St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$696.68
Max. Negotiated Rate	$2,560.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,760.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$718.34
Rate for Payer: Aetna Government	$718.34
Rate for Payer: Brighton Health Commercial	$2,400.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,560.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,176.00
Rate for Payer: EmblemHealth Commercial	$1,600.00
Rate for Payer: Group Health Inc Commercial	$1,600.00
Rate for Payer: Group Health Inc Medicare	$1,120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.00
Rate for Payer: Healthfirst Essential Plan	$1,567.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$696.68

HC X-RAYS TRANSCATH THERAPY - US TRANSCATHETER THERAPY EMBOLIZATION

Facility

$3,200.00

Service Code	CPT 75894 TC
Hospital Charge Code	4027589401
Hospital Revenue Code	402
Min. Negotiated Rate	$696.68
Max. Negotiated Rate	$2,560.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,760.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$718.34
Rate for Payer: Aetna Government	$718.34
Rate for Payer: Brighton Health Commercial	$2,400.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,560.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,176.00
Rate for Payer: EmblemHealth Commercial	$1,600.00
Rate for Payer: Group Health Inc Commercial	$1,600.00
Rate for Payer: Group Health Inc Medicare	$1,120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.00
Rate for Payer: Healthfirst Essential Plan	$1,567.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$696.68

HC X-RAYS TRANSCATH THERAPY - US TRANSCATHETER THERAPY EMBOLIZATION

Facility

$3,200.00

Service Code	CPT 75894 TC
Hospital Charge Code	4027589401
Hospital Revenue Code	402
Min. Negotiated Rate	$1,600.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00

HC X-RAY TEETH PARTIAL - XR TEETH PATRIANT

Facility

$705.00

Service Code	CPT 70310 TC
Hospital Charge Code	3207031001
Hospital Revenue Code	320
Min. Negotiated Rate	$22.46
Max. Negotiated Rate	$528.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.46
Rate for Payer: Aetna Government	$22.46
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$54.91
Rate for Payer: EmblemHealth Commercial	$34.44
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	$34.44
Rate for Payer: Healthfirst Essential Plan	$56.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25.14

HC X-RAY TEETH PARTIAL - XR TEETH PATRIANT

Facility

$705.00

Service Code	CPT 70310 TC
Hospital Charge Code	3207031001
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 THORACIC SPINE 2 VW - XR THORACIC SPINE 2 VIEWS

Facility

$327.00

Service Code	CPT 72070 TC
Hospital Charge Code	3207207001
Hospital Revenue Code	320
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	$24.66
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	$24.66
Rate for Payer: Healthfirst Essential Plan	$49.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22.01

HC X-RAY THORACIC SPINE 2 VW - XR THORACIC SPINE 2 VIEWS

Facility

$327.00

Service Code	CPT 72070 TC
Hospital Charge Code	3207207001
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 THORACIC SPINE+SWIM 3 VW - XR THORACIC SPINE 3 VIEWS

Facility

$327.00

Service Code	CPT 72072 TC
Hospital Charge Code	3207207201
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	$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	$54.99
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24.44

HC X-RAY THORACIC SPINE+SWIM 3 VW - XR THORACIC SPINE 3 VIEWS

Facility

$327.00

Service Code	CPT 72072 TC
Hospital Charge Code	3207207201
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 TIB + FIB, 2VW - XR TIBIA FIBULA 2 VIEWS

Facility

$241.00

Service Code	CPT 73590 TC
Hospital Charge Code	3207359001
Hospital Revenue Code	320
Min. Negotiated Rate	$15.76
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.76
Rate for Payer: Aetna Government	$15.76
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	$40.21
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.87

HC X-RAY TIB + FIB, 2VW - XR TIBIA FIBULA 2 VIEWS

Facility

$241.00

Service Code	CPT 73590 TC
Hospital Charge Code	3207359001
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 TIB + FIB, 2VW - XR TIBIA FIBULA 2 VIEWS RIGHT

Facility

$241.00

Service Code	CPT 73590 TC
Hospital Charge Code	3207359002
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 TIB + FIB, 2VW - XR TIBIA FIBULA 2 VIEWS RIGHT

Facility

$241.00

Service Code	CPT 73590 TC
Hospital Charge Code	3207359002
Hospital Revenue Code	320
Min. Negotiated Rate	$15.76
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.76
Rate for Payer: Aetna Government	$15.76
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	$40.21
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.87

