St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

XR PELVIS

Facility

$327.00

Service Code	HCPCS 72170 TC
Hospital Charge Code	41102214
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 PELVIS

Facility

$327.00

Service Code	HCPCS 72170 TC
Hospital Charge Code	41102214
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR PELVIS 3 VIEWS + (PLUS)

Facility

$327.00

Service Code	HCPCS 72190 TC
Hospital Charge Code	41102866
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR PELVIS 3 VIEWS + (PLUS)

Facility

$5,240.00

Service Code	HCPCS 72190 TC
Hospital Charge Code	41107520
Hospital Revenue Code	320
Min. Negotiated Rate	$1,834.00
Max. Negotiated Rate	$4,192.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,882.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,620.00
Rate for Payer: Aetna Government	$2,620.00
Rate for Payer: Brighton Health Commercial	$3,930.00
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,192.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,563.20
Rate for Payer: Group Health Inc Commercial	$2,620.00
Rate for Payer: Group Health Inc Medicare	$1,834.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,620.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,620.00

XR PELVIS 3 VIEWS + (PLUS)

Facility

$5,240.00

Service Code	HCPCS 72190 TC
Hospital Charge Code	41107520
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR PELVIS 3 VIEWS + (PLUS)

Facility

$327.00

Service Code	HCPCS 72190 TC
Hospital Charge Code	41102866
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 PHYSICS CONSULT

Facility

$383.40

Service Code	HCPCS 77370
Hospital Charge Code	66542946
Hospital Revenue Code	333
Min. Negotiated Rate	$125.53
Max. Negotiated Rate	$306.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$210.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$156.91
Rate for Payer: Aetna Government	$156.91
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: Cash Price	$156.91
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$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: Elderplan Medicare Advantage	$156.91
Rate for Payer: EmblemHealth Commercial	$156.91
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 Medicare Advantage	$156.91
Rate for Payer: Fidelis Qualified Health Plan	$294.00
Rate for Payer: Group Health Inc Commercial	$156.91
Rate for Payer: Group Health Inc Medicare	$156.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.70
Rate for Payer: Hamaspik Choice Inc Medicare	$156.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$141.22
Rate for Payer: Healthfirst Medicare Advantage	$156.91
Rate for Payer: Healthfirst QHP	$156.91
Rate for Payer: Senior Whole Health Medicare Advantage	$156.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$156.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$125.53
Rate for Payer: Wellcare Medicare	$149.06

XR PHYSICS CONSULT

Facility

$383.40

Service Code	HCPCS 77370
Hospital Charge Code	66542946
Hospital Revenue Code	333
Rate for Payer: Cash Price	$156.91

XR PORT FILMS

Facility

$103.48

Service Code	HCPCS 77417
Hospital Charge Code	66542949
Hospital Revenue Code	333
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$294.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.55
Rate for Payer: Aetna Government	$14.55
Rate for Payer: Brighton Health Commercial	$77.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$82.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$70.37
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	$51.74
Rate for Payer: Group Health Inc Medicare	$36.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.74
Rate for Payer: Hamaspik Choice Inc Medicare	$51.74

XR REPL DISLODG G-J TUBE COMPLEX

Facility

$697.79

Service Code	HCPCS 74355 TC
Hospital Charge Code	41107668
Hospital Revenue Code	320
Min. Negotiated Rate	$244.23
Max. Negotiated Rate	$558.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$383.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$348.90
Rate for Payer: Aetna Government	$348.90
Rate for Payer: Brighton Health Commercial	$523.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$558.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$474.50
Rate for Payer: Group Health Inc Commercial	$348.90
Rate for Payer: Group Health Inc Medicare	$244.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$348.90
Rate for Payer: Hamaspik Choice Inc Medicare	$348.90

XR RIBS BILATERAL

Facility

$327.00

Service Code	HCPCS 71110 TC
Hospital Charge Code	41102046
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 RIBS BILATERAL

Facility

$327.00

Service Code	HCPCS 71110 TC
Hospital Charge Code	41102046
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR RIBS BI W/CHEST 1 VIEW

Facility

$327.00

Service Code	HCPCS 71111 TC
Hospital Charge Code	41102432
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR RIBS BI W/CHEST 1 VIEW

Facility

$327.00

Service Code	HCPCS 71111 TC
Hospital Charge Code	41102432
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 RIBS UNILATERAL

Facility

$241.73

Service Code	HCPCS 71100 TC
Hospital Charge Code	41102044
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 RIBS UNILATERAL

Facility

$241.73

Service Code	HCPCS 71100 TC
Hospital Charge Code	41102044
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR RIBS W/CHEST 1 VIEW

Facility

$327.00

Service Code	HCPCS 71101 TC
Hospital Charge Code	41102430
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR RIBS W/CHEST 1 VIEW

Facility

$327.00

Service Code	HCPCS 71101 TC
Hospital Charge Code	41102430
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 SACRO-ILIAC COMPLETE

Facility

$327.00

Service Code	HCPCS 72202 TC
Hospital Charge Code	41102216
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 SACRO-ILIAC COMPLETE

Facility

$327.00

Service Code	HCPCS 72202 TC
Hospital Charge Code	41102216
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR SACRO-ILIAC LIMITED

Facility

$327.00

Service Code	HCPCS 72200 TC
Hospital Charge Code	41102634
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 SACRO-ILIAC LIMITED

Facility

$327.00

Service Code	HCPCS 72200 TC
Hospital Charge Code	41102634
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR SACRUM/COCCYX

Facility

$241.73

Service Code	HCPCS 72220 TC
Hospital Charge Code	41102210
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 SACRUM/COCCYX

Facility

$241.73

Service Code	HCPCS 72220 TC
Hospital Charge Code	41102210
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR SCAPULA

Facility

$339.45

Service Code	HCPCS 73010 TC
Hospital Charge Code	41102092
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

Know your out-of-pocket cost for care.

All Charges