St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

XR HAND 1 VIEW

Facility

$235.00

Service Code	HCPCS 76499 TC
Hospital Charge Code	41107496
Hospital Revenue Code	320
Min. Negotiated Rate	$82.25
Max. Negotiated Rate	$188.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$129.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$117.50
Rate for Payer: Aetna Government	$117.50
Rate for Payer: Brighton Health Commercial	$176.25
Rate for Payer: Cash Price	$105.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$188.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$159.80
Rate for Payer: Group Health Inc Commercial	$117.50
Rate for Payer: Group Health Inc Medicare	$82.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$117.50
Rate for Payer: Hamaspik Choice Inc Medicare	$117.50

XR HAND 2 VIEWS

Facility

$327.00

Service Code	HCPCS 73120 TC
Hospital Charge Code	41102078
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 HAND 2 VIEWS

Facility

$327.00

Service Code	HCPCS 73120 TC
Hospital Charge Code	41102078
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR HAND COMPLETE

Facility

$241.73

Service Code	HCPCS 73130 TC
Hospital Charge Code	41102674
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR HAND COMPLETE

Facility

$241.73

Service Code	HCPCS 73130 TC
Hospital Charge Code	41102674
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 HEAD ORTHODONTIC

Facility

$241.73

Service Code	HCPCS 70350 TC
Hospital Charge Code	41102929
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 HEAD ORTHODONTIC

Facility

$241.73

Service Code	HCPCS 70350 TC
Hospital Charge Code	30300140
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 HEAD ORTHODONTIC

Facility

$241.73

Service Code	HCPCS 70350 TC
Hospital Charge Code	30300140
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR HEAD ORTHODONTIC

Facility

$241.73

Service Code	HCPCS 70350 TC
Hospital Charge Code	41102929
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR HIP 1 VIEW

Facility

$241.73

Service Code	HCPCS 73501 TC
Hospital Charge Code	41102470
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR HIP 1 VIEW

Facility

$241.73

Service Code	HCPCS 73501 TC
Hospital Charge Code	41102470
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 HIP COMPLETE

Facility

$241.73

Service Code	HCPCS 73502 TC
Hospital Charge Code	41102472
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR HIP COMPLETE

Facility

$241.73

Service Code	HCPCS 73502 TC
Hospital Charge Code	41102472
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 HIP DURING OR 4/> VW

Facility

$339.45

Service Code	HCPCS 73503 TC
Hospital Charge Code	41102246
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR HIP DURING OR 4/> VW

Facility

$339.45

Service Code	HCPCS 73503 TC
Hospital Charge Code	41102246
Hospital Revenue Code	320
Min. Negotiated Rate	$118.81
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.72
Rate for Payer: Aetna Government	$169.72
Rate for Payer: Brighton Health Commercial	$254.59
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Group Health Inc Commercial	$169.72
Rate for Payer: Group Health Inc Medicare	$118.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72

XR HIPS 2 VIEWS BIL. W/PELVIS

Facility

$339.45

Service Code	HCPCS 73522 TC
Hospital Charge Code	41109979
Hospital Revenue Code	320
Min. Negotiated Rate	$118.81
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.72
Rate for Payer: Aetna Government	$169.72
Rate for Payer: Brighton Health Commercial	$254.59
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Group Health Inc Commercial	$169.72
Rate for Payer: Group Health Inc Medicare	$118.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72

XR HIPS 2 VIEWS BIL. W/PELVIS

Facility

$339.45

Service Code	HCPCS 73522 TC
Hospital Charge Code	41109979
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR HIPS 4 VIEWS

Facility

$339.45

Service Code	HCPCS 73503 TC
Hospital Charge Code	41102907
Hospital Revenue Code	320
Min. Negotiated Rate	$118.81
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.72
Rate for Payer: Aetna Government	$169.72
Rate for Payer: Brighton Health Commercial	$254.59
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Group Health Inc Commercial	$169.72
Rate for Payer: Group Health Inc Medicare	$118.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72

XR HIPS 4 VIEWS

Facility

$339.45

Service Code	HCPCS 73503 TC
Hospital Charge Code	41102907
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR HIPS 5 VIEWS

Facility

$339.45

Service Code	HCPCS 73523 TC
Hospital Charge Code	41102908
Hospital Revenue Code	320
Min. Negotiated Rate	$118.81
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.72
Rate for Payer: Aetna Government	$169.72
Rate for Payer: Brighton Health Commercial	$254.59
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Group Health Inc Commercial	$169.72
Rate for Payer: Group Health Inc Medicare	$118.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72

XR HIPS 5 VIEWS

Facility

$339.45

Service Code	HCPCS 73523 TC
Hospital Charge Code	41102908
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR HIPS COMPLETE BILATERAL

Facility

$339.45

Service Code	HCPCS 73521 TC
Hospital Charge Code	41102474
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR HIPS COMPLETE BILATERAL

Facility

$339.45

Service Code	HCPCS 73521 TC
Hospital Charge Code	41102474
Hospital Revenue Code	320
Min. Negotiated Rate	$118.81
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.72
Rate for Payer: Aetna Government	$169.72
Rate for Payer: Brighton Health Commercial	$254.59
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Group Health Inc Commercial	$169.72
Rate for Payer: Group Health Inc Medicare	$118.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72

XR HUMERUS

Facility

$241.73

Service Code	HCPCS 73060 TC
Hospital Charge Code	41102082
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR HUMERUS

Facility

$241.73

Service Code	HCPCS 73060 TC
Hospital Charge Code	41102082
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

Know your out-of-pocket cost for care.

All Charges