St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC VEEG 2-12 HR UNMONITORED

Facility

$766.00

Service Code	CPT 95711
Hospital Charge Code	7409571101
Hospital Revenue Code	740
Min. Negotiated Rate	$383.00
Max. Negotiated Rate	$383.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.00

HC VEEG EA 12-26HR CONT MNTR

Facility

$2,831.00

Service Code	CPT 95716
Hospital Charge Code	7409571601
Hospital Revenue Code	740
Min. Negotiated Rate	$1,415.50
Max. Negotiated Rate	$1,415.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,415.50

HC VEEG EA 12-26HR CONT MNTR

Facility

$2,831.00

Service Code	CPT 95716
Hospital Charge Code	7409571601
Hospital Revenue Code	740
Min. Negotiated Rate	$822.00
Max. Negotiated Rate	$2,264.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,557.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,243.07
Rate for Payer: Aetna Government	$1,243.07
Rate for Payer: Affinity Essential Plan 1&2	$870.15
Rate for Payer: Affinity Essential Plan 3&4	$870.15
Rate for Payer: Affinity Medicaid/CHP/HARP	$870.15
Rate for Payer: Brighton Health Commercial	$2,123.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,243.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,264.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,925.08
Rate for Payer: Elderplan Medicare Advantage	$1,243.07
Rate for Payer: EmblemHealth Commercial	$1,243.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,118.76
Rate for Payer: Fidelis Essential Plan Aliesa	$1,056.61
Rate for Payer: Fidelis Essential Plan QHP	$1,106.33
Rate for Payer: Fidelis Medicare Advantage	$1,243.07
Rate for Payer: Fidelis Qualified Health Plan	$1,106.33
Rate for Payer: Group Health Inc Commercial	$1,243.07
Rate for Payer: Group Health Inc Medicare	$1,243.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,243.07
Rate for Payer: Hamaspik Choice Inc Medicare	$1,243.07
Rate for Payer: Healthfirst Medicare Advantage	$1,056.61
Rate for Payer: Healthfirst QHP	$1,243.07
Rate for Payer: Humana Medicare	$1,267.93
Rate for Payer: Senior Whole Health Medicare Advantage	$1,243.07
Rate for Payer: United Healthcare Commercial	$822.00
Rate for Payer: United Healthcare Medicare Advantage	$1,243.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,243.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,180.92
Rate for Payer: Wellcare Medicare	$1,180.92

HC VEEG EA 12-26HR INTMT MNTR

Facility

$1,502.00

Service Code	CPT 95715
Hospital Charge Code	7409571501
Hospital Revenue Code	740
Min. Negotiated Rate	$453.81
Max. Negotiated Rate	$1,201.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$826.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$648.30
Rate for Payer: Aetna Government	$648.30
Rate for Payer: Affinity Essential Plan 1&2	$453.81
Rate for Payer: Affinity Essential Plan 3&4	$453.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$453.81
Rate for Payer: Brighton Health Commercial	$1,126.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$648.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,201.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,021.36
Rate for Payer: Elderplan Medicare Advantage	$648.30
Rate for Payer: EmblemHealth Commercial	$648.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$583.47
Rate for Payer: Fidelis Essential Plan Aliesa	$551.05
Rate for Payer: Fidelis Essential Plan QHP	$576.99
Rate for Payer: Fidelis Medicare Advantage	$648.30
Rate for Payer: Fidelis Qualified Health Plan	$576.99
Rate for Payer: Group Health Inc Commercial	$648.30
Rate for Payer: Group Health Inc Medicare	$648.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$648.30
Rate for Payer: Hamaspik Choice Inc Medicare	$648.30
Rate for Payer: Healthfirst Medicare Advantage	$551.05
Rate for Payer: Healthfirst QHP	$648.30
Rate for Payer: Humana Medicare	$661.27
Rate for Payer: Senior Whole Health Medicare Advantage	$648.30
Rate for Payer: United Healthcare Commercial	$822.00
Rate for Payer: United Healthcare Medicare Advantage	$648.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$648.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$615.88
Rate for Payer: Wellcare Medicare	$615.88

HC VEEG EA 12-26HR INTMT MNTR

Facility

$1,502.00

Service Code	CPT 95715
Hospital Charge Code	7409571501
Hospital Revenue Code	740
Min. Negotiated Rate	$751.00
Max. Negotiated Rate	$751.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$751.00

HC VEIN X-RAY LIVER - IR VENOGRAM HEPATIC WO HEMODYNAMIC EVALUATION

Facility

$8,393.00

Service Code	CPT 75891 TC
Hospital Charge Code	3237589101
Hospital Revenue Code	323
Min. Negotiated Rate	$4,196.50
Max. Negotiated Rate	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50

