St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC X-RAY ANKLE 2 VW - XR ANKLE 2 VIEWS

Facility

$241.00

Service Code	CPT 73600 TC
Hospital Charge Code	3207360001
Hospital Revenue Code	320
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$120.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50

HC X-RAY ANKLE 2 VW - XR ANKLE 2 VIEWS

Facility

$241.00

Service Code	CPT 73600 TC
Hospital Charge Code	3207360001
Hospital Revenue Code	320
Min. Negotiated Rate	$16.88
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.88
Rate for Payer: Aetna Government	$16.88
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	$25.71
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	$25.71
Rate for Payer: Healthfirst Essential Plan	$41.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18.32

HC X-RAY ANKLE 2 VW - XR ANKLE 2 VIEWS RIGHT

Facility

$241.00

Service Code	CPT 73600 TC
Hospital Charge Code	3207360002
Hospital Revenue Code	320
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$120.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50

HC X-RAY ANKLE 2 VW - XR ANKLE 2 VIEWS RIGHT

Facility

$241.00

Service Code	CPT 73600 TC
Hospital Charge Code	3207360002
Hospital Revenue Code	320
Min. Negotiated Rate	$16.88
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.88
Rate for Payer: Aetna Government	$16.88
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	$25.71
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	$25.71
Rate for Payer: Healthfirst Essential Plan	$41.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18.32

HC X-RAY ANKLE 3+ VW - XR ANKLE 3+ VIEWS

Facility

$241.00

Service Code	CPT 73610 TC
Hospital Charge Code	3207361001
Hospital Revenue Code	320
Min. Negotiated Rate	$17.44
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.44
Rate for Payer: Aetna Government	$17.44
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	$29.56
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	$29.56
Rate for Payer: Healthfirst Essential Plan	$47.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.96

HC X-RAY ANKLE 3+ VW - XR ANKLE 3+ VIEWS

Facility

$241.00

Service Code	CPT 73610 TC
Hospital Charge Code	3207361001
Hospital Revenue Code	320
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$120.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50

HC X-RAY ANKLE 3+ VW - XR ANKLE 3+ VIEWS RIGHT

Facility

$241.00

Service Code	CPT 73610 TC
Hospital Charge Code	3207361002
Hospital Revenue Code	320
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$120.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50

HC X-RAY ANKLE 3+ VW - XR ANKLE 3+ VIEWS RIGHT

Facility

$241.00

Service Code	CPT 73610 TC
Hospital Charge Code	3207361002
Hospital Revenue Code	320
Min. Negotiated Rate	$17.44
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.44
Rate for Payer: Aetna Government	$17.44
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	$29.56
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	$29.56
Rate for Payer: Healthfirst Essential Plan	$47.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.96

HC X-RAY ANTEGRADE PYELOGRAM TUBE - FL GUIDED NEPHROSTOGRAM

Facility

$1,141.00

Service Code	CPT 74425 TC
Hospital Charge Code	3207442501
Hospital Revenue Code	320
Min. Negotiated Rate	$46.86
Max. Negotiated Rate	$855.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$627.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$273.50
Rate for Payer: Aetna Government	$273.50
Rate for Payer: Brighton Health Commercial	$855.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$376.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$317.25
Rate for Payer: EmblemHealth Commercial	$114.80
Rate for Payer: Group Health Inc Commercial	$570.50
Rate for Payer: Group Health Inc Medicare	$399.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$570.50
Rate for Payer: Hamaspik Choice Inc Medicare	$570.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$114.80
Rate for Payer: Healthfirst Essential Plan	$105.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$46.86

HC X-RAY ANTEGRADE PYELOGRAM TUBE - FL GUIDED NEPHROSTOGRAM

Facility

$1,141.00

Service Code	CPT 74425 TC
Hospital Charge Code	3207442501
Hospital Revenue Code	320
Min. Negotiated Rate	$570.50
Max. Negotiated Rate	$570.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$570.50

