St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

XR TOE(S)

Facility

$241.73

Service Code	HCPCS 73660 TC
Hospital Charge Code	41102098
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 TOES 1 VIEW

Facility

$241.73

Service Code	HCPCS 73660 TC
Hospital Charge Code	41102864
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR TOES 1 VIEW

Facility

$241.73

Service Code	HCPCS 73660 TC
Hospital Charge Code	41102864
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 TOMO SINGLE PLANE

Facility

$339.45

Service Code	HCPCS 76100 TC
Hospital Charge Code	41102182
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 TOMO SINGLE PLANE

Facility

$339.45

Service Code	HCPCS 76100 TC
Hospital Charge Code	41102182
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR TRANSHEPA PORTOGRAPHY W/O HEMO

Facility

$4,940.28

Service Code	HCPCS 75887 TC
Hospital Charge Code	41107688
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	$3,686.08
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 TRANSHEPA PORTOGRAPHY W/O HEMO

Facility

$4,940.28

Service Code	HCPCS 75887 TC
Hospital Charge Code	41107688
Hospital Revenue Code	320
Rate for Payer: Cash Price	$3,686.08

XR TRANS/PORTABLE X-RAY

Facility

$70.88

Service Code	HCPCS R0075
Hospital Charge Code	41107721
Hospital Revenue Code	969
Min. Negotiated Rate	$20.10
Max. Negotiated Rate	$56.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.10
Rate for Payer: Aetna Government	$20.10
Rate for Payer: Brighton Health Commercial	$53.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.20
Rate for Payer: Group Health Inc Commercial	$35.44
Rate for Payer: Group Health Inc Medicare	$24.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.44
Rate for Payer: Hamaspik Choice Inc Medicare	$35.44

XR TREAT DEVICE-COMPLEX

Facility

$1,015.13

Service Code	HCPCS 77334 TC
Hospital Charge Code	66542943
Hospital Revenue Code	333
Rate for Payer: Cash Price	$427.29

XR TREAT DEVICE-COMPLEX

Facility

$1,015.13

Service Code	HCPCS 77334 TC
Hospital Charge Code	66542943
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 TREAT DEVICE INTERM

Facility

$383.40

Service Code	HCPCS 77333 TC
Hospital Charge Code	66542942
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 TREAT DEVICE INTERM

Facility

$383.40

Service Code	HCPCS 77333 TC
Hospital Charge Code	66542942
Hospital Revenue Code	333
Rate for Payer: Cash Price	$156.91

XR TREAT DEVICE SIMPLE

Facility

$383.40

Service Code	HCPCS 77332 TC
Hospital Charge Code	66542941
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 TREAT DEVICE SIMPLE

Facility

$383.40

Service Code	HCPCS 77332 TC
Hospital Charge Code	66542941
Hospital Revenue Code	333
Rate for Payer: Cash Price	$156.91

XR UPPER EXTREMITY (INFANT)

Facility

$327.00

Service Code	HCPCS 73092 TC
Hospital Charge Code	41102464
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 UPPER EXTREMITY (INFANT)

Facility

$327.00

Service Code	HCPCS 73092 TC
Hospital Charge Code	41102464
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

XR WRIST 1 VIEW

Facility

$719.03

Service Code	HCPCS 76499 TC
Hospital Charge Code	41107498
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR WRIST 1 VIEW

Facility

$241.73

Service Code	HCPCS 73100 TC
Hospital Charge Code	41102844
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR WRIST 1 VIEW

Facility

$241.73

Service Code	HCPCS 73100 TC
Hospital Charge Code	41102844
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 WRIST 1 VIEW

Facility

$719.03

Service Code	HCPCS 76499 TC
Hospital Charge Code	41107498
Hospital Revenue Code	320
Min. Negotiated Rate	$251.66
Max. Negotiated Rate	$575.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$395.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$359.52
Rate for Payer: Aetna Government	$359.52
Rate for Payer: Brighton Health Commercial	$539.27
Rate for Payer: Cash Price	$105.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$575.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$488.94
Rate for Payer: Group Health Inc Commercial	$359.52
Rate for Payer: Group Health Inc Medicare	$251.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$359.52
Rate for Payer: Hamaspik Choice Inc Medicare	$359.52

XR WRIST 2 VIEWS

Facility

$241.73

Service Code	HCPCS 73100 TC
Hospital Charge Code	41102466
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR WRIST 2 VIEWS

Facility

$241.73

Service Code	HCPCS 73100 TC
Hospital Charge Code	41102466
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 WRIST COMPLETE

Facility

$241.73

Service Code	HCPCS 73110 TC
Hospital Charge Code	41102100
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

XR WRIST COMPLETE

Facility

$241.73

Service Code	HCPCS 73110 TC
Hospital Charge Code	41102100
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 X-RAY EXAM OF SKULL

Facility

$327.00

Service Code	HCPCS 70250 TC
Hospital Charge Code	41102188
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

Know your out-of-pocket cost for care.

All Charges