St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC CT ABD & PELVIS W/O CONTRAST - CT ABDOMEN PELVIS WO CONTRAST

Facility

$705.00

Service Code	CPT 74176 TC
Hospital Charge Code	3527417601
Hospital Revenue Code	352
Min. Negotiated Rate	$110.11
Max. Negotiated Rate	$528.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$117.43
Rate for Payer: Aetna Government	$117.43
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$414.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$349.19
Rate for Payer: EmblemHealth Commercial	$110.11
Rate for Payer: Group Health Inc Commercial	$352.50
Rate for Payer: Group Health Inc Medicare	$246.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50
Rate for Payer: Hamaspik Choice Inc Medicare	$352.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$110.11
Rate for Payer: Healthfirst Essential Plan	$293.29
Rate for Payer: United Healthcare Commercial	$155.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$130.35

HC CT ABD & PELVIS W/O CONTRAST - CT ABDOMEN PELVIS WO CONTRAST

Facility

$705.00

Service Code	CPT 74176 TC
Hospital Charge Code	3527417601
Hospital Revenue Code	352
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC CT ABD & PELV W/CONTRAST - CT ABDOMEN PELVIS W CONTRAST

Facility

$1,156.00

Service Code	CPT 74177 TC
Hospital Charge Code	3527417701
Hospital Revenue Code	352
Min. Negotiated Rate	$206.04
Max. Negotiated Rate	$867.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$229.09
Rate for Payer: Aetna Government	$229.09
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$641.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$540.04
Rate for Payer: EmblemHealth Commercial	$231.33
Rate for Payer: Group Health Inc Commercial	$578.00
Rate for Payer: Group Health Inc Medicare	$404.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00
Rate for Payer: Hamaspik Choice Inc Medicare	$578.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$231.33
Rate for Payer: Healthfirst Essential Plan	$463.59
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$206.04

HC CT ABD & PELV W/CONTRAST - CT ABDOMEN PELVIS W CONTRAST

Facility

$1,156.00

Service Code	CPT 74177 TC
Hospital Charge Code	3527417701
Hospital Revenue Code	352
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC CT ANGIO ABDOMINAL ARTERIES - CT ANGIO AORTA & BILAT ILIOFEMORAL RUN

Facility

$551.00

Service Code	CPT 75635 TC
Hospital Charge Code	3527563501
Hospital Revenue Code	352
Min. Negotiated Rate	$192.85
Max. Negotiated Rate	$807.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$246.22
Rate for Payer: Aetna Government	$246.22
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$724.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$609.79
Rate for Payer: EmblemHealth Commercial	$321.17
Rate for Payer: Group Health Inc Commercial	$275.50
Rate for Payer: Group Health Inc Medicare	$192.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50
Rate for Payer: Hamaspik Choice Inc Medicare	$275.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$321.17
Rate for Payer: Healthfirst Essential Plan	$807.28
Rate for Payer: United Healthcare Commercial	$270.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$358.79

HC CT ANGIO ABDOMINAL ARTERIES - CT ANGIO AORTA & BILAT ILIOFEMORAL RUN

Facility

$551.00

Service Code	CPT 75635 TC
Hospital Charge Code	3527563501
Hospital Revenue Code	352
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

HC CT ANGIO ABDOM W/O & W/DYE - CT ANGIOGRAM ABDOMEN W CONTRAST

Facility

$551.00

Service Code	CPT 74175 TC
Hospital Charge Code	3527417501
Hospital Revenue Code	352
Min. Negotiated Rate	$192.85
Max. Negotiated Rate	$762.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$225.56
Rate for Payer: Aetna Government	$225.56
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$724.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$609.79
Rate for Payer: EmblemHealth Commercial	$236.43
Rate for Payer: Group Health Inc Commercial	$275.50
Rate for Payer: Group Health Inc Medicare	$192.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50
Rate for Payer: Hamaspik Choice Inc Medicare	$275.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$236.43
Rate for Payer: Healthfirst Essential Plan	$762.82
Rate for Payer: United Healthcare Commercial	$270.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$339.03

HC CT ANGIO ABDOM W/O & W/DYE - CT ANGIOGRAM ABDOMEN W CONTRAST

Facility

$551.00

Service Code	CPT 74175 TC
Hospital Charge Code	3527417501
Hospital Revenue Code	352
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

