St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC MRI, ABDOMEN, COMBO - MRI ABDOMEN RENAL W WO CONTRAST

Facility

$1,156.00

Service Code	CPT 74183 TC
Hospital Charge Code	6147418302
Hospital Revenue Code	614
Min. Negotiated Rate	$251.10
Max. Negotiated Rate	$1,151.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,141.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$961.17
Rate for Payer: EmblemHealth Commercial	$251.10
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	$251.10
Rate for Payer: Healthfirst Essential Plan	$1,151.19
Rate for Payer: United Healthcare Commercial	$426.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$511.64

HC MRI, ABDOMEN, COMBO - MRI ABDOMEN RENAL W WO CONTRAST

Facility

$1,156.00

Service Code	CPT 74183 TC
Hospital Charge Code	6147418302
Hospital Revenue Code	614
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC MRI, ABDOMEN, COMBO - MRI ABDOMEN W WO CONTRAST

Facility

$1,156.00

Service Code	CPT 74183 TC
Hospital Charge Code	6147418303
Hospital Revenue Code	614
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC MRI, ABDOMEN, COMBO - MRI ABDOMEN W WO CONTRAST

Facility

$1,156.00

Service Code	CPT 74183 TC
Hospital Charge Code	6147418303
Hospital Revenue Code	614
Min. Negotiated Rate	$251.10
Max. Negotiated Rate	$1,151.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,141.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$961.17
Rate for Payer: EmblemHealth Commercial	$251.10
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	$251.10
Rate for Payer: Healthfirst Essential Plan	$1,151.19
Rate for Payer: United Healthcare Commercial	$426.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$511.64

HC MRI, ABDOMEN (MRI) - MRI ABDOMEN WO CONTRAST

Facility

$705.00

Service Code	CPT 74181 TC
Hospital Charge Code	6147418102
Hospital Revenue Code	614
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC MRI, ABDOMEN (MRI) - MRI ABDOMEN WO CONTRAST

Facility

$705.00

Service Code	CPT 74181 TC
Hospital Charge Code	6147418102
Hospital Revenue Code	614
Min. Negotiated Rate	$136.66
Max. Negotiated Rate	$752.24
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	$136.66
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	$136.66
Rate for Payer: Healthfirst Essential Plan	$752.24
Rate for Payer: United Healthcare Commercial	$274.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$334.33

HC MRI, ABDOMEN (MRI) - MRI ABDOMEN WO CONTRAST MRCP

Facility

$705.00

Service Code	CPT 74181 TC
Hospital Charge Code	6147418101
Hospital Revenue Code	614
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC MRI, ABDOMEN (MRI) - MRI ABDOMEN WO CONTRAST MRCP

Facility

$705.00

Service Code	CPT 74181 TC
Hospital Charge Code	6147418101
Hospital Revenue Code	614
Min. Negotiated Rate	$136.66
Max. Negotiated Rate	$752.24
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	$136.66
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	$136.66
Rate for Payer: Healthfirst Essential Plan	$752.24
Rate for Payer: United Healthcare Commercial	$274.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$334.33

HC MRI, ABDOMEN W/CONTRAST - MRI ABDOMEN W CONTRAST

Facility

$1,156.00

Service Code	CPT 74182 TC
Hospital Charge Code	6147418202
Hospital Revenue Code	614
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC MRI, ABDOMEN W/CONTRAST - MRI ABDOMEN W CONTRAST

Facility

$1,156.00

Service Code	CPT 74182 TC
Hospital Charge Code	6147418202
Hospital Revenue Code	614
Min. Negotiated Rate	$236.77
Max. Negotiated Rate	$935.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$935.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$787.13
Rate for Payer: EmblemHealth Commercial	$236.77
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	$236.77
Rate for Payer: Healthfirst Essential Plan	$873.45
Rate for Payer: United Healthcare Commercial	$349.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$388.20

HC MRI, ABDOMEN W/CONTRAST - MRI ABDOMEN W CONTRAST MRCP

Facility

$1,156.00

Service Code	CPT 74182 TC
Hospital Charge Code	6147418201
Hospital Revenue Code	614
Min. Negotiated Rate	$236.77
Max. Negotiated Rate	$935.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$935.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$787.13
Rate for Payer: EmblemHealth Commercial	$236.77
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	$236.77
Rate for Payer: Healthfirst Essential Plan	$873.45
Rate for Payer: United Healthcare Commercial	$349.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$388.20

HC MRI, ABDOMEN W/CONTRAST - MRI ABDOMEN W CONTRAST MRCP

Facility

$1,156.00

Service Code	CPT 74182 TC
Hospital Charge Code	6147418201
Hospital Revenue Code	614
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC MRI BRAIN COMBO - MRI BRAIN W WO CONTRAST

Facility

$1,156.00

Service Code	CPT 70553 TC
Hospital Charge Code	6117055302
Hospital Revenue Code	611
Min. Negotiated Rate	$226.65
Max. Negotiated Rate	$1,158.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,141.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$961.17
Rate for Payer: EmblemHealth Commercial	$226.65
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	$226.65
Rate for Payer: Healthfirst Essential Plan	$1,158.39
Rate for Payer: United Healthcare Commercial	$426.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$514.84

