St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

XR ABD. FLAT W/ERECT-DECUBE

Facility

$339.45

Service Code	HCPCS 74021 TC
Hospital Charge Code	41102130
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR ABDOMEN

Facility

$241.73

Service Code	HCPCS 74018 TC
Hospital Charge Code	41102128
Hospital Revenue Code	320
Min. Negotiated Rate	$84.61
Max. Negotiated Rate	$193.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$120.86
Rate for Payer: Aetna Government	$120.86
Rate for Payer: Brighton Health Commercial	$181.30
Rate for Payer: Cash Price	$105.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$193.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$164.38
Rate for Payer: Group Health Inc Commercial	$120.86
Rate for Payer: Group Health Inc Medicare	$84.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.86
Rate for Payer: Hamaspik Choice Inc Medicare	$120.86

XR ABDOMEN

Facility

$241.73

Service Code	HCPCS 74018 TC
Hospital Charge Code	41102128
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR ABSCESSOGRAM (VIA CATHETER)

Facility

$1,458.58

Service Code	HCPCS 76080 TC
Hospital Charge Code	41107629
Hospital Revenue Code	320
Min. Negotiated Rate	$510.50
Max. Negotiated Rate	$1,166.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$802.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$729.29
Rate for Payer: Aetna Government	$729.29
Rate for Payer: Brighton Health Commercial	$1,093.94
Rate for Payer: Cash Price	$637.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,166.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$991.83
Rate for Payer: Group Health Inc Commercial	$729.29
Rate for Payer: Group Health Inc Medicare	$510.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.29
Rate for Payer: Hamaspik Choice Inc Medicare	$729.29

XR ABSCESSOGRAM (VIA CATHETER)

Facility

$1,458.58

Service Code	HCPCS 76080 TC
Hospital Charge Code	41107629
Hospital Revenue Code	320
Rate for Payer: Cash Price	$637.97

XR ACRO-CLAVICULAR JOINTS

Facility

$241.73

Service Code	HCPCS 73050 TC
Hospital Charge Code	41102058
Hospital Revenue Code	320
Min. Negotiated Rate	$84.61
Max. Negotiated Rate	$193.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$120.86
Rate for Payer: Aetna Government	$120.86
Rate for Payer: Brighton Health Commercial	$181.30
Rate for Payer: Cash Price	$105.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$193.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$164.38
Rate for Payer: Group Health Inc Commercial	$120.86
Rate for Payer: Group Health Inc Medicare	$84.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.86
Rate for Payer: Hamaspik Choice Inc Medicare	$120.86

XR ACRO-CLAVICULAR JOINTS

Facility

$241.73

Service Code	HCPCS 73050 TC
Hospital Charge Code	41102058
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR ANKLE 1 VIEW

Facility

$241.73

Service Code	HCPCS 73600 TC
Hospital Charge Code	41102860
Hospital Revenue Code	320
Min. Negotiated Rate	$84.61
Max. Negotiated Rate	$193.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$120.86
Rate for Payer: Aetna Government	$120.86
Rate for Payer: Brighton Health Commercial	$181.30
Rate for Payer: Cash Price	$105.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$193.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$164.38
Rate for Payer: Group Health Inc Commercial	$120.86
Rate for Payer: Group Health Inc Medicare	$84.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.86
Rate for Payer: Hamaspik Choice Inc Medicare	$120.86

XR ANKLE 1 VIEW

Facility

$241.73

Service Code	HCPCS 73600 TC
Hospital Charge Code	41102860
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR ANKLE 2 VIEWS

Facility

$241.73

Service Code	HCPCS 73600 TC
Hospital Charge Code	41102488
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR ANKLE 2 VIEWS

Facility

$241.73

Service Code	HCPCS 73600 TC
Hospital Charge Code	41102488
Hospital Revenue Code	320
Min. Negotiated Rate	$84.61
Max. Negotiated Rate	$193.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$120.86
Rate for Payer: Aetna Government	$120.86
Rate for Payer: Brighton Health Commercial	$181.30
Rate for Payer: Cash Price	$105.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$193.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$164.38
Rate for Payer: Group Health Inc Commercial	$120.86
Rate for Payer: Group Health Inc Medicare	$84.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.86
Rate for Payer: Hamaspik Choice Inc Medicare	$120.86

