St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

XR SPECIAL DOSIMETRY

Facility

$383.40

Service Code	HCPCS 77331 TC
Hospital Charge Code	66542940
Hospital Revenue Code	333
Min. Negotiated Rate	$134.19
Max. Negotiated Rate	$306.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$210.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$191.70
Rate for Payer: Aetna Government	$191.70
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: Cigna HMO/Network Benefit Plan/Open Access	$306.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$260.71
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	$191.70
Rate for Payer: Group Health Inc Medicare	$134.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.70
Rate for Payer: Hamaspik Choice Inc Medicare	$191.70

XR SPECIAL DOSIMETRY

Facility

$383.40

Service Code	HCPCS 77331 TC
Hospital Charge Code	66542940
Hospital Revenue Code	333
Rate for Payer: Cash Price	$156.91

XR SPECIAL TELETHERAPY

Facility

$1,015.13

Service Code	HCPCS 77321 TC
Hospital Charge Code	66542939
Hospital Revenue Code	333
Min. Negotiated Rate	$279.92
Max. Negotiated Rate	$812.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$558.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$507.56
Rate for Payer: Aetna Government	$507.56
Rate for Payer: Brighton Health Commercial	$761.35
Rate for Payer: Cash Price	$427.29
Rate for Payer: Cash Price	$427.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$812.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.29
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	$507.56
Rate for Payer: Group Health Inc Medicare	$355.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$507.56
Rate for Payer: Hamaspik Choice Inc Medicare	$507.56

XR SPECIAL TELETHERAPY

Facility

$1,015.13

Service Code	HCPCS 77321 TC
Hospital Charge Code	66542939
Hospital Revenue Code	333
Rate for Payer: Cash Price	$427.29

XR SPEC TRRMT PROC

Facility

$1,631.98

Service Code	HCPCS 77470 TC
Hospital Charge Code	66542954
Hospital Revenue Code	333
Rate for Payer: Cash Price	$680.74

XR SPEC TRRMT PROC

Facility

$1,631.98

Service Code	HCPCS 77470 TC
Hospital Charge Code	66542954
Hospital Revenue Code	333
Min. Negotiated Rate	$279.92
Max. Negotiated Rate	$1,305.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$897.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$815.99
Rate for Payer: Aetna Government	$815.99
Rate for Payer: Brighton Health Commercial	$1,223.98
Rate for Payer: Cash Price	$680.74
Rate for Payer: Cash Price	$680.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,305.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,109.75
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	$815.99
Rate for Payer: Group Health Inc Medicare	$571.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$815.99
Rate for Payer: Hamaspik Choice Inc Medicare	$815.99

XR SPINE 1 VIEW

Facility

$241.73

Service Code	HCPCS 72020 TC
Hospital Charge Code	41102436
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR SPINE 1 VIEW

Facility

$241.73

Service Code	HCPCS 72020 TC
Hospital Charge Code	41102436
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 STERNO-CLAVICULAR JOINTS

Facility

$241.73

Service Code	HCPCS 71130 TC
Hospital Charge Code	41102050
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 STERNO-CLAVICULAR JOINTS

Facility

$241.73

Service Code	HCPCS 71130 TC
Hospital Charge Code	41102050
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR STERNUM

Facility

$241.73

Service Code	HCPCS 71120 TC
Hospital Charge Code	41102048
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR STERNUM

Facility

$241.73

Service Code	HCPCS 71120 TC
Hospital Charge Code	41102048
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 TEMPOROMANDIBULAR JOINTS

Facility

$241.73

Service Code	HCPCS 70330 TC
Hospital Charge Code	41102196
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 TEMPOROMANDIBULAR JOINTS

Facility

$241.73

Service Code	HCPCS 70330 TC
Hospital Charge Code	41102196
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR THORACIC SPINE

Facility

$327.00

Service Code	HCPCS 72070 TC
Hospital Charge Code	41102438
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR THORACIC SPINE

Facility

$327.00

Service Code	HCPCS 72070 TC
Hospital Charge Code	41102438
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 THORACIC SPINE W/SWIMMERS

Facility

$327.00

Service Code	HCPCS 72072 TC
Hospital Charge Code	41102440
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR THORACIC SPINE W/SWIMMERS

Facility

$327.00

Service Code	HCPCS 72072 TC
Hospital Charge Code	41102440
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 TIB/FIB 1 VIEW

Facility

$241.73

Service Code	HCPCS 73590 TC
Hospital Charge Code	41102858
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 TIB/FIB 1 VIEW

Facility

$766.16

Service Code	HCPCS 76499 TC
Hospital Charge Code	41107512
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR TIB/FIB 1 VIEW

Facility

$766.16

Service Code	HCPCS 76499 TC
Hospital Charge Code	41107512
Hospital Revenue Code	320
Min. Negotiated Rate	$268.16
Max. Negotiated Rate	$612.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$383.08
Rate for Payer: Aetna Government	$383.08
Rate for Payer: Brighton Health Commercial	$574.62
Rate for Payer: Cash Price	$105.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$612.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$520.99
Rate for Payer: Group Health Inc Commercial	$383.08
Rate for Payer: Group Health Inc Medicare	$268.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.08
Rate for Payer: Hamaspik Choice Inc Medicare	$383.08

XR TIB/FIB 1 VIEW

Facility

$241.73

Service Code	HCPCS 73590 TC
Hospital Charge Code	41102858
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR TIBIA/FIBULA

Facility

$241.73

Service Code	HCPCS 73590 TC
Hospital Charge Code	41102096
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR TIBIA/FIBULA

Facility

$241.73

Service Code	HCPCS 73590 TC
Hospital Charge Code	41102096
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 TOE(S)

Facility

$241.73

Service Code	HCPCS 73660 TC
Hospital Charge Code	41102098
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

Know your out-of-pocket cost for care.

All Charges