HC VEIN X-RAY LIVER - IR VENOGRAM HEPATIC WO HEMODYNAMIC EVALUATION

Facility

$8,393.00

Service Code	CPT 75891 TC
Hospital Charge Code	3237589101
Hospital Revenue Code	323
Min. Negotiated Rate	$70.43
Max. Negotiated Rate	$6,294.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,616.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.43
Rate for Payer: Aetna Government	$70.43
Rate for Payer: Brighton Health Commercial	$6,294.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,336.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,650.49
Rate for Payer: EmblemHealth Commercial	$76.57
Rate for Payer: Group Health Inc Commercial	$4,196.50
Rate for Payer: Group Health Inc Medicare	$2,937.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,196.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$76.57
Rate for Payer: Healthfirst Essential Plan	$671.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$298.31

HC VEIN X-RAY LIVER W/HEMODYNAM - IR PERC TRANSHEPATIC PORTO W HEMO EVL

Facility

$8,393.00

Service Code	CPT 75885 TC
Hospital Charge Code	3237588502
Hospital Revenue Code	323
Min. Negotiated Rate	$69.88
Max. Negotiated Rate	$6,294.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,616.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.88
Rate for Payer: Aetna Government	$69.88
Rate for Payer: Brighton Health Commercial	$6,294.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,336.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,650.49
Rate for Payer: EmblemHealth Commercial	$76.57
Rate for Payer: Group Health Inc Commercial	$4,196.50
Rate for Payer: Group Health Inc Medicare	$2,937.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,196.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$76.57
Rate for Payer: Healthfirst Essential Plan	$697.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$309.91

HC VEIN X-RAY LIVER W/HEMODYNAM - IR PERC TRANSHEPATIC PORTO W HEMO EVL

Facility

$8,393.00

Service Code	CPT 75885 TC
Hospital Charge Code	3237588502
Hospital Revenue Code	323
Min. Negotiated Rate	$4,196.50
Max. Negotiated Rate	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50

HC VEIN X-RAY LIVER W/HEMODYNAM - IR VENO HEPATIC W HEMODYNAMIC EVAL

Facility

$8,393.00

Service Code	CPT 75889 TC
Hospital Charge Code	3237588901
Hospital Revenue Code	323
Min. Negotiated Rate	$4,196.50
Max. Negotiated Rate	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50

HC VEIN X-RAY LIVER W/HEMODYNAM - IR VENO HEPATIC W HEMODYNAMIC EVAL

Facility

$8,393.00

Service Code	CPT 75889 TC
Hospital Charge Code	3237588901
Hospital Revenue Code	323
Min. Negotiated Rate	$70.16
Max. Negotiated Rate	$6,294.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,616.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.16
Rate for Payer: Aetna Government	$70.16
Rate for Payer: Brighton Health Commercial	$6,294.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,336.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,650.49
Rate for Payer: EmblemHealth Commercial	$76.22
Rate for Payer: Group Health Inc Commercial	$4,196.50
Rate for Payer: Group Health Inc Medicare	$2,937.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,196.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$76.22
Rate for Payer: Healthfirst Essential Plan	$304.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$135.46

HC VEIN X-RAY LIVER W/O HEMODYN - IR PERC TRANSHEPATIC PORTO WO HEMO EV

Facility

$4,940.00

Service Code	CPT 75887 TC
Hospital Charge Code	3237588702
Hospital Revenue Code	323
Min. Negotiated Rate	$70.43
Max. Negotiated Rate	$3,705.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,717.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.43
Rate for Payer: Aetna Government	$70.43
Rate for Payer: Brighton Health Commercial	$3,705.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,538.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,294.59
Rate for Payer: EmblemHealth Commercial	$76.57
Rate for Payer: Group Health Inc Commercial	$2,470.00
Rate for Payer: Group Health Inc Medicare	$1,729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,470.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$76.57
Rate for Payer: Healthfirst Essential Plan	$705.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$313.64

HC VEIN X-RAY LIVER W/O HEMODYN - IR PERC TRANSHEPATIC PORTO WO HEMO EV

Facility

$4,940.00

Service Code	CPT 75887 TC
Hospital Charge Code	3237588702
Hospital Revenue Code	323
Min. Negotiated Rate	$2,470.00
Max. Negotiated Rate	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.00

HC VENIPUNCTURE, PHYSICAN SKILL, <3 YRS OLD

Facility

$58.00

Service Code	CPT 36400
Hospital Charge Code	3613640001
Hospital Revenue Code	361
Min. Negotiated Rate	$20.30
Max. Negotiated Rate	$342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.61
Rate for Payer: Aetna Government	$21.61
Rate for Payer: Brighton Health Commercial	$43.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.44
Rate for Payer: EmblemHealth Commercial	$29.00
Rate for Payer: Group Health Inc Commercial	$29.00
Rate for Payer: Group Health Inc Medicare	$20.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.00
Rate for Payer: Hamaspik Choice Inc Medicare	$29.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20.38

HC VENIPUNCTURE, PHYSICAN SKILL, <3 YRS OLD

Facility

$58.00

Service Code	CPT 36400
Hospital Charge Code	3613640001
Hospital Revenue Code	361
Min. Negotiated Rate	$29.00
Max. Negotiated Rate	$29.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.00

