St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

XR BONE AGE

Facility

$327.00

Service Code	HCPCS 77072 TC
Hospital Charge Code	41102314
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR BONE AGE

Facility

$327.00

Service Code	HCPCS 77072 TC
Hospital Charge Code	41102314
Hospital Revenue Code	320
Min. Negotiated Rate	$114.45
Max. Negotiated Rate	$261.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$163.50
Rate for Payer: Aetna Government	$163.50
Rate for Payer: Brighton Health Commercial	$245.25
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$261.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$222.36
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

XR BONE LENGTH

Facility

$335.12

Service Code	HCPCS 77073 TC
Hospital Charge Code	41102650
Hospital Revenue Code	320
Min. Negotiated Rate	$117.29
Max. Negotiated Rate	$268.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$184.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$167.56
Rate for Payer: Aetna Government	$167.56
Rate for Payer: Brighton Health Commercial	$251.34
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$268.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$227.88
Rate for Payer: Group Health Inc Commercial	$167.56
Rate for Payer: Group Health Inc Medicare	$117.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$167.56
Rate for Payer: Hamaspik Choice Inc Medicare	$167.56

XR BONE LENGTH

Facility

$335.12

Service Code	HCPCS 77073 TC
Hospital Charge Code	41102650
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR BONE SURVEY COMPLETE

Facility

$327.00

Service Code	HCPCS 77075 TC
Hospital Charge Code	41102202
Hospital Revenue Code	320
Min. Negotiated Rate	$114.45
Max. Negotiated Rate	$261.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$163.50
Rate for Payer: Aetna Government	$163.50
Rate for Payer: Brighton Health Commercial	$245.25
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$261.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$222.36
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

XR BONE SURVEY COMPLETE

Facility

$327.00

Service Code	HCPCS 77075 TC
Hospital Charge Code	41102202
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR BONE SURVEY (INFANT)

Facility

$327.00

Service Code	HCPCS 77076 TC
Hospital Charge Code	41102662
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR BONE SURVEY (INFANT)

Facility

$327.00

Service Code	HCPCS 77076 TC
Hospital Charge Code	41102662
Hospital Revenue Code	320
Min. Negotiated Rate	$114.45
Max. Negotiated Rate	$261.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$163.50
Rate for Payer: Aetna Government	$163.50
Rate for Payer: Brighton Health Commercial	$245.25
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$261.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$222.36
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

XR BONE SURVEY LIMITED

Facility

$327.00

Service Code	HCPCS 77074 TC
Hospital Charge Code	41102088
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR BONE SURVEY LIMITED

Facility

$327.00

Service Code	HCPCS 77074 TC
Hospital Charge Code	41102088
Hospital Revenue Code	320
Min. Negotiated Rate	$114.45
Max. Negotiated Rate	$261.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$163.50
Rate for Payer: Aetna Government	$163.50
Rate for Payer: Brighton Health Commercial	$245.25
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$261.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$222.36
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

XR CERVICAL SPINE AP/LAT/OM

Facility

$241.73

Service Code	HCPCS 72040 TC
Hospital Charge Code	41102256
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 CERVICAL SPINE AP/LAT/OM

Facility

$241.73

Service Code	HCPCS 72040 TC
Hospital Charge Code	41102256
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR CERVICAL SPINE COMPLETE

Facility

$327.00

Service Code	HCPCS 72050 TC
Hospital Charge Code	41102220
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR CERVICAL SPINE COMPLETE

Facility

$327.00

Service Code	HCPCS 72050 TC
Hospital Charge Code	41102220
Hospital Revenue Code	320
Min. Negotiated Rate	$114.45
Max. Negotiated Rate	$261.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$163.50
Rate for Payer: Aetna Government	$163.50
Rate for Payer: Brighton Health Commercial	$245.25
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$261.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$222.36
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

XR CERV. SPINE W/FLEX-EXT

Facility

$327.00

Service Code	HCPCS 72052 TC
Hospital Charge Code	41102222
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR CERV. SPINE W/FLEX-EXT

Facility

$327.00

Service Code	HCPCS 72052 TC
Hospital Charge Code	41102222
Hospital Revenue Code	320
Min. Negotiated Rate	$114.45
Max. Negotiated Rate	$261.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$163.50
Rate for Payer: Aetna Government	$163.50
Rate for Payer: Brighton Health Commercial	$245.25
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$261.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$222.36
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

XR CHEST 1 VIEW

Facility

$241.73

Service Code	HCPCS 71045 TC
Hospital Charge Code	41102014
Hospital Revenue Code	324
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 CHEST 1 VIEW

Facility

$241.73

Service Code	HCPCS 71045 TC
Hospital Charge Code	41102014
Hospital Revenue Code	324
Rate for Payer: Cash Price	$105.08

XR CHEST 2 VIEWS

Facility

$241.73

Service Code	HCPCS 71046 TC
Hospital Charge Code	41102016
Hospital Revenue Code	324
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 CHEST 2 VIEWS

Facility

$241.73

Service Code	HCPCS 71046 TC
Hospital Charge Code	41102016
Hospital Revenue Code	324
Rate for Payer: Cash Price	$105.08

XR CHEST 2 VIEWS W/APICAL

Facility

$241.73

Service Code	HCPCS 71047 TC
Hospital Charge Code	41102412
Hospital Revenue Code	324
Rate for Payer: Cash Price	$105.08

XR CHEST 2 VIEWS W/APICAL

Facility

$241.73

Service Code	HCPCS 71047 TC
Hospital Charge Code	41102412
Hospital Revenue Code	324
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 CHEST 2 VIEWS W/OBLIQUES

Facility

$241.73

Service Code	HCPCS 71046 TC
Hospital Charge Code	41102414
Hospital Revenue Code	324
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 CHEST 2 VIEWS W/OBLIQUES

Facility

$241.73

Service Code	HCPCS 71046 TC
Hospital Charge Code	41102414
Hospital Revenue Code	324
Rate for Payer: Cash Price	$105.08

XR CHEST 4 VIEWS

Facility

$339.45

Service Code	HCPCS 71048 TC
Hospital Charge Code	41109968
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

Know your out-of-pocket cost for care.

All Charges