HC CT ANGIO ABD&PELV W/O&W/DYE - CT ANGIOGRAM ABDOMEN PELVIS W CONTRAST

Facility

$551.00

Service Code	CPT 74174 TC
Hospital Charge Code	3527417401
Hospital Revenue Code	352
Min. Negotiated Rate	$192.85
Max. Negotiated Rate	$734.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$291.06
Rate for Payer: Aetna Government	$291.06
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$440.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$374.68
Rate for Payer: EmblemHealth Commercial	$296.72
Rate for Payer: Group Health Inc Commercial	$275.50
Rate for Payer: Group Health Inc Medicare	$192.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50
Rate for Payer: Hamaspik Choice Inc Medicare	$275.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$296.72
Rate for Payer: Healthfirst Essential Plan	$734.47
Rate for Payer: United Healthcare Commercial	$464.83
Rate for Payer: Wellcare CHP/FHP/Medicaid	$326.43

HC CT ANGIO ABD&PELV W/O&W/DYE - CT ANGIOGRAM ABDOMEN PELVIS W CONTRAST

Facility

$551.00

Service Code	CPT 74174 TC
Hospital Charge Code	3527417401
Hospital Revenue Code	352
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

HC CT ANGIO, CHEST, COMBO, INCL IMAGE - CT CHEST ANGIO W AND WO IV CONT

Facility

$551.00

Service Code	CPT 71275 TC
Hospital Charge Code	3527127501
Hospital Revenue Code	352
Min. Negotiated Rate	$192.85
Max. Negotiated Rate	$765.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$217.74
Rate for Payer: Aetna Government	$217.74
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$724.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$609.79
Rate for Payer: EmblemHealth Commercial	$210.92
Rate for Payer: Group Health Inc Commercial	$275.50
Rate for Payer: Group Health Inc Medicare	$192.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50
Rate for Payer: Hamaspik Choice Inc Medicare	$275.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$210.92
Rate for Payer: Healthfirst Essential Plan	$765.47
Rate for Payer: United Healthcare Commercial	$270.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$340.21

HC CT ANGIO, CHEST, COMBO, INCL IMAGE - CT CHEST ANGIO W AND WO IV CONT

Facility

$551.00

Service Code	CPT 71275 TC
Hospital Charge Code	3527127501
Hospital Revenue Code	352
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

HC CT ANGIO,HEAD COMBO - CT HEAD ANGIO W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 70496 TC
Hospital Charge Code	3517049601
Hospital Revenue Code	351
Min. Negotiated Rate	$192.85
Max. Negotiated Rate	$749.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$215.88
Rate for Payer: Aetna Government	$215.88
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$724.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$609.79
Rate for Payer: EmblemHealth Commercial	$208.83
Rate for Payer: Group Health Inc Commercial	$275.50
Rate for Payer: Group Health Inc Medicare	$192.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50
Rate for Payer: Hamaspik Choice Inc Medicare	$275.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$208.83
Rate for Payer: Healthfirst Essential Plan	$749.63
Rate for Payer: United Healthcare Commercial	$270.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$333.17

HC CT ANGIO,HEAD COMBO - CT HEAD ANGIO W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 70496 TC
Hospital Charge Code	3517049601
Hospital Revenue Code	351
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

HC CT ANGIO LWR EXTR W/O&W/DYE - CT LOWER EXT ANGIO W AND WO IV CONT

Facility

$551.00

Service Code	CPT 73706 TC
Hospital Charge Code	3527370601
Hospital Revenue Code	352
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

HC CT ANGIO LWR EXTR W/O&W/DYE - CT LOWER EXT ANGIO W AND WO IV CONT

Facility

$551.00

Service Code	CPT 73706 TC
Hospital Charge Code	3527370601
Hospital Revenue Code	352
Min. Negotiated Rate	$192.85
Max. Negotiated Rate	$764.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$246.22
Rate for Payer: Aetna Government	$246.22
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$724.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$609.79
Rate for Payer: EmblemHealth Commercial	$251.31
Rate for Payer: Group Health Inc Commercial	$275.50
Rate for Payer: Group Health Inc Medicare	$192.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50
Rate for Payer: Hamaspik Choice Inc Medicare	$275.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$251.31
Rate for Payer: Healthfirst Essential Plan	$764.14
Rate for Payer: United Healthcare Commercial	$270.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$339.62

HC CT ANGIO,NECK COMBO - CT NECK ANGIO W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 70498 TC
Hospital Charge Code	3517049801
Hospital Revenue Code	351
Min. Negotiated Rate	$192.85
Max. Negotiated Rate	$750.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$214.76
Rate for Payer: Aetna Government	$214.76
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$724.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$609.79
Rate for Payer: EmblemHealth Commercial	$208.48
Rate for Payer: Group Health Inc Commercial	$275.50
Rate for Payer: Group Health Inc Medicare	$192.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50
Rate for Payer: Hamaspik Choice Inc Medicare	$275.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$208.48
Rate for Payer: Healthfirst Essential Plan	$750.33
Rate for Payer: United Healthcare Commercial	$270.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$333.48

