St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC MR ANGIO, NECK W/CONTRAST - MR NECK ANGIO W IV CONTRAST

Facility

$1,156.00

Service Code	CPT 70548 TC
Hospital Charge Code	6157054801
Hospital Revenue Code	615
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC MR ANGIO PELVIS(MRA) - MR PELVIS ANGIO W AND WO IV CONTRAST

Facility

$1,461.00

Service Code	CPT 72198 TC
Hospital Charge Code	6147219802
Hospital Revenue Code	614
Min. Negotiated Rate	$730.50
Max. Negotiated Rate	$730.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$730.50

HC MR ANGIO PELVIS(MRA) - MR PELVIS ANGIO W AND WO IV CONTRAST

Facility

$1,461.00

Service Code	CPT 72198 TC
Hospital Charge Code	6147219802
Hospital Revenue Code	614
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,103.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$803.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$1,095.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,103.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$929.05
Rate for Payer: EmblemHealth Commercial	$272.27
Rate for Payer: Group Health Inc Commercial	$730.50
Rate for Payer: Group Health Inc Medicare	$511.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$730.50
Rate for Payer: Hamaspik Choice Inc Medicare	$730.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$272.27
Rate for Payer: Healthfirst Essential Plan	$806.26
Rate for Payer: United Healthcare Commercial	$295.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$358.34

HC MR ANGIO PELVIS(MRA) - MR PELVIS ANGIO W IV CONTRAST

Facility

$1,461.00

Service Code	CPT 72198 TC
Hospital Charge Code	6147219801
Hospital Revenue Code	614
Min. Negotiated Rate	$730.50
Max. Negotiated Rate	$730.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$730.50

HC MR ANGIO PELVIS(MRA) - MR PELVIS ANGIO W IV CONTRAST

Facility

$1,461.00

Service Code	CPT 72198 TC
Hospital Charge Code	6147219801
Hospital Revenue Code	614
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,103.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$803.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$1,095.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,103.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$929.05
Rate for Payer: EmblemHealth Commercial	$272.27
Rate for Payer: Group Health Inc Commercial	$730.50
Rate for Payer: Group Health Inc Medicare	$511.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$730.50
Rate for Payer: Hamaspik Choice Inc Medicare	$730.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$272.27
Rate for Payer: Healthfirst Essential Plan	$806.26
Rate for Payer: United Healthcare Commercial	$295.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$358.34

HC MR ANGIO PELVIS(MRA) - MR PELVIS ANGIO WO IV CONTRAST

Facility

$1,461.00

Service Code	CPT 72198 TC
Hospital Charge Code	6147219803
Hospital Revenue Code	614
Min. Negotiated Rate	$730.50
Max. Negotiated Rate	$730.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$730.50

HC MR ANGIO PELVIS(MRA) - MR PELVIS ANGIO WO IV CONTRAST

Facility

$1,461.00

Service Code	CPT 72198 TC
Hospital Charge Code	6147219803
Hospital Revenue Code	614
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,103.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$803.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$1,095.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,103.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$929.05
Rate for Payer: EmblemHealth Commercial	$272.27
Rate for Payer: Group Health Inc Commercial	$730.50
Rate for Payer: Group Health Inc Medicare	$511.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$730.50
Rate for Payer: Hamaspik Choice Inc Medicare	$730.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$272.27
Rate for Payer: Healthfirst Essential Plan	$806.26
Rate for Payer: United Healthcare Commercial	$295.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$358.34

HC MR ANGIO SPINE (MRA) - MR SPINE ANGIO W AND WO IV CONTRAST

Facility

$1,461.00

Service Code	CPT 72159 TC
Hospital Charge Code	6187215901
Hospital Revenue Code	618
Min. Negotiated Rate	$730.50
Max. Negotiated Rate	$730.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$730.50

