St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC X-RAY SHOULDER 2+ VW - XR SHOULDER 2+ VIEWS

Facility

$241.00

Service Code	CPT 73030 TC
Hospital Charge Code	3207303001
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 2+ VW - XR SHOULDER 2+ VIEWS

Facility

$241.00

Service Code	CPT 73030 TC
Hospital Charge Code	3207303001
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	$27.11
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	$27.11
Rate for Payer: Healthfirst Essential Plan	$45.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.01

HC X-RAY SHOULDER 2+ VW - XR SHOULDER 2+ VIEWS LEFT

Facility

$241.00

Service Code	CPT 73030 TC
Hospital Charge Code	3207303002
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	$27.11
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	$27.11
Rate for Payer: Healthfirst Essential Plan	$45.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.01

HC X-RAY SHOULDER 2+ VW - XR SHOULDER 2+ VIEWS LEFT

Facility

$241.00

Service Code	CPT 73030 TC
Hospital Charge Code	3207303002
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 2+ VW - XR SHOULDER 2+ VIEWS RIGHT

Facility

$241.00

Service Code	CPT 73030 TC
Hospital Charge Code	3207303003
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 2+ VW - XR SHOULDER 2+ VIEWS RIGHT

Facility

$241.00

Service Code	CPT 73030 TC
Hospital Charge Code	3207303003
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	$27.11
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	$27.11
Rate for Payer: Healthfirst Essential Plan	$45.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.01

HC X-RAY SIALOGRAM - XR SIALOGRAM WITH DUCT

Facility

$705.00

Service Code	CPT 70390 TC
Hospital Charge Code	3207039001
Hospital Revenue Code	320
Min. Negotiated Rate	$58.72
Max. Negotiated Rate	$528.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$58.72
Rate for Payer: Aetna Government	$58.72
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	$99.77
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	$99.77
Rate for Payer: Healthfirst Essential Plan	$178.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$79.53

HC X-RAY SIALOGRAM - XR SIALOGRAM WITH DUCT

Facility

$705.00

Service Code	CPT 70390 TC
Hospital Charge Code	3207039001
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 SINUSES <3 VW - XR PARANASAL SINUSES 1-2 VIEWS

Facility

$241.00

Service Code	CPT 70210 TC
Hospital Charge Code	3207021002
Hospital Revenue Code	320
Min. Negotiated Rate	$16.32
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.32
Rate for Payer: Aetna Government	$16.32
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	$25.36
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	$25.36
Rate for Payer: Healthfirst Essential Plan	$45.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.08

HC X-RAY SINUSES <3 VW - XR PARANASAL SINUSES 1-2 VIEWS

Facility

$241.00

Service Code	CPT 70210 TC
Hospital Charge Code	3207021002
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 SINUSES 3+ VW - XR PARANASAL SINUSES 3+ VIEWS

Facility

$241.00

Service Code	CPT 70220 TC
Hospital Charge Code	3207022001
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 SINUSES 3+ VW - XR PARANASAL SINUSES 3+ VIEWS

Facility

$241.00

Service Code	CPT 70220 TC
Hospital Charge Code	3207022001
Hospital Revenue Code	320
Min. Negotiated Rate	$19.39
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.39
Rate for Payer: Aetna Government	$19.39
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	$28.85
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	$28.85
Rate for Payer: Healthfirst Essential Plan	$56.41
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25.07

HC X-RAY SKULL <4 VW - XR SKULL 1-3 VIEWS

Facility

$327.00

Service Code	CPT 70250 TC
Hospital Charge Code	3207025001
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	$28.85
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	$28.85
Rate for Payer: Healthfirst Essential Plan	$53.93
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23.97

HC X-RAY SKULL <4 VW - XR SKULL 1-3 VIEWS

Facility

$327.00

Service Code	CPT 70250 TC
Hospital Charge Code	3207025001
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 SKULL 4+ VW - XR SKULL COMPLETE 4+ VIEWS

Facility

$327.00

Service Code	CPT 70260 TC
Hospital Charge Code	3207026001
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 SKULL 4+ VW - XR SKULL COMPLETE 4+ VIEWS

Facility

$327.00

Service Code	CPT 70260 TC
Hospital Charge Code	3207026001
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	$162.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.66
Rate for Payer: EmblemHealth Commercial	$33.05
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	$33.05
Rate for Payer: Healthfirst Essential Plan	$68.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30.47

HC XRAY SM INTEST FOLLOW-THRU STUDY

Facility

$455.00

Service Code	CPT 74248 TC
Hospital Charge Code	3207424801
Hospital Revenue Code	320
Min. Negotiated Rate	$38.15
Max. Negotiated Rate	$364.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$250.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$38.15
Rate for Payer: Aetna Government	$38.15
Rate for Payer: Brighton Health Commercial	$341.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$364.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$309.40
Rate for Payer: EmblemHealth Commercial	$50.86
Rate for Payer: Group Health Inc Commercial	$227.50
Rate for Payer: Group Health Inc Medicare	$159.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$227.50
Rate for Payer: Hamaspik Choice Inc Medicare	$227.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$50.86
Rate for Payer: Healthfirst Essential Plan	$122.42
Rate for Payer: Wellcare CHP/FHP/Medicaid	$54.41

HC XRAY SM INTEST FOLLOW-THRU STUDY

Facility

$455.00

Service Code	CPT 74248 TC
Hospital Charge Code	3207424801
Hospital Revenue Code	320
Min. Negotiated Rate	$227.50
Max. Negotiated Rate	$227.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$227.50

HC X-RAY SPINE ONE VIEW - XR SPINE

Facility

$241.00

Service Code	CPT 72020 TC
Hospital Charge Code	3207202001
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 SPINE ONE VIEW - XR SPINE

Facility

$241.00

Service Code	CPT 72020 TC
Hospital Charge Code	3207202001
Hospital Revenue Code	320
Min. Negotiated Rate	$11.30
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.30
Rate for Payer: Aetna Government	$11.30
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	$17.68
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	$17.68
Rate for Payer: Healthfirst Essential Plan	$34.76
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15.45

HC X-RAY STERNO-CLAVICLUAR JT - XR STERNOCLAVICULAR JOINTS 3+ VIEWS

Facility

$241.00

Service Code	CPT 71130 TC
Hospital Charge Code	3207113001
Hospital Revenue Code	320
Min. Negotiated Rate	$19.39
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.39
Rate for Payer: Aetna Government	$19.39
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	$32.35
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	$32.35
Rate for Payer: Healthfirst Essential Plan	$54.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24.22

HC X-RAY STERNO-CLAVICLUAR JT - XR STERNOCLAVICULAR JOINTS 3+ VIEWS

Facility

$241.00

Service Code	CPT 71130 TC
Hospital Charge Code	3207113001
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 STERNUM 2+ VW - XR STERNUM 2+ VIEWS

Facility

$241.00

Service Code	CPT 71120 TC
Hospital Charge Code	3207112001
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 STERNUM 2+ VW - XR STERNUM 2+ VIEWS

Facility

$241.00

Service Code	CPT 71120 TC
Hospital Charge Code	3207112001
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	$25.36
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	$25.36
Rate for Payer: Healthfirst Essential Plan	$46.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.71

HC X-RAYS TRANSCATH THERAPY - IR TRANSCATHETER THERAPY EMBOLIZATION

Facility

$3,200.00

Service Code	CPT 75894 TC
Hospital Charge Code	3207589401
Hospital Revenue Code	320
Min. Negotiated Rate	$1,600.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00

Know your out-of-pocket cost for care.

All Charges