St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$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 COMPL JOINT R-T W/IMG

Facility

$339.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688121
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 COMPL JOINT R-T W/IMG

Facility

$339.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688121
Hospital Revenue Code	402
Min. Negotiated Rate	$11.38
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.69
Rate for Payer: Aetna Government	$65.69
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	$11.38
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	$11.38
Rate for Payer: Healthfirst Essential Plan	$172.33
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$76.59

HC US COMPL JOINT R-T W/IMG - US ANKLE LEFT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688103
Hospital Revenue Code	402
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$187.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00

HC US COMPL JOINT R-T W/IMG - US ANKLE LEFT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688103
Hospital Revenue Code	402
Min. Negotiated Rate	$11.38
Max. Negotiated Rate	$280.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$205.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.69
Rate for Payer: Aetna Government	$65.69
Rate for Payer: Brighton Health Commercial	$280.50
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	$11.38
Rate for Payer: Group Health Inc Commercial	$187.00
Rate for Payer: Group Health Inc Medicare	$130.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00
Rate for Payer: Hamaspik Choice Inc Medicare	$187.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$11.38
Rate for Payer: Healthfirst Essential Plan	$172.33
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$76.59

HC US COMPL JOINT R-T W/IMG - US ANKLE RIGHT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688104
Hospital Revenue Code	402
Min. Negotiated Rate	$11.38
Max. Negotiated Rate	$280.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$205.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.69
Rate for Payer: Aetna Government	$65.69
Rate for Payer: Brighton Health Commercial	$280.50
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	$11.38
Rate for Payer: Group Health Inc Commercial	$187.00
Rate for Payer: Group Health Inc Medicare	$130.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00
Rate for Payer: Hamaspik Choice Inc Medicare	$187.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$11.38
Rate for Payer: Healthfirst Essential Plan	$172.33
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$76.59

HC US COMPL JOINT R-T W/IMG - US ANKLE RIGHT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688104
Hospital Revenue Code	402
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$187.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00

HC US COMPL JOINT R-T W/IMG - US ELBOW LEFT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688118
Hospital Revenue Code	402
Min. Negotiated Rate	$11.38
Max. Negotiated Rate	$280.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$205.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.69
Rate for Payer: Aetna Government	$65.69
Rate for Payer: Brighton Health Commercial	$280.50
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	$11.38
Rate for Payer: Group Health Inc Commercial	$187.00
Rate for Payer: Group Health Inc Medicare	$130.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00
Rate for Payer: Hamaspik Choice Inc Medicare	$187.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$11.38
Rate for Payer: Healthfirst Essential Plan	$172.33
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$76.59

HC US COMPL JOINT R-T W/IMG - US ELBOW LEFT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688118
Hospital Revenue Code	402
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$187.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00

HC US COMPL JOINT R-T W/IMG - US ELBOW RIGHT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688117
Hospital Revenue Code	402
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$187.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00

HC US COMPL JOINT R-T W/IMG - US ELBOW RIGHT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688117
Hospital Revenue Code	402
Min. Negotiated Rate	$11.38
Max. Negotiated Rate	$280.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$205.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.69
Rate for Payer: Aetna Government	$65.69
Rate for Payer: Brighton Health Commercial	$280.50
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	$11.38
Rate for Payer: Group Health Inc Commercial	$187.00
Rate for Payer: Group Health Inc Medicare	$130.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00
Rate for Payer: Hamaspik Choice Inc Medicare	$187.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$11.38
Rate for Payer: Healthfirst Essential Plan	$172.33
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$76.59

HC US COMPL JOINT R-T W/IMG - US FINGER LEFT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688115
Hospital Revenue Code	402
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$187.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00

HC US COMPL JOINT R-T W/IMG - US FINGER LEFT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688115
Hospital Revenue Code	402
Min. Negotiated Rate	$11.38
Max. Negotiated Rate	$280.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$205.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.69
Rate for Payer: Aetna Government	$65.69
Rate for Payer: Brighton Health Commercial	$280.50
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	$11.38
Rate for Payer: Group Health Inc Commercial	$187.00
Rate for Payer: Group Health Inc Medicare	$130.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00
Rate for Payer: Hamaspik Choice Inc Medicare	$187.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$11.38
Rate for Payer: Healthfirst Essential Plan	$172.33
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$76.59

