St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC CT SCAN CERV SPINE CONTRAST - CT CERVICAL SPINE W CONTRAST

Facility

$1,156.00

Service Code	CPT 72126 TC
Hospital Charge Code	3527212601
Hospital Revenue Code	352
Min. Negotiated Rate	$119.89
Max. Negotiated Rate	$867.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.12
Rate for Payer: Aetna Government	$175.12
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	$119.89
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	$119.89
Rate for Payer: Healthfirst Essential Plan	$609.12
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$270.72

HC CT SCAN CERV SPINE CONTRAST - CT CERVICAL SPINE W CONTRAST

Facility

$1,156.00

Service Code	CPT 72126 TC
Hospital Charge Code	3527212601
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 SCAN DORSAL SP COMBO - CT THORACIC SPINE W WO CONTRAST

Facility

$551.00

Service Code	CPT 72130 TC
Hospital Charge Code	3527213001
Hospital Revenue Code	352
Min. Negotiated Rate	$149.24
Max. Negotiated Rate	$715.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$218.29
Rate for Payer: Aetna Government	$218.29
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$715.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$602.07
Rate for Payer: EmblemHealth Commercial	$149.24
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	$149.24
Rate for Payer: Healthfirst Essential Plan	$702.86
Rate for Payer: United Healthcare Commercial	$267.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$312.38

HC CT SCAN DORSAL SP COMBO - CT THORACIC SPINE W WO CONTRAST

Facility

$551.00

Service Code	CPT 72130 TC
Hospital Charge Code	3527213001
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 SCAN DORSAL SP CONTRAST - CT THORACIC SPINE W CONTRAST

Facility

$551.00

Service Code	CPT 72129 TC
Hospital Charge Code	3527212901
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 SCAN DORSAL SP CONTRAST - CT THORACIC SPINE W CONTRAST

Facility

$551.00

Service Code	CPT 72129 TC
Hospital Charge Code	3527212901
Hospital Revenue Code	352
Min. Negotiated Rate	$121.28
Max. Negotiated Rate	$641.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.49
Rate for Payer: Aetna Government	$175.49
Rate for Payer: Brighton Health Commercial	$413.25
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	$121.28
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	$121.28
Rate for Payer: Healthfirst Essential Plan	$453.31
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$201.47

HC CT SCAN, FACE/JAW CONTRAST - CT SINUS FACIAL BONES W CONTRAST

Facility

$551.00

Service Code	CPT 70487 TC
Hospital Charge Code	3517048702
Hospital Revenue Code	351
Min. Negotiated Rate	$106.61
Max. Negotiated Rate	$641.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$116.69
Rate for Payer: Aetna Government	$116.69
Rate for Payer: Brighton Health Commercial	$413.25
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	$106.61
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	$106.61
Rate for Payer: Healthfirst Essential Plan	$460.57
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$204.70

HC CT SCAN, FACE/JAW CONTRAST - CT SINUS FACIAL BONES W CONTRAST

Facility

$551.00

Service Code	CPT 70487 TC
Hospital Charge Code	3517048702
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 SCAN,HEAD/BRAIN,W/O CONTRAST MATL - CT HEAD WO CONTRAST

Facility

$339.00

Service Code	CPT 70450 TC
Hospital Charge Code	3517045001
Hospital Revenue Code	351
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL - CT HEAD WO CONTRAST

Facility

$339.00

Service Code	CPT 70450 TC
Hospital Charge Code	3517045001
Hospital Revenue Code	351
Min. Negotiated Rate	$71.82
Max. Negotiated Rate	$414.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$76.49
Rate for Payer: Aetna Government	$76.49
Rate for Payer: Brighton Health Commercial	$254.25
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	$71.82
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$71.82
Rate for Payer: Healthfirst Essential Plan	$286.38
Rate for Payer: United Healthcare Commercial	$155.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$127.28

HC CT SCAN HEAD COMBO - CT HEAD W WO CONTRAST

Facility

$551.00

Service Code	CPT 70470 TC
Hospital Charge Code	3517047001
Hospital Revenue Code	351
Min. Negotiated Rate	$122.34
Max. Negotiated Rate	$715.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$133.43
Rate for Payer: Aetna Government	$133.43
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$715.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$602.07
Rate for Payer: EmblemHealth Commercial	$122.34
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	$122.34
Rate for Payer: Healthfirst Essential Plan	$451.69
Rate for Payer: United Healthcare Commercial	$267.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$200.75

HC CT SCAN HEAD COMBO - CT HEAD W WO CONTRAST

Facility

$551.00

Service Code	CPT 70470 TC
Hospital Charge Code	3517047001
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 SCAN HEAD CONTRAST - CT HEAD W CONTRAST

Facility

$551.00

Service Code	CPT 70460 TC
Hospital Charge Code	3517046001
Hospital Revenue Code	351
Min. Negotiated Rate	$102.77
Max. Negotiated Rate	$641.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$109.61
Rate for Payer: Aetna Government	$109.61
Rate for Payer: Brighton Health Commercial	$413.25
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	$102.77
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	$102.77
Rate for Payer: Healthfirst Essential Plan	$373.10
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$165.82

