St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MRI BREAST C- & C+ W/CAD UNI

Facility

$1,250.00

Service Code	HCPCS 77048 TC
Hospital Charge Code	41403708
Hospital Revenue Code	610
Min. Negotiated Rate	$235.55
Max. Negotiated Rate	$1,000.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$687.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$937.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$850.00
Rate for Payer: Group Health Inc Commercial	$625.00
Rate for Payer: Group Health Inc Medicare	$437.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$625.00
Rate for Payer: Hamaspik Choice Inc Medicare	$625.00
Rate for Payer: United Healthcare Commercial	$235.55

MRI BREAST C+ UNILATERAL

Facility

$705.83

Service Code	HCPCS 77046 TC
Hospital Charge Code	41405628
Hospital Revenue Code	610
Min. Negotiated Rate	$184.45
Max. Negotiated Rate	$564.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$388.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$283.37
Rate for Payer: Aetna Government	$283.37
Rate for Payer: Affinity Essential Plan 1&2	$198.36
Rate for Payer: Affinity Essential Plan 3&4	$198.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$198.36
Rate for Payer: Brighton Health Commercial	$529.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$283.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.96
Rate for Payer: Elderplan Medicare Advantage	$283.37
Rate for Payer: EmblemHealth Commercial	$198.36
Rate for Payer: Fidelis Essential Plan Aliesa	$240.86
Rate for Payer: Fidelis Essential Plan QHP	$252.20
Rate for Payer: Fidelis Medicare Advantage	$283.37
Rate for Payer: Fidelis Qualified Health Plan	$252.20
Rate for Payer: Group Health Inc Commercial	$255.03
Rate for Payer: Group Health Inc Medicare	$255.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.92
Rate for Payer: Hamaspik Choice Inc Medicare	$283.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$255.03
Rate for Payer: Healthfirst Medicare Advantage	$283.37
Rate for Payer: Healthfirst QHP	$283.37
Rate for Payer: Humana Medicare	$289.04
Rate for Payer: Senior Whole Health Medicare Advantage	$283.37
Rate for Payer: United Healthcare Commercial	$184.45
Rate for Payer: United Healthcare Medicare Advantage	$283.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$283.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$226.70
Rate for Payer: Wellcare Medicare	$269.20

MRI BREAST C+ UNILATERAL

Facility

$705.83

Service Code	HCPCS 77046 TC
Hospital Charge Code	41405628
Hospital Revenue Code	610
Rate for Payer: Cash Price	$283.37

MRI CONNECTING ROD 5MM X 200MM

Facility

$170.00

Service Code	HCPCS C1713
Hospital Charge Code	40201256
Hospital Revenue Code	278
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$178.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$102.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$85.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$97.75
Rate for Payer: EmblemHealth Commercial	$85.00
Rate for Payer: Fidelis Medicare Advantage	$178.50
Rate for Payer: Group Health Inc Commercial	$85.00
Rate for Payer: Group Health Inc Medicare	$59.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.00
Rate for Payer: Hamaspik Choice Inc Medicare	$85.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$110.50

MRI CONNECTING ROD 5MM X 200MM

Facility

$170.00

Service Code	HCPCS C1713
Hospital Charge Code	40201256
Hospital Revenue Code	278
Min. Negotiated Rate	$85.00
Max. Negotiated Rate	$85.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.00
Rate for Payer: Hamaspik Choice Inc Medicare	$85.00

MRI CONNECT ROD 5MM X 100MM

Facility

$326.00

Service Code	HCPCS C1713
Hospital Charge Code	40201363
Hospital Revenue Code	278
Min. Negotiated Rate	$163.00
Max. Negotiated Rate	$163.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.00
Rate for Payer: Hamaspik Choice Inc Medicare	$163.00

MRI CONNECT ROD 5MM X 100MM

Facility

$326.00

Service Code	HCPCS C1713
Hospital Charge Code	40201363
Hospital Revenue Code	278
Min. Negotiated Rate	$114.10
Max. Negotiated Rate	$342.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$195.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$163.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$187.45
Rate for Payer: EmblemHealth Commercial	$163.00
Rate for Payer: Fidelis Medicare Advantage	$342.30
Rate for Payer: Group Health Inc Commercial	$163.00
Rate for Payer: Group Health Inc Medicare	$114.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.00
Rate for Payer: Hamaspik Choice Inc Medicare	$163.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$211.90

MRI CONNECT ROD 5MM X 150MM

Facility

$326.00

Service Code	HCPCS C1713
Hospital Charge Code	40201364
Hospital Revenue Code	278
Min. Negotiated Rate	$163.00
Max. Negotiated Rate	$163.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.00
Rate for Payer: Hamaspik Choice Inc Medicare	$163.00

MRI CONNECT ROD 5MM X 150MM

Facility

$326.00

Service Code	HCPCS C1713
Hospital Charge Code	40201364
Hospital Revenue Code	278
Min. Negotiated Rate	$114.10
Max. Negotiated Rate	$342.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$195.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$163.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$187.45
Rate for Payer: EmblemHealth Commercial	$163.00
Rate for Payer: Fidelis Medicare Advantage	$342.30
Rate for Payer: Group Health Inc Commercial	$163.00
Rate for Payer: Group Health Inc Medicare	$114.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.00
Rate for Payer: Hamaspik Choice Inc Medicare	$163.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$211.90

