St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG MRA HEAD W/O CONTRST MATERIAL

Professional

Both

$724.22

Service Code	HCPCS 70544 TC
Min. Negotiated Rate	$543.16
Max. Negotiated Rate	$543.16
Rate for Payer: Cash Price	$195.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$543.16
Rate for Payer: SOMOS Essential	$543.16

CHG MRA HEAD W/O & W/CONTRAST MATERIAL

Professional

Both

$283.43

Service Code	HCPCS 70546 26
Min. Negotiated Rate	$212.57
Max. Negotiated Rate	$212.57
Rate for Payer: Cash Price	$77.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$212.57
Rate for Payer: SOMOS Essential	$212.57

CHG MRA HEAD W/O & W/CONTRAST MATERIAL

Professional

Both

$1,467.38

Service Code	HCPCS 70546
Min. Negotiated Rate	$1,100.54
Max. Negotiated Rate	$1,100.54
Rate for Payer: Cash Price	$396.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,100.54
Rate for Payer: SOMOS Essential	$1,100.54

CHG MRA HEAD W/O & W/CONTRAST MATERIAL

Professional

Both

$1,183.95

Service Code	HCPCS 70546 TC
Min. Negotiated Rate	$887.96
Max. Negotiated Rate	$887.96
Rate for Payer: Cash Price	$319.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$887.96
Rate for Payer: SOMOS Essential	$887.96

CHG MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL

Professional

Both

$1,148.00

Service Code	HCPCS 73725 TC
Min. Negotiated Rate	$861.00
Max. Negotiated Rate	$861.00
Rate for Payer: Cash Price	$308.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$861.00
Rate for Payer: SOMOS Essential	$861.00

CHG MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL

Professional

Both

$1,492.44

Service Code	HCPCS 73725
Min. Negotiated Rate	$1,119.33
Max. Negotiated Rate	$1,119.33
Rate for Payer: Cash Price	$402.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,119.33
Rate for Payer: SOMOS Essential	$1,119.33

CHG MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL

Professional

Both

$344.44

Service Code	HCPCS 73725 26
Min. Negotiated Rate	$258.33
Max. Negotiated Rate	$258.33
Rate for Payer: Cash Price	$93.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$258.33
Rate for Payer: SOMOS Essential	$258.33

CHG MRA NECK W/CONTRAST MATERIAL

Professional

Both

$804.44

Service Code	HCPCS 70548 TC
Min. Negotiated Rate	$603.33
Max. Negotiated Rate	$603.33
Rate for Payer: Cash Price	$216.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$603.33
Rate for Payer: SOMOS Essential	$603.33

CHG MRA NECK W/CONTRAST MATERIAL

Professional

Both

$1,091.83

Service Code	HCPCS 70548
Min. Negotiated Rate	$818.87
Max. Negotiated Rate	$818.87
Rate for Payer: Cash Price	$294.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$818.87
Rate for Payer: SOMOS Essential	$818.87

CHG MRA NECK W/CONTRAST MATERIAL

Professional

Both

$287.39

Service Code	HCPCS 70548 26
Min. Negotiated Rate	$215.54
Max. Negotiated Rate	$215.54
Rate for Payer: Cash Price	$78.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$215.54
Rate for Payer: SOMOS Essential	$215.54

CHG MRA NECK W/O CONTRST MATERIAL

Professional

Both

$725.66

Service Code	HCPCS 70547 TC
Min. Negotiated Rate	$544.24
Max. Negotiated Rate	$544.24
Rate for Payer: Cash Price	$196.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$544.24
Rate for Payer: SOMOS Essential	$544.24

CHG MRA NECK W/O CONTRST MATERIAL

Professional

Both

$229.95

Service Code	HCPCS 70547 26
Min. Negotiated Rate	$172.46
Max. Negotiated Rate	$172.46
Rate for Payer: Cash Price	$62.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$172.46
Rate for Payer: SOMOS Essential	$172.46

CHG MRA NECK W/O CONTRST MATERIAL

Professional

Both

$955.61

Service Code	HCPCS 70547
Min. Negotiated Rate	$716.71
Max. Negotiated Rate	$716.71
Rate for Payer: Cash Price	$258.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$716.71
Rate for Payer: SOMOS Essential	$716.71

