St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

Professional

Both

$1,425.73

Service Code	HCPCS 70559
Min. Negotiated Rate	$1,069.30
Max. Negotiated Rate	$1,069.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,069.30
Rate for Payer: SOMOS Essential	$1,069.30

CHG MRI BREAST WITHOUT CONTRAST MATERIAL BILATERAL

Professional

Both

$970.94

Service Code	HCPCS 77047
Min. Negotiated Rate	$728.20
Max. Negotiated Rate	$728.20
Rate for Payer: Cash Price	$260.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$728.20
Rate for Payer: SOMOS Essential	$728.20

CHG MRI BREAST WITHOUT CONTRAST MATERIAL BILATERAL

Professional

Both

$305.66

Service Code	HCPCS 77047 26
Min. Negotiated Rate	$229.24
Max. Negotiated Rate	$229.24
Rate for Payer: Cash Price	$82.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$229.24
Rate for Payer: SOMOS Essential	$229.24

CHG MRI BREAST WITHOUT CONTRAST MATERIAL BILATERAL

Professional

Both

$665.28

Service Code	HCPCS 77047 TC
Min. Negotiated Rate	$498.96
Max. Negotiated Rate	$498.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$498.96
Rate for Payer: SOMOS Essential	$498.96

CHG MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL

Professional

Both

$275.52

Service Code	HCPCS 77046 26
Min. Negotiated Rate	$206.64
Max. Negotiated Rate	$206.64
Rate for Payer: Cash Price	$74.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$206.64
Rate for Payer: SOMOS Essential	$206.64

CHG MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL

Professional

Both

$662.41

Service Code	HCPCS 77046 TC
Min. Negotiated Rate	$496.81
Max. Negotiated Rate	$496.81
Rate for Payer: Cash Price	$178.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$496.81
Rate for Payer: SOMOS Essential	$496.81

CHG MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL

Professional

Both

$937.93

Service Code	HCPCS 77046
Min. Negotiated Rate	$703.45
Max. Negotiated Rate	$703.45
Rate for Payer: Cash Price	$253.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$703.45
Rate for Payer: SOMOS Essential	$703.45

CHG MRI BREAST WITHOUT&WITH CONTRAST W/CAD BILATERAL

Professional

Both

$1,084.76

Service Code	HCPCS 77049 TC
Min. Negotiated Rate	$813.57
Max. Negotiated Rate	$813.57
Rate for Payer: Cash Price	$289.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$813.57
Rate for Payer: SOMOS Essential	$813.57

CHG MRI BREAST WITHOUT&WITH CONTRAST W/CAD BILATERAL

Professional

Both

$1,524.99

Service Code	HCPCS 77049
Min. Negotiated Rate	$1,143.74
Max. Negotiated Rate	$1,143.74
Rate for Payer: Cash Price	$408.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,143.74
Rate for Payer: SOMOS Essential	$1,143.74

CHG MRI BREAST WITHOUT&WITH CONTRAST W/CAD BILATERAL

Professional

Both

$440.23

Service Code	HCPCS 77049 26
Min. Negotiated Rate	$330.17
Max. Negotiated Rate	$330.17
Rate for Payer: Cash Price	$119.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$330.17
Rate for Payer: SOMOS Essential	$330.17

CHG MRI BREAST W/OUT&WITH CONTRAST W/CAD UNILATERAL

Professional

Both

$402.36

Service Code	HCPCS 77048 26
Min. Negotiated Rate	$301.77
Max. Negotiated Rate	$301.77
Rate for Payer: Cash Price	$109.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$301.77
Rate for Payer: SOMOS Essential	$301.77

CHG MRI BREAST W/OUT&WITH CONTRAST W/CAD UNILATERAL

Professional

Both

$1,093.37

Service Code	HCPCS 77048 TC
Min. Negotiated Rate	$820.03
Max. Negotiated Rate	$820.03
Rate for Payer: Cash Price	$291.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$820.03
Rate for Payer: SOMOS Essential	$820.03

CHG MRI BREAST W/OUT&WITH CONTRAST W/CAD UNILATERAL

Professional

Both

$1,495.76

Service Code	HCPCS 77048
Min. Negotiated Rate	$1,121.82
Max. Negotiated Rate	$1,121.82
Rate for Payer: Cash Price	$401.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,121.82
Rate for Payer: SOMOS Essential	$1,121.82