MRI CONNECT ROD 5MM X 250MM

Facility

$326.00

Service Code	HCPCS C1713
Hospital Charge Code	40201365
Hospital Revenue Code	278
Min. Negotiated Rate	$163.00
Max. Negotiated Rate	$163.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.00
Rate for Payer: Hamaspik Choice Inc Medicare	$163.00

MRI CONNECT ROD 5MM X 250MM

Facility

$326.00

Service Code	HCPCS C1713
Hospital Charge Code	40201365
Hospital Revenue Code	278
Min. Negotiated Rate	$114.10
Max. Negotiated Rate	$342.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$195.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$163.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$187.45
Rate for Payer: EmblemHealth Commercial	$163.00
Rate for Payer: Fidelis Medicare Advantage	$342.30
Rate for Payer: Group Health Inc Commercial	$163.00
Rate for Payer: Group Health Inc Medicare	$114.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.00
Rate for Payer: Hamaspik Choice Inc Medicare	$163.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$211.90

MRI CONNECT ROD 5MM X 65MM

Facility

$326.00

Service Code	HCPCS C1713
Hospital Charge Code	40201367
Hospital Revenue Code	278
Min. Negotiated Rate	$163.00
Max. Negotiated Rate	$163.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.00
Rate for Payer: Hamaspik Choice Inc Medicare	$163.00

MRI CONNECT ROD 5MM X 65MM

Facility

$326.00

Service Code	HCPCS C1713
Hospital Charge Code	40201367
Hospital Revenue Code	278
Min. Negotiated Rate	$114.10
Max. Negotiated Rate	$342.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$195.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$163.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$187.45
Rate for Payer: EmblemHealth Commercial	$163.00
Rate for Payer: Fidelis Medicare Advantage	$342.30
Rate for Payer: Group Health Inc Commercial	$163.00
Rate for Payer: Group Health Inc Medicare	$114.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.00
Rate for Payer: Hamaspik Choice Inc Medicare	$163.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$211.90

MRI CONSULTATION

Facility

$81.19

Hospital Charge Code	41103265
Hospital Revenue Code	619
Min. Negotiated Rate	$28.42
Max. Negotiated Rate	$64.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.60
Rate for Payer: Aetna Government	$40.60
Rate for Payer: Brighton Health Commercial	$60.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$64.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.21
Rate for Payer: Group Health Inc Commercial	$40.60
Rate for Payer: Group Health Inc Medicare	$28.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.60
Rate for Payer: Hamaspik Choice Inc Medicare	$40.60

MR INFERIOR VENA CAVA C+

Facility

$1,374.83

Service Code	HCPCS 74185 TC
Hospital Charge Code	41407379
Hospital Revenue Code	610
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,031.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$756.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$1,031.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,030.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$871.55
Rate for Payer: Group Health Inc Commercial	$687.42
Rate for Payer: Group Health Inc Medicare	$481.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$687.42
Rate for Payer: Hamaspik Choice Inc Medicare	$687.42
Rate for Payer: United Healthcare Commercial	$295.18

MR INFERIOR VENA CAVA C-

Facility

$1,374.83

Service Code	HCPCS 74185 TC
Hospital Charge Code	41407551
Hospital Revenue Code	610
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,031.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$756.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$1,031.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,030.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$871.55
Rate for Payer: Group Health Inc Commercial	$687.42
Rate for Payer: Group Health Inc Medicare	$481.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$687.42
Rate for Payer: Hamaspik Choice Inc Medicare	$687.42
Rate for Payer: United Healthcare Commercial	$295.18

MRI OF BREAST BILATERAL

Facility

$1,133.53

Service Code	HCPCS C8908
Hospital Charge Code	41101581
Hospital Revenue Code	610
Min. Negotiated Rate	$311.31
Max. Negotiated Rate	$906.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$623.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$444.73
Rate for Payer: Aetna Government	$444.73
Rate for Payer: Affinity Essential Plan 1&2	$311.31
Rate for Payer: Affinity Essential Plan 3&4	$311.31
Rate for Payer: Affinity Medicaid/CHP/HARP	$311.31
Rate for Payer: Brighton Health Commercial	$850.15
Rate for Payer: Cash Price	$444.73
Rate for Payer: Cash Price	$444.73
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$444.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$906.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$770.80
Rate for Payer: Elderplan Medicare Advantage	$444.73
Rate for Payer: EmblemHealth Commercial	$311.31
Rate for Payer: Fidelis Essential Plan Aliesa	$378.02
Rate for Payer: Fidelis Essential Plan QHP	$395.81
Rate for Payer: Fidelis Medicare Advantage	$444.73
Rate for Payer: Fidelis Qualified Health Plan	$395.81
Rate for Payer: Group Health Inc Commercial	$400.26
Rate for Payer: Group Health Inc Medicare	$400.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$566.76
Rate for Payer: Hamaspik Choice Inc Medicare	$444.73
Rate for Payer: Healthfirst Medicare Advantage	$378.02
Rate for Payer: Healthfirst QHP	$444.73
Rate for Payer: Humana Medicare	$453.62
Rate for Payer: Senior Whole Health Medicare Advantage	$444.73
Rate for Payer: United Healthcare Commercial	$426.88
Rate for Payer: United Healthcare Medicare Advantage	$444.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$444.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$355.78
Rate for Payer: Wellcare Medicare	$422.49

