St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC MRI, JOINT OF LEG W/CONTRAST - MR KNEE ARTHROGRAM

Facility

$2,062.00

Service Code	CPT 73722 TC
Hospital Charge Code	6147372201
Hospital Revenue Code	614
Min. Negotiated Rate	$1,031.00
Max. Negotiated Rate	$1,031.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.00

HC MRI, JOINT OF LEG W/CONTRAST - MR KNEE W IV CONTRAST

Facility

$2,062.00

Service Code	CPT 73722 TC
Hospital Charge Code	6147372209
Hospital Revenue Code	614
Min. Negotiated Rate	$252.50
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	$252.50
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	$252.50
Rate for Payer: Healthfirst Essential Plan	$864.09
Rate for Payer: United Healthcare Commercial	$349.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$384.04

HC MRI, JOINT OF LEG W/CONTRAST - MR KNEE W IV CONTRAST

Facility

$2,062.00

Service Code	CPT 73722 TC
Hospital Charge Code	6147372209
Hospital Revenue Code	614
Min. Negotiated Rate	$1,031.00
Max. Negotiated Rate	$1,031.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.00

HC MRI, JOINT UPPER EXTREM - MR BRACHIAL PLEXUS WO IV CONTRAST

Facility

$705.00

Service Code	CPT 73221 TC
Hospital Charge Code	6147322107
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, JOINT UPPER EXTREM - MR BRACHIAL PLEXUS WO IV CONTRAST

Facility

$705.00

Service Code	CPT 73221 TC
Hospital Charge Code	6147322107
Hospital Revenue Code	614
Min. Negotiated Rate	$150.49
Max. Negotiated Rate	$742.54
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	$150.49
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	$150.49
Rate for Payer: Healthfirst Essential Plan	$742.54
Rate for Payer: United Healthcare Commercial	$274.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$330.02

HC MRI, JOINT UPPER EXTREM - MR ELBOW WO IV CONTRAST

Facility

$705.00

Service Code	CPT 73221 TC
Hospital Charge Code	6147322103
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, JOINT UPPER EXTREM - MR ELBOW WO IV CONTRAST

Facility

$705.00

Service Code	CPT 73221 TC
Hospital Charge Code	6147322103
Hospital Revenue Code	614
Min. Negotiated Rate	$150.49
Max. Negotiated Rate	$742.54
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	$150.49
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	$150.49
Rate for Payer: Healthfirst Essential Plan	$742.54
Rate for Payer: United Healthcare Commercial	$274.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$330.02

HC MRI, JOINT UPPER EXTREM - MR SHOULDER WO IV CONTRAST

Facility

$705.00

Service Code	CPT 73221 TC
Hospital Charge Code	6147322105
Hospital Revenue Code	614
Min. Negotiated Rate	$150.49
Max. Negotiated Rate	$742.54
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	$150.49
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	$150.49
Rate for Payer: Healthfirst Essential Plan	$742.54
Rate for Payer: United Healthcare Commercial	$274.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$330.02

HC MRI, JOINT UPPER EXTREM - MR SHOULDER WO IV CONTRAST

Facility

$705.00

Service Code	CPT 73221 TC
Hospital Charge Code	6147322105
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, JOINT UPPER EXTREM - MR WRIST WO IV CONTRAST

Facility

$705.00

Service Code	CPT 73221 TC
Hospital Charge Code	6147322101
Hospital Revenue Code	614
Min. Negotiated Rate	$150.49
Max. Negotiated Rate	$742.54
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	$150.49
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	$150.49
Rate for Payer: Healthfirst Essential Plan	$742.54
Rate for Payer: United Healthcare Commercial	$274.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$330.02

HC MRI, JOINT UPPER EXTREM - MR WRIST WO IV CONTRAST

Facility

$705.00

Service Code	CPT 73221 TC
Hospital Charge Code	6147322101
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 JOINT UPR EXTREM W/DYE - MR ELBOW ARTHROGRAM

Facility

$2,062.00

Service Code	CPT 73222 TC
Hospital Charge Code	6147322202
Hospital Revenue Code	614
Min. Negotiated Rate	$250.75
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	$250.75
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	$250.75
Rate for Payer: Healthfirst Essential Plan	$864.09
Rate for Payer: United Healthcare Commercial	$349.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$384.04

HC MRI JOINT UPR EXTREM W/DYE - MR ELBOW ARTHROGRAM

Facility

$2,062.00

Service Code	CPT 73222 TC
Hospital Charge Code	6147322202
Hospital Revenue Code	614
Min. Negotiated Rate	$1,031.00
Max. Negotiated Rate	$1,031.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.00

