St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW - XR SCOLIOSIS 1 VW

Facility

$241.00

Service Code	CPT 72081 TC
Hospital Charge Code	3207208101
Hospital Revenue Code	320
Min. Negotiated Rate	$19.95
Max. Negotiated Rate	$192.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.95
Rate for Payer: Aetna Government	$19.95
Rate for Payer: Brighton Health Commercial	$180.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$192.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.88
Rate for Payer: EmblemHealth Commercial	$32.35
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	$32.35
Rate for Payer: Healthfirst Essential Plan	$71.21
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31.65

HC RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW - XR SCOLIOSIS 1 VW

Facility

$241.00

Service Code	CPT 72081 TC
Hospital Charge Code	3207208101
Hospital Revenue Code	320
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$120.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50

HC RADEX SPINE CERVICAL 2 OR 3 VIEWS - XR CERVICAL SPINE 2-3 VIEWS

Facility

$241.00

Service Code	CPT 72040 TC
Hospital Charge Code	3207204002
Hospital Revenue Code	320
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$120.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50

HC RADEX SPINE CERVICAL 2 OR 3 VIEWS - XR CERVICAL SPINE 2-3 VIEWS

Facility

$241.00

Service Code	CPT 72040 TC
Hospital Charge Code	3207204002
Hospital Revenue Code	320
Min. Negotiated Rate	$17.16
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.16
Rate for Payer: Aetna Government	$17.16
Rate for Payer: Brighton Health Commercial	$180.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.13
Rate for Payer: EmblemHealth Commercial	$30.60
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	$30.60
Rate for Payer: Healthfirst Essential Plan	$56.86
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25.27

HC RADEX SPINE CERVICAL 4 OR 5 VIEWS - XR CERVICAL SPINE COMP 4-5 VIEWS

Facility

$327.00

Service Code	CPT 72050 TC
Hospital Charge Code	3207205001
Hospital Revenue Code	320
Min. Negotiated Rate	$163.50
Max. Negotiated Rate	$163.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.50

HC RADEX SPINE CERVICAL 4 OR 5 VIEWS - XR CERVICAL SPINE COMP 4-5 VIEWS

Facility

$327.00

Service Code	CPT 72050 TC
Hospital Charge Code	3207205001
Hospital Revenue Code	320
Min. Negotiated Rate	$22.74
Max. Negotiated Rate	$245.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.74
Rate for Payer: Aetna Government	$22.74
Rate for Payer: Brighton Health Commercial	$245.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$162.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.66
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Group Health Inc Commercial	$163.50
Rate for Payer: Group Health Inc Medicare	$114.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.50
Rate for Payer: Hamaspik Choice Inc Medicare	$163.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$43.17
Rate for Payer: Healthfirst Essential Plan	$77.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34.22

HC RADEX SPINE CERVICAL 6 OR MORE VIEWS - XR C-SPINE COMPLETE 6+ VIEWS

Facility

$327.00

Service Code	CPT 72052 TC
Hospital Charge Code	3207205201
Hospital Revenue Code	320
Min. Negotiated Rate	$29.71
Max. Negotiated Rate	$245.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.71
Rate for Payer: Aetna Government	$29.71
Rate for Payer: Brighton Health Commercial	$245.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$162.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.66
Rate for Payer: EmblemHealth Commercial	$50.17
Rate for Payer: Group Health Inc Commercial	$163.50
Rate for Payer: Group Health Inc Medicare	$114.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.50
Rate for Payer: Hamaspik Choice Inc Medicare	$163.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$50.17
Rate for Payer: Healthfirst Essential Plan	$97.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$43.44

HC RADEX SPINE CERVICAL 6 OR MORE VIEWS - XR C-SPINE COMPLETE 6+ VIEWS

Facility

$327.00

Service Code	CPT 72052 TC
Hospital Charge Code	3207205201
Hospital Revenue Code	320
Min. Negotiated Rate	$163.50
Max. Negotiated Rate	$163.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.50

