St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC CT SCAN SKULL COMBO - CT AUDITORY CANALS / POSTERIOR FOSSA W WO CONT

Facility

$551.00

Service Code	CPT 70482 TC
Hospital Charge Code	3517048202
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 SKULL COMBO - CT AUDITORY CANALS / POSTERIOR FOSSA W WO CONT

Facility

$551.00

Service Code	CPT 70482 TC
Hospital Charge Code	3517048202
Hospital Revenue Code	351
Min. Negotiated Rate	$161.46
Max. Negotiated Rate	$718.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$239.33
Rate for Payer: Aetna Government	$239.33
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	$161.46
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	$161.46
Rate for Payer: Healthfirst Essential Plan	$718.02
Rate for Payer: United Healthcare Commercial	$267.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$319.12

HC CT SCAN SKULL COMBO - CT ORBITS/SELLA W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 70482 TC
Hospital Charge Code	3517048201
Hospital Revenue Code	351
Min. Negotiated Rate	$161.46
Max. Negotiated Rate	$718.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$239.33
Rate for Payer: Aetna Government	$239.33
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	$161.46
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	$161.46
Rate for Payer: Healthfirst Essential Plan	$718.02
Rate for Payer: United Healthcare Commercial	$267.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$319.12

HC CT SCAN SKULL COMBO - CT ORBITS/SELLA W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 70482 TC
Hospital Charge Code	3517048201
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 SKULL CONTRAST - CT AUDITORY CANALS/POSTERIOR FOSSA W IV CNT

Facility

$551.00

Service Code	CPT 70481 TC
Hospital Charge Code	3517048102
Hospital Revenue Code	351
Min. Negotiated Rate	$136.66
Max. Negotiated Rate	$641.58
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	$641.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$540.04
Rate for Payer: EmblemHealth Commercial	$136.66
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	$136.66
Rate for Payer: Healthfirst Essential Plan	$532.91
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$236.85

HC CT SCAN SKULL CONTRAST - CT AUDITORY CANALS/POSTERIOR FOSSA W IV CNT

Facility

$551.00

Service Code	CPT 70481 TC
Hospital Charge Code	3517048102
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 SKULL CONTRAST - CT ORBITS/SELLA W IV CONTRAST

Facility

$551.00

Service Code	CPT 70481 TC
Hospital Charge Code	3517048101
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 SKULL CONTRAST - CT ORBITS/SELLA W IV CONTRAST

Facility

$551.00

Service Code	CPT 70481 TC
Hospital Charge Code	3517048101
Hospital Revenue Code	351
Min. Negotiated Rate	$136.66
Max. Negotiated Rate	$641.58
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	$641.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$540.04
Rate for Payer: EmblemHealth Commercial	$136.66
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	$136.66
Rate for Payer: Healthfirst Essential Plan	$532.91
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$236.85

HC CT SCAN,SOFT TISSUE NECK,W/O CONTRAST - CT SOFT TISSUE NECK WO CONT

Facility

$339.00

Service Code	CPT 70490 TC
Hospital Charge Code	3517049001
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,SOFT TISSUE NECK,W/O CONTRAST - CT SOFT TISSUE NECK WO CONT

Facility

$339.00

Service Code	CPT 70490 TC
Hospital Charge Code	3517049001
Hospital Revenue Code	351
Min. Negotiated Rate	$96.62
Max. Negotiated Rate	$459.29
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	$96.62
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	$96.62
Rate for Payer: Healthfirst Essential Plan	$459.29
Rate for Payer: United Healthcare Commercial	$155.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$204.13

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

Facility

$339.00

Service Code	CPT 72128 TC
Hospital Charge Code	3527212801
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,THORACIC SPINE,W/O CONTRAST - CT THORACIC SPINE WO CONTRAST

Facility

$339.00

Service Code	CPT 72128 TC
Hospital Charge Code	3527212801
Hospital Revenue Code	352
Min. Negotiated Rate	$89.29
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	$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	$448.43
Rate for Payer: United Healthcare Commercial	$155.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$199.30

HC CT SCAN,THORAX,W/O CONTRAST - CT CHEST WO CONTRAST

Facility

$339.00

Service Code	CPT 71250 TC
Hospital Charge Code	3527125001
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,THORAX,W/O CONTRAST - CT CHEST WO CONTRAST

Facility

$339.00

Service Code	CPT 71250 TC
Hospital Charge Code	3527125001
Hospital Revenue Code	352
Min. Negotiated Rate	$88.59
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	$88.59
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	$88.59
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,THORAX,W/O CONTRAST - LDCT LUNG SCREENING

Facility

$339.00

Service Code	CPT 71250 TC
Hospital Charge Code	3527125002
Hospital Revenue Code	352
Min. Negotiated Rate	$88.59
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	$88.59
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	$88.59
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,THORAX,W/O CONTRAST - LDCT LUNG SCREENING

Facility

$339.00

Service Code	CPT 71250 TC
Hospital Charge Code	3527125002
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 UPPER EXTREMITY W/O DYE - CT ELBOW WO IV CONTRAST

Facility

$339.00

Service Code	CPT 73200 TC
Hospital Charge Code	3527320012
Hospital Revenue Code	352
Min. Negotiated Rate	$117.06
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	$122.34
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	$122.34
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 UPPER EXTREMITY W/O DYE - CT ELBOW WO IV CONTRAST

Facility

$339.00

Service Code	CPT 73200 TC
Hospital Charge Code	3527320012
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 UPPER EXTREMITY W/O DYE - CT HAND WO IV CONTRAST

Facility

$339.00

Service Code	CPT 73200 TC
Hospital Charge Code	3527320007
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 UPPER EXTREMITY W/O DYE - CT HAND WO IV CONTRAST

Facility

$339.00

Service Code	CPT 73200 TC
Hospital Charge Code	3527320007
Hospital Revenue Code	352
Min. Negotiated Rate	$117.06
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	$122.34
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	$122.34
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 UPPER EXTREMITY W/O DYE - CT RADIUS ULNA WO IV CONT

Facility

$339.00

Service Code	CPT 73200 TC
Hospital Charge Code	3527320003
Hospital Revenue Code	352
Min. Negotiated Rate	$117.06
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	$122.34
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	$122.34
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 UPPER EXTREMITY W/O DYE - CT RADIUS ULNA WO IV CONT

Facility

$339.00

Service Code	CPT 73200 TC
Hospital Charge Code	3527320003
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 UPPER EXTREMITY W/O DYE - CT SHOULDER WO IV CONTRAST

Facility

$339.00

Service Code	CPT 73200 TC
Hospital Charge Code	3527320001
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 UPPER EXTREMITY W/O DYE - CT SHOULDER WO IV CONTRAST

Facility

$339.00

Service Code	CPT 73200 TC
Hospital Charge Code	3527320001
Hospital Revenue Code	352
Min. Negotiated Rate	$117.06
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	$122.34
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	$122.34
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 UPPER EXTREMITY W/O DYE - CT UPPER EXT WO IV CONTRAST

Facility

$339.00

Service Code	CPT 73200 TC
Hospital Charge Code	3527320010
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