St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

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

Facility

$339.00

Service Code	CPT 73700 TC
Hospital Charge Code	3527370011
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 KNEE WO IV CONTRAST

Facility

$339.00

Service Code	CPT 73700 TC
Hospital Charge Code	3527370011
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 TIBIA FIBULA WO IV CONT

Facility

$339.00

Service Code	CPT 73700 TC
Hospital Charge Code	3527370005
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 TIBIA FIBULA WO IV CONT

Facility

$339.00

Service Code	CPT 73700 TC
Hospital Charge Code	3527370005
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 LUMBAR SP COMBO - CT LUMBAR SPINE W WO CONTRAST

Facility

$551.00

Service Code	CPT 72133 TC
Hospital Charge Code	3527213301
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 LUMBAR SP COMBO - CT LUMBAR SPINE W WO CONTRAST

Facility

$551.00

Service Code	CPT 72133 TC
Hospital Charge Code	3527213301
Hospital Revenue Code	352
Min. Negotiated Rate	$147.48
Max. Negotiated Rate	$715.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$216.06
Rate for Payer: Aetna Government	$216.06
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	$147.48
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	$147.48
Rate for Payer: Healthfirst Essential Plan	$548.71
Rate for Payer: United Healthcare Commercial	$267.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$243.87

HC CT SCAN LUMBAR SP CONTRAST - CT LUMBAR SPINE W CONTRAST

Facility

$1,156.00

Service Code	CPT 72132 TC
Hospital Charge Code	3527213201
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 LUMBAR SP CONTRAST - CT LUMBAR SPINE W CONTRAST

Facility

$1,156.00

Service Code	CPT 72132 TC
Hospital Charge Code	3527213201
Hospital Revenue Code	352
Min. Negotiated Rate	$120.59
Max. Negotiated Rate	$867.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$174.75
Rate for Payer: Aetna Government	$174.75
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	$120.59
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	$120.59
Rate for Payer: Healthfirst Essential Plan	$452.32
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$201.03

HC CT SCAN,LUMBAR SPINE,W/O CONTRAST - CT LUMBAR SPINE WO CONTRAST

Facility

$339.00

Service Code	CPT 72131 TC
Hospital Charge Code	3527213101
Hospital Revenue Code	352
Min. Negotiated Rate	$88.94
Max. Negotiated Rate	$448.43
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	$88.94
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	$88.94
Rate for Payer: Healthfirst Essential Plan	$448.43
Rate for Payer: United Healthcare Commercial	$155.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$199.30

HC CT SCAN,LUMBAR SPINE,W/O CONTRAST - CT LUMBAR SPINE WO CONTRAST

Facility

$339.00

Service Code	CPT 72131 TC
Hospital Charge Code	3527213101
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,MAXILLOFACIAL W/O CONTRAST - CT SINUS FACIAL BONES WO CONT

Facility

$339.00

Service Code	CPT 70486 TC
Hospital Charge Code	3517048602
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,MAXILLOFACIAL W/O CONTRAST - CT SINUS FACIAL BONES WO CONT

Facility

$339.00

Service Code	CPT 70486 TC
Hospital Charge Code	3517048602
Hospital Revenue Code	351
Min. Negotiated Rate	$94.18
Max. Negotiated Rate	$446.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$101.43
Rate for Payer: Aetna Government	$101.43
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	$94.18
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	$94.18
Rate for Payer: Healthfirst Essential Plan	$446.60
Rate for Payer: United Healthcare Commercial	$155.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$198.49

HC CT SCAN OF ARM COMBO - CT ELBOW W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 73202 TC
Hospital Charge Code	3527320211
Hospital Revenue Code	352
Min. Negotiated Rate	$192.85
Max. Negotiated Rate	$715.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$226.11
Rate for Payer: Aetna Government	$226.11
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	$202.89
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	$202.89
Rate for Payer: Healthfirst Essential Plan	$697.84
Rate for Payer: United Healthcare Commercial	$267.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$310.15

HC CT SCAN OF ARM COMBO - CT ELBOW W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 73202 TC
Hospital Charge Code	3527320211
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 OF ARM COMBO - CT HAND W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 73202 TC
Hospital Charge Code	3527320207
Hospital Revenue Code	352
Min. Negotiated Rate	$192.85
Max. Negotiated Rate	$715.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$226.11
Rate for Payer: Aetna Government	$226.11
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	$202.89
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	$202.89
Rate for Payer: Healthfirst Essential Plan	$697.84
Rate for Payer: United Healthcare Commercial	$267.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$310.15

HC CT SCAN OF ARM COMBO - CT HAND W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 73202 TC
Hospital Charge Code	3527320207
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 OF ARM COMBO - CT RADIUS ULNA W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 73202 TC
Hospital Charge Code	3527320204
Hospital Revenue Code	352
Min. Negotiated Rate	$192.85
Max. Negotiated Rate	$715.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$226.11
Rate for Payer: Aetna Government	$226.11
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	$202.89
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	$202.89
Rate for Payer: Healthfirst Essential Plan	$697.84
Rate for Payer: United Healthcare Commercial	$267.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$310.15

HC CT SCAN OF ARM COMBO - CT RADIUS ULNA W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 73202 TC
Hospital Charge Code	3527320204
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 OF ARM COMBO - CT SHOULDER W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 73202 TC
Hospital Charge Code	3527320201
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 OF ARM COMBO - CT SHOULDER W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 73202 TC
Hospital Charge Code	3527320201
Hospital Revenue Code	352
Min. Negotiated Rate	$192.85
Max. Negotiated Rate	$715.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$226.11
Rate for Payer: Aetna Government	$226.11
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	$202.89
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	$202.89
Rate for Payer: Healthfirst Essential Plan	$697.84
Rate for Payer: United Healthcare Commercial	$267.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$310.15

HC CT SCAN OF ARM COMBO - CT UPPER EXTREMITY W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 73202 TC
Hospital Charge Code	3527320209
Hospital Revenue Code	352
Min. Negotiated Rate	$192.85
Max. Negotiated Rate	$715.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$226.11
Rate for Payer: Aetna Government	$226.11
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	$202.89
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	$202.89
Rate for Payer: Healthfirst Essential Plan	$697.84
Rate for Payer: United Healthcare Commercial	$267.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$310.15

HC CT SCAN OF ARM COMBO - CT UPPER EXTREMITY W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 73202 TC
Hospital Charge Code	3527320209
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 OF ARM COMBO - CT WRIST W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 73202 TC
Hospital Charge Code	3527320205
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 OF ARM COMBO - CT WRIST W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 73202 TC
Hospital Charge Code	3527320205
Hospital Revenue Code	352
Min. Negotiated Rate	$192.85
Max. Negotiated Rate	$715.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$226.11
Rate for Payer: Aetna Government	$226.11
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	$202.89
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	$202.89
Rate for Payer: Healthfirst Essential Plan	$697.84
Rate for Payer: United Healthcare Commercial	$267.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$310.15

Know your out-of-pocket cost for care.

All Charges