HC VENIPUNCTURE, PHYSICAN SKILL, >3 YRS OLD

Facility

$28.00

Service Code	CPT 36410 TC
Hospital Charge Code	3613641001
Hospital Revenue Code	361
Min. Negotiated Rate	$9.68
Max. Negotiated Rate	$342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.98
Rate for Payer: Aetna Government	$9.98
Rate for Payer: Brighton Health Commercial	$21.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.68
Rate for Payer: EmblemHealth Commercial	$14.00
Rate for Payer: Group Health Inc Commercial	$14.00
Rate for Payer: Group Health Inc Medicare	$9.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14.00

HC VENIPUNCTURE, PHYSICAN SKILL, >3 YRS OLD

Facility

$28.00

Service Code	CPT 36410 TC
Hospital Charge Code	3613641001
Hospital Revenue Code	361
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$14.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.00

HC VENIPUNCTURE, PHYSICAN SKILL, <3 YRS OLD, OTHER VEIN

Facility

$37.00

Service Code	CPT 36406
Hospital Charge Code	3613640601
Hospital Revenue Code	361
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.59
Rate for Payer: Aetna Government	$17.59
Rate for Payer: Brighton Health Commercial	$27.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.16
Rate for Payer: EmblemHealth Commercial	$18.50
Rate for Payer: Group Health Inc Commercial	$18.50
Rate for Payer: Group Health Inc Medicare	$12.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.50
Rate for Payer: Hamaspik Choice Inc Medicare	$18.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$9.54

HC VENIPUNCTURE, PHYSICAN SKILL, <3 YRS OLD, OTHER VEIN

Facility

$37.00

Service Code	CPT 36406
Hospital Charge Code	3613640601
Hospital Revenue Code	361
Min. Negotiated Rate	$18.50
Max. Negotiated Rate	$18.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.50

HC VENIPUNCTURE, PHYSICAN SKILL, <3 YRS OLD, SCALP VEIN

Facility

$66.00

Service Code	CPT 36405
Hospital Charge Code	3613640501
Hospital Revenue Code	361
Min. Negotiated Rate	$16.19
Max. Negotiated Rate	$342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.30
Rate for Payer: Aetna Government	$17.30
Rate for Payer: Brighton Health Commercial	$49.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.88
Rate for Payer: EmblemHealth Commercial	$33.00
Rate for Payer: Group Health Inc Commercial	$33.00
Rate for Payer: Group Health Inc Medicare	$23.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.00
Rate for Payer: Hamaspik Choice Inc Medicare	$33.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16.19

HC VENIPUNCTURE, PHYSICAN SKILL, <3 YRS OLD, SCALP VEIN

Facility

$66.00

Service Code	CPT 36405
Hospital Charge Code	3613640501
Hospital Revenue Code	361
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$33.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.00

HC VENOGRAM ADRENAL BILAT - IR VENOGRAM ADRENAL BILATERAL SELECTIVE

Facility

$13,920.00

Service Code	CPT 75842 TC
Hospital Charge Code	3237584201
Hospital Revenue Code	323
Min. Negotiated Rate	$6,960.00
Max. Negotiated Rate	$6,960.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,960.00

HC VENOGRAM ADRENAL BILAT - IR VENOGRAM ADRENAL BILATERAL SELECTIVE

Facility

$13,920.00

Service Code	CPT 75842 TC
Hospital Charge Code	3237584201
Hospital Revenue Code	323
Min. Negotiated Rate	$83.41
Max. Negotiated Rate	$10,440.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7,656.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$83.41
Rate for Payer: Aetna Government	$83.41
Rate for Payer: Brighton Health Commercial	$10,440.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,336.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,650.49
Rate for Payer: EmblemHealth Commercial	$93.34
Rate for Payer: Group Health Inc Commercial	$6,960.00
Rate for Payer: Group Health Inc Medicare	$4,872.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,960.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,960.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$93.34
Rate for Payer: Healthfirst Essential Plan	$720.83
Rate for Payer: Wellcare CHP/FHP/Medicaid	$320.37

HC VENOGRAM ADRENAL UNILAT - IR VENOGRAM ADRENAL SELECTIVE

Facility

$8,393.00

Service Code	CPT 75840 TC
Hospital Charge Code	3237584001
Hospital Revenue Code	323
Min. Negotiated Rate	$71.83
Max. Negotiated Rate	$6,294.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,616.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$71.83
Rate for Payer: Aetna Government	$71.83
Rate for Payer: Brighton Health Commercial	$6,294.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,336.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,650.49
Rate for Payer: EmblemHealth Commercial	$78.32
Rate for Payer: Group Health Inc Commercial	$4,196.50
Rate for Payer: Group Health Inc Medicare	$2,937.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,196.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$78.32
Rate for Payer: Healthfirst Essential Plan	$669.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$297.63

HC VENOGRAM ADRENAL UNILAT - IR VENOGRAM ADRENAL SELECTIVE

Facility

$8,393.00

Service Code	CPT 75840 TC
Hospital Charge Code	3237584001
Hospital Revenue Code	323
Min. Negotiated Rate	$4,196.50
Max. Negotiated Rate	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50

Know your out-of-pocket cost for care.

All Charges