St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC US, EYE BIOMETRY - US EYE BIOMETRY

Facility

$339.00

Service Code	CPT 76516 TC
Hospital Charge Code	4027651601
Hospital Revenue Code	402
Min. Negotiated Rate	$25.71
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.52
Rate for Payer: Aetna Government	$37.52
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	$25.71
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	$25.71
Rate for Payer: Healthfirst Essential Plan	$103.84
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$46.15

HC US, EYE BIOMETRY - US EYE BIOMETRY

Facility

$339.00

Service Code	CPT 76516 TC
Hospital Charge Code	4027651601
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, B-SCAN & QUANT A-SCAN - US DIAGNOSTIC OPHTHALMIC A & B SCAN

Facility

$330.00

Service Code	CPT 76510 TC
Hospital Charge Code	4027651001
Hospital Revenue Code	402
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$165.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.00

HC US, EYE, B-SCAN & QUANT A-SCAN - US DIAGNOSTIC OPHTHALMIC A & B SCAN

Facility

$330.00

Service Code	CPT 76510 TC
Hospital Charge Code	4027651001
Hospital Revenue Code	402
Min. Negotiated Rate	$30.95
Max. Negotiated Rate	$375.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$181.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.02
Rate for Payer: Aetna Government	$64.02
Rate for Payer: Brighton Health Commercial	$247.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$375.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$316.13
Rate for Payer: EmblemHealth Commercial	$30.95
Rate for Payer: Group Health Inc Commercial	$165.00
Rate for Payer: Group Health Inc Medicare	$115.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.00
Rate for Payer: Hamaspik Choice Inc Medicare	$165.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30.95
Rate for Payer: Healthfirst Essential Plan	$239.29
Rate for Payer: United Healthcare Commercial	$140.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$106.35

HC US, EYE B-SCAN - US EYE B SCAN

Facility

$339.00

Service Code	CPT 76512 TC
Hospital Charge Code	4027651201
Hospital Revenue Code	402
Min. Negotiated Rate	$18.72
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.38
Rate for Payer: Aetna Government	$31.38
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	$18.72
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	$18.72
Rate for Payer: Healthfirst Essential Plan	$132.37
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$58.83

HC US, EYE B-SCAN - US EYE B SCAN

Facility

$339.00

Service Code	CPT 76512 TC
Hospital Charge Code	4027651201
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 F.B. LOCALIZATION - US EYE FOREIGN BODY LOCALIZATION

Facility

$241.00

Service Code	CPT 76529 TC
Hospital Charge Code	4027652901
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 F.B. LOCALIZATION - US EYE FOREIGN BODY LOCALIZATION

Facility

$241.00

Service Code	CPT 76529 TC
Hospital Charge Code	4027652901
Hospital Revenue Code	402
Min. Negotiated Rate	$36.96
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.96
Rate for Payer: Aetna Government	$36.96
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	$55.76
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	$55.76
Rate for Payer: Healthfirst Essential Plan	$127.39
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$56.62

HC US, EYE, FOR CORNEAL THICKNESS - US EXAM OF EYE THICKNESS

Facility

$69.00

Service Code	CPT 76514 TC
Hospital Charge Code	4027651401
Hospital Revenue Code	402
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$51.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.33
Rate for Payer: Aetna Government	$4.33
Rate for Payer: Brighton Health Commercial	$51.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.18
Rate for Payer: EmblemHealth Commercial	$4.05
Rate for Payer: Group Health Inc Commercial	$34.50
Rate for Payer: Group Health Inc Medicare	$24.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.50
Rate for Payer: Hamaspik Choice Inc Medicare	$34.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$4.05
Rate for Payer: Healthfirst Essential Plan	$19.80
Rate for Payer: United Healthcare Commercial	$14.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$8.80

HC US, EYE, FOR CORNEAL THICKNESS - US EXAM OF EYE THICKNESS

Facility

$69.00

Service Code	CPT 76514 TC
Hospital Charge Code	4027651401
Hospital Revenue Code	402
Min. Negotiated Rate	$34.50
Max. Negotiated Rate	$34.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.50

