St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ARTERY XRAYS ARM/LEG

Facility

$8,393.53

Service Code	HCPCS 75710 TC
Hospital Charge Code	41102548
Hospital Revenue Code	320
Rate for Payer: Cash Price	$3,686.08

ARTERY XRAYS ARM/LEG

Facility

$8,393.53

Service Code	HCPCS 75710 TC
Hospital Charge Code	41102006
Hospital Revenue Code	320
Rate for Payer: Cash Price	$3,686.08

ARTERY XRAYS ARM/LEG

Facility

$8,393.53

Service Code	HCPCS 75710 TC
Hospital Charge Code	41102548
Hospital Revenue Code	320
Min. Negotiated Rate	$2,580.26
Max. Negotiated Rate	$4,616.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,616.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,686.08
Rate for Payer: Aetna Government	$3,686.08
Rate for Payer: Affinity Essential Plan 1&2	$2,580.26
Rate for Payer: Affinity Essential Plan 3&4	$2,580.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,580.26
Rate for Payer: Brighton Health Commercial	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,686.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,056.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,432.09
Rate for Payer: Elderplan Medicare Advantage	$3,686.08
Rate for Payer: EmblemHealth Commercial	$2,580.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,133.17
Rate for Payer: Fidelis Essential Plan Aliesa	$3,133.17
Rate for Payer: Fidelis Essential Plan QHP	$3,280.61
Rate for Payer: Fidelis Medicare Advantage	$3,686.08
Rate for Payer: Fidelis Qualified Health Plan	$3,280.61
Rate for Payer: Group Health Inc Commercial	$3,317.47
Rate for Payer: Group Health Inc Medicare	$3,317.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.76
Rate for Payer: Hamaspik Choice Inc Medicare	$3,686.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,317.47
Rate for Payer: Healthfirst Medicare Advantage	$3,686.08
Rate for Payer: Healthfirst QHP	$3,686.08
Rate for Payer: Humana Medicare	$3,759.80
Rate for Payer: Senior Whole Health Medicare Advantage	$3,686.08
Rate for Payer: United Healthcare Medicare Advantage	$3,686.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,686.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,948.86
Rate for Payer: Wellcare Medicare	$3,501.78

ARTERY X-RAYS ARMS/LEGS

Facility

$8,393.53

Service Code	HCPCS 75716 TC
Hospital Charge Code	41103181
Hospital Revenue Code	320
Min. Negotiated Rate	$2,580.26
Max. Negotiated Rate	$4,616.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,616.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,686.08
Rate for Payer: Aetna Government	$3,686.08
Rate for Payer: Affinity Essential Plan 1&2	$2,580.26
Rate for Payer: Affinity Essential Plan 3&4	$2,580.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,580.26
Rate for Payer: Brighton Health Commercial	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,686.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,056.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,432.09
Rate for Payer: Elderplan Medicare Advantage	$3,686.08
Rate for Payer: EmblemHealth Commercial	$2,580.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,133.17
Rate for Payer: Fidelis Essential Plan Aliesa	$3,133.17
Rate for Payer: Fidelis Essential Plan QHP	$3,280.61
Rate for Payer: Fidelis Medicare Advantage	$3,686.08
Rate for Payer: Fidelis Qualified Health Plan	$3,280.61
Rate for Payer: Group Health Inc Commercial	$3,317.47
Rate for Payer: Group Health Inc Medicare	$3,317.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.76
Rate for Payer: Hamaspik Choice Inc Medicare	$3,686.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,317.47
Rate for Payer: Healthfirst Medicare Advantage	$3,686.08
Rate for Payer: Healthfirst QHP	$3,686.08
Rate for Payer: Humana Medicare	$3,759.80
Rate for Payer: Senior Whole Health Medicare Advantage	$3,686.08
Rate for Payer: United Healthcare Medicare Advantage	$3,686.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,686.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,948.86
Rate for Payer: Wellcare Medicare	$3,501.78

ARTERY X-RAYS ARMS/LEGS

Facility

$8,393.53

Service Code	HCPCS 75716 TC
Hospital Charge Code	41103181
Hospital Revenue Code	320
Rate for Payer: Cash Price	$3,686.08

ARTH 2.7 MM LCK SCR #10

Facility

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	40204225
Hospital Revenue Code	278
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$241.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$138.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$115.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.25
Rate for Payer: EmblemHealth Commercial	$115.00
Rate for Payer: Fidelis Medicare Advantage	$241.50
Rate for Payer: Group Health Inc Commercial	$115.00
Rate for Payer: Group Health Inc Medicare	$80.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$149.50

ARTH 2.7 MM LCK SCR #10

Facility

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	40204225
Hospital Revenue Code	278
Min. Negotiated Rate	$115.00
Max. Negotiated Rate	$115.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00

ARTH 2.7 MM LCK SCR #12

Facility

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	40204226
Hospital Revenue Code	278
Min. Negotiated Rate	$115.00
Max. Negotiated Rate	$115.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00

ARTH 2.7 MM LCK SCR #12

Facility

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	40204226
Hospital Revenue Code	278
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$241.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$138.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$115.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.25
Rate for Payer: EmblemHealth Commercial	$115.00
Rate for Payer: Fidelis Medicare Advantage	$241.50
Rate for Payer: Group Health Inc Commercial	$115.00
Rate for Payer: Group Health Inc Medicare	$80.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$149.50