HC MR ANGIO SPINE (MRA) - MR SPINE ANGIO W AND WO IV CONTRAST

Facility

$1,461.00

Service Code	CPT 72159 TC
Hospital Charge Code	6187215901
Hospital Revenue Code	618
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,247.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$803.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$1,095.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,247.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,049.92
Rate for Payer: EmblemHealth Commercial	$275.06
Rate for Payer: Group Health Inc Commercial	$730.50
Rate for Payer: Group Health Inc Medicare	$511.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$730.50
Rate for Payer: Hamaspik Choice Inc Medicare	$730.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$275.06
Rate for Payer: Healthfirst Essential Plan	$1,116.67
Rate for Payer: United Healthcare Commercial	$349.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$496.30

HC MR ANGIO SPINE (MRA) - MR SPINE ANGIO W IV CONTRAST

Facility

$1,461.00

Service Code	CPT 72159 TC
Hospital Charge Code	6187215902
Hospital Revenue Code	618
Min. Negotiated Rate	$730.50
Max. Negotiated Rate	$730.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$730.50

HC MR ANGIO SPINE (MRA) - MR SPINE ANGIO W IV CONTRAST

Facility

$1,461.00

Service Code	CPT 72159 TC
Hospital Charge Code	6187215902
Hospital Revenue Code	618
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,247.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$803.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$1,095.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,247.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,049.92
Rate for Payer: EmblemHealth Commercial	$275.06
Rate for Payer: Group Health Inc Commercial	$730.50
Rate for Payer: Group Health Inc Medicare	$511.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$730.50
Rate for Payer: Hamaspik Choice Inc Medicare	$730.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$275.06
Rate for Payer: Healthfirst Essential Plan	$1,116.67
Rate for Payer: United Healthcare Commercial	$349.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$496.30

HC MR ANGIO UPPER EXTREM - MR UPPER EXTREMITY ANGIO W IV CONTRAST

Facility

$1,461.00

Service Code	CPT 73225 TC
Hospital Charge Code	6107322504
Hospital Revenue Code	610
Min. Negotiated Rate	$730.50
Max. Negotiated Rate	$730.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$730.50

HC MR ANGIO UPPER EXTREM - MR UPPER EXTREMITY ANGIO W IV CONTRAST

Facility

$1,461.00

Service Code	CPT 73225 TC
Hospital Charge Code	6107322504
Hospital Revenue Code	610
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,232.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$803.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$1,095.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,232.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,037.02
Rate for Payer: EmblemHealth Commercial	$263.88
Rate for Payer: Group Health Inc Commercial	$730.50
Rate for Payer: Group Health Inc Medicare	$511.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$730.50
Rate for Payer: Hamaspik Choice Inc Medicare	$730.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$263.88
Rate for Payer: Healthfirst Essential Plan	$881.28
Rate for Payer: United Healthcare Commercial	$349.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$391.68

HC MR ANGIO UPPER EXTREM - MR UPPER EXTREMITY ANGIO WO IV CONTRAST

Facility

$1,461.00

Service Code	CPT 73225 TC
Hospital Charge Code	6107322508
Hospital Revenue Code	610
Min. Negotiated Rate	$730.50
Max. Negotiated Rate	$730.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$730.50

HC MR ANGIO UPPER EXTREM - MR UPPER EXTREMITY ANGIO WO IV CONTRAST

Facility

$1,461.00

Service Code	CPT 73225 TC
Hospital Charge Code	6107322508
Hospital Revenue Code	610
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,232.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$803.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$1,095.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,232.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,037.02
Rate for Payer: EmblemHealth Commercial	$263.88
Rate for Payer: Group Health Inc Commercial	$730.50
Rate for Payer: Group Health Inc Medicare	$511.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$730.50
Rate for Payer: Hamaspik Choice Inc Medicare	$730.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$263.88
Rate for Payer: Healthfirst Essential Plan	$881.28
Rate for Payer: United Healthcare Commercial	$349.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$391.68

HC MR ANGIO UPPER EXTREM - MR UPPER EXTREMITY ANGIO W/WO IV CONTRAST

Facility

$1,461.00

Service Code	CPT 73225 TC
Hospital Charge Code	6107322501
Hospital Revenue Code	610
Min. Negotiated Rate	$730.50
Max. Negotiated Rate	$730.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$730.50

