St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$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 RIGHT

Facility

$241.00

Service Code	CPT 73130 TC
Hospital Charge Code	3207313002
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 RIGHT

Facility

$241.00

Service Code	CPT 73130 TC
Hospital Charge Code	3207313002
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 HEAD FOR ORTHODONTIA - XR HEAD CEPHALOGRAM FOR ORTHODONTIA

Facility

$241.00

Service Code	CPT 70350 TC
Hospital Charge Code	3207035001
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 HEAD FOR ORTHODONTIA - XR HEAD CEPHALOGRAM FOR ORTHODONTIA

Facility

$241.00

Service Code	CPT 70350 TC
Hospital Charge Code	3207035001
Hospital Revenue Code	320
Min. Negotiated Rate	$7.67
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.67
Rate for Payer: Aetna Government	$7.67
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	$9.64
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	$9.64
Rate for Payer: Healthfirst Essential Plan	$39.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.35

HC X-RAY HEEL - XR CALCANEUS 1 VIEW

Facility

$241.00

Service Code	CPT 73650 TC
Hospital Charge Code	3207365003
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 HEEL - XR CALCANEUS 1 VIEW

Facility

$241.00

Service Code	CPT 73650 TC
Hospital Charge Code	3207365003
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	$21.87
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	$21.87
Rate for Payer: Healthfirst Essential Plan	$40.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18.10

HC X-RAY HEEL - XR CALCANEUS 1 VIEW RIGHT

Facility

$241.00

Service Code	CPT 73650 TC
Hospital Charge Code	3207365005
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	$21.87
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	$21.87
Rate for Payer: Healthfirst Essential Plan	$40.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18.10

HC X-RAY HEEL - XR CALCANEUS 1 VIEW RIGHT

Facility

$241.00

Service Code	CPT 73650 TC
Hospital Charge Code	3207365005
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 HEEL - XR CALCANEUS 2 VIEWS

Facility

$241.00

Service Code	CPT 73650 TC
Hospital Charge Code	3207365001
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 HEEL - XR CALCANEUS 2 VIEWS

Facility

$241.00

Service Code	CPT 73650 TC
Hospital Charge Code	3207365001
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	$21.87
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	$21.87
Rate for Payer: Healthfirst Essential Plan	$40.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18.10

HC X-RAY HEEL - XR CALCANEUS 2 VIEWS BILATERAL

Facility

$241.00

Service Code	CPT 73650 TC
Hospital Charge Code	3207365006
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 HEEL - XR CALCANEUS 2 VIEWS BILATERAL

Facility

$241.00

Service Code	CPT 73650 TC
Hospital Charge Code	3207365006
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	$21.87
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	$21.87
Rate for Payer: Healthfirst Essential Plan	$40.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18.10

HC X-RAY HEEL - XR CALCANEUS 2 VIEWS RIGHT

Facility

$241.00

Service Code	CPT 73650 TC
Hospital Charge Code	3207365002
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	$21.87
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	$21.87
Rate for Payer: Healthfirst Essential Plan	$40.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18.10

HC X-RAY HEEL - XR CALCANEUS 2 VIEWS RIGHT

Facility

$241.00

Service Code	CPT 73650 TC
Hospital Charge Code	3207365002
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 HUMERUS - XR HUMERUS

Facility

$241.00

Service Code	CPT 73060 TC
Hospital Charge Code	3207306001
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	$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	$42.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18.98

HC X-RAY HUMERUS - XR HUMERUS

Facility

$241.00

Service Code	CPT 73060 TC
Hospital Charge Code	3207306001
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 HUMERUS - XR HUMERUS LEFT

Facility

$241.00

Service Code	CPT 73060 TC
Hospital Charge Code	3207306002
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	$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	$42.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18.98

HC X-RAY HUMERUS - XR HUMERUS LEFT

Facility

$241.00

Service Code	CPT 73060 TC
Hospital Charge Code	3207306002
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 HUMERUS - XR HUMERUS RIGHT

Facility

$241.00

Service Code	CPT 73060 TC
Hospital Charge Code	3207306003
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 HUMERUS - XR HUMERUS RIGHT

Facility

$241.00

Service Code	CPT 73060 TC
Hospital Charge Code	3207306003
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	$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	$42.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18.98

HC X-RAY HYSTEROSALPINGOGRAM - XR HYSTEROSALPINGOGRAM

Facility

$705.00

Service Code	CPT 74740 TC
Hospital Charge Code	3207474001
Hospital Revenue Code	320
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC X-RAY HYSTEROSALPINGOGRAM - XR HYSTEROSALPINGOGRAM

Facility

$705.00

Service Code	CPT 74740 TC
Hospital Charge Code	3207474001
Hospital Revenue Code	320
Min. Negotiated Rate	$43.66
Max. Negotiated Rate	$528.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.66
Rate for Payer: Aetna Government	$43.66
Rate for Payer: Brighton Health Commercial	$528.75
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	$76.01
Rate for Payer: Group Health Inc Commercial	$352.50
Rate for Payer: Group Health Inc Medicare	$246.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50
Rate for Payer: Hamaspik Choice Inc Medicare	$352.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$76.01
Rate for Payer: Healthfirst Essential Plan	$115.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$51.22

HC X-RAY IV PYELOGRAM (IVP) - XR UROGRAM W/WO KUB W/WO TOMOGRAM

Facility

$551.00

Service Code	CPT 74400 TC
Hospital Charge Code	3207440001
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 IV PYELOGRAM (IVP) - XR UROGRAM W/WO KUB W/WO TOMOGRAM

Facility

$551.00

Service Code	CPT 74400 TC
Hospital Charge Code	3207440001
Hospital Revenue Code	320
Min. Negotiated Rate	$66.81
Max. Negotiated Rate	$413.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$66.81
Rate for Payer: Aetna Government	$66.81
Rate for Payer: Brighton Health Commercial	$413.25
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	$115.34
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	$115.34
Rate for Payer: Healthfirst Essential Plan	$163.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$72.47

Know your out-of-pocket cost for care.

All Charges