St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

HC MRI LWR EXTREMITY W/O&W/DYE - MR FOOT W AND WO IV CONT

Facility

$1,156.00

Service Code	CPT 73720 TC
Hospital Charge Code	6147372001
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 LWR EXTREMITY W/O&W/DYE - MR FOOT W AND WO IV CONT

Facility

$1,156.00

Service Code	CPT 73720 TC
Hospital Charge Code	6147372001
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

HC MRI LWR EXTREMITY W/O&W/DYE - MR TIBIA FIBULA W AND WO IV CONT

Facility

$1,156.00

Service Code	CPT 73720 TC
Hospital Charge Code	6147372002
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

HC MRI LWR EXTREMITY W/O&W/DYE - MR TIBIA FIBULA W AND WO IV CONT

Facility

$1,156.00

Service Code	CPT 73720 TC
Hospital Charge Code	6147372002
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, PELVIS, COMBO - MRI PELVIS W WO CONTRAST

Facility

$1,156.00

Service Code	CPT 72197 TC
Hospital Charge Code	6147219701
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, PELVIS, COMBO - MRI PELVIS W WO CONTRAST

Facility

$1,156.00

Service Code	CPT 72197 TC
Hospital Charge Code	6147219701
Hospital Revenue Code	614
Min. Negotiated Rate	$249.71
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	$249.71
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	$249.71
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, PELVIS W/CONTRAST - MRI PELVIS W CONTRAST

Facility

$1,156.00

Service Code	CPT 72196 TC
Hospital Charge Code	6147219601
Hospital Revenue Code	614
Min. Negotiated Rate	$201.14
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	$201.14
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	$201.14
Rate for Payer: Healthfirst Essential Plan	$873.34
Rate for Payer: United Healthcare Commercial	$349.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$388.15

HC MRI, PELVIS W/CONTRAST - MRI PELVIS W CONTRAST

Facility

$1,156.00

Service Code	CPT 72196 TC
Hospital Charge Code	6147219601
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, PELVIS, W/O CONTRAST - MRI PELVIS WO CONTRAST

Facility

$705.00

Service Code	CPT 72195 TC
Hospital Charge Code	6147219501
Hospital Revenue Code	614
Min. Negotiated Rate	$170.89
Max. Negotiated Rate	$751.73
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	$170.89
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	$170.89
Rate for Payer: Healthfirst Essential Plan	$751.73
Rate for Payer: United Healthcare Commercial	$274.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$334.10

HC MRI, PELVIS, W/O CONTRAST - MRI PELVIS WO CONTRAST

Facility

$705.00

Service Code	CPT 72195 TC
Hospital Charge Code	6147219501
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, TMJ - MR TEMPOROMANDIBULAR JOINTS WO IV CONTRAST

Facility

$705.00

Service Code	CPT 70336 TC
Hospital Charge Code	6147033601
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, TMJ - MR TEMPOROMANDIBULAR JOINTS WO IV CONTRAST

Facility

$705.00

Service Code	CPT 70336 TC
Hospital Charge Code	6147033601
Hospital Revenue Code	614
Min. Negotiated Rate	$206.73
Max. Negotiated Rate	$733.88
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	$206.73
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	$206.73
Rate for Payer: Healthfirst Essential Plan	$693.74
Rate for Payer: United Healthcare Commercial	$274.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$308.33

HC MRI UPPER EXTREMITY COMBO - MR BRACHIAL PLEXUS W AND WO IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73220 TC
Hospital Charge Code	6147322007
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 UPPER EXTREMITY COMBO - MR BRACHIAL PLEXUS W AND WO IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73220 TC
Hospital Charge Code	6147322007
Hospital Revenue Code	614
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,142.75
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	$328.51
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	$328.51
Rate for Payer: Healthfirst Essential Plan	$1,142.75
Rate for Payer: United Healthcare Commercial	$426.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$507.89

HC MRI UPPER EXTREMITY COMBO - MR FOREARM W AND WO IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73220 TC
Hospital Charge Code	6147322001
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 UPPER EXTREMITY COMBO - MR FOREARM W AND WO IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73220 TC
Hospital Charge Code	6147322001
Hospital Revenue Code	614
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,142.75
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	$328.51
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	$328.51
Rate for Payer: Healthfirst Essential Plan	$1,142.75
Rate for Payer: United Healthcare Commercial	$426.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$507.89

HC MRI UPPER EXTREMITY COMBO - MR HAND W AND WO IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73220 TC
Hospital Charge Code	6147322003
Hospital Revenue Code	614
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,142.75
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	$328.51
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	$328.51
Rate for Payer: Healthfirst Essential Plan	$1,142.75
Rate for Payer: United Healthcare Commercial	$426.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$507.89

HC MRI UPPER EXTREMITY COMBO - MR HAND W AND WO IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73220 TC
Hospital Charge Code	6147322003
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 UPPER EXTREMITY COMBO - MR HUMERUS W AND WO IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73220 TC
Hospital Charge Code	6147322005
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 UPPER EXTREMITY COMBO - MR HUMERUS W AND WO IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73220 TC
Hospital Charge Code	6147322005
Hospital Revenue Code	614
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,142.75
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	$328.51
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	$328.51
Rate for Payer: Healthfirst Essential Plan	$1,142.75
Rate for Payer: United Healthcare Commercial	$426.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$507.89

HC MRI, UPPER EXTREMITY W/CONTRAST - MR BRACHIAL PLEXUS W IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73219 TC
Hospital Charge Code	6147321907
Hospital Revenue Code	614
Min. Negotiated Rate	$259.35
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	$271.36
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	$271.36
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, UPPER EXTREMITY W/CONTRAST - MR BRACHIAL PLEXUS W IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73219 TC
Hospital Charge Code	6147321907
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, UPPER EXTREMITY W/CONTRAST - MR HAND W IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73219 TC
Hospital Charge Code	6147321903
Hospital Revenue Code	614
Min. Negotiated Rate	$259.35
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	$271.36
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	$271.36
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, UPPER EXTREMITY W/CONTRAST - MR HAND W IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73219 TC
Hospital Charge Code	6147321903
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