HC RADEX X-RAY EXAM ENTIRE SPI 2/3 VW - XR ENTIRE SPINE 2 OR 3 VW

Facility

$339.00

Service Code	CPT 72082 TC
Hospital Charge Code	3207208201
Hospital Revenue Code	320
Min. Negotiated Rate	$36.13
Max. Negotiated Rate	$271.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.13
Rate for Payer: Aetna Government	$36.13
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.52
Rate for Payer: EmblemHealth Commercial	$58.19
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	$58.19
Rate for Payer: Healthfirst Essential Plan	$114.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50.80

HC RADEX X-RAY EXAM ENTIRE SPI 2/3 VW - XR ENTIRE SPINE 2 OR 3 VW

Facility

$339.00

Service Code	CPT 72082 TC
Hospital Charge Code	3207208201
Hospital Revenue Code	320
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC RADEX X-RAY EXAM ENTIRE SPI 4/5 VW - XR ENTIRE SPINE 4 OR 5 VW

Facility

$339.00

Service Code	CPT 72083 TC
Hospital Charge Code	3207208301
Hospital Revenue Code	320
Min. Negotiated Rate	$39.19
Max. Negotiated Rate	$271.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$39.19
Rate for Payer: Aetna Government	$39.19
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.52
Rate for Payer: EmblemHealth Commercial	$66.44
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	$66.44
Rate for Payer: Healthfirst Essential Plan	$124.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$55.11

HC RADEX X-RAY EXAM ENTIRE SPI 4/5 VW - XR ENTIRE SPINE 4 OR 5 VW

Facility

$339.00

Service Code	CPT 72083 TC
Hospital Charge Code	3207208301
Hospital Revenue Code	320
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC RADEX X-RAY EXAM ENTIRE SPI 6/> VW - XR ENTIRE SPINE 6+ VW

Facility

$339.00

Service Code	CPT 72084 TC
Hospital Charge Code	3207208401
Hospital Revenue Code	320
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC RADEX X-RAY EXAM ENTIRE SPI 6/> VW - XR ENTIRE SPINE 6+ VW

Facility

$339.00

Service Code	CPT 72084 TC
Hospital Charge Code	3207208401
Hospital Revenue Code	320
Min. Negotiated Rate	$47.28
Max. Negotiated Rate	$271.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.28
Rate for Payer: Aetna Government	$47.28
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.52
Rate for Payer: EmblemHealth Commercial	$82.51
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	$82.51
Rate for Payer: Healthfirst Essential Plan	$147.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$65.50

HC RADEX X-RAY EXAM THORACOLMB 2+ VW - XR THORACOLUMBAR SPINE 2 VIEWS

Facility

$260.00

Service Code	CPT 72080 TC
Hospital Charge Code	3207208001
Hospital Revenue Code	320
Min. Negotiated Rate	$130.00
Max. Negotiated Rate	$130.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.00

HC RADEX X-RAY EXAM THORACOLMB 2+ VW - XR THORACOLUMBAR SPINE 2 VIEWS

Facility

$260.00

Service Code	CPT 72080 TC
Hospital Charge Code	3207208001
Hospital Revenue Code	320
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$195.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$143.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.48
Rate for Payer: Aetna Government	$15.48
Rate for Payer: Brighton Health Commercial	$195.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.13
Rate for Payer: EmblemHealth Commercial	$26.05
Rate for Payer: Group Health Inc Commercial	$130.00
Rate for Payer: Group Health Inc Medicare	$91.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.00
Rate for Payer: Hamaspik Choice Inc Medicare	$130.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26.05
Rate for Payer: Healthfirst Essential Plan	$53.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23.72

HC RADIOFREQUENCY ABLATION, NERVES INNERVATING THE SACROILIAC JOINT, W/ GUIDANCE

Facility

$4,599.00

Service Code	CPT 64625
Hospital Charge Code	3616462501
Hospital Revenue Code	361
Min. Negotiated Rate	$2,299.50
Max. Negotiated Rate	$2,299.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,299.50

