St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC X-RAY EXAM OF SMALL BOWEL - FL SMALL BOWEL SERIES

Facility

$551.00

Service Code	CPT 74250 TC
Hospital Charge Code	3207425001
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 EXAM SELLA - XR SELLA TURCICA

Facility

$241.00

Service Code	CPT 70240 TC
Hospital Charge Code	3207024001
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 EXAM SELLA - XR SELLA TURCICA

Facility

$241.00

Service Code	CPT 70240 TC
Hospital Charge Code	3207024001
Hospital Revenue Code	320
Min. Negotiated Rate	$15.76
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.76
Rate for Payer: Aetna Government	$15.76
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	$25.01
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	$25.01
Rate for Payer: Healthfirst Essential Plan	$43.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19.17

HC X-RAY EYE FOR FOREIGN BODY - XR EYE FOREIGN BODY

Facility

$241.00

Service Code	CPT 70030 TC
Hospital Charge Code	3207003001
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 EYE FOR FOREIGN BODY - XR EYE FOREIGN BODY

Facility

$241.00

Service Code	CPT 70030 TC
Hospital Charge Code	3207003001
Hospital Revenue Code	320
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.20
Rate for Payer: Aetna Government	$15.20
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	$41.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18.53

HC X-RAY FACIAL BONES <3 VW - XR FACIAL BONES 1-2 VIEWS

Facility

$241.00

Service Code	CPT 70140 TC
Hospital Charge Code	3207014001
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	$23.62
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	$23.62
Rate for Payer: Healthfirst Essential Plan	$44.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19.61

HC X-RAY FACIAL BONES <3 VW - XR FACIAL BONES 1-2 VIEWS

Facility

$241.00

Service Code	CPT 70140 TC
Hospital Charge Code	3207014001
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 FACIAL BONES 3+ VW - XR FACIAL BONES 3+ VIEWS

Facility

$327.00

Service Code	CPT 70150 TC
Hospital Charge Code	3207015001
Hospital Revenue Code	320
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$245.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.90
Rate for Payer: Aetna Government	$21.90
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	$36.19
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	$36.19
Rate for Payer: Healthfirst Essential Plan	$62.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27.70

HC X-RAY FACIAL BONES 3+ VW - XR FACIAL BONES 3+ VIEWS

Facility

$327.00

Service Code	CPT 70150 TC
Hospital Charge Code	3207015001
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 FISTULA,ABSCESS,SINUS TRACT - FL FISTULA SINUS TRACT

Facility

$1,458.00

Service Code	CPT 76080 TC
Hospital Charge Code	3207608005
Hospital Revenue Code	320
Min. Negotiated Rate	$729.00
Max. Negotiated Rate	$729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00

HC X-RAY FISTULA,ABSCESS,SINUS TRACT - FL FISTULA SINUS TRACT

Facility

$1,458.00

Service Code	CPT 76080 TC
Hospital Charge Code	3207608005
Hospital Revenue Code	320
Min. Negotiated Rate	$22.74
Max. Negotiated Rate	$1,093.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$801.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.74
Rate for Payer: Aetna Government	$22.74
Rate for Payer: Brighton Health Commercial	$1,093.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$492.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$414.22
Rate for Payer: EmblemHealth Commercial	$37.23
Rate for Payer: Group Health Inc Commercial	$729.00
Rate for Payer: Group Health Inc Medicare	$510.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00
Rate for Payer: Hamaspik Choice Inc Medicare	$729.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37.23
Rate for Payer: Healthfirst Essential Plan	$90.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$40.13

HC X-RAY FISTULA,ABSCESS,SINUS TRACT - IR ABSCESSOGRAM W/ CONTRAST

Facility

$1,458.00

Service Code	CPT 76080 TC
Hospital Charge Code	3207608001
Hospital Revenue Code	320
Min. Negotiated Rate	$22.74
Max. Negotiated Rate	$1,093.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$801.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.74
Rate for Payer: Aetna Government	$22.74
Rate for Payer: Brighton Health Commercial	$1,093.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$492.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$414.22
Rate for Payer: EmblemHealth Commercial	$37.23
Rate for Payer: Group Health Inc Commercial	$729.00
Rate for Payer: Group Health Inc Medicare	$510.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00
Rate for Payer: Hamaspik Choice Inc Medicare	$729.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37.23
Rate for Payer: Healthfirst Essential Plan	$90.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$40.13