MRI OF BREAST BILATERAL

Facility

$1,133.53

Service Code	HCPCS C8908
Hospital Charge Code	41101581
Hospital Revenue Code	610
Rate for Payer: Cash Price	$444.73

MRI OF BREAST UNILATERIAL

Facility

$1,133.53

Service Code	HCPCS C8905
Hospital Charge Code	41101580
Hospital Revenue Code	610
Rate for Payer: Cash Price	$444.73

MRI OF BREAST UNILATERIAL

Facility

$1,133.53

Service Code	HCPCS C8905
Hospital Charge Code	41101580
Hospital Revenue Code	610
Min. Negotiated Rate	$311.31
Max. Negotiated Rate	$906.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$623.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$444.73
Rate for Payer: Aetna Government	$444.73
Rate for Payer: Affinity Essential Plan 1&2	$311.31
Rate for Payer: Affinity Essential Plan 3&4	$311.31
Rate for Payer: Affinity Medicaid/CHP/HARP	$311.31
Rate for Payer: Brighton Health Commercial	$850.15
Rate for Payer: Cash Price	$444.73
Rate for Payer: Cash Price	$444.73
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$444.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$906.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$770.80
Rate for Payer: Elderplan Medicare Advantage	$444.73
Rate for Payer: EmblemHealth Commercial	$311.31
Rate for Payer: Fidelis Essential Plan Aliesa	$378.02
Rate for Payer: Fidelis Essential Plan QHP	$395.81
Rate for Payer: Fidelis Medicare Advantage	$444.73
Rate for Payer: Fidelis Qualified Health Plan	$395.81
Rate for Payer: Group Health Inc Commercial	$400.26
Rate for Payer: Group Health Inc Medicare	$400.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$566.76
Rate for Payer: Hamaspik Choice Inc Medicare	$444.73
Rate for Payer: Healthfirst Medicare Advantage	$378.02
Rate for Payer: Healthfirst QHP	$444.73
Rate for Payer: Humana Medicare	$453.62
Rate for Payer: Senior Whole Health Medicare Advantage	$444.73
Rate for Payer: United Healthcare Commercial	$426.88
Rate for Payer: United Healthcare Medicare Advantage	$444.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$444.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$355.78
Rate for Payer: Wellcare Medicare	$422.49

MRI SAFE CONENCT ROD 8 X 300MM

Facility

$326.00

Service Code	HCPCS C1713
Hospital Charge Code	40201371
Hospital Revenue Code	278
Min. Negotiated Rate	$163.00
Max. Negotiated Rate	$163.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.00
Rate for Payer: Hamaspik Choice Inc Medicare	$163.00

MRI SAFE CONENCT ROD 8 X 300MM

Facility

$326.00

Service Code	HCPCS C1713
Hospital Charge Code	40201371
Hospital Revenue Code	278
Min. Negotiated Rate	$114.10
Max. Negotiated Rate	$342.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$195.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$163.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$187.45
Rate for Payer: EmblemHealth Commercial	$163.00
Rate for Payer: Fidelis Medicare Advantage	$342.30
Rate for Payer: Group Health Inc Commercial	$163.00
Rate for Payer: Group Health Inc Medicare	$114.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.00
Rate for Payer: Hamaspik Choice Inc Medicare	$163.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$211.90

MRI SAFE CONNECTING ROD 8X300MM

Facility

$336.00

Service Code	HCPCS C1713
Hospital Charge Code	40200754
Hospital Revenue Code	278
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$352.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$184.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$201.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$168.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$193.20
Rate for Payer: EmblemHealth Commercial	$168.00
Rate for Payer: Fidelis Medicare Advantage	$352.80
Rate for Payer: Group Health Inc Commercial	$168.00
Rate for Payer: Group Health Inc Medicare	$117.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.00
Rate for Payer: Hamaspik Choice Inc Medicare	$168.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$218.40

MRI SAFE CONNECTING ROD 8X300MM

Facility

$336.00

Service Code	HCPCS C1713
Hospital Charge Code	40200754
Hospital Revenue Code	278
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$168.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.00
Rate for Payer: Hamaspik Choice Inc Medicare	$168.00

MRI SAFE CONNECTIONG ROD 8X200MM

Facility

$336.00

Service Code	HCPCS C1713
Hospital Charge Code	40202296
Hospital Revenue Code	278
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$168.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.00
Rate for Payer: Hamaspik Choice Inc Medicare	$168.00

Know your out-of-pocket cost for care.

All Charges