St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC X-RAY OPTIC FORAMEN - XR OPTIC FORAMINA

Facility

$241.00

Service Code	CPT 70190 TC
Hospital Charge Code	3207019001
Hospital Revenue Code	320
Min. Negotiated Rate	$19.11
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.11
Rate for Payer: Aetna Government	$19.11
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	$28.15
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	$28.15
Rate for Payer: Healthfirst Essential Plan	$64.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28.74

HC X-RAY OPTIC FORAMEN - XR OPTIC FORAMINA

Facility

$241.00

Service Code	CPT 70190 TC
Hospital Charge Code	3207019001
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 ORBITS - XR ORBITS COMPLETE 4+ VIEWS

Facility

$327.00

Service Code	CPT 70200 TC
Hospital Charge Code	3207020001
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 ORBITS - XR ORBITS COMPLETE 4+ VIEWS

Facility

$327.00

Service Code	CPT 70200 TC
Hospital Charge Code	3207020001
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	$64.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28.56

HC X-RAY PELVIS 1/2 VW - XR PELVIS 1-2 VIEWS

Facility

$327.00

Service Code	CPT 72170 TC
Hospital Charge Code	3207217001
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 PELVIS 1/2 VW - XR PELVIS 1-2 VIEWS

Facility

$327.00

Service Code	CPT 72170 TC
Hospital Charge Code	3207217001
Hospital Revenue Code	320
Min. Negotiated Rate	$17.59
Max. Negotiated Rate	$245.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.99
Rate for Payer: Aetna Government	$17.99
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	$20.82
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	$20.82
Rate for Payer: Healthfirst Essential Plan	$39.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.59

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

Facility

$327.00

Service Code	CPT 72190 TC
Hospital Charge Code	3207219001
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 PELVIS 3+ VW - XR PELVIS 3+ VIEWS

Facility

$327.00

Service Code	CPT 72190 TC
Hospital Charge Code	3207219001
Hospital Revenue Code	320
Min. Negotiated Rate	$21.34
Max. Negotiated Rate	$245.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.34
Rate for Payer: Aetna Government	$21.34
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	$31.64
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	$31.64
Rate for Payer: Healthfirst Essential Plan	$61.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27.27

HC X-RAY PENIS - XR PENIS

Facility

$339.00

Service Code	CPT 74445 TC
Hospital Charge Code	3207444501
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 PENIS - XR PENIS

Facility

$339.00

Service Code	CPT 74445 TC
Hospital Charge Code	3207444501
Hospital Revenue Code	320
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$376.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$273.50
Rate for Payer: Aetna Government	$273.50
Rate for Payer: Brighton Health Commercial	$254.25
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	$169.50
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 Essential Plan	$183.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$81.60

HC X-RAY PERITONEUM - CT GUIDED PERITONEOGRAM W CONTRAST

Facility

$1,458.00

Service Code	CPT 74190 TC
Hospital Charge Code	3507419001
Hospital Revenue Code	350
Min. Negotiated Rate	$61.17
Max. Negotiated Rate	$1,093.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$801.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$273.50
Rate for Payer: Aetna Government	$273.50
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	$729.00
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 Essential Plan	$137.63
Rate for Payer: United Healthcare Commercial	$183.97
Rate for Payer: Wellcare CHP/FHP/Medicaid	$61.17

HC X-RAY PERITONEUM - CT GUIDED PERITONEOGRAM W CONTRAST

Facility

$1,458.00

Service Code	CPT 74190 TC
Hospital Charge Code	3507419001
Hospital Revenue Code	350
Min. Negotiated Rate	$729.00
Max. Negotiated Rate	$729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00

HC X-RAY PERITONEUM - MR GUIDED PERITONEOGRAM W CONTRAST

Facility

$1,458.00

Service Code	CPT 74190 TC
Hospital Charge Code	6107419001
Hospital Revenue Code	610
Min. Negotiated Rate	$61.17
Max. Negotiated Rate	$1,093.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$801.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$273.50
Rate for Payer: Aetna Government	$273.50
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	$729.00
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 Essential Plan	$137.63
Rate for Payer: United Healthcare Commercial	$183.97
Rate for Payer: Wellcare CHP/FHP/Medicaid	$61.17

