St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC VENOGRAM EPIDURAL - IR VENOGRAM EPIDURAL

Facility

$1,909.00

Service Code	CPT 75872 TC
Hospital Charge Code	3237587201
Hospital Revenue Code	323
Min. Negotiated Rate	$68.48
Max. Negotiated Rate	$1,538.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,049.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$68.48
Rate for Payer: Aetna Government	$68.48
Rate for Payer: Brighton Health Commercial	$1,431.75
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	$78.32
Rate for Payer: Group Health Inc Commercial	$954.50
Rate for Payer: Group Health Inc Medicare	$668.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.50
Rate for Payer: Hamaspik Choice Inc Medicare	$954.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$78.32
Rate for Payer: Healthfirst Essential Plan	$711.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$316.40

HC VENOGRAM EPIDURAL - IR VENOGRAM EPIDURAL

Facility

$1,909.00

Service Code	CPT 75872 TC
Hospital Charge Code	3237587201
Hospital Revenue Code	323
Min. Negotiated Rate	$954.50
Max. Negotiated Rate	$954.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.50

HC VENOGRAM EXTREM BILAT - IR VENOGRAM LOWER EXTREMITY BILATERAL

Facility

$4,940.00

Service Code	CPT 75822 TC
Hospital Charge Code	3237582201
Hospital Revenue Code	323
Min. Negotiated Rate	$67.09
Max. Negotiated Rate	$3,705.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,717.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$67.09
Rate for Payer: Aetna Government	$67.09
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	$67.98
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	$67.98
Rate for Payer: Healthfirst Essential Plan	$222.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$99.07

HC VENOGRAM EXTREM BILAT - IR VENOGRAM LOWER EXTREMITY BILATERAL

Facility

$4,940.00

Service Code	CPT 75822 TC
Hospital Charge Code	3237582201
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 VENOGRAM EXTREM BILAT - IR VENOGRAM UPPER EXTREMITY BILATERAL

Facility

$4,940.00

Service Code	CPT 75822 TC
Hospital Charge Code	3237582203
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 VENOGRAM EXTREM BILAT - IR VENOGRAM UPPER EXTREMITY BILATERAL

Facility

$4,940.00

Service Code	CPT 75822 TC
Hospital Charge Code	3237582203
Hospital Revenue Code	323
Min. Negotiated Rate	$67.09
Max. Negotiated Rate	$3,705.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,717.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$67.09
Rate for Payer: Aetna Government	$67.09
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	$67.98
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	$67.98
Rate for Payer: Healthfirst Essential Plan	$222.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$99.07

HC VENOGRAM EXTREM UNILAT

Facility

$4,462.00

Service Code	CPT 75820 TC
Hospital Charge Code	3207582001
Hospital Revenue Code	320
Min. Negotiated Rate	$60.99
Max. Negotiated Rate	$3,346.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,454.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.46
Rate for Payer: Aetna Government	$63.46
Rate for Payer: Brighton Health Commercial	$3,346.50
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	$60.99
Rate for Payer: Group Health Inc Commercial	$2,231.00
Rate for Payer: Group Health Inc Medicare	$1,561.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,231.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,231.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$60.99
Rate for Payer: Healthfirst Essential Plan	$182.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$81.03

HC VENOGRAM EXTREM UNILAT

Facility

$4,462.00

Service Code	CPT 75820 TC
Hospital Charge Code	3207582001
Hospital Revenue Code	320
Min. Negotiated Rate	$2,231.00
Max. Negotiated Rate	$2,231.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,231.00

HC VENOGRAM EXTREM UNILAT - IR VENOGRAM LOWER EXTREMITY

Facility

$1,909.00

Service Code	CPT 75820 TC
Hospital Charge Code	3207582009
Hospital Revenue Code	320
Min. Negotiated Rate	$954.50
Max. Negotiated Rate	$954.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.50

HC VENOGRAM EXTREM UNILAT - IR VENOGRAM LOWER EXTREMITY

Facility

$1,909.00

Service Code	CPT 75820 TC
Hospital Charge Code	3207582009
Hospital Revenue Code	320
Min. Negotiated Rate	$60.99
Max. Negotiated Rate	$1,538.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,049.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.46
Rate for Payer: Aetna Government	$63.46
Rate for Payer: Brighton Health Commercial	$1,431.75
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	$60.99
Rate for Payer: Group Health Inc Commercial	$954.50
Rate for Payer: Group Health Inc Medicare	$668.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.50
Rate for Payer: Hamaspik Choice Inc Medicare	$954.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$60.99
Rate for Payer: Healthfirst Essential Plan	$182.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$81.03

HC VENOGRAM EXTREM UNILAT - IR VENOGRAM UPPER EXTREMITY

Facility

$1,909.00

Service Code	CPT 75820 TC
Hospital Charge Code	3207582005
Hospital Revenue Code	320
Min. Negotiated Rate	$954.50
Max. Negotiated Rate	$954.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.50

HC VENOGRAM EXTREM UNILAT - IR VENOGRAM UPPER EXTREMITY

Facility

$1,909.00

Service Code	CPT 75820 TC
Hospital Charge Code	3207582005
Hospital Revenue Code	320
Min. Negotiated Rate	$60.99
Max. Negotiated Rate	$1,538.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,049.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.46
Rate for Payer: Aetna Government	$63.46
Rate for Payer: Brighton Health Commercial	$1,431.75
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	$60.99
Rate for Payer: Group Health Inc Commercial	$954.50
Rate for Payer: Group Health Inc Medicare	$668.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.50
Rate for Payer: Hamaspik Choice Inc Medicare	$954.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$60.99
Rate for Payer: Healthfirst Essential Plan	$182.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$81.03

