St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$15.48
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.48
Rate for Payer: Aetna Government	$15.48
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	$45.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.09

HC X-RAY LUMBAR SPINE 2/3 VW - XR LUMBAR SPINE 2-3 VIEWS

Facility

$339.00

Service Code	CPT 72100 TC
Hospital Charge Code	3207210001
Hospital Revenue Code	320
Min. Negotiated Rate	$18.55
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.55
Rate for Payer: Aetna Government	$18.55
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	$30.60
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	$30.60
Rate for Payer: Healthfirst Essential Plan	$59.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26.37

HC X-RAY LUMBAR SPINE 2/3 VW - XR LUMBAR SPINE 2-3 VIEWS

Facility

$339.00

Service Code	CPT 72100 TC
Hospital Charge Code	3207210001
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 LUMBAR SPINE 4 VW - XR LUMBAR SPINE COMPLETE 4+ VIEWS

Facility

$327.00

Service Code	CPT 72110 TC
Hospital Charge Code	3207211001
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 LUMBAR SPINE 4 VW - XR LUMBAR SPINE COMPLETE 4+ VIEWS

Facility

$327.00

Service Code	CPT 72110 TC
Hospital Charge Code	3207211001
Hospital Revenue Code	320
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$245.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.80
Rate for Payer: Aetna Government	$25.80
Rate for Payer: Brighton Health Commercial	$245.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$162.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.66
Rate for Payer: EmblemHealth Commercial	$41.43
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	$41.43
Rate for Payer: Healthfirst Essential Plan	$80.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$35.99

HC X-RAY LUMBAR SPINE 6+ VW - XR LUMBAR SPINE 6+ VWS INCLUDING BENDING

Facility

$327.00

Service Code	CPT 72114 TC
Hospital Charge Code	3207211401
Hospital Revenue Code	320
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$245.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.85
Rate for Payer: Aetna Government	$35.85
Rate for Payer: Brighton Health Commercial	$245.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$162.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.66
Rate for Payer: EmblemHealth Commercial	$49.11
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	$49.11
Rate for Payer: Healthfirst Essential Plan	$108.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$48.29

HC X-RAY LUMBAR SPINE 6+ VW - XR LUMBAR SPINE 6+ VWS INCLUDING BENDING

Facility

$327.00

Service Code	CPT 72114 TC
Hospital Charge Code	3207211401
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 MASTOIDS <3 VW - XR MASTOIDS 1-2 VIEWS

Facility

$339.00

Service Code	CPT 70120 TC
Hospital Charge Code	3207012001
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 MASTOIDS <3 VW - XR MASTOIDS 1-2 VIEWS

Facility

$339.00

Service Code	CPT 70120 TC
Hospital Charge Code	3207012001
Hospital Revenue Code	320
Min. Negotiated Rate	$19.39
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.39
Rate for Payer: Aetna Government	$19.39
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	$31.30
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	$31.30
Rate for Payer: Healthfirst Essential Plan	$61.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27.53

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

Facility

$327.00

Service Code	CPT 70130 TC
Hospital Charge Code	3207013001
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 MASTOIDS 3+ VW - XR MASTOIDS 3+ VIEWS

Facility

$327.00

Service Code	CPT 70130 TC
Hospital Charge Code	3207013001
Hospital Revenue Code	320
Min. Negotiated Rate	$29.15
Max. Negotiated Rate	$245.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.15
Rate for Payer: Aetna Government	$29.15
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	$48.42
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	$48.42
Rate for Payer: Healthfirst Essential Plan	$81.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$36.23

HC X-RAY MIDDLE EAR - XR INTERNAL AUDITORY MEATUS

Facility

$1,458.00

Service Code	CPT 70134 TC
Hospital Charge Code	3207013401
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 MIDDLE EAR - XR INTERNAL AUDITORY MEATUS

Facility

$1,458.00

Service Code	CPT 70134 TC
Hospital Charge Code	3207013401
Hospital Revenue Code	320
Min. Negotiated Rate	$26.36
Max. Negotiated Rate	$1,093.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$801.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.36
Rate for Payer: Aetna Government	$26.36
Rate for Payer: Brighton Health Commercial	$1,093.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$162.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.66
Rate for Payer: EmblemHealth Commercial	$46.66
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	$46.66
Rate for Payer: Healthfirst Essential Plan	$67.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29.82