HC X-RAY FISTULA,ABSCESS,SINUS TRACT - IR ABSCESSOGRAM W/ CONTRAST

Facility

$1,458.00

Service Code	CPT 76080 TC
Hospital Charge Code	3207608001
Hospital Revenue Code	320
Min. Negotiated Rate	$729.00
Max. Negotiated Rate	$729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00

HC X-RAY FISTULA,ABSCESS,SINUS TRACT - IR DIAGNOSTIC SINOGRAM

Facility

$1,458.00

Service Code	CPT 76080 TC
Hospital Charge Code	3207608003
Hospital Revenue Code	320
Min. Negotiated Rate	$729.00
Max. Negotiated Rate	$729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00

HC X-RAY FISTULA,ABSCESS,SINUS TRACT - IR DIAGNOSTIC SINOGRAM

Facility

$1,458.00

Service Code	CPT 76080 TC
Hospital Charge Code	3207608003
Hospital Revenue Code	320
Min. Negotiated Rate	$22.74
Max. Negotiated Rate	$1,093.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$801.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.74
Rate for Payer: Aetna Government	$22.74
Rate for Payer: Brighton Health Commercial	$1,093.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$492.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$414.22
Rate for Payer: EmblemHealth Commercial	$37.23
Rate for Payer: Group Health Inc Commercial	$729.00
Rate for Payer: Group Health Inc Medicare	$510.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00
Rate for Payer: Hamaspik Choice Inc Medicare	$729.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37.23
Rate for Payer: Healthfirst Essential Plan	$90.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$40.13

HC X-RAY FOOT 2 VW - XR FOOT 1-2 VIEWS

Facility

$241.00

Service Code	CPT 73620 TC
Hospital Charge Code	3207362001
Hospital Revenue Code	320
Min. Negotiated Rate	$14.37
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.37
Rate for Payer: Aetna Government	$14.37
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	$22.21
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	$22.21
Rate for Payer: Healthfirst Essential Plan	$39.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.65

HC X-RAY FOOT 2 VW - XR FOOT 1-2 VIEWS

Facility

$241.00

Service Code	CPT 73620 TC
Hospital Charge Code	3207362001
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 FOOT 2 VW - XR FOOT 1-2 VIEWS BILATERAL

Facility

$241.00

Service Code	CPT 73620 TC
Hospital Charge Code	3207362003
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 FOOT 2 VW - XR FOOT 1-2 VIEWS BILATERAL

Facility

$241.00

Service Code	CPT 73620 TC
Hospital Charge Code	3207362003
Hospital Revenue Code	320
Min. Negotiated Rate	$14.37
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.37
Rate for Payer: Aetna Government	$14.37
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	$22.21
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	$22.21
Rate for Payer: Healthfirst Essential Plan	$39.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.65

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

Facility

$241.00

Service Code	CPT 73620 TC
Hospital Charge Code	3207362002
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 FOOT 2 VW - XR FOOT 1-2 VIEWS RIGHT

Facility

$241.00

Service Code	CPT 73620 TC
Hospital Charge Code	3207362002
Hospital Revenue Code	320
Min. Negotiated Rate	$14.37
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.37
Rate for Payer: Aetna Government	$14.37
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	$22.21
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	$22.21
Rate for Payer: Healthfirst Essential Plan	$39.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.65

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

Facility

$241.00

Service Code	CPT 73630 TC
Hospital Charge Code	3207363001
Hospital Revenue Code	320
Min. Negotiated Rate	$16.04
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.04
Rate for Payer: Aetna Government	$16.04
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	$27.46
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	$27.46
Rate for Payer: Healthfirst Essential Plan	$46.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.52

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

Facility

$241.00

Service Code	CPT 73630 TC
Hospital Charge Code	3207363001
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 FOOT 3+ VW - XR FOOT 3+ VIEWS BILATERAL

Facility

$241.00

Service Code	CPT 73630 TC
Hospital Charge Code	3207363003
Hospital Revenue Code	320
Min. Negotiated Rate	$16.04
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.04
Rate for Payer: Aetna Government	$16.04
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	$27.46
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	$27.46
Rate for Payer: Healthfirst Essential Plan	$46.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.52

HC X-RAY FOOT 3+ VW - XR FOOT 3+ VIEWS BILATERAL

Facility

$241.00

Service Code	CPT 73630 TC
Hospital Charge Code	3207363003
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