XR ANKLE COMPLETE

Facility

$241.73

Service Code	HCPCS 73610 TC
Hospital Charge Code	41102672
Hospital Revenue Code	320
Min. Negotiated Rate	$84.61
Max. Negotiated Rate	$193.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$120.86
Rate for Payer: Aetna Government	$120.86
Rate for Payer: Brighton Health Commercial	$181.30
Rate for Payer: Cash Price	$105.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$193.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$164.38
Rate for Payer: Group Health Inc Commercial	$120.86
Rate for Payer: Group Health Inc Medicare	$84.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.86
Rate for Payer: Hamaspik Choice Inc Medicare	$120.86

XR ANKLE COMPLETE

Facility

$241.73

Service Code	HCPCS 73610 TC
Hospital Charge Code	41102672
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

X-RAY IAC'S (INTERNAL AUD CANAL)

Facility

$5.31

Service Code	HCPCS 70134 TC
Hospital Charge Code	41107522
Hospital Revenue Code	320
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$4.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.66
Rate for Payer: Aetna Government	$2.66
Rate for Payer: Brighton Health Commercial	$3.98
Rate for Payer: Cash Price	$637.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.61
Rate for Payer: Group Health Inc Commercial	$2.66
Rate for Payer: Group Health Inc Medicare	$1.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.66
Rate for Payer: Hamaspik Choice Inc Medicare	$2.66

X-RAY IAC'S (INTERNAL AUD CANAL)

Facility

$5.31

Service Code	HCPCS 70134 TC
Hospital Charge Code	41107522
Hospital Revenue Code	320
Rate for Payer: Cash Price	$637.97

X-RAY OF THE NECK MUSCLES

Facility

$248.98

Service Code	HCPCS 70360
Hospital Charge Code	30302050
Hospital Revenue Code	329
Rate for Payer: Cash Price	$105.08

X-RAY OF THE NECK MUSCLES

Facility

$248.98

Service Code	HCPCS 70360
Hospital Charge Code	30302050
Hospital Revenue Code	329
Min. Negotiated Rate	$73.56
Max. Negotiated Rate	$136.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$136.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$105.08
Rate for Payer: Aetna Government	$105.08
Rate for Payer: Brighton Health Commercial	$105.08
Rate for Payer: Cash Price	$105.08
Rate for Payer: Cash Price	$105.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$105.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.27
Rate for Payer: Elderplan Medicare Advantage	$105.08
Rate for Payer: EmblemHealth Commercial	$73.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$89.32
Rate for Payer: Fidelis Essential Plan Aliesa	$89.32
Rate for Payer: Fidelis Essential Plan QHP	$93.52
Rate for Payer: Fidelis Medicare Advantage	$105.08
Rate for Payer: Fidelis Qualified Health Plan	$93.52
Rate for Payer: Group Health Inc Commercial	$94.57
Rate for Payer: Group Health Inc Medicare	$94.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$124.49
Rate for Payer: Hamaspik Choice Inc Medicare	$105.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$94.57
Rate for Payer: Healthfirst Medicare Advantage	$105.08
Rate for Payer: Healthfirst QHP	$105.08
Rate for Payer: Senior Whole Health Medicare Advantage	$105.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$84.06
Rate for Payer: Wellcare Medicare	$99.83

X-RAY SHOWING AT LEAST 3 VIEWS

Facility

$248.98

Service Code	HCPCS 73610
Hospital Charge Code	30302052
Hospital Revenue Code	329
Min. Negotiated Rate	$73.56
Max. Negotiated Rate	$136.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$136.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$105.08
Rate for Payer: Aetna Government	$105.08
Rate for Payer: Brighton Health Commercial	$105.08
Rate for Payer: Cash Price	$105.08
Rate for Payer: Cash Price	$105.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$105.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.27
Rate for Payer: Elderplan Medicare Advantage	$105.08
Rate for Payer: EmblemHealth Commercial	$73.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$89.32
Rate for Payer: Fidelis Essential Plan Aliesa	$89.32
Rate for Payer: Fidelis Essential Plan QHP	$93.52
Rate for Payer: Fidelis Medicare Advantage	$105.08
Rate for Payer: Fidelis Qualified Health Plan	$93.52
Rate for Payer: Group Health Inc Commercial	$94.57
Rate for Payer: Group Health Inc Medicare	$94.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$124.49
Rate for Payer: Hamaspik Choice Inc Medicare	$105.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$94.57
Rate for Payer: Healthfirst Medicare Advantage	$105.08
Rate for Payer: Healthfirst QHP	$105.08
Rate for Payer: Senior Whole Health Medicare Advantage	$105.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$84.06
Rate for Payer: Wellcare Medicare	$99.83