HC RADIOFREQUENCY ABLATION, NERVES INNERVATING THE SACROILIAC JOINT, W/ GUIDANCE

Facility

$4,599.00

Service Code	CPT 64625
Hospital Charge Code	3616462501
Hospital Revenue Code	361
Min. Negotiated Rate	$221.80
Max. Negotiated Rate	$3,449.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,385.93
Rate for Payer: Aetna Government	$2,385.93
Rate for Payer: Affinity Essential Plan 1&2	$1,670.15
Rate for Payer: Affinity Essential Plan 3&4	$1,670.15
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,670.15
Rate for Payer: Brighton Health Commercial	$3,449.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,385.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,092.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,628.64
Rate for Payer: Elderplan Medicare Advantage	$2,385.93
Rate for Payer: EmblemHealth Commercial	$2,385.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,147.34
Rate for Payer: Fidelis Essential Plan Aliesa	$2,028.04
Rate for Payer: Fidelis Essential Plan QHP	$2,123.48
Rate for Payer: Fidelis Medicare Advantage	$2,385.93
Rate for Payer: Fidelis Qualified Health Plan	$2,123.48
Rate for Payer: Group Health Inc Commercial	$2,385.93
Rate for Payer: Group Health Inc Medicare	$2,385.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,385.93
Rate for Payer: Hamaspik Choice Inc Medicare	$924.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$221.80
Rate for Payer: Healthfirst Medicare Advantage	$2,028.04
Rate for Payer: Healthfirst QHP	$2,385.93
Rate for Payer: Humana Medicare	$2,433.65
Rate for Payer: Senior Whole Health Medicare Advantage	$2,385.93
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$2,385.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,385.93
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,266.63
Rate for Payer: Wellcare Medicare	$2,266.63

HC RADIOLOGIC EXAM ABDOMEN 1 VIEW - XR ABDOMEN 1 VIEW

Facility

$241.00

Service Code	CPT 74018 TC
Hospital Charge Code	3207401802
Hospital Revenue Code	320
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$120.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50

HC RADIOLOGIC EXAM ABDOMEN 1 VIEW - XR ABDOMEN 1 VIEW

Facility

$241.00

Service Code	CPT 74018 TC
Hospital Charge Code	3207401802
Hospital Revenue Code	320
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$192.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.55
Rate for Payer: Aetna Government	$14.55
Rate for Payer: Brighton Health Commercial	$180.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$192.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.88
Rate for Payer: EmblemHealth Commercial	$22.56
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	$22.56
Rate for Payer: Healthfirst Essential Plan	$50.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22.34

HC RADIOLOGIC EXAM ABDOMEN 2 VIEWS - XR ABDOMEN 2 VW POSTER W DECUBITUS

Facility

$339.00

Service Code	CPT 74019 TC
Hospital Charge Code	3207401901
Hospital Revenue Code	320
Min. Negotiated Rate	$17.39
Max. Negotiated Rate	$271.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.39
Rate for Payer: Aetna Government	$17.39
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.52
Rate for Payer: EmblemHealth Commercial	$27.46
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	$27.46
Rate for Payer: Healthfirst Essential Plan	$61.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27.23

HC RADIOLOGIC EXAM ABDOMEN 2 VIEWS - XR ABDOMEN 2 VW POSTER W DECUBITUS

Facility

$339.00

Service Code	CPT 74019 TC
Hospital Charge Code	3207401901
Hospital Revenue Code	320
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC RADIOLOGIC EXAM ABDOMEN 3+ VIEWS - XR ABDOMEN 3+ VIEWS

Facility

$339.00

Service Code	CPT 74021 TC
Hospital Charge Code	3207402101
Hospital Revenue Code	320
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC RADIOLOGIC EXAM ABDOMEN 3+ VIEWS - XR ABDOMEN 3+ VIEWS

Facility

$339.00

Service Code	CPT 74021 TC
Hospital Charge Code	3207402101
Hospital Revenue Code	320
Min. Negotiated Rate	$20.22
Max. Negotiated Rate	$271.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.22
Rate for Payer: Aetna Government	$20.22
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.52
Rate for Payer: EmblemHealth Commercial	$31.64
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	$31.64
Rate for Payer: Healthfirst Essential Plan	$71.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31.90

HC RADIOLOGIC EXAM CHEST 2 VIEWS - XR CHEST 2 VIEWS

Facility

$241.00

Service Code	CPT 71046 TC
Hospital Charge Code	3247104601
Hospital Revenue Code	324
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$120.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50

Know your out-of-pocket cost for care.

All Charges