St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$24.41
Max. Negotiated Rate	$245.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.41
Rate for Payer: Aetna Government	$24.41
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	$38.99
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	$38.99
Rate for Payer: Healthfirst Essential Plan	$76.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34.04

HC X-RAY SACROILIAC JTS <3 VW - XR SACROILIAC JOINTS 1-2 VIEWS

Facility

$327.00

Service Code	CPT 72200 TC
Hospital Charge Code	3207220001
Hospital Revenue Code	320
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$245.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.48
Rate for Payer: Aetna Government	$15.48
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	$26.76
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	$26.76
Rate for Payer: Healthfirst Essential Plan	$43.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19.19

HC X-RAY SACROILIAC JTS <3 VW - XR SACROILIAC JOINTS 1-2 VIEWS

Facility

$327.00

Service Code	CPT 72200 TC
Hospital Charge Code	3207220001
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 SACROILIAC JTS 3+ VW - XR SACROILIAC JOINTS 3+ VIEWS

Facility

$327.00

Service Code	CPT 72202 TC
Hospital Charge Code	3207220201
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 SACROILIAC JTS 3+ VW - XR SACROILIAC JOINTS 3+ VIEWS

Facility

$327.00

Service Code	CPT 72202 TC
Hospital Charge Code	3207220201
Hospital Revenue Code	320
Min. Negotiated Rate	$18.27
Max. Negotiated Rate	$245.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.27
Rate for Payer: Aetna Government	$18.27
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	$30.25
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	$30.25
Rate for Payer: Healthfirst Essential Plan	$50.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22.48

HC X-RAY SACRUM/COCCYX 2+ VW - XR SACRUM COCCYX 2+ VIEWS

Facility

$241.00

Service Code	CPT 72220 TC
Hospital Charge Code	3207222001
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 SACRUM/COCCYX 2+ VW - XR SACRUM COCCYX 2+ VIEWS

Facility

$241.00

Service Code	CPT 72220 TC
Hospital Charge Code	3207222001
Hospital Revenue Code	320
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.20
Rate for Payer: Aetna Government	$15.20
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-RAYS, BONE LENGTH STUDIES - XR LOWER EXTREMITY LEG LENGTH EVAL

Facility

$320.00

Service Code	CPT 77073 TC
Hospital Charge Code	3207707301
Hospital Revenue Code	320
Min. Negotiated Rate	$160.00
Max. Negotiated Rate	$160.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00

HC X-RAYS, BONE LENGTH STUDIES - XR LOWER EXTREMITY LEG LENGTH EVAL

Facility

$320.00

Service Code	CPT 77073 TC
Hospital Charge Code	3207707301
Hospital Revenue Code	320
Min. Negotiated Rate	$16.88
Max. Negotiated Rate	$240.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$176.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.88
Rate for Payer: Aetna Government	$16.88
Rate for Payer: Brighton Health Commercial	$240.00
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	$34.09
Rate for Payer: Group Health Inc Commercial	$160.00
Rate for Payer: Group Health Inc Medicare	$112.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34.09
Rate for Payer: Healthfirst Essential Plan	$56.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25.18

HC X-RAYS, BONE SURVEY COMPLETE - XR BONE SURVEY COMPLETE

Facility

$327.00

Service Code	CPT 77075 TC
Hospital Charge Code	3207707501
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-RAYS, BONE SURVEY COMPLETE - XR BONE SURVEY COMPLETE

Facility

$327.00

Service Code	CPT 77075 TC
Hospital Charge Code	3207707501
Hospital Revenue Code	320
Min. Negotiated Rate	$47.28
Max. Negotiated Rate	$245.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.28
Rate for Payer: Aetna Government	$47.28
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	$76.92
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	$76.92
Rate for Payer: Healthfirst Essential Plan	$175.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$77.78

HC X-RAYS, BONE SURVEY, INFANT - XR BONE SURVEY INFANT

Facility

$327.00

Service Code	CPT 77076 TC
Hospital Charge Code	3207707601
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-RAYS, BONE SURVEY, INFANT - XR BONE SURVEY INFANT