HC CT ANGIO,NECK COMBO - CT NECK ANGIO W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 70498 TC
Hospital Charge Code	3517049801
Hospital Revenue Code	351
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

HC CT ANGIO, PELVIS, COMBO, INCL IMG - CT PELVIS ANGIO W AND WO IV CONT

Facility

$551.00

Service Code	CPT 72191 TC
Hospital Charge Code	3527219101
Hospital Revenue Code	352
Min. Negotiated Rate	$192.85
Max. Negotiated Rate	$756.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$224.07
Rate for Payer: Aetna Government	$224.07
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$724.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$609.79
Rate for Payer: EmblemHealth Commercial	$236.08
Rate for Payer: Group Health Inc Commercial	$275.50
Rate for Payer: Group Health Inc Medicare	$192.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50
Rate for Payer: Hamaspik Choice Inc Medicare	$275.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$236.08
Rate for Payer: Healthfirst Essential Plan	$756.11
Rate for Payer: United Healthcare Commercial	$270.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$336.05

HC CT ANGIO, PELVIS, COMBO, INCL IMG - CT PELVIS ANGIO W AND WO IV CONT

Facility

$551.00

Service Code	CPT 72191 TC
Hospital Charge Code	3527219101
Hospital Revenue Code	352
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

HC CT ANGIO,UPPER EXTREM,COMBO - CT UPPER EXT ANGIO W AND WO IV CONT

Facility

$551.00

Service Code	CPT 73206 TC
Hospital Charge Code	3527320601
Hospital Revenue Code	352
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

HC CT ANGIO,UPPER EXTREM,COMBO - CT UPPER EXT ANGIO W AND WO IV CONT

Facility

$551.00

Service Code	CPT 73206 TC
Hospital Charge Code	3527320601
Hospital Revenue Code	352
Min. Negotiated Rate	$192.85
Max. Negotiated Rate	$755.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$246.03
Rate for Payer: Aetna Government	$246.03
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$724.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$609.79
Rate for Payer: EmblemHealth Commercial	$228.60
Rate for Payer: Group Health Inc Commercial	$275.50
Rate for Payer: Group Health Inc Medicare	$192.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50
Rate for Payer: Hamaspik Choice Inc Medicare	$275.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$228.60
Rate for Payer: Healthfirst Essential Plan	$755.98
Rate for Payer: United Healthcare Commercial	$270.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$335.99

HC CT CEREBRAL PERFUSION ANALYSIS W/ CONTRAST

Facility

$1,289.00

Service Code	CPT 0042T
Hospital Charge Code	3500042T01
Hospital Revenue Code	350
Min. Negotiated Rate	$275.00
Max. Negotiated Rate	$1,031.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$708.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.00
Rate for Payer: Aetna Government	$275.00
Rate for Payer: Brighton Health Commercial	$966.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,031.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$876.52
Rate for Payer: EmblemHealth Commercial	$644.50
Rate for Payer: Group Health Inc Commercial	$644.50
Rate for Payer: Group Health Inc Medicare	$451.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$644.50
Rate for Payer: Hamaspik Choice Inc Medicare	$644.50

HC CT CEREBRAL PERFUSION ANALYSIS W/ CONTRAST

Facility

$1,289.00

Service Code	CPT 0042T
Hospital Charge Code	3500042T01
Hospital Revenue Code	350
Min. Negotiated Rate	$644.50
Max. Negotiated Rate	$644.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$644.50

HC CT GUIDANCE NEEDLE PLACEMENT - CT GUIDANCE FOR NEEDLE PLACEMENT

Facility

$1,978.00

Service Code	CPT 77012 TC
Hospital Charge Code	3507701243
Hospital Revenue Code	350
Min. Negotiated Rate	$60.29
Max. Negotiated Rate	$1,582.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,087.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.16
Rate for Payer: Aetna Government	$70.16
Rate for Payer: Brighton Health Commercial	$1,483.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,582.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,345.04
Rate for Payer: EmblemHealth Commercial	$60.29
Rate for Payer: Group Health Inc Commercial	$989.00
Rate for Payer: Group Health Inc Medicare	$692.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$989.00
Rate for Payer: Hamaspik Choice Inc Medicare	$989.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$60.29
Rate for Payer: Healthfirst Essential Plan	$236.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$105.00

Know your out-of-pocket cost for care.

All Charges