St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC CT SCAN OF LEG CONTRAST - CT ANKLE W IV CONTRAST

Facility

$551.00

Service Code	CPT 73701 TC
Hospital Charge Code	3527370112
Hospital Revenue Code	352
Min. Negotiated Rate	$120.59
Max. Negotiated Rate	$641.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.12
Rate for Payer: Aetna Government	$175.12
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	$120.59
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	$120.59
Rate for Payer: Healthfirst Essential Plan	$440.57
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$195.81

HC CT SCAN OF LEG CONTRAST - CT FEMUR W IV CONTRAST

Facility

$551.00

Service Code	CPT 73701 TC
Hospital Charge Code	3527370103
Hospital Revenue Code	352
Min. Negotiated Rate	$120.59
Max. Negotiated Rate	$641.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.12
Rate for Payer: Aetna Government	$175.12
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	$120.59
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	$120.59
Rate for Payer: Healthfirst Essential Plan	$440.57
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$195.81

HC CT SCAN OF LEG CONTRAST - CT FEMUR W IV CONTRAST

Facility

$551.00

Service Code	CPT 73701 TC
Hospital Charge Code	3527370103
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 LEG CONTRAST - CT FOOT W IV CONTRAST

Facility

$551.00

Service Code	CPT 73701 TC
Hospital Charge Code	3527370101
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 LEG CONTRAST - CT FOOT W IV CONTRAST

Facility

$551.00

Service Code	CPT 73701 TC
Hospital Charge Code	3527370101
Hospital Revenue Code	352
Min. Negotiated Rate	$120.59
Max. Negotiated Rate	$641.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.12
Rate for Payer: Aetna Government	$175.12
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	$120.59
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	$120.59
Rate for Payer: Healthfirst Essential Plan	$440.57
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$195.81

HC CT SCAN OF LEG CONTRAST - CT HIP W IV CONTRAST

Facility

$551.00

Service Code	CPT 73701 TC
Hospital Charge Code	3527370102
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 LEG CONTRAST - CT HIP W IV CONTRAST

Facility

$551.00

Service Code	CPT 73701 TC
Hospital Charge Code	3527370102
Hospital Revenue Code	352
Min. Negotiated Rate	$120.59
Max. Negotiated Rate	$641.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.12
Rate for Payer: Aetna Government	$175.12
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	$120.59
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	$120.59
Rate for Payer: Healthfirst Essential Plan	$440.57
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$195.81

HC CT SCAN OF LEG CONTRAST - CT KNEE W IV CONTRAST

Facility

$551.00

Service Code	CPT 73701 TC
Hospital Charge Code	3527370105
Hospital Revenue Code	352
Min. Negotiated Rate	$120.59
Max. Negotiated Rate	$641.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.12
Rate for Payer: Aetna Government	$175.12
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	$120.59
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	$120.59
Rate for Payer: Healthfirst Essential Plan	$440.57
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$195.81

HC CT SCAN OF LEG CONTRAST - CT KNEE W IV CONTRAST

Facility

$551.00

Service Code	CPT 73701 TC
Hospital Charge Code	3527370105
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 LEG CONTRAST - CT LOWER EXTREMITY W IV CONTRAST

Facility

$551.00

Service Code	CPT 73701 TC
Hospital Charge Code	3527370107
Hospital Revenue Code	352
Min. Negotiated Rate	$120.59
Max. Negotiated Rate	$641.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.12
Rate for Payer: Aetna Government	$175.12
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	$120.59
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	$120.59
Rate for Payer: Healthfirst Essential Plan	$440.57
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$195.81

HC CT SCAN OF LEG CONTRAST - CT LOWER EXTREMITY W IV CONTRAST

Facility

$551.00

Service Code	CPT 73701 TC
Hospital Charge Code	3527370107
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 LEG CONTRAST - CT TIBIA FIBULA W IV CONTRAST

Facility

$551.00

Service Code	CPT 73701 TC
Hospital Charge Code	3527370104
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 LEG CONTRAST - CT TIBIA FIBULA W IV CONTRAST

Facility

$551.00

Service Code	CPT 73701 TC
Hospital Charge Code	3527370104
Hospital Revenue Code	352
Min. Negotiated Rate	$120.59
Max. Negotiated Rate	$641.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.12
Rate for Payer: Aetna Government	$175.12
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	$120.59
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	$120.59
Rate for Payer: Healthfirst Essential Plan	$440.57
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$195.81