X-RAY SHOWING AT LEAST 3 VIEWS

Facility

$248.98

Service Code	HCPCS 73610
Hospital Charge Code	30302052
Hospital Revenue Code	329
Rate for Payer: Cash Price	$105.08

XRAY SM INTEST F-THRU STD

Facility

$455.50

Service Code	HCPCS 74248 TC
Hospital Charge Code	41103731
Hospital Revenue Code	320
Min. Negotiated Rate	$159.42
Max. Negotiated Rate	$364.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$250.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$227.75
Rate for Payer: Aetna Government	$227.75
Rate for Payer: Brighton Health Commercial	$341.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$364.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$309.74
Rate for Payer: Group Health Inc Commercial	$227.75
Rate for Payer: Group Health Inc Medicare	$159.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$227.75
Rate for Payer: Hamaspik Choice Inc Medicare	$227.75

XRAY UPPER GI DELAY W/O KUB

Facility

$551.90

Service Code	HCPCS 74240 TC
Hospital Charge Code	41102502
Hospital Revenue Code	320
Min. Negotiated Rate	$193.16
Max. Negotiated Rate	$441.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.95
Rate for Payer: Aetna Government	$275.95
Rate for Payer: Brighton Health Commercial	$413.92
Rate for Payer: Cash Price	$212.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$441.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$375.29
Rate for Payer: Group Health Inc Commercial	$275.95
Rate for Payer: Group Health Inc Medicare	$193.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.95
Rate for Payer: Hamaspik Choice Inc Medicare	$275.95

XRAY UPPER GI DELAY W/O KUB

Facility

$551.90

Service Code	HCPCS 74240 TC
Hospital Charge Code	41102502
Hospital Revenue Code	320
Rate for Payer: Cash Price	$212.47

XR BASIC DOSIM CALC

Facility

$383.40

Service Code	HCPCS 77300 TC
Hospital Charge Code	66542932
Hospital Revenue Code	333
Rate for Payer: Cash Price	$156.91

XR BASIC DOSIM CALC

Facility

$383.40

Service Code	HCPCS 77300 TC
Hospital Charge Code	66542932
Hospital Revenue Code	333
Min. Negotiated Rate	$134.19
Max. Negotiated Rate	$306.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$210.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$191.70
Rate for Payer: Aetna Government	$191.70
Rate for Payer: Brighton Health Commercial	$287.55
Rate for Payer: Cash Price	$156.91
Rate for Payer: Cash Price	$156.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$306.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$260.71
Rate for Payer: Fidelis CHP/HARP/Medicaid	$279.92
Rate for Payer: Fidelis Essential Plan Aliesa	$279.92
Rate for Payer: Fidelis Essential Plan QHP	$294.00
Rate for Payer: Fidelis Qualified Health Plan	$294.00
Rate for Payer: Group Health Inc Commercial	$191.70
Rate for Payer: Group Health Inc Medicare	$134.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.70
Rate for Payer: Hamaspik Choice Inc Medicare	$191.70

XR BILE DUCT ENDOSCOPY

Facility

$515.90

Service Code	HCPCS 74328 TC
Hospital Charge Code	41108743
Hospital Revenue Code	320
Min. Negotiated Rate	$180.56
Max. Negotiated Rate	$412.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$283.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$257.95
Rate for Payer: Aetna Government	$257.95
Rate for Payer: Brighton Health Commercial	$386.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$412.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$350.81
Rate for Payer: Group Health Inc Commercial	$257.95
Rate for Payer: Group Health Inc Medicare	$180.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$257.95
Rate for Payer: Hamaspik Choice Inc Medicare	$257.95

Know your out-of-pocket cost for care.

All Charges