St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$120.50
Max. Negotiated Rate	$120.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.50

HC X-RAY CLAVICLE - XR CLAVICLE RIGHT

Facility

$241.00

Service Code	CPT 73000 TC
Hospital Charge Code	3207300002
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

HC X-RAY CLAVICLE - XR CLAVICLE RIGHT

Facility

$241.00

Service Code	CPT 73000 TC
Hospital Charge Code	3207300002
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 COLON AIR CONTRAST - FL BARIUM ENEMA AIR CONTRAST

Facility

$551.00

Service Code	CPT 74280 TC
Hospital Charge Code	3207428001
Hospital Revenue Code	320
Min. Negotiated Rate	$127.34
Max. Negotiated Rate	$413.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.34
Rate for Payer: Aetna Government	$127.34
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$303.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$255.75
Rate for Payer: EmblemHealth Commercial	$163.91
Rate for Payer: Group Health Inc Commercial	$275.50
Rate for Payer: Group Health Inc Medicare	$192.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50
Rate for Payer: Hamaspik Choice Inc Medicare	$275.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$163.91
Rate for Payer: Healthfirst Essential Plan	$330.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$146.79

HC X-RAY COLON AIR CONTRAST - FL BARIUM ENEMA AIR CONTRAST

Facility

$551.00

Service Code	CPT 74280 TC
Hospital Charge Code	3207428001
Hospital Revenue Code	320
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

HC X-RAY COLON CONTRAST - FL BARIUM ENEMA SINGLE CONTRAST WATER SOLUBLE

Facility

$551.00

Service Code	CPT 74270 TC
Hospital Charge Code	3207427001
Hospital Revenue Code	320
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

HC X-RAY COLON CONTRAST - FL BARIUM ENEMA SINGLE CONTRAST WATER SOLUBLE

Facility

$551.00

Service Code	CPT 74270 TC
Hospital Charge Code	3207427001
Hospital Revenue Code	320
Min. Negotiated Rate	$78.52
Max. Negotiated Rate	$413.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$78.52
Rate for Payer: Aetna Government	$78.52
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$185.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$156.21
Rate for Payer: EmblemHealth Commercial	$107.45
Rate for Payer: Group Health Inc Commercial	$275.50
Rate for Payer: Group Health Inc Medicare	$192.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50
Rate for Payer: Hamaspik Choice Inc Medicare	$275.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$107.45
Rate for Payer: Healthfirst Essential Plan	$220.43
Rate for Payer: Wellcare CHP/FHP/Medicaid	$97.97

HC XRAY CONTROL CATHETER CHANGE - IR GJ TUBE CHANGE

Facility

$650.00

Service Code	CPT 75984 TC
Hospital Charge Code	3237598401
Hospital Revenue Code	323
Min. Negotiated Rate	$55.93
Max. Negotiated Rate	$520.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$357.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$55.93
Rate for Payer: Aetna Government	$55.93
Rate for Payer: Brighton Health Commercial	$487.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$520.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$442.00
Rate for Payer: EmblemHealth Commercial	$59.95
Rate for Payer: Group Health Inc Commercial	$325.00
Rate for Payer: Group Health Inc Medicare	$227.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$325.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$59.95
Rate for Payer: Healthfirst Essential Plan	$166.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$74.15

HC XRAY CONTROL CATHETER CHANGE - IR GJ TUBE CHANGE

Facility

$650.00

Service Code	CPT 75984 TC
Hospital Charge Code	3237598401
Hospital Revenue Code	323
Min. Negotiated Rate	$325.00
Max. Negotiated Rate	$325.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00

HC XRAY CONTROL CATHETER CHANGE - IR NEPHROSTOMY TUBE CHANGE

Facility

$650.00

Service Code	CPT 75984 TC
Hospital Charge Code	3237598402
Hospital Revenue Code	323
Min. Negotiated Rate	$55.93
Max. Negotiated Rate	$520.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$357.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$55.93
Rate for Payer: Aetna Government	$55.93
Rate for Payer: Brighton Health Commercial	$487.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$520.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$442.00
Rate for Payer: EmblemHealth Commercial	$59.95
Rate for Payer: Group Health Inc Commercial	$325.00
Rate for Payer: Group Health Inc Medicare	$227.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$325.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$59.95
Rate for Payer: Healthfirst Essential Plan	$166.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$74.15

HC XRAY CONTROL CATHETER CHANGE - IR NEPHROSTOMY TUBE CHANGE

Facility

$650.00

Service Code	CPT 75984 TC
Hospital Charge Code	3237598402
Hospital Revenue Code	323
Min. Negotiated Rate	$325.00
Max. Negotiated Rate	$325.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00

