St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC MRI, CERV SPINE - MRI COMPLETE SPINE WO CONTRAST

Facility

$705.00

Service Code	CPT 72141 TC
Hospital Charge Code	6127214101
Hospital Revenue Code	612
Min. Negotiated Rate	$130.02
Max. Negotiated Rate	$762.98
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	$130.02
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	$130.02
Rate for Payer: Healthfirst Essential Plan	$762.98
Rate for Payer: United Healthcare Commercial	$274.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$339.10

HC MRI, CERV SPINE - MRI COMPLETE SPINE WO CONTRAST

Facility

$705.00

Service Code	CPT 72141 TC
Hospital Charge Code	6127214101
Hospital Revenue Code	612
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

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

Facility

$1,156.00

Service Code	CPT 71552 TC
Hospital Charge Code	6107155202
Hospital Revenue Code	610
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,152.92
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	$387.55
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	$387.55
Rate for Payer: Healthfirst Essential Plan	$1,152.92
Rate for Payer: United Healthcare Commercial	$426.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$512.41

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

Facility

$1,156.00

Service Code	CPT 71552 TC
Hospital Charge Code	6107155202
Hospital Revenue Code	610
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC MRI, CHEST - MRI CHEST WO CONTRAST

Facility

$705.00

Service Code	CPT 71550 TC
Hospital Charge Code	6107155001
Hospital Revenue Code	610
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC MRI, CHEST - MRI CHEST WO CONTRAST

Facility

$705.00

Service Code	CPT 71550 TC
Hospital Charge Code	6107155001
Hospital Revenue Code	610
Min. Negotiated Rate	$246.75
Max. Negotiated Rate	$751.86
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	$284.63
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	$284.63
Rate for Payer: Healthfirst Essential Plan	$751.86
Rate for Payer: United Healthcare Commercial	$274.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$334.16

HC MRI, CHEST, W/CONTRAST - MRI CHEST W CONTRAST

Facility

$2,062.00

Service Code	CPT 71551 TC
Hospital Charge Code	6107155101
Hospital Revenue Code	610
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,546.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,134.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$1,546.50
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	$312.24
Rate for Payer: Group Health Inc Commercial	$1,031.00
Rate for Payer: Group Health Inc Medicare	$721.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,031.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$312.24
Rate for Payer: Healthfirst Essential Plan	$872.82
Rate for Payer: United Healthcare Commercial	$349.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$387.92

HC MRI, CHEST, W/CONTRAST - MRI CHEST W CONTRAST

Facility

$2,062.00

Service Code	CPT 71551 TC
Hospital Charge Code	6107155101
Hospital Revenue Code	610
Min. Negotiated Rate	$1,031.00
Max. Negotiated Rate	$1,031.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.00

HC MRI, DORSAL SPINE COMBO - MRI THORACIC SPINE W WO CONTRAST

Facility

$1,156.00

Service Code	CPT 72157 TC
Hospital Charge Code	6127215701
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, DORSAL SPINE COMBO - MRI THORACIC SPINE W WO CONTRAST

Facility

$1,156.00

Service Code	CPT 72157 TC
Hospital Charge Code	6127215701
Hospital Revenue Code	612
Min. Negotiated Rate	$228.04
Max. Negotiated Rate	$1,175.58
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	$228.04
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	$228.04
Rate for Payer: Healthfirst Essential Plan	$1,175.58
Rate for Payer: United Healthcare Commercial	$426.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$522.48

HC MRI, DORSAL SPINE CONTRAST - MRI THORACIC SPINE W CONTRAST

Facility

$1,156.00

Service Code	CPT 72147 TC
Hospital Charge Code	6127214701
Hospital Revenue Code	612
Min. Negotiated Rate	$202.54
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	$202.54
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	$202.54
Rate for Payer: Healthfirst Essential Plan	$768.04
Rate for Payer: United Healthcare Commercial	$349.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$341.35

HC MRI, DORSAL SPINE CONTRAST - MRI THORACIC SPINE W CONTRAST

Facility

$1,156.00

Service Code	CPT 72147 TC
Hospital Charge Code	6127214701
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, DORSAL SPINE - MRI THORACIC SPINE WO CONTRAST