HC MRI JOINT UPR EXTREM W/DYE - MR ELBOW W IV CONTRAST

Facility

$2,062.00

Service Code	CPT 73222 TC
Hospital Charge Code	6147322207
Hospital Revenue Code	614
Min. Negotiated Rate	$250.75
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	$250.75
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	$250.75
Rate for Payer: Healthfirst Essential Plan	$864.09
Rate for Payer: United Healthcare Commercial	$349.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$384.04

HC MRI JOINT UPR EXTREM W/DYE - MR ELBOW W IV CONTRAST

Facility

$2,062.00

Service Code	CPT 73222 TC
Hospital Charge Code	6147322207
Hospital Revenue Code	614
Min. Negotiated Rate	$1,031.00
Max. Negotiated Rate	$1,031.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.00

HC MRI JOINT UPR EXTREM W/DYE - MR SHOULDER ARTHROGRAM

Facility

$2,062.00

Service Code	CPT 73222 TC
Hospital Charge Code	6147322203
Hospital Revenue Code	614
Min. Negotiated Rate	$250.75
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	$250.75
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	$250.75
Rate for Payer: Healthfirst Essential Plan	$864.09
Rate for Payer: United Healthcare Commercial	$349.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$384.04

HC MRI JOINT UPR EXTREM W/DYE - MR SHOULDER ARTHROGRAM

Facility

$2,062.00

Service Code	CPT 73222 TC
Hospital Charge Code	6147322203
Hospital Revenue Code	614
Min. Negotiated Rate	$1,031.00
Max. Negotiated Rate	$1,031.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.00

HC MRI JOINT UPR EXTREM W/DYE - MR SHOULDER W IV CONTRAST

Facility

$2,062.00

Service Code	CPT 73222 TC
Hospital Charge Code	6147322208
Hospital Revenue Code	614
Min. Negotiated Rate	$1,031.00
Max. Negotiated Rate	$1,031.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.00

HC MRI JOINT UPR EXTREM W/DYE - MR SHOULDER W IV CONTRAST

Facility

$2,062.00

Service Code	CPT 73222 TC
Hospital Charge Code	6147322208
Hospital Revenue Code	614
Min. Negotiated Rate	$250.75
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	$250.75
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	$250.75
Rate for Payer: Healthfirst Essential Plan	$864.09
Rate for Payer: United Healthcare Commercial	$349.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$384.04

HC MRI JOINT UPR EXTREM W/DYE - MR WRIST ARTHROGRAM

Facility

$2,062.00

Service Code	CPT 73222 TC
Hospital Charge Code	6147322201
Hospital Revenue Code	614
Min. Negotiated Rate	$1,031.00
Max. Negotiated Rate	$1,031.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.00

HC MRI JOINT UPR EXTREM W/DYE - MR WRIST ARTHROGRAM

Facility

$2,062.00

Service Code	CPT 73222 TC
Hospital Charge Code	6147322201
Hospital Revenue Code	614
Min. Negotiated Rate	$250.75
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	$250.75
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	$250.75
Rate for Payer: Healthfirst Essential Plan	$864.09
Rate for Payer: United Healthcare Commercial	$349.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$384.04

HC MRI JOINT UPR EXTREM W/DYE - MR WRIST W IV CONTRAST

Facility

$2,062.00

Service Code	CPT 73222 TC
Hospital Charge Code	6147322213
Hospital Revenue Code	614
Min. Negotiated Rate	$1,031.00
Max. Negotiated Rate	$1,031.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.00

HC MRI JOINT UPR EXTREM W/DYE - MR WRIST W IV CONTRAST

Facility

$2,062.00

Service Code	CPT 73222 TC
Hospital Charge Code	6147322213
Hospital Revenue Code	614
Min. Negotiated Rate	$250.75
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	$250.75
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	$250.75
Rate for Payer: Healthfirst Essential Plan	$864.09
Rate for Payer: United Healthcare Commercial	$349.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$384.04

HC MRI JOINT UPR EXTR W/O&W/DYE - MR ELBOW W AND WO IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73223 TC
Hospital Charge Code	6147322302
Hospital Revenue Code	614
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,141.99
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	$302.81
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	$302.81
Rate for Payer: Healthfirst Essential Plan	$1,141.99
Rate for Payer: United Healthcare Commercial	$426.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$507.55

HC MRI JOINT UPR EXTR W/O&W/DYE - MR ELBOW W AND WO IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73223 TC
Hospital Charge Code	6147322302
Hospital Revenue Code	614
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

Know your out-of-pocket cost for care.

All Charges