St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$241.00

Service Code	CPT 73630 TC
Hospital Charge Code	3207363002
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 RIGHT

Facility

$241.00

Service Code	CPT 73630 TC
Hospital Charge Code	3207363002
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 FOR BILE DUCT ENDOSCOPY - FL ERCP BILIARY DUCT

Facility

$515.00

Service Code	CPT 74328 TC
Hospital Charge Code	3207432801
Hospital Revenue Code	320
Min. Negotiated Rate	$257.50
Max. Negotiated Rate	$257.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$257.50

HC X-RAY FOR BILE DUCT ENDOSCOPY - FL ERCP BILIARY DUCT

Facility

$515.00

Service Code	CPT 74328 TC
Hospital Charge Code	3207432801
Hospital Revenue Code	320
Min. Negotiated Rate	$67.54
Max. Negotiated Rate	$412.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$283.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$67.54
Rate for Payer: Aetna Government	$67.54
Rate for Payer: Brighton Health Commercial	$386.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$412.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$350.20
Rate for Payer: EmblemHealth Commercial	$257.50
Rate for Payer: Group Health Inc Commercial	$257.50
Rate for Payer: Group Health Inc Medicare	$180.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$257.50
Rate for Payer: Hamaspik Choice Inc Medicare	$257.50
Rate for Payer: Healthfirst Essential Plan	$242.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$107.63

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

Facility

$241.00

Service Code	CPT 73090 TC
Hospital Charge Code	3207309001
Hospital Revenue Code	320
Min. Negotiated Rate	$13.53
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.53
Rate for Payer: Aetna Government	$13.53
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	$22.91
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	$22.91
Rate for Payer: Healthfirst Essential Plan	$40.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18.10

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

Facility

$241.00

Service Code	CPT 73090 TC
Hospital Charge Code	3207309001
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 FOREARM 2 VW - XR FOREARM 2 VIEWS RIGHT

Facility

$241.00

Service Code	CPT 73090 TC
Hospital Charge Code	3207309002
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 FOREARM 2 VW - XR FOREARM 2 VIEWS RIGHT

Facility

$241.00

Service Code	CPT 73090 TC
Hospital Charge Code	3207309002
Hospital Revenue Code	320
Min. Negotiated Rate	$13.53
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.53
Rate for Payer: Aetna Government	$13.53
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	$22.91
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	$22.91
Rate for Payer: Healthfirst Essential Plan	$40.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18.10

HC X-RAY GUIDE GI DILATION - IR INTRALUMINAL DILATION STRICT W FL GUIDE

Facility

$650.00

Service Code	CPT 74360 TC
Hospital Charge Code	3207436002
Hospital Revenue Code	320
Min. Negotiated Rate	$72.42
Max. Negotiated Rate	$520.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$357.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$72.42
Rate for Payer: Aetna Government	$72.42
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	$325.00
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 Essential Plan	$232.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$103.20

HC X-RAY GUIDE GI DILATION - IR INTRALUMINAL DILATION STRICT W FL GUIDE

Facility

$650.00

Service Code	CPT 74360 TC
Hospital Charge Code	3207436002
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 GUIDE, GU DILATION - IR NEPHROSTOMY DILATION

Facility

$5,365.00

Service Code	CPT 74485 TC
Hospital Charge Code	3237448503
Hospital Revenue Code	323
Min. Negotiated Rate	$2,682.50
Max. Negotiated Rate	$2,682.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,682.50

HC X-RAY GUIDE, GU DILATION - IR NEPHROSTOMY DILATION

Facility

$5,365.00

Service Code	CPT 74485 TC
Hospital Charge Code	3237448503
Hospital Revenue Code	323
Min. Negotiated Rate	$51.75
Max. Negotiated Rate	$4,023.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,950.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.75
Rate for Payer: Aetna Government	$51.75
Rate for Payer: Brighton Health Commercial	$4,023.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,590.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,180.31
Rate for Payer: EmblemHealth Commercial	$83.00
Rate for Payer: Group Health Inc Commercial	$2,682.50
Rate for Payer: Group Health Inc Medicare	$1,877.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,682.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,682.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$83.00
Rate for Payer: Healthfirst Essential Plan	$160.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$71.53