CHG MRI CHEST W/CONTRAST MATERIAL

Professional

Both

$333.17

Service Code	HCPCS 71551 26
Min. Negotiated Rate	$249.88
Max. Negotiated Rate	$249.88
Rate for Payer: Cash Price	$89.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$249.88
Rate for Payer: SOMOS Essential	$249.88

CHG MRI CHEST W/CONTRAST MATERIAL

Professional

Both

$1,675.24

Service Code	HCPCS 71551
Min. Negotiated Rate	$1,256.43
Max. Negotiated Rate	$1,256.43
Rate for Payer: Cash Price	$448.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,256.43
Rate for Payer: SOMOS Essential	$1,256.43

CHG MRI CHEST W/CONTRAST MATERIAL

Professional

Both

$1,342.08

Service Code	HCPCS 71551 TC
Min. Negotiated Rate	$1,006.56
Max. Negotiated Rate	$1,006.56
Rate for Payer: Cash Price	$358.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,006.56
Rate for Payer: SOMOS Essential	$1,006.56

CHG MRI CHEST W/O CONTRAST MATERIAL

Professional

Both

$280.95

Service Code	HCPCS 71550 26
Min. Negotiated Rate	$210.71
Max. Negotiated Rate	$210.71
Rate for Payer: Cash Price	$75.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$210.71
Rate for Payer: SOMOS Essential	$210.71

CHG MRI CHEST W/O CONTRAST MATERIAL

Professional

Both

$994.32

Service Code	HCPCS 71550 TC
Min. Negotiated Rate	$745.74
Max. Negotiated Rate	$745.74
Rate for Payer: Cash Price	$329.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$745.74
Rate for Payer: SOMOS Essential	$745.74

CHG MRI CHEST W/O CONTRAST MATERIAL

Professional

Both

$1,275.26

Service Code	HCPCS 71550
Min. Negotiated Rate	$956.44
Max. Negotiated Rate	$956.44
Rate for Payer: Cash Price	$405.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$956.44
Rate for Payer: SOMOS Essential	$956.44

CHG MRI CHEST W/O & W/CONTRAST MATERIAL

Professional

Both

$433.76

Service Code	HCPCS 71552 26
Min. Negotiated Rate	$325.32
Max. Negotiated Rate	$325.32
Rate for Payer: Cash Price	$117.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$325.32
Rate for Payer: SOMOS Essential	$325.32

CHG MRI CHEST W/O & W/CONTRAST MATERIAL

Professional

Both

$2,002.95

Service Code	HCPCS 71552
Min. Negotiated Rate	$1,502.21
Max. Negotiated Rate	$1,502.21
Rate for Payer: Cash Price	$565.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,502.21
Rate for Payer: SOMOS Essential	$1,502.21

CHG MRI CHEST W/O & W/CONTRAST MATERIAL

Professional

Both

$1,569.19

Service Code	HCPCS 71552 TC
Min. Negotiated Rate	$1,176.89
Max. Negotiated Rate	$1,176.89
Rate for Payer: Cash Price	$448.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,176.89
Rate for Payer: SOMOS Essential	$1,176.89

CHG MRI GUIDANCE FOR PARENCHYMAL TISSUE ABLATION

Professional

Both

$2,520.32

Service Code	HCPCS 77022 TC
Min. Negotiated Rate	$1,890.24
Max. Negotiated Rate	$1,890.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,890.24
Rate for Payer: SOMOS Essential	$1,890.24

CHG MRI GUIDANCE FOR PARENCHYMAL TISSUE ABLATION

Professional

Both

$815.08

Service Code	HCPCS 77022 26
Min. Negotiated Rate	$611.31
Max. Negotiated Rate	$611.31
Rate for Payer: Cash Price	$216.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$611.31
Rate for Payer: SOMOS Essential	$611.31

CHG MRI GUIDANCE FOR PARENCHYMAL TISSUE ABLATION

Professional

Both

$3,335.40

Service Code	HCPCS 77022
Min. Negotiated Rate	$2,501.55
Max. Negotiated Rate	$2,501.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,501.55
Rate for Payer: SOMOS Essential	$2,501.55

Know your out-of-pocket cost for care.

All Charges