St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC X-RAY IV PYELOGRAM+TOMOGRAPHY - FL IV PYELOGRAM W TOMOGRAPHY

Facility

$551.00

Service Code	CPT 74415 TC
Hospital Charge Code	3207441501
Hospital Revenue Code	320
Min. Negotiated Rate	$87.73
Max. Negotiated Rate	$413.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$87.73
Rate for Payer: Aetna Government	$87.73
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	$132.81
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	$132.81
Rate for Payer: Healthfirst Essential Plan	$198.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$88.40

HC X-RAY IV PYELOGRAM+TOMOGRAPHY - FL IV PYELOGRAM W TOMOGRAPHY

Facility

$551.00

Service Code	CPT 74415 TC
Hospital Charge Code	3207441501
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 JAW <4 VW - XR MANDIBLE < 4 VIEWS

Facility

$241.00

Service Code	CPT 70100 TC
Hospital Charge Code	3207010001
Hospital Revenue Code	320
Min. Negotiated Rate	$18.55
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.55
Rate for Payer: Aetna Government	$18.55
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	$31.64
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	$31.64
Rate for Payer: Healthfirst Essential Plan	$48.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21.39

HC X-RAY JAW <4 VW - XR MANDIBLE < 4 VIEWS

Facility

$241.00

Service Code	CPT 70100 TC
Hospital Charge Code	3207010001
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 JAW 4+ VW - XR MANDIBLE 4+ VIEWS

Facility

$327.00

Service Code	CPT 70110 TC
Hospital Charge Code	3207011001
Hospital Revenue Code	320
Min. Negotiated Rate	$19.67
Max. Negotiated Rate	$245.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.67
Rate for Payer: Aetna Government	$19.67
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	$33.39
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	$33.39
Rate for Payer: Healthfirst Essential Plan	$57.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25.51

HC X-RAY JAW 4+ VW - XR MANDIBLE 4+ VIEWS

Facility

$327.00

Service Code	CPT 70110 TC
Hospital Charge Code	3207011001
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 KNEE 1 OR 2 VIEW - XR KNEE 1-2 VIEWS

Facility

$241.00

Service Code	CPT 73560 TC
Hospital Charge Code	3207356001
Hospital Revenue Code	320
Min. Negotiated Rate	$17.72
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.72
Rate for Payer: Aetna Government	$17.72
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	$44.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19.81

HC X-RAY KNEE 1 OR 2 VIEW - XR KNEE 1-2 VIEWS

Facility

$241.00

Service Code	CPT 73560 TC
Hospital Charge Code	3207356001
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 KNEE 1 OR 2 VIEW - XR KNEE 1-2 VIEWS BILAT

Facility

$241.00

Service Code	CPT 73560 TC
Hospital Charge Code	3207356003
Hospital Revenue Code	320
Min. Negotiated Rate	$17.72
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.72
Rate for Payer: Aetna Government	$17.72
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	$44.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19.81

HC X-RAY KNEE 1 OR 2 VIEW - XR KNEE 1-2 VIEWS BILAT

Facility

$241.00

Service Code	CPT 73560 TC
Hospital Charge Code	3207356003
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 KNEE 1 OR 2 VIEW - XR KNEE 1-2 VIEWS RIGHT

Facility

$241.00

Service Code	CPT 73560 TC
Hospital Charge Code	3207356002
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 KNEE 1 OR 2 VIEW - XR KNEE 1-2 VIEWS RIGHT

Facility

$241.00

Service Code	CPT 73560 TC
Hospital Charge Code	3207356002
Hospital Revenue Code	320
Min. Negotiated Rate	$17.72
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.72
Rate for Payer: Aetna Government	$17.72
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	$44.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19.81

HC X-RAY KNEE 3 VIEW - XR KNEE 3 VIEWS

Facility

$241.00

Service Code	CPT 73562 TC
Hospital Charge Code	3207356201
Hospital Revenue Code	320
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.50
Rate for Payer: Aetna Government	$20.50
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	$33.39
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	$33.39
Rate for Payer: Healthfirst Essential Plan	$53.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23.78

HC X-RAY KNEE 3 VIEW - XR KNEE 3 VIEWS

Facility

$241.00

Service Code	CPT 73562 TC
Hospital Charge Code	3207356201
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 KNEE 3 VIEW - XR KNEE 3 VIEWS BILATERAL

Facility

$241.00

Service Code	CPT 73562 TC
Hospital Charge Code	3207356203
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 KNEE 3 VIEW - XR KNEE 3 VIEWS BILATERAL

Facility

$241.00

Service Code	CPT 73562 TC
Hospital Charge Code	3207356203
Hospital Revenue Code	320
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.50
Rate for Payer: Aetna Government	$20.50
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	$33.39
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	$33.39
Rate for Payer: Healthfirst Essential Plan	$53.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23.78

HC X-RAY KNEE 3 VIEW - XR KNEE 3 VIEWS RIGHT

Facility

$241.00

Service Code	CPT 73562 TC
Hospital Charge Code	3207356202
Hospital Revenue Code	320
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.50
Rate for Payer: Aetna Government	$20.50
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	$33.39
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	$33.39
Rate for Payer: Healthfirst Essential Plan	$53.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23.78

HC X-RAY KNEE 3 VIEW - XR KNEE 3 VIEWS RIGHT

Facility

$241.00

Service Code	CPT 73562 TC
Hospital Charge Code	3207356202
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 KNEE 4+ VIEW - XR KNEE 4+ VIEWS

Facility

$339.00

Service Code	CPT 73564 TC
Hospital Charge Code	3207356401
Hospital Revenue Code	320
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.90
Rate for Payer: Aetna Government	$21.90
Rate for Payer: Brighton Health Commercial	$254.25
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	$38.29
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38.29
Rate for Payer: Healthfirst Essential Plan	$61.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27.26

HC X-RAY KNEE 4+ VIEW - XR KNEE 4+ VIEWS

Facility

$339.00

Service Code	CPT 73564 TC
Hospital Charge Code	3207356401
Hospital Revenue Code	320
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC X-RAY KNEE 4+ VIEW - XR KNEE 4+ VIEWS BILATERAL

Facility

$339.00

Service Code	CPT 73564 TC
Hospital Charge Code	3207356403
Hospital Revenue Code	320
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC X-RAY KNEE 4+ VIEW - XR KNEE 4+ VIEWS BILATERAL

Facility

$339.00

Service Code	CPT 73564 TC
Hospital Charge Code	3207356403
Hospital Revenue Code	320
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.90
Rate for Payer: Aetna Government	$21.90
Rate for Payer: Brighton Health Commercial	$254.25
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	$38.29
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38.29
Rate for Payer: Healthfirst Essential Plan	$61.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27.26

HC X-RAY KNEE 4+ VIEW - XR KNEE 4+ VIEWS RIGHT

Facility

$339.00

Service Code	CPT 73564 TC
Hospital Charge Code	3207356402
Hospital Revenue Code	320
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.90
Rate for Payer: Aetna Government	$21.90
Rate for Payer: Brighton Health Commercial	$254.25
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	$38.29
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38.29
Rate for Payer: Healthfirst Essential Plan	$61.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27.26

HC X-RAY KNEE 4+ VIEW - XR KNEE 4+ VIEWS RIGHT

Facility

$339.00

Service Code	CPT 73564 TC
Hospital Charge Code	3207356402
Hospital Revenue Code	320
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC X-RAY LEG, INFANT - XR LOWER EXTREMITY 2+ VIEWS INFANT

Facility

$241.00

Service Code	CPT 73592 TC
Hospital Charge Code	3207359203
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