HC X-RAY GUIDE, GU DILATION - IR NEPHROSTOMY DILATION FOR STONE REMOVAL

Facility

$5,365.00

Service Code	CPT 74485 TC
Hospital Charge Code	3237448502
Hospital Revenue Code	323
Min. Negotiated Rate	$51.75
Max. Negotiated Rate	$4,023.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,950.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.75
Rate for Payer: Aetna Government	$51.75
Rate for Payer: Brighton Health Commercial	$4,023.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,590.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,180.31
Rate for Payer: EmblemHealth Commercial	$83.00
Rate for Payer: Group Health Inc Commercial	$2,682.50
Rate for Payer: Group Health Inc Medicare	$1,877.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,682.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,682.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$83.00
Rate for Payer: Healthfirst Essential Plan	$160.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$71.53

HC X-RAY GUIDE, GU DILATION - IR NEPHROSTOMY DILATION FOR STONE REMOVAL

Facility

$5,365.00

Service Code	CPT 74485 TC
Hospital Charge Code	3237448502
Hospital Revenue Code	323
Min. Negotiated Rate	$2,682.50
Max. Negotiated Rate	$2,682.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,682.50

HC X-RAY GUIDE PERCUTANEOUS PLACEMENT OF ENTEROCLYSIS TUBE

Facility

$697.00

Service Code	CPT 74355 TC
Hospital Charge Code	3207435501
Hospital Revenue Code	320
Min. Negotiated Rate	$84.98
Max. Negotiated Rate	$557.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$383.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$84.98
Rate for Payer: Aetna Government	$84.98
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	$257.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$114.54

HC X-RAY GUIDE PERCUTANEOUS PLACEMENT OF ENTEROCLYSIS TUBE

Facility

$697.00

Service Code	CPT 74355 TC
Hospital Charge Code	3207435501
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 HAND 2 VW - XR HAND 1-2 VIEWS

Facility

$327.00

Service Code	CPT 73120 TC
Hospital Charge Code	3207312001
Hospital Revenue Code	320
Min. Negotiated Rate	$13.81
Max. Negotiated Rate	$245.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.81
Rate for Payer: Aetna Government	$13.81
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	$24.66
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	$24.66
Rate for Payer: Healthfirst Essential Plan	$40.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.88

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

Facility

$327.00

Service Code	CPT 73120 TC
Hospital Charge Code	3207312001
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 HAND 2 VW - XR HAND 1-2 VIEWS BILATERAL

Facility

$327.00

Service Code	CPT 73120 TC
Hospital Charge Code	3207312003
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 HAND 2 VW - XR HAND 1-2 VIEWS BILATERAL

Facility

$327.00

Service Code	CPT 73120 TC
Hospital Charge Code	3207312003
Hospital Revenue Code	320
Min. Negotiated Rate	$13.81
Max. Negotiated Rate	$245.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.81
Rate for Payer: Aetna Government	$13.81
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	$24.66
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	$24.66
Rate for Payer: Healthfirst Essential Plan	$40.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.88

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

Facility

$327.00

Service Code	CPT 73120 TC
Hospital Charge Code	3207312002
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 HAND 2 VW - XR HAND 1-2 VIEWS RIGHT

Facility

$327.00

Service Code	CPT 73120 TC
Hospital Charge Code	3207312002
Hospital Revenue Code	320
Min. Negotiated Rate	$13.81
Max. Negotiated Rate	$245.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.81
Rate for Payer: Aetna Government	$13.81
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	$24.66
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	$24.66
Rate for Payer: Healthfirst Essential Plan	$40.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.88

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

Facility

$241.00

Service Code	CPT 73130 TC
Hospital Charge Code	3207313001
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 HAND 3+ VW - XR HAND 3+ VIEWS

Facility

$241.00

Service Code	CPT 73130 TC
Hospital Charge Code	3207313001
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	$46.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.75

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

Facility

$241.00

Service Code	CPT 73130 TC
Hospital Charge Code	3207313003
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	$46.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.75

Know your out-of-pocket cost for care.

All Charges