Facility

$705.00

Service Code	CPT 72146 TC
Hospital Charge Code	6127214602
Hospital Revenue Code	612
Min. Negotiated Rate	$130.37
Max. Negotiated Rate	$762.91
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	$130.37
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	$130.37
Rate for Payer: Healthfirst Essential Plan	$762.91
Rate for Payer: United Healthcare Commercial	$274.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$339.07

HC MRI, DORSAL SPINE - MRI THORACIC SPINE WO CONTRAST

Facility

$705.00

Service Code	CPT 72146 TC
Hospital Charge Code	6127214602
Hospital Revenue Code	612
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC MRI, FACE, NECK, COMBO - MRI NECK SOFT TISSUE ONLY W WO CONTRAST

Facility

$1,156.00

Service Code	CPT 70543 TC
Hospital Charge Code	6157054301
Hospital Revenue Code	615
Min. Negotiated Rate	$254.59
Max. Negotiated Rate	$1,142.06
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	$254.59
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	$254.59
Rate for Payer: Healthfirst Essential Plan	$1,142.06
Rate for Payer: United Healthcare Commercial	$426.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$507.58

HC MRI, FACE, NECK, COMBO - MRI NECK SOFT TISSUE ONLY W WO CONTRAST

Facility

$1,156.00

Service Code	CPT 70543 TC
Hospital Charge Code	6157054301
Hospital Revenue Code	615
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC MRI, FACE, NECK, COMBO - MR ORBIT FACE NECK W AND WO IV CONTRAST

Facility

$1,156.00

Service Code	CPT 70543 TC
Hospital Charge Code	6157054302
Hospital Revenue Code	615
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC MRI, FACE, NECK, COMBO - MR ORBIT FACE NECK W AND WO IV CONTRAST

Facility

$1,156.00

Service Code	CPT 70543 TC
Hospital Charge Code	6157054302
Hospital Revenue Code	615
Min. Negotiated Rate	$254.59
Max. Negotiated Rate	$1,142.06
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	$254.59
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	$254.59
Rate for Payer: Healthfirst Essential Plan	$1,142.06
Rate for Payer: United Healthcare Commercial	$426.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$507.58

HC MRI, FACE, NECK - MRI NECK SOFT TISSUE ONLY WO CONTRAST

Facility

$705.00

Service Code	CPT 70540 TC
Hospital Charge Code	6157054001
Hospital Revenue Code	615
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC MRI, FACE, NECK - MRI NECK SOFT TISSUE ONLY WO CONTRAST

Facility

$705.00

Service Code	CPT 70540 TC
Hospital Charge Code	6157054001
Hospital Revenue Code	615
Min. Negotiated Rate	$174.38
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	$174.38
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	$174.38
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 MRI, FACE, NECK - MR ORBIT FACE NECK WO IV CONTRAST

Facility

$705.00

Service Code	CPT 70540 TC
Hospital Charge Code	6157054002
Hospital Revenue Code	615
Min. Negotiated Rate	$174.38
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	$174.38
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	$174.38
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 MRI, FACE, NECK - MR ORBIT FACE NECK WO IV CONTRAST

Facility

$705.00

Service Code	CPT 70540 TC
Hospital Charge Code	6157054002
Hospital Revenue Code	615
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC MRI, FACE, NECK W/CONTRAST - MRI NECK SOFT TISSUE W CONTRAST

Facility

$1,156.00

Service Code	CPT 70542 TC
Hospital Charge Code	6157054201
Hospital Revenue Code	615
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC MRI, FACE, NECK W/CONTRAST - MRI NECK SOFT TISSUE W CONTRAST

Facility

$1,156.00

Service Code	CPT 70542 TC
Hospital Charge Code	6157054201
Hospital Revenue Code	615
Min. Negotiated Rate	$204.98
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	$204.98
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	$204.98
Rate for Payer: Healthfirst Essential Plan	$864.16
Rate for Payer: United Healthcare Commercial	$349.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$384.07

Know your out-of-pocket cost for care.

All Charges