HC X-RAY ANTEGRADE PYELOGRAM TUBE - FL LOOPOGRAM

Facility

$1,141.00

Service Code	CPT 74425 TC
Hospital Charge Code	3207442502
Hospital Revenue Code	320
Min. Negotiated Rate	$570.50
Max. Negotiated Rate	$570.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$570.50

HC X-RAY ANTEGRADE PYELOGRAM TUBE - FL LOOPOGRAM

Facility

$1,141.00

Service Code	CPT 74425 TC
Hospital Charge Code	3207442502
Hospital Revenue Code	320
Min. Negotiated Rate	$46.86
Max. Negotiated Rate	$855.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$627.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$273.50
Rate for Payer: Aetna Government	$273.50
Rate for Payer: Brighton Health Commercial	$855.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$376.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$317.25
Rate for Payer: EmblemHealth Commercial	$114.80
Rate for Payer: Group Health Inc Commercial	$570.50
Rate for Payer: Group Health Inc Medicare	$399.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$570.50
Rate for Payer: Hamaspik Choice Inc Medicare	$570.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$114.80
Rate for Payer: Healthfirst Essential Plan	$105.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$46.86

HC X-RAY ANTEGRADE PYELOGRAM TUBE - IR NEPHROSTOGRAM

Facility

$1,156.00

Service Code	CPT 74425 TC
Hospital Charge Code	3237442504
Hospital Revenue Code	323
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC X-RAY ANTEGRADE PYELOGRAM TUBE - IR NEPHROSTOGRAM

Facility

$1,156.00

Service Code	CPT 74425 TC
Hospital Charge Code	3237442504
Hospital Revenue Code	323
Min. Negotiated Rate	$46.86
Max. Negotiated Rate	$867.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$273.50
Rate for Payer: Aetna Government	$273.50
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$376.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$317.25
Rate for Payer: EmblemHealth Commercial	$114.80
Rate for Payer: Group Health Inc Commercial	$578.00
Rate for Payer: Group Health Inc Medicare	$404.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00
Rate for Payer: Hamaspik Choice Inc Medicare	$578.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$114.80
Rate for Payer: Healthfirst Essential Plan	$105.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$46.86

HC X-RAY ANTEGRADE PYELOGRAM TUBE - IR NEPHROSTOGRAM CHARGE

Facility

$1,156.00

Service Code	CPT 74425 TC
Hospital Charge Code	3207442503
Hospital Revenue Code	320
Min. Negotiated Rate	$46.86
Max. Negotiated Rate	$867.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$273.50
Rate for Payer: Aetna Government	$273.50
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$376.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$317.25
Rate for Payer: EmblemHealth Commercial	$114.80
Rate for Payer: Group Health Inc Commercial	$578.00
Rate for Payer: Group Health Inc Medicare	$404.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00
Rate for Payer: Hamaspik Choice Inc Medicare	$578.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$114.80
Rate for Payer: Healthfirst Essential Plan	$105.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$46.86

HC X-RAY ANTEGRADE PYELOGRAM TUBE - IR NEPHROSTOGRAM CHARGE

Facility

$1,156.00

Service Code	CPT 74425 TC
Hospital Charge Code	3207442503
Hospital Revenue Code	320
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC X-RAY AORTA LEG ARTERIES - IR ANGIO ABDOM AORTA & BILAT ILIOFEMORAL

Facility

$8,393.00

Service Code	CPT 75630 TC
Hospital Charge Code	3237563002
Hospital Revenue Code	323
Min. Negotiated Rate	$64.86
Max. Negotiated Rate	$6,294.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,616.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.86
Rate for Payer: Aetna Government	$64.86
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	$67.14
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	$67.14
Rate for Payer: Healthfirst Essential Plan	$362.97
Rate for Payer: Wellcare CHP/FHP/Medicaid	$161.32

