St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688110
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 HEEL RIGHT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688110
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 KNEE LEFT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688101
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 KNEE LEFT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688101
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 KNEE RIGHT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688102
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 KNEE RIGHT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688102
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 SHOULDER LEFT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688119
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 SHOULDER LEFT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688119
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 TOE LEFT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688107
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 TOE LEFT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688107
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 TOE RIGHT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688108
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 TOE RIGHT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688108
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 WRIST LEFT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688111
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 WRIST LEFT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688111
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 WRIST RIGHT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688112
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 WRIST RIGHT

Facility

$374.00

Service Code	CPT 76881 TC
Hospital Charge Code	4027688112
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 ECHO GUIDE 4 ARTERY RPR - US GUIDE ARTERIOVENOUS FISTULA TRT

Facility

$766.00

Service Code	CPT 76936 TC
Hospital Charge Code	4027693601
Hospital Revenue Code	402
Min. Negotiated Rate	$383.00
Max. Negotiated Rate	$383.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.00

HC US ECHO GUIDE 4 ARTERY RPR - US GUIDE ARTERIOVENOUS FISTULA TRT

Facility

$766.00

Service Code	CPT 76936 TC
Hospital Charge Code	4027693601
Hospital Revenue Code	402
Min. Negotiated Rate	$85.18
Max. Negotiated Rate	$603.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$136.96
Rate for Payer: Aetna Government	$136.96
Rate for Payer: Brighton Health Commercial	$574.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$227.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$191.80
Rate for Payer: EmblemHealth Commercial	$173.20
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	$173.20
Rate for Payer: Healthfirst Essential Plan	$603.11
Rate for Payer: United Healthcare Commercial	$85.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$268.05

HC US EXAM INFANT HIPS DYNAMIC - US HIP PEDIATRIC LMTD MANIPULATION

Facility

$241.00

Service Code	CPT 76885 TC
Hospital Charge Code	4027688502
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 EXAM INFANT HIPS DYNAMIC - US HIP PEDIATRIC LMTD MANIPULATION

Facility

$241.00

Service Code	CPT 76885 TC
Hospital Charge Code	4027688502
Hospital Revenue Code	402
Min. Negotiated Rate	$49.80
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$71.83
Rate for Payer: Aetna Government	$71.83
Rate for Payer: Brighton Health Commercial	$180.75
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	$104.52
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	$104.52
Rate for Payer: Healthfirst Essential Plan	$172.91
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$76.85

HC US EXAM INFANT HIPS STATIC - US HIP PEDIATRIC LMT WO MANIPULATION

Facility

$241.00

Service Code	CPT 76886 TC
Hospital Charge Code	4027688602
Hospital Revenue Code	402
Min. Negotiated Rate	$49.80
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.56
Rate for Payer: Aetna Government	$59.56
Rate for Payer: Brighton Health Commercial	$180.75
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	$73.22
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	$73.22
Rate for Payer: Healthfirst Essential Plan	$164.23
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$72.99

HC US EXAM INFANT HIPS STATIC - US HIP PEDIATRIC LMT WO MANIPULATION

Facility

$241.00

Service Code	CPT 76886 TC
Hospital Charge Code	4027688602
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, EYE,ANTERIOR - US EYE ANTERIOR

Facility

$339.00

Service Code	CPT 76513 TC
Hospital Charge Code	4027651301
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, EYE,ANTERIOR - US EYE ANTERIOR

Facility

$339.00

Service Code	CPT 76513 TC
Hospital Charge Code	4027651301
Hospital Revenue Code	402
Min. Negotiated Rate	$44.58
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.00
Rate for Payer: Aetna Government	$47.00
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	$44.58
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	$44.58
Rate for Payer: Healthfirst Essential Plan	$126.90
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$56.40

HC US, EYE A-SCAN - US EYE A SCAN

Facility

$339.00

Service Code	CPT 76511 TC
Hospital Charge Code	4027651101
Hospital Revenue Code	402
Min. Negotiated Rate	$22.56
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$38.08
Rate for Payer: Aetna Government	$38.08
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	$22.56
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	$22.56
Rate for Payer: Healthfirst Essential Plan	$143.01
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$63.56

Know your out-of-pocket cost for care.

All Charges