HC US COMPL JOINT R-T W/IMG - US FINGER RIGHT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688116
Hospital Revenue Code	402
Min. Negotiated Rate	$11.38
Max. Negotiated Rate	$280.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$205.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.69
Rate for Payer: Aetna Government	$65.69
Rate for Payer: Brighton Health Commercial	$280.50
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	$11.38
Rate for Payer: Group Health Inc Commercial	$187.00
Rate for Payer: Group Health Inc Medicare	$130.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00
Rate for Payer: Hamaspik Choice Inc Medicare	$187.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$11.38
Rate for Payer: Healthfirst Essential Plan	$172.33
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$76.59

HC US COMPL JOINT R-T W/IMG - US FINGER RIGHT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688116
Hospital Revenue Code	402
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$187.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00

HC US COMPL JOINT R-T W/IMG - US FOOT LEFT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688105
Hospital Revenue Code	402
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$187.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00

HC US COMPL JOINT R-T W/IMG - US FOOT LEFT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688105
Hospital Revenue Code	402
Min. Negotiated Rate	$11.38
Max. Negotiated Rate	$280.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$205.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.69
Rate for Payer: Aetna Government	$65.69
Rate for Payer: Brighton Health Commercial	$280.50
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	$11.38
Rate for Payer: Group Health Inc Commercial	$187.00
Rate for Payer: Group Health Inc Medicare	$130.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00
Rate for Payer: Hamaspik Choice Inc Medicare	$187.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$11.38
Rate for Payer: Healthfirst Essential Plan	$172.33
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$76.59

HC US COMPL JOINT R-T W/IMG - US FOOT RIGHT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688106
Hospital Revenue Code	402
Min. Negotiated Rate	$11.38
Max. Negotiated Rate	$280.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$205.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.69
Rate for Payer: Aetna Government	$65.69
Rate for Payer: Brighton Health Commercial	$280.50
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	$11.38
Rate for Payer: Group Health Inc Commercial	$187.00
Rate for Payer: Group Health Inc Medicare	$130.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00
Rate for Payer: Hamaspik Choice Inc Medicare	$187.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$11.38
Rate for Payer: Healthfirst Essential Plan	$172.33
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$76.59

HC US COMPL JOINT R-T W/IMG - US FOOT RIGHT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688106
Hospital Revenue Code	402
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$187.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00

HC US COMPL JOINT R-T W/IMG - US HAND LEFT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688113
Hospital Revenue Code	402
Min. Negotiated Rate	$11.38
Max. Negotiated Rate	$280.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$205.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.69
Rate for Payer: Aetna Government	$65.69
Rate for Payer: Brighton Health Commercial	$280.50
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	$11.38
Rate for Payer: Group Health Inc Commercial	$187.00
Rate for Payer: Group Health Inc Medicare	$130.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00
Rate for Payer: Hamaspik Choice Inc Medicare	$187.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$11.38
Rate for Payer: Healthfirst Essential Plan	$172.33
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$76.59

HC US COMPL JOINT R-T W/IMG - US HAND LEFT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688113
Hospital Revenue Code	402
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$187.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00

HC US COMPL JOINT R-T W/IMG - US HAND RIGHT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688114
Hospital Revenue Code	402
Min. Negotiated Rate	$11.38
Max. Negotiated Rate	$280.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$205.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.69
Rate for Payer: Aetna Government	$65.69
Rate for Payer: Brighton Health Commercial	$280.50
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	$11.38
Rate for Payer: Group Health Inc Commercial	$187.00
Rate for Payer: Group Health Inc Medicare	$130.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00
Rate for Payer: Hamaspik Choice Inc Medicare	$187.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$11.38
Rate for Payer: Healthfirst Essential Plan	$172.33
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$76.59

HC US COMPL JOINT R-T W/IMG - US HAND RIGHT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688114
Hospital Revenue Code	402
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$187.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00

HC US COMPL JOINT R-T W/IMG - US HEEL LEFT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688109
Hospital Revenue Code	402
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$187.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00

HC US COMPL JOINT R-T W/IMG - US HEEL LEFT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688109
Hospital Revenue Code	402
Min. Negotiated Rate	$11.38
Max. Negotiated Rate	$280.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$205.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.69
Rate for Payer: Aetna Government	$65.69
Rate for Payer: Brighton Health Commercial	$280.50
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	$11.38
Rate for Payer: Group Health Inc Commercial	$187.00
Rate for Payer: Group Health Inc Medicare	$130.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00
Rate for Payer: Hamaspik Choice Inc Medicare	$187.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$11.38
Rate for Payer: Healthfirst Essential Plan	$172.33
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$76.59

Know your out-of-pocket cost for care.

All Charges