St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

XR LUMBAR SPINE AP/LATERAL

Facility

$327.00

Service Code	HCPCS 72110 TC
Hospital Charge Code	41102262
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 LUMBAR SPINE W/OBLIQUES

Facility

$327.00

Service Code	HCPCS 72110 TC
Hospital Charge Code	41102446
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR LUMBAR SPINE W/OBLIQUES

Facility

$327.00

Service Code	HCPCS 72110 TC
Hospital Charge Code	41102446
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 LUMB. SPINE W/BEND VIEWS

Facility

$327.00

Service Code	HCPCS 72114 TC
Hospital Charge Code	41102230
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR LUMB. SPINE W/BEND VIEWS

Facility

$327.00

Service Code	HCPCS 72114 TC
Hospital Charge Code	41102230
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 LYMPHANG,EXTREMITY ONLY, BIL

Facility

$4,940.28

Service Code	HCPCS 75803 TC
Hospital Charge Code	41107633
Hospital Revenue Code	320
Rate for Payer: Cash Price	$1,852.05

XR LYMPHANG,EXTREMITY ONLY, BIL

Facility

$4,940.28

Service Code	HCPCS 75803 TC
Hospital Charge Code	41107633
Hospital Revenue Code	320
Min. Negotiated Rate	$1,729.10
Max. Negotiated Rate	$3,952.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,717.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,470.14
Rate for Payer: Aetna Government	$2,470.14
Rate for Payer: Brighton Health Commercial	$3,705.21
Rate for Payer: Cash Price	$1,852.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,952.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,359.39
Rate for Payer: Group Health Inc Commercial	$2,470.14
Rate for Payer: Group Health Inc Medicare	$1,729.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.14
Rate for Payer: Hamaspik Choice Inc Medicare	$2,470.14

XR LYMPHANG,PELVIC/ABD, BIL

Facility

$8,393.53

Service Code	HCPCS 75807 TC
Hospital Charge Code	41107637
Hospital Revenue Code	320
Rate for Payer: Cash Price	$3,686.08

XR LYMPHANG,PELVIC/ABD, BIL

Facility

$8,393.53

Service Code	HCPCS 75807 TC
Hospital Charge Code	41107637
Hospital Revenue Code	320
Min. Negotiated Rate	$2,937.74
Max. Negotiated Rate	$6,714.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,616.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,196.76
Rate for Payer: Aetna Government	$4,196.76
Rate for Payer: Brighton Health Commercial	$6,295.15
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,714.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,707.60
Rate for Payer: Group Health Inc Commercial	$4,196.76
Rate for Payer: Group Health Inc Medicare	$2,937.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.76
Rate for Payer: Hamaspik Choice Inc Medicare	$4,196.76

XR MANDIBLE COMPLETE

Facility

$327.00

Service Code	HCPCS 70110 TC
Hospital Charge Code	41102166
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 MANDIBLE COMPLETE

Facility

$327.00

Service Code	HCPCS 70110 TC
Hospital Charge Code	41102166
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR MANDIBLE LIMITED

Facility

$241.73

Service Code	HCPCS 70100 TC
Hospital Charge Code	41102398
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR MANDIBLE LIMITED

Facility

$241.73

Service Code	HCPCS 70100 TC
Hospital Charge Code	41102398
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 MASTOIDS COMPLETE

Facility

$327.00

Service Code	HCPCS 70130 TC
Hospital Charge Code	41102168
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 MASTOIDS COMPLETE

Facility

$327.00

Service Code	HCPCS 70130 TC
Hospital Charge Code	41102168
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR MASTOIDS LIMITED

Facility

$339.45

Service Code	HCPCS 70120 TC
Hospital Charge Code	41102400
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR MASTOIDS LIMITED

Facility

$339.45

Service Code	HCPCS 70120 TC
Hospital Charge Code	41102400
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 NASAL BONES

Facility

$241.73

Service Code	HCPCS 70160 TC
Hospital Charge Code	41102172
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR NASAL BONES

Facility

$241.73

Service Code	HCPCS 70160 TC
Hospital Charge Code	41102172
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 OPTIC FERAMINA

Facility

$241.73

Service Code	HCPCS 70190 TC
Hospital Charge Code	41102176
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 OPTIC FERAMINA

Facility

$241.73

Service Code	HCPCS 70190 TC
Hospital Charge Code	41102176
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR ORBITS

Facility

$327.00

Service Code	HCPCS 70200 TC
Hospital Charge Code	41102174
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR ORBITS

Facility

$327.00

Service Code	HCPCS 70200 TC
Hospital Charge Code	41102174
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 OS CALCIS

Facility

$241.73

Service Code	HCPCS 73650 TC
Hospital Charge Code	41102084
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR OS CALCIS

Facility

$241.73

Service Code	HCPCS 73650 TC
Hospital Charge Code	41102084
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