St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

XR HUMERUS 1 VIEW

Facility

$50.67

Service Code	HCPCS 76499 TC
Hospital Charge Code	41107504
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR HUMERUS 1 VIEW

Facility

$241.73

Service Code	HCPCS 73060 TC
Hospital Charge Code	41102850
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 HUMERUS 1 VIEW

Facility

$50.67

Service Code	HCPCS 76499 TC
Hospital Charge Code	41107504
Hospital Revenue Code	320
Min. Negotiated Rate	$17.73
Max. Negotiated Rate	$40.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.34
Rate for Payer: Aetna Government	$25.34
Rate for Payer: Brighton Health Commercial	$38.00
Rate for Payer: Cash Price	$105.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.46
Rate for Payer: Group Health Inc Commercial	$25.34
Rate for Payer: Group Health Inc Medicare	$17.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.34
Rate for Payer: Hamaspik Choice Inc Medicare	$25.34

XR HUMERUS 1 VIEW

Facility

$241.73

Service Code	HCPCS 73060 TC
Hospital Charge Code	41102850
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR INTERSTIT APPL COMP

Facility

$2,242.85

Service Code	HCPCS 77778 TC
Hospital Charge Code	66542960
Hospital Revenue Code	342
Min. Negotiated Rate	$785.00
Max. Negotiated Rate	$1,794.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,233.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,121.42
Rate for Payer: Aetna Government	$1,121.42
Rate for Payer: Brighton Health Commercial	$1,682.14
Rate for Payer: Cash Price	$829.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,794.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,525.14
Rate for Payer: Group Health Inc Commercial	$1,121.42
Rate for Payer: Group Health Inc Medicare	$785.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,121.42
Rate for Payer: Hamaspik Choice Inc Medicare	$1,121.42

XR INTERSTIT APPL COMP

Facility

$2,242.85

Service Code	HCPCS 77778 TC
Hospital Charge Code	66542960
Hospital Revenue Code	342
Rate for Payer: Cash Price	$829.13

XR INTERSTIT APPL INTER

Facility

$371.65

Service Code	HCPCS 77799 TC
Hospital Charge Code	66542959
Hospital Revenue Code	342
Min. Negotiated Rate	$130.08
Max. Negotiated Rate	$297.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$204.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$185.82
Rate for Payer: Aetna Government	$185.82
Rate for Payer: Brighton Health Commercial	$278.74
Rate for Payer: Cash Price	$138.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$297.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$252.72
Rate for Payer: Group Health Inc Commercial	$185.82
Rate for Payer: Group Health Inc Medicare	$130.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.82
Rate for Payer: Hamaspik Choice Inc Medicare	$185.82

XR INTERSTIT APPL INTER

Facility

$371.65

Service Code	HCPCS 77799 TC
Hospital Charge Code	66542959
Hospital Revenue Code	342
Rate for Payer: Cash Price	$138.67

XR INTERSTIT APPL SIMP

Facility

$371.65

Service Code	HCPCS 77799 TC
Hospital Charge Code	66542958
Hospital Revenue Code	342
Rate for Payer: Cash Price	$138.67

XR INTERSTIT APPL SIMP

Facility

$371.65

Service Code	HCPCS 77799 TC
Hospital Charge Code	66542958
Hospital Revenue Code	342
Min. Negotiated Rate	$130.08
Max. Negotiated Rate	$297.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$204.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$185.82
Rate for Payer: Aetna Government	$185.82
Rate for Payer: Brighton Health Commercial	$278.74
Rate for Payer: Cash Price	$138.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$297.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$252.72
Rate for Payer: Group Health Inc Commercial	$185.82
Rate for Payer: Group Health Inc Medicare	$130.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.82
Rate for Payer: Hamaspik Choice Inc Medicare	$185.82

XR KNEE 1 VIEW

Facility

$241.73

Service Code	HCPCS 73560 TC
Hospital Charge Code	41102856
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR KNEE 1 VIEW

Facility

$241.73

Service Code	HCPCS 73560 TC
Hospital Charge Code	41102856
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 KNEE 2 VIEWS

Facility

$241.73

Service Code	HCPCS 73560 TC
Hospital Charge Code	41102086
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 KNEE 2 VIEWS

Facility

$241.73

Service Code	HCPCS 73560 TC
Hospital Charge Code	41102086
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR KNEE 2 W/OBL-PAT-TUN

Facility

$339.45

Service Code	HCPCS 73564 TC
Hospital Charge Code	41102484
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR KNEE 2 W/OBL-PAT-TUN

Facility

$339.45

Service Code	HCPCS 73564 TC
Hospital Charge Code	41102484
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 KNEE 3 VIEWS

Facility

$241.73

Service Code	HCPCS 73562 TC
Hospital Charge Code	41102482
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 KNEE 3 VIEWS

Facility

$241.73

Service Code	HCPCS 73562 TC
Hospital Charge Code	41102482
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR LOCALIZE F.B. FOR CHILD

Facility

$241.73

Service Code	HCPCS 76010 TC
Hospital Charge Code	41102640
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR LOCALIZE F.B. FOR CHILD

Facility

$241.73

Service Code	HCPCS 76010 TC
Hospital Charge Code	41102640
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 LOWER EXTREMITY (INFANT)

Facility

$241.73

Service Code	HCPCS 73592 TC
Hospital Charge Code	41102486
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 LOWER EXTREMITY (INFANT)

Facility

$241.73

Service Code	HCPCS 73592 TC
Hospital Charge Code	41102486
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR LOWER SPINE DISK LUMBAR

Facility

$5,207.48

Service Code	HCPCS 72295 TC
Hospital Charge Code	41109980
Hospital Revenue Code	320
Rate for Payer: Cash Price	$2,232.80

XR LOWER SPINE DISK LUMBAR

Facility

$5,207.48

Service Code	HCPCS 72295 TC
Hospital Charge Code	41109980
Hospital Revenue Code	320
Min. Negotiated Rate	$1,822.62
Max. Negotiated Rate	$4,165.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,864.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,603.74
Rate for Payer: Aetna Government	$2,603.74
Rate for Payer: Brighton Health Commercial	$3,905.61
Rate for Payer: Cash Price	$2,232.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,165.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,541.09
Rate for Payer: Group Health Inc Commercial	$2,603.74
Rate for Payer: Group Health Inc Medicare	$1,822.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,603.74
Rate for Payer: Hamaspik Choice Inc Medicare	$2,603.74

XR LUMBAR SPINE AP/LATERAL

Facility

$327.00

Service Code	HCPCS 72110 TC
Hospital Charge Code	41102262
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

Know your out-of-pocket cost for care.

All Charges