HC X-RAY PERITONEUM - MR GUIDED PERITONEOGRAM W CONTRAST

Facility

$1,458.00

Service Code	CPT 74190 TC
Hospital Charge Code	6107419001
Hospital Revenue Code	610
Min. Negotiated Rate	$729.00
Max. Negotiated Rate	$729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00

HC X-RAY RENAL CYST XLUMBAR+CONTRST - XR RENAL CYST LUMBAR W CONTRAST

Facility

$1,458.00

Service Code	CPT 74470 TC
Hospital Charge Code	3207447001
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 RENAL CYST XLUMBAR+CONTRST - XR RENAL CYST LUMBAR W CONTRAST

Facility

$1,458.00

Service Code	CPT 74470 TC
Hospital Charge Code	3207447001
Hospital Revenue Code	320
Min. Negotiated Rate	$61.36
Max. Negotiated Rate	$1,093.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$801.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$273.50
Rate for Payer: Aetna Government	$273.50
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	$729.00
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 Essential Plan	$138.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$61.36

HC X-RAY RETROGRADE PYELOGRAM - FL PYELOGRAM RETROGRADE

Facility

$1,156.00

Service Code	CPT 74420 TC
Hospital Charge Code	3207442001
Hospital Revenue Code	320
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC X-RAY RETROGRADE PYELOGRAM - FL PYELOGRAM RETROGRADE

Facility

$1,156.00

Service Code	CPT 74420 TC
Hospital Charge Code	3207442001
Hospital Revenue Code	320
Min. Negotiated Rate	$56.45
Max. Negotiated Rate	$867.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$273.50
Rate for Payer: Aetna Government	$273.50
Rate for Payer: Brighton Health Commercial	$867.00
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	$56.45
Rate for Payer: Group Health Inc Commercial	$578.00
Rate for Payer: Group Health Inc Medicare	$404.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00
Rate for Payer: Hamaspik Choice Inc Medicare	$578.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$56.45
Rate for Payer: Healthfirst Essential Plan	$185.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$82.63

HC X-RAY RIBS 2 VW UNILAT - XR RIBS 2 VIEWS

Facility

$241.00

Service Code	CPT 71100 TC
Hospital Charge Code	3207110001
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 RIBS 2 VW UNILAT - XR RIBS 2 VIEWS

Facility

$241.00

Service Code	CPT 71100 TC
Hospital Charge Code	3207110001
Hospital Revenue Code	320
Min. Negotiated Rate	$16.88
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.88
Rate for Payer: Aetna Government	$16.88
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	$47.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.90

HC X-RAY RIBS 3 VW BILAT - XR RIBS 3 VIEWS BILATERAL

Facility

$327.00

Service Code	CPT 71110 TC
Hospital Charge Code	3207111001
Hospital Revenue Code	320
Min. Negotiated Rate	$18.55
Max. Negotiated Rate	$245.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.55
Rate for Payer: Aetna Government	$18.55
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	$31.64
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	$31.64
Rate for Payer: Healthfirst Essential Plan	$59.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26.37

HC X-RAY RIBS 3 VW BILAT - XR RIBS 3 VIEWS BILATERAL

Facility

$327.00

Service Code	CPT 71110 TC
Hospital Charge Code	3207111001
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 RIBS, CHEST 3+ VW - XR RIBS 2 VWS W/ CHEST ANTEROPOSTERIOR

Facility

$327.00

Service Code	CPT 71101 TC
Hospital Charge Code	3247110101
Hospital Revenue Code	324
Min. Negotiated Rate	$163.50
Max. Negotiated Rate	$163.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.50

HC X-RAY RIBS, CHEST 3+ VW - XR RIBS 2 VWS W/ CHEST ANTEROPOSTERIOR

Facility

$327.00

Service Code	CPT 71101 TC
Hospital Charge Code	3247110101
Hospital Revenue Code	324
Min. Negotiated Rate	$17.72
Max. Negotiated Rate	$245.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.72
Rate for Payer: Aetna Government	$17.72
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	$30.95
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	$30.95
Rate for Payer: Healthfirst Essential Plan	$57.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25.48

HC X-RAY RIBS, CHEST 4+ VW - XR RIBS 3 VWS BIL W/ CHEST POSTEROANTERIOR

Facility

$327.00

Service Code	CPT 71111 TC
Hospital Charge Code	3247111101
Hospital Revenue Code	324
Min. Negotiated Rate	$163.50
Max. Negotiated Rate	$163.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.50

Know your out-of-pocket cost for care.

All Charges