HC X-RAY NASAL BONES - XR NASAL BONES

Facility

$241.00

Service Code	CPT 70160 TC
Hospital Charge Code	3207016001
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	$30.95
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	$30.95
Rate for Payer: Healthfirst Essential Plan	$48.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21.40

HC X-RAY NASAL BONES - XR NASAL BONES

Facility

$241.00

Service Code	CPT 70160 TC
Hospital Charge Code	3207016001
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 NECK SOFT TISSUE - XR NECK SOFT TISSUE

Facility

$241.00

Service Code	CPT 70360 TC
Hospital Charge Code	3207036001
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 NECK SOFT TISSUE - XR NECK SOFT TISSUE

Facility

$241.00

Service Code	CPT 70360 TC
Hospital Charge Code	3207036001
Hospital Revenue Code	320
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.48
Rate for Payer: Aetna Government	$15.48
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	$23.96
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	$23.96
Rate for Payer: Healthfirst Essential Plan	$40.21
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.87

HC X-RAY NOSE-RECTUM CHILD F.B. - XR ABDOMEN CHILD

Facility

$241.00

Service Code	CPT 76010 TC
Hospital Charge Code	3207601002
Hospital Revenue Code	320
Min. Negotiated Rate	$13.25
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.25
Rate for Payer: Aetna Government	$13.25
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	$40.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.86

HC X-RAY NOSE-RECTUM CHILD F.B. - XR ABDOMEN CHILD

Facility

$241.00

Service Code	CPT 76010 TC
Hospital Charge Code	3207601002
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 NOSE-RECTUM CHILD F.B. - XR NOSE TO RECTUM FOREIGN BODY PEDS

Facility

$241.00

Service Code	CPT 76010 TC
Hospital Charge Code	3207601001
Hospital Revenue Code	320
Min. Negotiated Rate	$13.25
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.25
Rate for Payer: Aetna Government	$13.25
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	$40.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.86

HC X-RAY NOSE-RECTUM CHILD F.B. - XR NOSE TO RECTUM FOREIGN BODY PEDS

Facility

$241.00

Service Code	CPT 76010 TC
Hospital Charge Code	3207601001
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 OPER CHOLANGIO ADDNL SET - XR CHOLANGIOGRAM INTRAOPERATIVE ADD

Facility

$306.00

Service Code	CPT 74301 TC
Hospital Charge Code	3207430101
Hospital Revenue Code	320
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$153.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$153.00

HC X-RAY OPER CHOLANGIO ADDNL SET - XR CHOLANGIOGRAM INTRAOPERATIVE ADD

Facility

$306.00

Service Code	CPT 74301 TC
Hospital Charge Code	3207430101
Hospital Revenue Code	320
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$244.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$168.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.05
Rate for Payer: Aetna Government	$16.05
Rate for Payer: Brighton Health Commercial	$229.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$244.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$208.08
Rate for Payer: EmblemHealth Commercial	$153.00
Rate for Payer: Group Health Inc Commercial	$153.00
Rate for Payer: Group Health Inc Medicare	$107.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$153.00
Rate for Payer: Hamaspik Choice Inc Medicare	$153.00
Rate for Payer: Healthfirst Essential Plan	$61.31
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27.25

HC X-RAY OPER CHOLANGIOGRAM - XR CHOLANGIOGRAM INTRAOPERATIVE

Facility

$306.00

Service Code	CPT 74300 TC
Hospital Charge Code	3207430001
Hospital Revenue Code	320
Min. Negotiated Rate	$27.77
Max. Negotiated Rate	$244.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$168.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.77
Rate for Payer: Aetna Government	$27.77
Rate for Payer: Brighton Health Commercial	$229.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$244.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$208.08
Rate for Payer: EmblemHealth Commercial	$153.00
Rate for Payer: Group Health Inc Commercial	$153.00
Rate for Payer: Group Health Inc Medicare	$107.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$153.00
Rate for Payer: Hamaspik Choice Inc Medicare	$153.00
Rate for Payer: Healthfirst Essential Plan	$108.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$48.35

HC X-RAY OPER CHOLANGIOGRAM - XR CHOLANGIOGRAM INTRAOPERATIVE

Facility

$306.00

Service Code	CPT 74300 TC
Hospital Charge Code	3207430001
Hospital Revenue Code	320
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$153.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$153.00

Know your out-of-pocket cost for care.

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