St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$1,156.00

Service Code	CPT 73223 TC
Hospital Charge Code	6147322303
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 SHOULDER W AND WO IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73223 TC
Hospital Charge Code	6147322303
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 JOINT UPR EXTR W/O&W/DYE - MR WRIST W AND WO IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73223 TC
Hospital Charge Code	6147322301
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 WRIST W AND WO IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73223 TC
Hospital Charge Code	6147322301
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, LOWER EXTREM - MR FEMUR WO IV CONTRAST

Facility

$705.00

Service Code	CPT 73718 TC
Hospital Charge Code	6147371802
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, LOWER EXTREM - MR FEMUR WO IV CONTRAST

Facility

$705.00

Service Code	CPT 73718 TC
Hospital Charge Code	6147371802
Hospital Revenue Code	614
Min. Negotiated Rate	$170.54
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	$170.54
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	$170.54
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, LOWER EXTREM - MR FOOT WO IV CONTRAST

Facility

$705.00

Service Code	CPT 73718 TC
Hospital Charge Code	6147371803
Hospital Revenue Code	614
Min. Negotiated Rate	$170.54
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	$170.54
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	$170.54
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, LOWER EXTREM - MR FOOT WO IV CONTRAST

Facility

$705.00

Service Code	CPT 73718 TC
Hospital Charge Code	6147371803
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, LOWER EXTREM - MR TIBIA FIBULA WO IV CONTRAST

Facility

$705.00

Service Code	CPT 73718 TC
Hospital Charge Code	6147371801
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, LOWER EXTREM - MR TIBIA FIBULA WO IV CONTRAST

Facility

$705.00

Service Code	CPT 73718 TC
Hospital Charge Code	6147371801
Hospital Revenue Code	614
Min. Negotiated Rate	$170.54
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	$170.54
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	$170.54
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, LOWER EXTREM W/CONTRAST - MR FEMUR W IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73719 TC
Hospital Charge Code	6147371905
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, LOWER EXTREM W/CONTRAST - MR FEMUR W IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73719 TC
Hospital Charge Code	6147371905
Hospital Revenue Code	614
Min. Negotiated Rate	$200.10
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	$200.10
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	$200.10
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

HC MRI, LOWER EXTREM W/CONTRAST - MR FOOT W IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73719 TC
Hospital Charge Code	6147371901
Hospital Revenue Code	614
Min. Negotiated Rate	$200.10
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	$200.10
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	$200.10
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

HC MRI, LOWER EXTREM W/CONTRAST - MR FOOT W IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73719 TC
Hospital Charge Code	6147371901
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, LOWER EXTREM W/CONTRAST - MR TIBIA FIBULA W IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73719 TC
Hospital Charge Code	6147371903
Hospital Revenue Code	614
Min. Negotiated Rate	$200.10
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	$200.10
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	$200.10
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

HC MRI, LOWER EXTREM W/CONTRAST - MR TIBIA FIBULA W IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73719 TC
Hospital Charge Code	6147371903
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, LUMBAR SPINE COMBO - MRI LUMBAR SPINE W WO CONTRAST

Facility

$1,156.00

Service Code	CPT 72158 TC
Hospital Charge Code	6127215801
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, LUMBAR SPINE COMBO - MRI LUMBAR SPINE W WO CONTRAST

Facility

$1,156.00

Service Code	CPT 72158 TC
Hospital Charge Code	6127215801
Hospital Revenue Code	612
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, LUMBAR SPINE CONTRAST - MRI LUMBAR SPINE W CONTRAST

Facility

$1,156.00

Service Code	CPT 72149 TC
Hospital Charge Code	6127214901
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, LUMBAR SPINE CONTRAST - MRI LUMBAR SPINE W CONTRAST

Facility

$1,156.00

Service Code	CPT 72149 TC
Hospital Charge Code	6127214901
Hospital Revenue Code	612
Min. Negotiated Rate	$199.75
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	$199.75
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	$199.75
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, LUMBAR SPINE - MRI COMPLETE SPINE WO CONTRAST

Facility

$705.00

Service Code	CPT 72148 TC
Hospital Charge Code	6127214801
Hospital Revenue Code	612
Min. Negotiated Rate	$130.72
Max. Negotiated Rate	$752.85
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	$130.72
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	$130.72
Rate for Payer: Healthfirst Essential Plan	$752.85
Rate for Payer: United Healthcare Commercial	$274.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$334.60

HC MRI, LUMBAR SPINE - MRI COMPLETE SPINE WO CONTRAST

Facility

$705.00

Service Code	CPT 72148 TC
Hospital Charge Code	6127214801
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, LUMBAR SPINE - MRI LUMBAR SPINE WO CONTRAST

Facility

$705.00

Service Code	CPT 72148 TC
Hospital Charge Code	6127214802
Hospital Revenue Code	612
Min. Negotiated Rate	$130.72
Max. Negotiated Rate	$752.85
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	$130.72
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	$130.72
Rate for Payer: Healthfirst Essential Plan	$752.85
Rate for Payer: United Healthcare Commercial	$274.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$334.60

HC MRI, LUMBAR SPINE - MRI LUMBAR SPINE WO CONTRAST

Facility

$705.00

Service Code	CPT 72148 TC
Hospital Charge Code	6127214802
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 LWR EXTREMITY W/O&W/DYE - MR FEMUR W AND WO IV CONT

Facility

$1,156.00

Service Code	CPT 73720 TC
Hospital Charge Code	6147372003
Hospital Revenue Code	614
Min. Negotiated Rate	$252.14
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	$252.14
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	$252.14
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

Know your out-of-pocket cost for care.

All Charges