HC VENOGRAM INFER VENA CAVA - IR VENO CAVAL INFERIOR W SERIALOGRAPHY

Facility

$8,393.00

Service Code	CPT 75825 TC
Hospital Charge Code	3237582501
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 VENOGRAM INFER VENA CAVA - IR VENO CAVAL INFERIOR W SERIALOGRAPHY

Facility

$8,393.00

Service Code	CPT 75825 TC
Hospital Charge Code	3237582501
Hospital Revenue Code	323
Min. Negotiated Rate	$62.90
Max. Negotiated Rate	$6,294.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,616.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$62.90
Rate for Payer: Aetna Government	$62.90
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	$64.13
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	$64.13
Rate for Payer: Healthfirst Essential Plan	$299.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$133.00

HC VENOGRAM ORBITAL - IR VENOGRAM ORBITAL

Facility

$1,909.00

Service Code	CPT 75880 TC
Hospital Charge Code	3237588001
Hospital Revenue Code	323
Min. Negotiated Rate	$78.32
Max. Negotiated Rate	$1,538.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,049.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$83.82
Rate for Payer: Aetna Government	$83.82
Rate for Payer: Brighton Health Commercial	$1,431.75
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	$78.32
Rate for Payer: Group Health Inc Commercial	$954.50
Rate for Payer: Group Health Inc Medicare	$668.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.50
Rate for Payer: Hamaspik Choice Inc Medicare	$954.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$78.32
Rate for Payer: Healthfirst Essential Plan	$200.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$89.05

HC VENOGRAM ORBITAL - IR VENOGRAM ORBITAL

Facility

$1,909.00

Service Code	CPT 75880 TC
Hospital Charge Code	3237588001
Hospital Revenue Code	323
Min. Negotiated Rate	$954.50
Max. Negotiated Rate	$954.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.50

HC VENOGRAM RENAL BILAT - IR VENOGRAM RENAL BILATERAL

Facility

$8,393.00

Service Code	CPT 75833 TC
Hospital Charge Code	3237583301
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 VENOGRAM RENAL BILAT - IR VENOGRAM RENAL BILATERAL

Facility

$8,393.00

Service Code	CPT 75833 TC
Hospital Charge Code	3237583301
Hospital Revenue Code	323
Min. Negotiated Rate	$72.81
Max. Negotiated Rate	$6,294.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,616.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$72.81
Rate for Payer: Aetna Government	$72.81
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	$82.86
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	$82.86
Rate for Payer: Healthfirst Essential Plan	$720.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$320.01

HC VENOGRAM RENAL UNILAT - IR VENOGRAM RENAL

Facility

$8,393.00

Service Code	CPT 75831 TC
Hospital Charge Code	3237583101
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 VENOGRAM RENAL UNILAT - IR VENOGRAM RENAL

Facility

$8,393.00

Service Code	CPT 75831 TC
Hospital Charge Code	3237583101
Hospital Revenue Code	323
Min. Negotiated Rate	$67.37
Max. Negotiated Rate	$6,294.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,616.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$67.37
Rate for Payer: Aetna Government	$67.37
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	$72.73
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	$72.73
Rate for Payer: Healthfirst Essential Plan	$671.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$298.28

HC VENOGRAM SINUS/JUGULAR - IR VENOGRAM VENOUS SINUS, JUGULAR LEFT

Facility

$8,393.00

Service Code	CPT 75860 TC
Hospital Charge Code	3207586001
Hospital Revenue Code	320
Min. Negotiated Rate	$4,196.50
Max. Negotiated Rate	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50

HC VENOGRAM SINUS/JUGULAR - IR VENOGRAM VENOUS SINUS, JUGULAR LEFT

Facility

$8,393.00

Service Code	CPT 75860 TC
Hospital Charge Code	3207586001
Hospital Revenue Code	320
Min. Negotiated Rate	$68.76
Max. Negotiated Rate	$6,294.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,616.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$68.76
Rate for Payer: Aetna Government	$68.76
Rate for Payer: Brighton Health Commercial	$6,294.75
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	$76.92
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	$76.92
Rate for Payer: Healthfirst Essential Plan	$309.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$137.42

HC VENOGRAM SUPER SAG SINUS - IR VENOGRAM SUPERIOR SAGITTAL SINUS

Facility

$4,940.00

Service Code	CPT 75870 TC
Hospital Charge Code	3207587001
Hospital Revenue Code	320
Min. Negotiated Rate	$71.27
Max. Negotiated Rate	$3,705.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,717.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$71.27
Rate for Payer: Aetna Government	$71.27
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	$109.75
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	$109.75
Rate for Payer: Healthfirst Essential Plan	$680.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$302.35

HC VENOGRAM SUPER SAG SINUS - IR VENOGRAM SUPERIOR SAGITTAL SINUS

Facility

$4,940.00

Service Code	CPT 75870 TC
Hospital Charge Code	3207587001
Hospital Revenue Code	320
Min. Negotiated Rate	$2,470.00
Max. Negotiated Rate	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.00

HC VENOGRAM SUPER VENA CAVA - IR VENO CAVAL SUPERIOR W SERIALOGRAPHY

Facility

$1,909.00

Service Code	CPT 75827 TC
Hospital Charge Code	3237582701
Hospital Revenue Code	323
Min. Negotiated Rate	$64.86
Max. Negotiated Rate	$1,538.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,049.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.86
Rate for Payer: Aetna Government	$64.86
Rate for Payer: Brighton Health Commercial	$1,431.75
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	$67.98
Rate for Payer: Group Health Inc Commercial	$954.50
Rate for Payer: Group Health Inc Medicare	$668.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.50
Rate for Payer: Hamaspik Choice Inc Medicare	$954.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$67.98
Rate for Payer: Healthfirst Essential Plan	$302.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$134.57

Know your out-of-pocket cost for care.

All Charges