HC XRAY CONTROL CATHETER CHANGE - IR URETERAL STENT CHANGE

Facility

$650.00

Service Code	CPT 75984 TC
Hospital Charge Code	3207598401
Hospital Revenue Code	320
Min. Negotiated Rate	$55.93
Max. Negotiated Rate	$520.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$357.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$55.93
Rate for Payer: Aetna Government	$55.93
Rate for Payer: Brighton Health Commercial	$487.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$520.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$442.00
Rate for Payer: EmblemHealth Commercial	$59.95
Rate for Payer: Group Health Inc Commercial	$325.00
Rate for Payer: Group Health Inc Medicare	$227.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$325.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$59.95
Rate for Payer: Healthfirst Essential Plan	$166.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$74.15

HC XRAY CONTROL CATHETER CHANGE - IR URETERAL STENT CHANGE

Facility

$650.00

Service Code	CPT 75984 TC
Hospital Charge Code	3237598403
Hospital Revenue Code	323
Min. Negotiated Rate	$55.93
Max. Negotiated Rate	$520.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$357.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$55.93
Rate for Payer: Aetna Government	$55.93
Rate for Payer: Brighton Health Commercial	$487.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$520.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$442.00
Rate for Payer: EmblemHealth Commercial	$59.95
Rate for Payer: Group Health Inc Commercial	$325.00
Rate for Payer: Group Health Inc Medicare	$227.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$325.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$59.95
Rate for Payer: Healthfirst Essential Plan	$166.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$74.15

HC XRAY CONTROL CATHETER CHANGE - IR URETERAL STENT CHANGE

Facility

$650.00

Service Code	CPT 75984 TC
Hospital Charge Code	3237598403
Hospital Revenue Code	323
Min. Negotiated Rate	$325.00
Max. Negotiated Rate	$325.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00

HC XRAY CONTROL CATHETER CHANGE - IR URETERAL STENT CHANGE

Facility

$650.00

Service Code	CPT 75984 TC
Hospital Charge Code	3207598401
Hospital Revenue Code	320
Min. Negotiated Rate	$325.00
Max. Negotiated Rate	$325.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00

HC X-RAY CYSTOGRAM, MIN 3 VIEW - FL CYSTOGRAM 3V

Facility

$1,156.00

Service Code	CPT 74430 TC
Hospital Charge Code	3207443001
Hospital Revenue Code	320
Min. Negotiated Rate	$16.88
Max. Negotiated Rate	$867.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.88
Rate for Payer: Aetna Government	$16.88
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	$27.80
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	$27.80
Rate for Payer: Healthfirst Essential Plan	$88.54
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39.35

HC X-RAY CYSTOGRAM, MIN 3 VIEW - FL CYSTOGRAM 3V

Facility

$1,156.00

Service Code	CPT 74430 TC
Hospital Charge Code	3207443001
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 ELBOW 2 VW - XR ELBOW 1-2 VIEWS LEFT

Facility

$241.00

Service Code	CPT 73070 TC
Hospital Charge Code	3207307002
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 ELBOW 2 VW - XR ELBOW 1-2 VIEWS LEFT

Facility

$241.00

Service Code	CPT 73070 TC
Hospital Charge Code	3207307002
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	$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	$41.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18.33

HC X-RAY ELBOW 2 VW - XR ELBOW 1-2 VIEWS RIGHT

Facility

$241.00

Service Code	CPT 73070 TC
Hospital Charge Code	3207307003
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 ELBOW 2 VW - XR ELBOW 1-2 VIEWS RIGHT

Facility

$241.00

Service Code	CPT 73070 TC
Hospital Charge Code	3207307003
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	$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	$41.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18.33

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

Facility

$241.00

Service Code	CPT 73080 TC
Hospital Charge Code	3207308001
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 ELBOW 3+ VW - XR ELBOW 3+ VIEWS

Facility

$241.00

Service Code	CPT 73080 TC
Hospital Charge Code	3207308001
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	$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	$49.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22.07

HC X-RAY ELBOW 3+ VW - XR ELBOW 3+ VIEWS LEFT

Facility

$241.00

Service Code	CPT 73080 TC
Hospital Charge Code	3207308002
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	$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	$49.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22.07

HC X-RAY ELBOW 3+ VW - XR ELBOW 3+ VIEWS LEFT

Facility

$241.00

Service Code	CPT 73080 TC
Hospital Charge Code	3207308002
Hospital Revenue Code	320
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