ARTH 2.7 MM LCK SCR #14

Facility

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	40204227
Hospital Revenue Code	278
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$241.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$138.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$115.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.25
Rate for Payer: EmblemHealth Commercial	$115.00
Rate for Payer: Fidelis Medicare Advantage	$241.50
Rate for Payer: Group Health Inc Commercial	$115.00
Rate for Payer: Group Health Inc Medicare	$80.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$149.50

ARTH 2.7 MM LCK SCR #14

Facility

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	40204227
Hospital Revenue Code	278
Min. Negotiated Rate	$115.00
Max. Negotiated Rate	$115.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00

ARTH 2.7 MM LCK SCR #16

Facility

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	40204228
Hospital Revenue Code	278
Min. Negotiated Rate	$115.00
Max. Negotiated Rate	$115.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00

ARTH 2.7 MM LCK SCR #16

Facility

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	40204228
Hospital Revenue Code	278
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$241.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$138.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$115.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.25
Rate for Payer: EmblemHealth Commercial	$115.00
Rate for Payer: Fidelis Medicare Advantage	$241.50
Rate for Payer: Group Health Inc Commercial	$115.00
Rate for Payer: Group Health Inc Medicare	$80.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$149.50

ARTH 2.7 MM LCK SCR #18

Facility

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	40204229
Hospital Revenue Code	278
Min. Negotiated Rate	$115.00
Max. Negotiated Rate	$115.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00

ARTH 2.7 MM LCK SCR #18

Facility

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	40204229
Hospital Revenue Code	278
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$241.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$138.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$115.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.25
Rate for Payer: EmblemHealth Commercial	$115.00
Rate for Payer: Fidelis Medicare Advantage	$241.50
Rate for Payer: Group Health Inc Commercial	$115.00
Rate for Payer: Group Health Inc Medicare	$80.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$149.50

ARTH 2.7 MM LCK SCR #20

Facility

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	40204230
Hospital Revenue Code	278
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$241.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$138.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$115.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.25
Rate for Payer: EmblemHealth Commercial	$115.00
Rate for Payer: Fidelis Medicare Advantage	$241.50
Rate for Payer: Group Health Inc Commercial	$115.00
Rate for Payer: Group Health Inc Medicare	$80.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$149.50

ARTH 2.7 MM LCK SCR #20

Facility

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	40204230
Hospital Revenue Code	278
Min. Negotiated Rate	$115.00
Max. Negotiated Rate	$115.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00

ARTH 3.5 MM CORT SCR #24

Facility

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	40204231
Hospital Revenue Code	278
Min. Negotiated Rate	$115.00
Max. Negotiated Rate	$115.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00

ARTH 3.5 MM CORT SCR #24

Facility

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	40204231
Hospital Revenue Code	278
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$241.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$138.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$115.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.25
Rate for Payer: EmblemHealth Commercial	$115.00
Rate for Payer: Fidelis Medicare Advantage	$241.50
Rate for Payer: Group Health Inc Commercial	$115.00
Rate for Payer: Group Health Inc Medicare	$80.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$149.50

ARTH 3.5 MM LCK SCR #18

Facility

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	40204233
Hospital Revenue Code	278
Min. Negotiated Rate	$115.00
Max. Negotiated Rate	$115.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00

ARTH 3.5 MM LCK SCR #18

Facility

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	40204233
Hospital Revenue Code	278
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$241.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$138.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$115.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.25
Rate for Payer: EmblemHealth Commercial	$115.00
Rate for Payer: Fidelis Medicare Advantage	$241.50
Rate for Payer: Group Health Inc Commercial	$115.00
Rate for Payer: Group Health Inc Medicare	$80.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$149.50

ARTH 3.5 MM LCK SCR #20

Facility

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	40204232
Hospital Revenue Code	278
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$241.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$138.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$115.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.25
Rate for Payer: EmblemHealth Commercial	$115.00
Rate for Payer: Fidelis Medicare Advantage	$241.50
Rate for Payer: Group Health Inc Commercial	$115.00
Rate for Payer: Group Health Inc Medicare	$80.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$149.50

ARTH 3.5 MM LCK SCR #20

Facility

$230.00

Service Code	HCPCS C1713
Hospital Charge Code	40204232
Hospital Revenue Code	278
Min. Negotiated Rate	$115.00
Max. Negotiated Rate	$115.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00

ARTH ANGEEL BMC

Facility

$3,500.00

Service Code	HCPCS C1713
Hospital Charge Code	64903897
Hospital Revenue Code	278
Min. Negotiated Rate	$1,750.00
Max. Negotiated Rate	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,750.00

ARTH ANGEEL BMC

Facility

$3,500.00

Service Code	HCPCS C1713
Hospital Charge Code	64903897
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,675.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,925.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,100.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,750.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,012.50
Rate for Payer: EmblemHealth Commercial	$1,750.00
Rate for Payer: Fidelis Medicare Advantage	$3,675.00
Rate for Payer: Group Health Inc Commercial	$1,750.00
Rate for Payer: Group Health Inc Medicare	$1,225.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,750.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,275.00

Know your out-of-pocket cost for care.

All Charges