Facility

$327.00

Service Code	CPT 77076 TC
Hospital Charge Code	3207707601
Hospital Revenue Code	320
Min. Negotiated Rate	$47.56
Max. Negotiated Rate	$245.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.56
Rate for Payer: Aetna Government	$47.56
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	$77.62
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	$77.62
Rate for Payer: Healthfirst Essential Plan	$145.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$64.67

HC X-RAYS, BONE SURVEY, LIMITED - XR BONE SURVEY LIMITED

Facility

$327.00

Service Code	CPT 77074 TC
Hospital Charge Code	3207707401
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-RAYS, BONE SURVEY, LIMITED - XR BONE SURVEY LIMITED

Facility

$327.00

Service Code	CPT 77074 TC
Hospital Charge Code	3207707401
Hospital Revenue Code	320
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$245.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.50
Rate for Payer: Aetna Government	$32.50
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	$47.02
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	$47.02
Rate for Payer: Healthfirst Essential Plan	$101.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$45.11

HC X-RAY SCAPULA - XR SCAPULA

Facility

$339.00

Service Code	CPT 73010 TC
Hospital Charge Code	3207301001
Hospital Revenue Code	320
Min. Negotiated Rate	$16.28
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.32
Rate for Payer: Aetna Government	$16.32
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	$16.28
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	$16.28
Rate for Payer: Healthfirst Essential Plan	$44.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19.81

HC X-RAY SCAPULA - XR SCAPULA

Facility

$339.00

Service Code	CPT 73010 TC
Hospital Charge Code	3207301001
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-RAYS FOR BONE AGE - XR BONE AGE EXTENDED

Facility

$327.00

Service Code	CPT 77072 TC
Hospital Charge Code	3207707201
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-RAYS FOR BONE AGE - XR BONE AGE EXTENDED

Facility

$327.00

Service Code	CPT 77072 TC
Hospital Charge Code	3207707201
Hospital Revenue Code	320
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$245.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.74
Rate for Payer: Aetna Government	$10.74
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	$17.68
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	$17.68
Rate for Payer: Healthfirst Essential Plan	$34.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15.19

HC X-RAY SHOULDER 1 VW - XR SHOULDER 1 VIEW

Facility

$241.00

Service Code	CPT 73020 TC
Hospital Charge Code	3207302002
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 SHOULDER 1 VW - XR SHOULDER 1 VIEW

Facility

$241.00

Service Code	CPT 73020 TC
Hospital Charge Code	3207302002
Hospital Revenue Code	320
Min. Negotiated Rate	$11.86
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.86
Rate for Payer: Aetna Government	$11.86
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	$15.23
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	$15.23
Rate for Payer: Healthfirst Essential Plan	$34.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15.23

HC X-RAY SHOULDER 1 VW - XR SHOULDER 1 VIEW BILATERAL

Facility

$241.00

Service Code	CPT 73020 TC
Hospital Charge Code	3207302001
Hospital Revenue Code	320
Min. Negotiated Rate	$11.86
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.86
Rate for Payer: Aetna Government	$11.86
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	$15.23
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	$15.23
Rate for Payer: Healthfirst Essential Plan	$34.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15.23

HC X-RAY SHOULDER 1 VW - XR SHOULDER 1 VIEW BILATERAL

Facility

$241.00

Service Code	CPT 73020 TC
Hospital Charge Code	3207302001
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 SHOULDER 1 VW - XR SHOULDER 1 VIEW RIGHT

Facility

$241.00

Service Code	CPT 73020 TC
Hospital Charge Code	3207302003
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 SHOULDER 1 VW - XR SHOULDER 1 VIEW RIGHT

Facility

$241.00

Service Code	CPT 73020 TC
Hospital Charge Code	3207302003
Hospital Revenue Code	320
Min. Negotiated Rate	$11.86
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.86
Rate for Payer: Aetna Government	$11.86
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	$15.23
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	$15.23
Rate for Payer: Healthfirst Essential Plan	$34.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15.23

Know your out-of-pocket cost for care.

All Charges