HC X-RAY AORTA LEG ARTERIES - IR ANGIO ABDOM AORTA & BILAT ILIOFEMORAL

Facility

$8,393.00

Service Code	CPT 75630 TC
Hospital Charge Code	3237563002
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 X-RAY ARM, INFANT - XR UPPER EXTREMITY 2+ VIEWS INFANT

Facility

$327.00

Service Code	CPT 73092 TC
Hospital Charge Code	3207309201
Hospital Revenue Code	320
Min. Negotiated Rate	$14.93
Max. Negotiated Rate	$245.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.93
Rate for Payer: Aetna Government	$14.93
Rate for Payer: Brighton Health Commercial	$245.25
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	$25.01
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	$25.01
Rate for Payer: Healthfirst Essential Plan	$44.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19.87

HC X-RAY ARM, INFANT - XR UPPER EXTREMITY 2+ VIEWS INFANT

Facility

$327.00

Service Code	CPT 73092 TC
Hospital Charge Code	3207309201
Hospital Revenue Code	320
Min. Negotiated Rate	$163.50
Max. Negotiated Rate	$163.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.50

HC X-RAY BILE DUCT DILATION - IR BILIARY DILATION

Facility

$1,116.00

Service Code	CPT 74363 TC
Hospital Charge Code	3237436301
Hospital Revenue Code	323
Min. Negotiated Rate	$64.88
Max. Negotiated Rate	$892.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$613.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.88
Rate for Payer: Aetna Government	$64.88
Rate for Payer: Brighton Health Commercial	$837.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$892.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$758.88
Rate for Payer: EmblemHealth Commercial	$558.00
Rate for Payer: Group Health Inc Commercial	$558.00
Rate for Payer: Group Health Inc Medicare	$390.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$558.00
Rate for Payer: Hamaspik Choice Inc Medicare	$558.00
Rate for Payer: Healthfirst Essential Plan	$521.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$231.89

HC X-RAY BILE DUCT DILATION - IR BILIARY DILATION

Facility

$1,116.00

Service Code	CPT 74363 TC
Hospital Charge Code	3237436301
Hospital Revenue Code	323
Min. Negotiated Rate	$558.00
Max. Negotiated Rate	$558.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$558.00

HC X-RAY BILE/PANCREAS ENDOSCOPY - FL ERCP BILIARY AND PANCREAS

Facility

$697.00

Service Code	CPT 74330 TC
Hospital Charge Code	3207433001
Hospital Revenue Code	320
Min. Negotiated Rate	$100.47
Max. Negotiated Rate	$557.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$383.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$100.47
Rate for Payer: Aetna Government	$100.47
Rate for Payer: Brighton Health Commercial	$522.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$557.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$473.96
Rate for Payer: EmblemHealth Commercial	$348.50
Rate for Payer: Group Health Inc Commercial	$348.50
Rate for Payer: Group Health Inc Medicare	$243.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$348.50
Rate for Payer: Hamaspik Choice Inc Medicare	$348.50
Rate for Payer: Healthfirst Essential Plan	$256.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$113.79

HC X-RAY BILE/PANCREAS ENDOSCOPY - FL ERCP BILIARY AND PANCREAS

Facility

$697.00

Service Code	CPT 74330 TC
Hospital Charge Code	3207433001
Hospital Revenue Code	320
Min. Negotiated Rate	$348.50
Max. Negotiated Rate	$348.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$348.50

HC X-RAY CLAVICLE - XR CLAVICLE

Facility

$241.00

Service Code	CPT 73000 TC
Hospital Charge Code	3207300001
Hospital Revenue Code	320
Min. Negotiated Rate	$14.93
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.93
Rate for Payer: Aetna Government	$14.93
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	$26.05
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	$26.05
Rate for Payer: Healthfirst Essential Plan	$41.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18.54

Know your out-of-pocket cost for care.

All Charges