HC CT SCAN OF PELVIS COMBO - CT PELVIS W WO CONTRAST

Facility

$551.00

Service Code	CPT 72194 TC
Hospital Charge Code	3527219401
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	$208.25
Rate for Payer: Aetna Government	$208.25
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	$206.87
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	$206.87
Rate for Payer: Healthfirst Essential Plan	$550.35
Rate for Payer: United Healthcare Commercial	$267.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$244.60

HC CT SCAN OF PELVIS COMBO - CT PELVIS W WO CONTRAST

Facility

$551.00

Service Code	CPT 72194 TC
Hospital Charge Code	3527219401
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 PELVIS CONTRAST - CT PELVIS W CONTRAST

Facility

$551.00

Service Code	CPT 72193 TC
Hospital Charge Code	3527219301
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 PELVIS CONTRAST - CT PELVIS W CONTRAST

Facility

$551.00

Service Code	CPT 72193 TC
Hospital Charge Code	3527219301
Hospital Revenue Code	352
Min. Negotiated Rate	$175.12
Max. Negotiated Rate	$641.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.12
Rate for Payer: Aetna Government	$175.12
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	$184.52
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	$184.52
Rate for Payer: Healthfirst Essential Plan	$429.12
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$190.72

HC CT SCAN,ORBIT/SELLA/POST FOSSA/EAR,W/O - CT AUDITORY CANALS WO CONT

Facility

$339.00

Service Code	CPT 70480 TC
Hospital Charge Code	3517048002
Hospital Revenue Code	351
Min. Negotiated Rate	$106.26
Max. Negotiated Rate	$459.47
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	$106.26
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	$106.26
Rate for Payer: Healthfirst Essential Plan	$459.47
Rate for Payer: United Healthcare Commercial	$155.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$204.21

HC CT SCAN,ORBIT/SELLA/POST FOSSA/EAR,W/O - CT AUDITORY CANALS WO CONT

Facility

$339.00

Service Code	CPT 70480 TC
Hospital Charge Code	3517048002
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,ORBIT/SELLA/POST FOSSA/EAR,W/O - CT ORBITS/SELLA WO IV CONT

Facility

$339.00

Service Code	CPT 70480 TC
Hospital Charge Code	3517048001
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,ORBIT/SELLA/POST FOSSA/EAR,W/O - CT ORBITS/SELLA WO IV CONT

Facility

$339.00

Service Code	CPT 70480 TC
Hospital Charge Code	3517048001
Hospital Revenue Code	351
Min. Negotiated Rate	$106.26
Max. Negotiated Rate	$459.47
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	$106.26
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	$106.26
Rate for Payer: Healthfirst Essential Plan	$459.47
Rate for Payer: United Healthcare Commercial	$155.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$204.21

HC CT SCAN,PELVIS,W/O CONTRAST - CT PELVIS WO CONTRAST

Facility

$339.00

Service Code	CPT 72192 TC
Hospital Charge Code	3527219201
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,PELVIS,W/O CONTRAST - CT PELVIS WO CONTRAST

Facility

$339.00

Service Code	CPT 72192 TC
Hospital Charge Code	3527219201
Hospital Revenue Code	352
Min. Negotiated Rate	$88.25
Max. Negotiated Rate	$414.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$95.10
Rate for Payer: Aetna Government	$95.10
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	$88.25
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	$88.25
Rate for Payer: Healthfirst Essential Plan	$353.81
Rate for Payer: United Healthcare Commercial	$155.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$157.25

HC CT SCANS FACE/JAW COMBO - CT SINUS FACIAL BONES W WO CONTRAST

Facility

$551.00

Service Code	CPT 70488 TC
Hospital Charge Code	3517048802
Hospital Revenue Code	351
Min. Negotiated Rate	$133.87
Max. Negotiated Rate	$715.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$147.58
Rate for Payer: Aetna Government	$147.58
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	$133.87
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	$133.87
Rate for Payer: Healthfirst Essential Plan	$560.18
Rate for Payer: United Healthcare Commercial	$267.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$248.97

HC CT SCANS FACE/JAW COMBO - CT SINUS FACIAL BONES W WO CONTRAST

Facility

$551.00

Service Code	CPT 70488 TC
Hospital Charge Code	3517048802
Hospital Revenue Code	351
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

Know your out-of-pocket cost for care.

All Charges