HC X-RAY TMJ ARTHROGRAM - XR TEMPOROMANDIBULAR JOINT ARTHROGRAM

Facility

$705.00

Service Code	CPT 70332 TC
Hospital Charge Code	3227033201
Hospital Revenue Code	322
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC X-RAY TMJ ARTHROGRAM - XR TEMPOROMANDIBULAR JOINT ARTHROGRAM

Facility

$705.00

Service Code	CPT 70332 TC
Hospital Charge Code	3227033201
Hospital Revenue Code	322
Min. Negotiated Rate	$38.91
Max. Negotiated Rate	$588.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$38.91
Rate for Payer: Aetna Government	$38.91
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$588.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$495.42
Rate for Payer: EmblemHealth Commercial	$58.55
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	$58.55
Rate for Payer: Healthfirst Essential Plan	$171.99
Rate for Payer: Wellcare CHP/FHP/Medicaid	$76.44

HC X-RAY TMJ BILAT - XR TEMPOROMANDIBULAR JOINT OPEN AND CLOSED BIL

Facility

$241.00

Service Code	CPT 70330 TC
Hospital Charge Code	3207033001
Hospital Revenue Code	320
Min. Negotiated Rate	$26.92
Max. Negotiated Rate	$180.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.92
Rate for Payer: Aetna Government	$26.92
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	$43.88
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	$43.88
Rate for Payer: Healthfirst Essential Plan	$70.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31.27

HC X-RAY TMJ BILAT - XR TEMPOROMANDIBULAR JOINT OPEN AND CLOSED BIL

Facility

$241.00

Service Code	CPT 70330 TC
Hospital Charge Code	3207033001
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 TOE(S) - XR TOES 2+ VIEWS

Facility

$241.00

Service Code	CPT 73660 TC
Hospital Charge Code	3207366001
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	$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	$42.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19.02

HC X-RAY TOE(S) - XR TOES 2+ VIEWS

Facility

$241.00

Service Code	CPT 73660 TC
Hospital Charge Code	3207366001
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 TOMOGRAM - FL TOMOGRAPHY LIMITED

Facility

$339.00

Service Code	CPT 76100 TC
Hospital Charge Code	3207610001
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 TOMOGRAM - FL TOMOGRAPHY LIMITED

Facility

$339.00

Service Code	CPT 76100 TC
Hospital Charge Code	3207610001
Hospital Revenue Code	320
Min. Negotiated Rate	$47.56
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.56
Rate for Payer: Aetna Government	$47.56
Rate for Payer: Brighton Health Commercial	$254.25
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	$63.99
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	$63.99
Rate for Payer: Healthfirst Essential Plan	$184.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$82.10

HC X-RAY UPPER GI DELAY W/O KUB - FL UPPER GI WITHOUT KUB

Facility

$551.00

Service Code	CPT 74240 TC
Hospital Charge Code	3207424001
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 UPPER GI DELAY W/O KUB - FL UPPER GI WITHOUT KUB

Facility

$551.00

Service Code	CPT 74240 TC
Hospital Charge Code	3207424001
Hospital Revenue Code	320
Min. Negotiated Rate	$61.23
Max. Negotiated Rate	$780.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$61.23
Rate for Payer: Aetna Government	$61.23
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$185.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$156.21
Rate for Payer: EmblemHealth Commercial	$86.84
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	$86.84
Rate for Payer: Healthfirst Essential Plan	$162.43
Rate for Payer: Wellcare CHP/FHP/Medicaid	$72.19

HC X-RAY URETHROCYSTOGRAM+VOIDING - FL VOIDING CYSTOURETHROGRAM

Facility

$705.00

Service Code	CPT 74455 TC
Hospital Charge Code	3207445501
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 URETHROCYSTOGRAM+VOIDING - FL VOIDING CYSTOURETHROGRAM

Facility

$705.00

Service Code	CPT 74455 TC
Hospital Charge Code	3207445501
Hospital Revenue Code	320
Min. Negotiated Rate	$50.91
Max. Negotiated Rate	$528.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.91
Rate for Payer: Aetna Government	$50.91
Rate for Payer: Brighton Health Commercial	$528.75
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	$90.33
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	$90.33
Rate for Payer: Healthfirst Essential Plan	$130.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$58.14

Know your out-of-pocket cost for care.

All Charges