HC CT SCAN HEAD CONTRAST - CT HEAD W CONTRAST

Facility

$551.00

Service Code	CPT 70460 TC
Hospital Charge Code	3517046001
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 SCAN,LIMITED/LOCALIZED F/U STUDY - CT LIMITED FOLLOW UP

Facility

$2,450.00

Service Code	CPT 76380 TC
Hospital Charge Code	3507638001
Hospital Revenue Code	350
Min. Negotiated Rate	$1,225.00
Max. Negotiated Rate	$1,225.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,225.00

HC CT SCAN,LIMITED/LOCALIZED F/U STUDY - CT LIMITED FOLLOW UP

Facility

$2,450.00

Service Code	CPT 76380 TC
Hospital Charge Code	3507638001
Hospital Revenue Code	350
Min. Negotiated Rate	$63.46
Max. Negotiated Rate	$1,837.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,347.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.46
Rate for Payer: Aetna Government	$63.46
Rate for Payer: Brighton Health Commercial	$1,837.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$242.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$204.42
Rate for Payer: EmblemHealth Commercial	$92.43
Rate for Payer: Group Health Inc Commercial	$1,225.00
Rate for Payer: Group Health Inc Medicare	$857.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,225.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$92.43
Rate for Payer: Healthfirst Essential Plan	$266.76
Rate for Payer: United Healthcare Commercial	$90.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$118.56

HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT ANKLE WO IV CONTRAST

Facility

$339.00

Service Code	CPT 73700 TC
Hospital Charge Code	3527370009
Hospital Revenue Code	352
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT ANKLE WO IV CONTRAST

Facility

$339.00

Service Code	CPT 73700 TC
Hospital Charge Code	3527370009
Hospital Revenue Code	352
Min. Negotiated Rate	$89.29
Max. Negotiated Rate	$443.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$117.06
Rate for Payer: Aetna Government	$117.06
Rate for Payer: Brighton Health Commercial	$254.25
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	$89.29
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$89.29
Rate for Payer: Healthfirst Essential Plan	$443.27
Rate for Payer: United Healthcare Commercial	$155.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$197.01

HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT FEMUR WO IV CONTRAST

Facility

$339.00

Service Code	CPT 73700 TC
Hospital Charge Code	3527370003
Hospital Revenue Code	352
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT FEMUR WO IV CONTRAST

Facility

$339.00

Service Code	CPT 73700 TC
Hospital Charge Code	3527370003
Hospital Revenue Code	352
Min. Negotiated Rate	$89.29
Max. Negotiated Rate	$443.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$117.06
Rate for Payer: Aetna Government	$117.06
Rate for Payer: Brighton Health Commercial	$254.25
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	$89.29
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$89.29
Rate for Payer: Healthfirst Essential Plan	$443.27
Rate for Payer: United Healthcare Commercial	$155.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$197.01

HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT FOOT WO IV CONTRAST

Facility

$339.00

Service Code	CPT 73700 TC
Hospital Charge Code	3527370007
Hospital Revenue Code	352
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT FOOT WO IV CONTRAST

Facility

$339.00

Service Code	CPT 73700 TC
Hospital Charge Code	3527370007
Hospital Revenue Code	352
Min. Negotiated Rate	$89.29
Max. Negotiated Rate	$443.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$117.06
Rate for Payer: Aetna Government	$117.06
Rate for Payer: Brighton Health Commercial	$254.25
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	$89.29
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$89.29
Rate for Payer: Healthfirst Essential Plan	$443.27
Rate for Payer: United Healthcare Commercial	$155.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$197.01

HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT HIP WO IV CONTRAST

Facility

$339.00

Service Code	CPT 73700 TC
Hospital Charge Code	3527370001
Hospital Revenue Code	352
Min. Negotiated Rate	$89.29
Max. Negotiated Rate	$443.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$117.06
Rate for Payer: Aetna Government	$117.06
Rate for Payer: Brighton Health Commercial	$254.25
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	$89.29
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$89.29
Rate for Payer: Healthfirst Essential Plan	$443.27
Rate for Payer: United Healthcare Commercial	$155.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$197.01

HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT HIP WO IV CONTRAST

Facility

$339.00

Service Code	CPT 73700 TC
Hospital Charge Code	3527370002
Hospital Revenue Code	352
Min. Negotiated Rate	$89.29
Max. Negotiated Rate	$443.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$117.06
Rate for Payer: Aetna Government	$117.06
Rate for Payer: Brighton Health Commercial	$254.25
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	$89.29
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$89.29
Rate for Payer: Healthfirst Essential Plan	$443.27
Rate for Payer: United Healthcare Commercial	$155.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$197.01

HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT HIP WO IV CONTRAST

Facility

$339.00

Service Code	CPT 73700 TC
Hospital Charge Code	3527370002
Hospital Revenue Code	352
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

Know your out-of-pocket cost for care.

All Charges