St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC US GUIDE, VASCULAR ACCESS - US GUIDANCE INSERT IV

Facility

$766.00

Service Code	CPT 76937 TC
Hospital Charge Code	4027693702
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 - US GUIDANCE INSERT IV

Facility

$766.00

Service Code	CPT 76937 TC
Hospital Charge Code	4027693702
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 GUIDE, VASCULAR ACCESS - XR PICC LINE VASCULARE INSERTION

Facility

$766.00

Service Code	CPT 76937 TC
Hospital Charge Code	4027693701
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 GUIDE, VASCULAR ACCESS - XR PICC LINE VASCULARE INSERTION

Facility

$766.00

Service Code	CPT 76937 TC
Hospital Charge Code	4027693701
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, HEAD/NECK TISSUES,REAL TIME - US HEAD NECK SOFT TISSUE

Facility

$339.00

Service Code	CPT 76536 TC
Hospital Charge Code	4027653605
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, HEAD/NECK TISSUES,REAL TIME - US HEAD NECK SOFT TISSUE

Facility

$339.00

Service Code	CPT 76536 TC
Hospital Charge Code	4027653605
Hospital Revenue Code	402
Min. Negotiated Rate	$69.60
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.60
Rate for Payer: Aetna Government	$69.60
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	$87.05
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	$87.05
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, HEAD/NECK TISSUES,REAL TIME - US NECK

Facility

$339.00

Service Code	CPT 76536 TC
Hospital Charge Code	4027653602
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, HEAD/NECK TISSUES,REAL TIME - US NECK

Facility

$339.00

Service Code	CPT 76536 TC
Hospital Charge Code	4027653602
Hospital Revenue Code	402
Min. Negotiated Rate	$69.60
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.60
Rate for Payer: Aetna Government	$69.60
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	$87.05
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	$87.05
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, HEAD/NECK TISSUES,REAL TIME - US NECK PARATHYROID

Facility

$339.00

Service Code	CPT 76536 TC
Hospital Charge Code	4027653603
Hospital Revenue Code	402
Min. Negotiated Rate	$69.60
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.60
Rate for Payer: Aetna Government	$69.60
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	$87.05
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	$87.05
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, HEAD/NECK TISSUES,REAL TIME - US NECK PARATHYROID

Facility

$339.00

Service Code	CPT 76536 TC
Hospital Charge Code	4027653603
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, HEAD/NECK TISSUES,REAL TIME - US NECK PAROTID

Facility

$339.00

Service Code	CPT 76536 TC
Hospital Charge Code	4027653604
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, HEAD/NECK TISSUES,REAL TIME - US NECK PAROTID

Facility

$339.00

Service Code	CPT 76536 TC
Hospital Charge Code	4027653604
Hospital Revenue Code	402
Min. Negotiated Rate	$69.60
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.60
Rate for Payer: Aetna Government	$69.60
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	$87.05
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	$87.05
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, HEAD/NECK TISSUES,REAL TIME - US THYROID

Facility

$339.00

Service Code	CPT 76536 TC
Hospital Charge Code	4027653601
Hospital Revenue Code	402
Min. Negotiated Rate	$69.60
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.60
Rate for Payer: Aetna Government	$69.60
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	$87.05
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	$87.05
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, HEAD/NECK TISSUES,REAL TIME - US THYROID

Facility

$339.00

Service Code	CPT 76536 TC
Hospital Charge Code	4027653601
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, HEAD, REAL TIME - US HEAD

Facility

$339.00

Service Code	CPT 76506 TC
Hospital Charge Code	4027650602
Hospital Revenue Code	402
Min. Negotiated Rate	$49.80
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$68.20
Rate for Payer: Aetna Government	$68.20
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	$83.35
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	$83.35
Rate for Payer: Healthfirst Essential Plan	$166.91
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$74.18

HC US, HEAD, REAL TIME - US HEAD

Facility

$339.00

Service Code	CPT 76506 TC
Hospital Charge Code	4027650602
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, HEAD, REAL TIME - US TMJ BILATERAL

Facility

$339.00

Service Code	CPT 76506 TC
Hospital Charge Code	4027650601
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, HEAD, REAL TIME - US TMJ BILATERAL

Facility

$339.00

Service Code	CPT 76506 TC
Hospital Charge Code	4027650601
Hospital Revenue Code	402
Min. Negotiated Rate	$49.80
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$68.20
Rate for Payer: Aetna Government	$68.20
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	$83.35
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	$83.35
Rate for Payer: Healthfirst Essential Plan	$166.91
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$74.18

HC US LMTD JT/NONVASC XTR STRUX - SOFT TISSUE

Facility

$339.00

Service Code	CPT 76882 TC
Hospital Charge Code	4027688201
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 LMTD JT/NONVASC XTR STRUX - SOFT TISSUE

Facility

$339.00

Service Code	CPT 76882 TC
Hospital Charge Code	4027688201
Hospital Revenue Code	402
Min. Negotiated Rate	$9.07
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.07
Rate for Payer: Aetna Government	$9.07
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	$33.39
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	$33.39
Rate for Payer: Healthfirst Essential Plan	$42.88
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19.06

HC US LMTD JT/NONVASC XTR STRUX - US KNEE RIGHT LIMITED

Facility

$339.00

Service Code	CPT 76882 TC
Hospital Charge Code	4027688202
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 LMTD JT/NONVASC XTR STRUX - US KNEE RIGHT LIMITED

Facility

$339.00

Service Code	CPT 76882 TC
Hospital Charge Code	4027688202
Hospital Revenue Code	402
Min. Negotiated Rate	$9.07
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.07
Rate for Payer: Aetna Government	$9.07
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	$33.39
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	$33.39
Rate for Payer: Healthfirst Essential Plan	$42.88
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19.06

HC US, OB < 14 WKS, SINGLE FETUS

Facility

$339.00

Service Code	CPT 76801 TC
Hospital Charge Code	4027680102
Hospital Revenue Code	402
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$318.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$57.60
Rate for Payer: Aetna Government	$57.60
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	$73.22
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	$73.22
Rate for Payer: Healthfirst Essential Plan	$318.35
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$141.49

HC US, OB < 14 WKS, SINGLE FETUS

Facility

$339.00

Service Code	CPT 76801 TC
Hospital Charge Code	4027680102
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,PREGNANT UTERUS,LIMITED, 1/> FETUSES

Facility

$339.00

Service Code	CPT 76815 TC
Hospital Charge Code	4027681502
Hospital Revenue Code	402
Min. Negotiated Rate	$40.87
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.87
Rate for Payer: Aetna Government	$40.87
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	$52.60
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	$52.60
Rate for Payer: Healthfirst Essential Plan	$219.74
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$97.66

Know your out-of-pocket cost for care.

All Charges