Payer: Hamaspik Choice Inc Medicare	$151.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$62.04
Rate for Payer: Healthfirst Essential Plan	$155.32
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$69.03

HC US, ABDOMEN LIMITED - US GALLBLADDER

Facility

$302.00

Service Code	CPT 76705 TC
Hospital Charge Code	4027670505
Hospital Revenue Code	402
Min. Negotiated Rate	$151.00
Max. Negotiated Rate	$151.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$151.00

HC US, ABDOMEN LIMITED - US GALLBLADDER

Facility

$302.00

Service Code	CPT 76705 TC
Hospital Charge Code	4027670505
Hospital Revenue Code	402
Min. Negotiated Rate	$48.96
Max. Negotiated Rate	$226.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$166.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$48.96
Rate for Payer: Aetna Government	$48.96
Rate for Payer: Brighton Health Commercial	$226.50
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	$62.04
Rate for Payer: Group Health Inc Commercial	$151.00
Rate for Payer: Group Health Inc Medicare	$105.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$151.00
Rate for Payer: Hamaspik Choice Inc Medicare	$151.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$62.04
Rate for Payer: Healthfirst Essential Plan	$155.32
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$69.03

HC US, ABDOMEN LIMITED - US PELVIS APPENDIX

Facility

$302.00

Service Code	CPT 76705 TC
Hospital Charge Code	4027670504
Hospital Revenue Code	402
Min. Negotiated Rate	$48.96
Max. Negotiated Rate	$226.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$166.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$48.96
Rate for Payer: Aetna Government	$48.96
Rate for Payer: Brighton Health Commercial	$226.50
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	$62.04
Rate for Payer: Group Health Inc Commercial	$151.00
Rate for Payer: Group Health Inc Medicare	$105.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$151.00
Rate for Payer: Hamaspik Choice Inc Medicare	$151.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$62.04
Rate for Payer: Healthfirst Essential Plan	$155.32
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$69.03

HC US, ABDOMEN LIMITED - US PELVIS APPENDIX

Facility

$302.00

Service Code	CPT 76705 TC
Hospital Charge Code	4027670504
Hospital Revenue Code	402
Min. Negotiated Rate	$151.00
Max. Negotiated Rate	$151.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$151.00

HC US BONE DENSITY MEASURE - US BONE DENSITY MEASUREMENT PERIPHERAL

Facility

$339.00

Service Code	CPT 76977 TC
Hospital Charge Code	4027697701
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC US BONE DENSITY MEASURE - US BONE DENSITY MEASUREMENT PERIPHERAL

Facility

$339.00

Service Code	CPT 76977 TC
Hospital Charge Code	4027697701
Hospital Revenue Code	402
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.49
Rate for Payer: Aetna Government	$3.49
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$98.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$83.27
Rate for Payer: EmblemHealth Commercial	$5.09
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	$5.09
Rate for Payer: Healthfirst Essential Plan	$15.16
Rate for Payer: United Healthcare Commercial	$36.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.74

HC US BREAST UNI REAL TIME WITH IMAGE LIMITED

Facility

$241.00

Service Code	CPT 76642 TC
Hospital Charge Code	4027664204
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 US BREAST UNI REAL TIME WITH IMAGE LIMITED

Facility

$241.00

Service Code	CPT 76642 TC
Hospital Charge Code	4027664204
Hospital Revenue Code	402
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$120.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50

HC US, CHEST,REAL TIME

Facility

$339.00

Service Code	CPT 76604 TC
Hospital Charge Code	4027660402
Hospital Revenue Code	402
Min. Negotiated Rate	$32.70
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$48.12
Rate for Payer: Aetna Government	$48.12
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	$32.70
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	$32.70
Rate for Payer: Healthfirst Essential Plan	$127.58
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$56.70

HC US, CHEST,REAL TIME

Facility

$339.00

Service Code	CPT 76604 TC
Hospital Charge Code	4027660402
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC US, CHEST,REAL TIME - US CHEST

Facility

$339.00

Service Code	CPT 76604 TC
Hospital Charge Code	4027660401
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

Know your out-of-pocket cost for care.

All Charges