HC US GUIDE FOR NEEDLE PLACEMENT

Facility

$1,144.00

Service Code	CPT 76942 TC
Hospital Charge Code	4027694201
Hospital Revenue Code	402
Min. Negotiated Rate	$21.62
Max. Negotiated Rate	$915.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$629.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.62
Rate for Payer: Aetna Government	$21.62
Rate for Payer: Brighton Health Commercial	$858.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$915.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$777.92
Rate for Payer: EmblemHealth Commercial	$30.60
Rate for Payer: Group Health Inc Commercial	$572.00
Rate for Payer: Group Health Inc Medicare	$400.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$572.00
Rate for Payer: Hamaspik Choice Inc Medicare	$572.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30.60
Rate for Payer: Healthfirst Essential Plan	$287.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$127.95

HC US GUIDE FOR NEEDLE PLACEMENT

Facility

$1,144.00

Service Code	CPT 76942 TC
Hospital Charge Code	4027694201
Hospital Revenue Code	402
Min. Negotiated Rate	$572.00
Max. Negotiated Rate	$572.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$572.00

HC US GUIDE FOR NEEDLE PLACEMENT - ASPIRAT OF ABSCESS, HEMATOMA, CYST

Facility

$1,144.00

Service Code	CPT 76942 TC
Hospital Charge Code	4027694202
Hospital Revenue Code	402
Min. Negotiated Rate	$572.00
Max. Negotiated Rate	$572.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$572.00

HC US GUIDE FOR NEEDLE PLACEMENT - ASPIRAT OF ABSCESS, HEMATOMA, CYST

Facility

$1,144.00

Service Code	CPT 76942 TC
Hospital Charge Code	4027694202
Hospital Revenue Code	402
Min. Negotiated Rate	$21.62
Max. Negotiated Rate	$915.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$629.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.62
Rate for Payer: Aetna Government	$21.62
Rate for Payer: Brighton Health Commercial	$858.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$915.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$777.92
Rate for Payer: EmblemHealth Commercial	$30.60
Rate for Payer: Group Health Inc Commercial	$572.00
Rate for Payer: Group Health Inc Medicare	$400.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$572.00
Rate for Payer: Hamaspik Choice Inc Medicare	$572.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30.60
Rate for Payer: Healthfirst Essential Plan	$287.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$127.95

HC US GUIDE FOR NEEDLE PLACEMENT - IJ PUNCTURE

Facility

$1,144.00

Service Code	CPT 76942 TC
Hospital Charge Code	4027694205
Hospital Revenue Code	402
Min. Negotiated Rate	$21.62
Max. Negotiated Rate	$915.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$629.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.62
Rate for Payer: Aetna Government	$21.62
Rate for Payer: Brighton Health Commercial	$858.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$915.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$777.92
Rate for Payer: EmblemHealth Commercial	$30.60
Rate for Payer: Group Health Inc Commercial	$572.00
Rate for Payer: Group Health Inc Medicare	$400.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$572.00
Rate for Payer: Hamaspik Choice Inc Medicare	$572.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30.60
Rate for Payer: Healthfirst Essential Plan	$287.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$127.95

HC US GUIDE FOR NEEDLE PLACEMENT - IJ PUNCTURE

Facility

$1,144.00

Service Code	CPT 76942 TC
Hospital Charge Code	4027694205
Hospital Revenue Code	402
Min. Negotiated Rate	$572.00
Max. Negotiated Rate	$572.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$572.00