HC MR ANGIO UPPER EXTREM - MR UPPER EXTREMITY ANGIO W/WO IV CONTRAST

Facility

$1,461.00

Service Code	CPT 73225 TC
Hospital Charge Code	6107322501
Hospital Revenue Code	610
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,232.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$803.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$1,095.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,232.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,037.02
Rate for Payer: EmblemHealth Commercial	$263.88
Rate for Payer: Group Health Inc Commercial	$730.50
Rate for Payer: Group Health Inc Medicare	$511.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$730.50
Rate for Payer: Hamaspik Choice Inc Medicare	$730.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$263.88
Rate for Payer: Healthfirst Essential Plan	$881.28
Rate for Payer: United Healthcare Commercial	$349.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$391.68

HC MR BRACHIAL PLEXUS

Facility

$705.00

Service Code	CPT 73218 TC
Hospital Charge Code	6147321807
Hospital Revenue Code	614
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC MR BRACHIAL PLEXUS

Facility

$705.00

Service Code	CPT 73218 TC
Hospital Charge Code	6147321807
Hospital Revenue Code	614
Min. Negotiated Rate	$246.75
Max. Negotiated Rate	$742.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$733.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$617.72
Rate for Payer: EmblemHealth Commercial	$253.89
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	$253.89
Rate for Payer: Healthfirst Essential Plan	$742.59
Rate for Payer: United Healthcare Commercial	$274.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$330.04

HC MR BREAST C- BILATERAL

Facility

$705.00

Service Code	CPT 77047 TC
Hospital Charge Code	6147704701
Hospital Revenue Code	614
Min. Negotiated Rate	$154.12
Max. Negotiated Rate	$564.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.40
Rate for Payer: EmblemHealth Commercial	$154.12
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	$154.12
Rate for Payer: Healthfirst Essential Plan	$470.05
Rate for Payer: United Healthcare Commercial	$184.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$208.91

HC MR BREAST C- BILATERAL

Facility

$705.00

Service Code	CPT 77047 TC
Hospital Charge Code	6147704701
Hospital Revenue Code	614
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC MR BREAST C- UNILATERAL

Facility

$705.00

Service Code	CPT 77046 TC
Hospital Charge Code	6147704601
Hospital Revenue Code	614
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC MR BREAST C- UNILATERAL

Facility

$705.00

Service Code	CPT 77046 TC
Hospital Charge Code	6147704601
Hospital Revenue Code	614
Min. Negotiated Rate	$154.83
Max. Negotiated Rate	$564.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.40
Rate for Payer: EmblemHealth Commercial	$154.83
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	$154.83
Rate for Payer: Healthfirst Essential Plan	$457.92
Rate for Payer: United Healthcare Commercial	$184.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$203.52

HC MR GUIDANCE FOR NEEDLE PLACE - MR GUIDED RENAL CYST ASPIR BILAT CHG

Facility

$2,176.00

Service Code	CPT 77021 TC
Hospital Charge Code	6107702121
Hospital Revenue Code	610
Min. Negotiated Rate	$1,088.00
Max. Negotiated Rate	$1,088.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,088.00

HC MR GUIDANCE FOR NEEDLE PLACE - MR GUIDED RENAL CYST ASPIR BILAT CHG

Facility

$2,176.00

Service Code	CPT 77021 TC
Hospital Charge Code	6107702121
Hospital Revenue Code	610
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,740.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,196.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$1,632.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,740.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,479.68
Rate for Payer: EmblemHealth Commercial	$362.89
Rate for Payer: Group Health Inc Commercial	$1,088.00
Rate for Payer: Group Health Inc Medicare	$761.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,088.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,088.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$362.89
Rate for Payer: Healthfirst Essential Plan	$631.35
Rate for Payer: Wellcare CHP/FHP/Medicaid	$280.60

Know your out-of-pocket cost for care.

All Charges