HC MRI BRAIN COMBO - MRI BRAIN W WO CONTRAST

Facility

$1,156.00

Service Code	CPT 70553 TC
Hospital Charge Code	6117055302
Hospital Revenue Code	611
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC MRI BRAIN CONTRAST - MRI BRAIN W CONTRAST

Facility

$1,156.00

Service Code	CPT 70552 TC
Hospital Charge Code	6117055202
Hospital Revenue Code	611
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC MRI BRAIN CONTRAST - MRI BRAIN W CONTRAST

Facility

$1,156.00

Service Code	CPT 70552 TC
Hospital Charge Code	6117055202
Hospital Revenue Code	611
Min. Negotiated Rate	$200.79
Max. Negotiated Rate	$935.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$935.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$787.13
Rate for Payer: EmblemHealth Commercial	$200.79
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	$200.79
Rate for Payer: Healthfirst Essential Plan	$877.30
Rate for Payer: United Healthcare Commercial	$349.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$389.91

HC MRI BRAIN - MRI BRAIN WO CONTRAST

Facility

$705.00

Service Code	CPT 70551 TC
Hospital Charge Code	6117055102
Hospital Revenue Code	611
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC MRI BRAIN - MRI BRAIN WO CONTRAST

Facility

$705.00

Service Code	CPT 70551 TC
Hospital Charge Code	6117055102
Hospital Revenue Code	611
Min. Negotiated Rate	$136.66
Max. Negotiated Rate	$752.47
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	$136.66
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	$136.66
Rate for Payer: Healthfirst Essential Plan	$752.47
Rate for Payer: United Healthcare Commercial	$274.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$334.43

HC MRI BREAST C- & C+ W/CAD BILAT

Facility

$2,500.00

Service Code	CPT 77049 TC
Hospital Charge Code	6147704901
Hospital Revenue Code	614
Min. Negotiated Rate	$234.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,375.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$1,875.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,700.00
Rate for Payer: EmblemHealth Commercial	$250.40
Rate for Payer: Group Health Inc Commercial	$1,250.00
Rate for Payer: Group Health Inc Medicare	$875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,250.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$250.40
Rate for Payer: Healthfirst Essential Plan	$743.22
Rate for Payer: United Healthcare Commercial	$234.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$330.32

HC MRI BREAST C- & C+ W/CAD BILAT

Facility

$2,500.00

Service Code	CPT 77049 TC
Hospital Charge Code	6147704901
Hospital Revenue Code	614
Min. Negotiated Rate	$1,250.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,250.00

HC MRI BREAST C- & C+ W/CAD UNI

Facility

$1,250.00

Service Code	CPT 77048 TC
Hospital Charge Code	6147704801
Hospital Revenue Code	614
Min. Negotiated Rate	$235.55
Max. Negotiated Rate	$1,000.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$687.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$937.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$850.00
Rate for Payer: EmblemHealth Commercial	$253.55
Rate for Payer: Group Health Inc Commercial	$625.00
Rate for Payer: Group Health Inc Medicare	$437.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$625.00
Rate for Payer: Hamaspik Choice Inc Medicare	$625.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$253.55
Rate for Payer: Healthfirst Essential Plan	$727.94
Rate for Payer: United Healthcare Commercial	$235.55
Rate for Payer: Wellcare CHP/FHP/Medicaid	$323.53

HC MRI BREAST C- & C+ W/CAD UNI

Facility

$1,250.00

Service Code	CPT 77048 TC
Hospital Charge Code	6147704801
Hospital Revenue Code	614
Min. Negotiated Rate	$625.00
Max. Negotiated Rate	$625.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$625.00

HC MRI, CERV SPINE COMBO - MRI CERVICAL SPINE W WO CONTRAST

Facility

$1,156.00

Service Code	CPT 72156 TC
Hospital Charge Code	6127215601
Hospital Revenue Code	612
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC MRI, CERV SPINE COMBO - MRI CERVICAL SPINE W WO CONTRAST

Facility

$1,156.00

Service Code	CPT 72156 TC
Hospital Charge Code	6127215601
Hospital Revenue Code	612
Min. Negotiated Rate	$227.34
Max. Negotiated Rate	$1,175.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,141.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$961.17
Rate for Payer: EmblemHealth Commercial	$227.34
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	$227.34
Rate for Payer: Healthfirst Essential Plan	$1,175.76
Rate for Payer: United Healthcare Commercial	$426.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$522.56

HC MRI, CERV SPINE CONTRAST - MRI CERVICAL SPINE W CONTRAST

Facility

$1,156.00

Service Code	CPT 72142 TC
Hospital Charge Code	6127214201
Hospital Revenue Code	612
Min. Negotiated Rate	$204.63
Max. Negotiated Rate	$935.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$935.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$787.13
Rate for Payer: EmblemHealth Commercial	$204.63
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	$204.63
Rate for Payer: Healthfirst Essential Plan	$888.64
Rate for Payer: United Healthcare Commercial	$349.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$394.95

Know your out-of-pocket cost for care.

All Charges