CHG MRA NECK W/O &W/CONTRAST MATERIAL

Professional

Both

$1,189.69

Service Code	HCPCS 70549 TC
Min. Negotiated Rate	$892.27
Max. Negotiated Rate	$892.27
Rate for Payer: Cash Price	$320.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$892.27
Rate for Payer: SOMOS Essential	$892.27

CHG MRA NECK W/O &W/CONTRAST MATERIAL

Professional

Both

$346.26

Service Code	HCPCS 70549 26
Min. Negotiated Rate	$259.70
Max. Negotiated Rate	$259.70
Rate for Payer: Cash Price	$93.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$259.70
Rate for Payer: SOMOS Essential	$259.70

CHG MRA NECK W/O &W/CONTRAST MATERIAL

Professional

Both

$1,535.94

Service Code	HCPCS 70549
Min. Negotiated Rate	$1,151.96
Max. Negotiated Rate	$1,151.96
Rate for Payer: Cash Price	$413.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,151.96
Rate for Payer: SOMOS Essential	$1,151.96

CHG MRA PELVIS W/WO CONTRAST MATERIAL

Professional

Both

$1,504.30

Service Code	HCPCS 72198
Min. Negotiated Rate	$1,128.22
Max. Negotiated Rate	$1,128.22
Rate for Payer: Cash Price	$404.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,128.22
Rate for Payer: SOMOS Essential	$1,128.22

CHG MRA PELVIS W/WO CONTRAST MATERIAL

Professional

Both

$1,160.95

Service Code	HCPCS 72198 TC
Min. Negotiated Rate	$870.71
Max. Negotiated Rate	$870.71
Rate for Payer: Cash Price	$312.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$870.71
Rate for Payer: SOMOS Essential	$870.71

CHG MRA PELVIS W/WO CONTRAST MATERIAL

Professional

Both

$343.39

Service Code	HCPCS 72198 26
Min. Negotiated Rate	$257.54
Max. Negotiated Rate	$257.54
Rate for Payer: Cash Price	$92.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$257.54
Rate for Payer: SOMOS Essential	$257.54

CHG MRA SPINAL CANAL W/WO CONTRAST MATERIAL

Professional

Both

$1,193.99

Service Code	HCPCS 72159 TC
Min. Negotiated Rate	$895.49
Max. Negotiated Rate	$895.49
Rate for Payer: Cash Price	$320.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$895.49
Rate for Payer: SOMOS Essential	$895.49

CHG MRA SPINAL CANAL W/WO CONTRAST MATERIAL

Professional

Both

$1,541.68

Service Code	HCPCS 72159
Min. Negotiated Rate	$1,156.26
Max. Negotiated Rate	$1,156.26
Rate for Payer: Cash Price	$413.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,156.26
Rate for Payer: SOMOS Essential	$1,156.26

CHG MRA SPINAL CANAL W/WO CONTRAST MATERIAL

Professional

Both

$347.69

Service Code	HCPCS 72159 26
Min. Negotiated Rate	$260.77
Max. Negotiated Rate	$260.77
Rate for Payer: Cash Price	$93.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$260.77
Rate for Payer: SOMOS Essential	$260.77

CHG MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL

Professional

Both

$334.60

Service Code	HCPCS 73225 26
Min. Negotiated Rate	$250.95
Max. Negotiated Rate	$250.95
Rate for Payer: Cash Price	$89.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$250.95
Rate for Payer: SOMOS Essential	$250.95

CHG MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL

Professional

Both

$1,193.99

Service Code	HCPCS 73225 TC
Min. Negotiated Rate	$895.49
Max. Negotiated Rate	$895.49
Rate for Payer: Cash Price	$320.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$895.49
Rate for Payer: SOMOS Essential	$895.49

CHG MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL

Professional

Both

$1,528.59

Service Code	HCPCS 73225
Min. Negotiated Rate	$1,146.44
Max. Negotiated Rate	$1,146.44
Rate for Payer: Cash Price	$410.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,146.44
Rate for Payer: SOMOS Essential	$1,146.44

Know your out-of-pocket cost for care.

All Charges