HC US GUIDE FOR NEEDLE PLACEMENT - NEEDLE BIOPSY

Facility

$1,144.00

Service Code	CPT 76942 TC
Hospital Charge Code	4027694244
Hospital Revenue Code	402
Min. Negotiated Rate	$21.62
Max. Negotiated Rate	$915.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$629.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.62
Rate for Payer: Aetna Government	$21.62
Rate for Payer: Brighton Health Commercial	$858.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$915.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$777.92
Rate for Payer: EmblemHealth Commercial	$30.60
Rate for Payer: Group Health Inc Commercial	$572.00
Rate for Payer: Group Health Inc Medicare	$400.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$572.00
Rate for Payer: Hamaspik Choice Inc Medicare	$572.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30.60
Rate for Payer: Healthfirst Essential Plan	$287.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$127.95

HC US GUIDE FOR NEEDLE PLACEMENT - NEEDLE BIOPSY

Facility

$1,144.00

Service Code	CPT 76942 TC
Hospital Charge Code	4027694244
Hospital Revenue Code	402
Min. Negotiated Rate	$572.00
Max. Negotiated Rate	$572.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$572.00

HC US GUIDE FOR NEEDLE PLACEMENT - RENAL CYST ASPIRATION

Facility

$1,144.00

Service Code	CPT 76942 TC
Hospital Charge Code	4027694204
Hospital Revenue Code	402
Min. Negotiated Rate	$572.00
Max. Negotiated Rate	$572.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$572.00

HC US GUIDE FOR NEEDLE PLACEMENT - RENAL CYST ASPIRATION

Facility

$1,144.00

Service Code	CPT 76942 TC
Hospital Charge Code	4027694204
Hospital Revenue Code	402
Min. Negotiated Rate	$21.62
Max. Negotiated Rate	$915.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$629.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.62
Rate for Payer: Aetna Government	$21.62
Rate for Payer: Brighton Health Commercial	$858.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$915.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$777.92
Rate for Payer: EmblemHealth Commercial	$30.60
Rate for Payer: Group Health Inc Commercial	$572.00
Rate for Payer: Group Health Inc Medicare	$400.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$572.00
Rate for Payer: Hamaspik Choice Inc Medicare	$572.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30.60
Rate for Payer: Healthfirst Essential Plan	$287.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$127.95

HC US GUIDE, TISSUE ABLATION - US GUIDED RF ABLATION

Facility

$549.00

Service Code	CPT 76940 TC
Hospital Charge Code	4027694001
Hospital Revenue Code	402
Min. Negotiated Rate	$274.50
Max. Negotiated Rate	$274.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$274.50

HC US GUIDE, TISSUE ABLATION - US GUIDED RF ABLATION

Facility

$549.00

Service Code	CPT 76940 TC
Hospital Charge Code	4027694001
Hospital Revenue Code	402
Min. Negotiated Rate	$51.49
Max. Negotiated Rate	$439.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$301.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.49
Rate for Payer: Aetna Government	$51.49
Rate for Payer: Brighton Health Commercial	$411.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$439.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$373.32
Rate for Payer: EmblemHealth Commercial	$274.50
Rate for Payer: Group Health Inc Commercial	$274.50
Rate for Payer: Group Health Inc Medicare	$192.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$274.50
Rate for Payer: Hamaspik Choice Inc Medicare	$274.50
Rate for Payer: Healthfirst Essential Plan	$313.54
Rate for Payer: Wellcare CHP/FHP/Medicaid	$139.35

HC US GUIDE, VASCULAR ACCESS

Facility

$766.00

Service Code	CPT 76937 TC
Hospital Charge Code	4027693703
Hospital Revenue Code	402
Min. Negotiated Rate	$13.39
Max. Negotiated Rate	$612.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.39
Rate for Payer: Aetna Government	$13.39
Rate for Payer: Brighton Health Commercial	$574.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$612.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$520.88
Rate for Payer: EmblemHealth Commercial	$26.41
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	$26.41
Rate for Payer: Healthfirst Essential Plan	$50.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22.29

HC US GUIDE, VASCULAR ACCESS

Facility

$766.00

Service Code	CPT 76937 TC
Hospital Charge Code	4027693703
Hospital Revenue Code	402
Min. Negotiated Rate	$383.00
Max. Negotiated Rate	$383.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.00

Know your out-of-pocket cost for care.

All Charges