St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL

Professional

Both

$1,316.18

Service Code	HCPCS 73223 TC
Min. Negotiated Rate	$987.14
Max. Negotiated Rate	$987.14
Rate for Payer: Cash Price	$351.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$987.14
Rate for Payer: SOMOS Essential	$987.14

CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL

Professional

Both

$1,729.14

Service Code	HCPCS 73223
Min. Negotiated Rate	$1,296.86
Max. Negotiated Rate	$1,296.86
Rate for Payer: Cash Price	$463.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,296.86
Rate for Payer: SOMOS Essential	$1,296.86

CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL

Professional

Both

$343.74

Service Code	HCPCS 70552 26
Min. Negotiated Rate	$257.80
Max. Negotiated Rate	$257.80
Rate for Payer: Cash Price	$92.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$257.80
Rate for Payer: SOMOS Essential	$257.80

CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL

Professional

Both

$1,201.38

Service Code	HCPCS 70552
Min. Negotiated Rate	$901.04
Max. Negotiated Rate	$901.04
Rate for Payer: Cash Price	$322.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$901.04
Rate for Payer: SOMOS Essential	$901.04

CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL

Professional

Both

$857.64

Service Code	HCPCS 70552 TC
Min. Negotiated Rate	$643.23
Max. Negotiated Rate	$643.23
Rate for Payer: Cash Price	$230.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$643.23
Rate for Payer: SOMOS Essential	$643.23

CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL

Professional

Both

$284.87

Service Code	HCPCS 70551 26
Min. Negotiated Rate	$213.65
Max. Negotiated Rate	$213.65
Rate for Payer: Cash Price	$77.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$213.65
Rate for Payer: SOMOS Essential	$213.65

CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL

Professional

Both

$863.91

Service Code	HCPCS 70551
Min. Negotiated Rate	$647.93
Max. Negotiated Rate	$647.93
Rate for Payer: Cash Price	$233.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$647.93
Rate for Payer: SOMOS Essential	$647.93

CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL

Professional

Both

$579.04

Service Code	HCPCS 70551 TC
Min. Negotiated Rate	$434.28
Max. Negotiated Rate	$434.28
Rate for Payer: Cash Price	$156.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$434.28
Rate for Payer: SOMOS Essential	$434.28

CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL

Professional

Both

$1,410.15

Service Code	HCPCS 70553
Min. Negotiated Rate	$1,057.61
Max. Negotiated Rate	$1,057.61
Rate for Payer: Cash Price	$379.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,057.61
Rate for Payer: SOMOS Essential	$1,057.61

CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL

Professional

Both

$438.97

Service Code	HCPCS 70553 26
Min. Negotiated Rate	$329.23
Max. Negotiated Rate	$329.23
Rate for Payer: Cash Price	$118.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$329.23
Rate for Payer: SOMOS Essential	$329.23

CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL

Professional

Both

$971.18

Service Code	HCPCS 70553 TC
Min. Negotiated Rate	$728.38
Max. Negotiated Rate	$728.38
Rate for Payer: Cash Price	$260.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$728.38
Rate for Payer: SOMOS Essential	$728.38

CHG MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION

Professional

Both

$1,280.27

Service Code	HCPCS 70554 TC
Min. Negotiated Rate	$960.20
Max. Negotiated Rate	$960.20
Rate for Payer: Cash Price	$344.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$960.20
Rate for Payer: SOMOS Essential	$960.20

CHG MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION

Professional

Both

$1,686.62

Service Code	HCPCS 70554
Min. Negotiated Rate	$1,264.96
Max. Negotiated Rate	$1,264.96
Rate for Payer: Cash Price	$455.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,264.96
Rate for Payer: SOMOS Essential	$1,264.96

CHG MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION

Professional

Both

$406.35

Service Code	HCPCS 70554 26
Min. Negotiated Rate	$304.76
Max. Negotiated Rate	$304.76
Rate for Payer: Cash Price	$110.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$304.76
Rate for Payer: SOMOS Essential	$304.76

CHG MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION

Professional

Both

$2,502.40

Service Code	HCPCS 70555 TC
Min. Negotiated Rate	$1,876.80
Max. Negotiated Rate	$1,876.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,876.80
Rate for Payer: SOMOS Essential	$1,876.80

CHG MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION

Professional

Both

$477.47

Service Code	HCPCS 70555 26
Min. Negotiated Rate	$358.10
Max. Negotiated Rate	$358.10
Rate for Payer: Cash Price	$129.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$358.10
Rate for Payer: SOMOS Essential	$358.10

CHG MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION

Professional

Both

$2,979.87

Service Code	HCPCS 70555
Min. Negotiated Rate	$2,234.90
Max. Negotiated Rate	$2,234.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,234.90
Rate for Payer: SOMOS Essential	$2,234.90

CHG MRI BRAIN OPEN INTRACRANIAL PX W/CONTRAST MATL

Professional

Both

$1,433.71

Service Code	HCPCS 70558
Min. Negotiated Rate	$1,075.28
Max. Negotiated Rate	$1,075.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,075.28
Rate for Payer: SOMOS Essential	$1,075.28

CHG MRI BRAIN OPEN INTRACRANIAL PX W/CONTRAST MATL

Professional

Both

$766.05

Service Code	HCPCS 70558 TC
Min. Negotiated Rate	$574.54
Max. Negotiated Rate	$574.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$574.54
Rate for Payer: SOMOS Essential	$574.54

CHG MRI BRAIN OPEN INTRACRANIAL PX W/CONTRAST MATL

Professional

Both

$667.66

Service Code	HCPCS 70558 26
Min. Negotiated Rate	$500.74
Max. Negotiated Rate	$500.74
Rate for Payer: Cash Price	$184.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$500.74
Rate for Payer: SOMOS Essential	$500.74

CHG MRI BRAIN OPEN INTRACRANIAL PX W/O CONTRAST MATL

Professional

Both

$710.85

Service Code	HCPCS 70557 26
Min. Negotiated Rate	$533.14
Max. Negotiated Rate	$533.14
Rate for Payer: Cash Price	$167.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$533.14
Rate for Payer: SOMOS Essential	$533.14

CHG MRI BRAIN OPEN INTRACRANIAL PX W/O CONTRAST MATL

Professional

Both

$2,135.98

Service Code	HCPCS 70557 TC
Min. Negotiated Rate	$1,601.98
Max. Negotiated Rate	$1,601.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,601.98
Rate for Payer: SOMOS Essential	$1,601.98

CHG MRI BRAIN OPEN INTRACRANIAL PX W/O CONTRAST MATL

Professional

Both

$2,846.83

Service Code	HCPCS 70557
Min. Negotiated Rate	$2,135.12
Max. Negotiated Rate	$2,135.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,135.12
Rate for Payer: SOMOS Essential	$2,135.12

CHG MRI BRAIN OPEN INTRACRANIAL PX W/O & W/CONTRAST

Professional

Both

$659.68

Service Code	HCPCS 70559 26
Min. Negotiated Rate	$494.76
Max. Negotiated Rate	$494.76
Rate for Payer: Cash Price	$175.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$494.76
Rate for Payer: SOMOS Essential	$494.76

CHG MRI BRAIN OPEN INTRACRANIAL PX W/O & W/CONTRAST

Professional

Both

$766.05

Service Code	HCPCS 70559 TC
Min. Negotiated Rate	$574.54
Max. Negotiated Rate	$574.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$574.54
Rate for Payer: SOMOS Essential	$574.54

Know your out-of-pocket cost for care.

All Charges