St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG MRI GUIDANCE NEEDLE PLACEMENT RS&I

Professional

Both

$1,832.57

Service Code	HCPCS 77021
Min. Negotiated Rate	$1,374.43
Max. Negotiated Rate	$1,374.43
Rate for Payer: Cash Price	$496.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,374.43
Rate for Payer: SOMOS Essential	$1,374.43

CHG MRI GUIDANCE NEEDLE PLACEMENT RS&I

Professional

Both

$281.79

Service Code	HCPCS 77021 26
Min. Negotiated Rate	$211.34
Max. Negotiated Rate	$211.34
Rate for Payer: Cash Price	$76.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$211.34
Rate for Payer: SOMOS Essential	$211.34

CHG MRI GUIDANCE NEEDLE PLACEMENT RS&I

Professional

Both

$1,550.78

Service Code	HCPCS 77021 TC
Min. Negotiated Rate	$1,163.08
Max. Negotiated Rate	$1,163.08
Rate for Payer: Cash Price	$419.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,163.08
Rate for Payer: SOMOS Essential	$1,163.08

CHG MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL

Professional

Both

$1,164.63

Service Code	HCPCS 73719
Min. Negotiated Rate	$873.47
Max. Negotiated Rate	$873.47
Rate for Payer: Cash Price	$314.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$873.47
Rate for Payer: SOMOS Essential	$873.47

CHG MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL

Professional

Both

$855.02

Service Code	HCPCS 73719 TC
Min. Negotiated Rate	$641.26
Max. Negotiated Rate	$641.26
Rate for Payer: Cash Price	$230.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$641.26
Rate for Payer: SOMOS Essential	$641.26

CHG MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL

Professional

Both

$309.61

Service Code	HCPCS 73719 26
Min. Negotiated Rate	$232.21
Max. Negotiated Rate	$232.21
Rate for Payer: Cash Price	$83.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$232.21
Rate for Payer: SOMOS Essential	$232.21

CHG MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL

Professional

Both

$992.95

Service Code	HCPCS 73718
Min. Negotiated Rate	$744.71
Max. Negotiated Rate	$744.71
Rate for Payer: Cash Price	$266.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$744.71
Rate for Payer: SOMOS Essential	$744.71

CHG MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL

Professional

Both

$258.69

Service Code	HCPCS 73718 26
Min. Negotiated Rate	$194.02
Max. Negotiated Rate	$194.02
Rate for Payer: Cash Price	$69.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$194.02
Rate for Payer: SOMOS Essential	$194.02

CHG MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL

Professional

Both

$734.27

Service Code	HCPCS 73718 TC
Min. Negotiated Rate	$550.70
Max. Negotiated Rate	$550.70
Rate for Payer: Cash Price	$196.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$550.70
Rate for Payer: SOMOS Essential	$550.70

CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR

Professional

Both

$1,500.56

Service Code	HCPCS 73720
Min. Negotiated Rate	$1,125.42
Max. Negotiated Rate	$1,125.42
Rate for Payer: Cash Price	$402.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,125.42
Rate for Payer: SOMOS Essential	$1,125.42

CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR

Professional

Both

$1,089.06

Service Code	HCPCS 73720 TC
Min. Negotiated Rate	$816.80
Max. Negotiated Rate	$816.80
Rate for Payer: Cash Price	$291.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$816.80
Rate for Payer: SOMOS Essential	$816.80

CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR

Professional

Both

$411.50

Service Code	HCPCS 73720 26
Min. Negotiated Rate	$308.62
Max. Negotiated Rate	$308.62
Rate for Payer: Cash Price	$111.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$308.62
Rate for Payer: SOMOS Essential	$308.62

CHG MRI ORBIT FACE & NECK W/CONTRAST MATERIAL

Professional

Both

$309.61

Service Code	HCPCS 70542 26
Min. Negotiated Rate	$232.21
Max. Negotiated Rate	$232.21
Rate for Payer: Cash Price	$83.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$232.21
Rate for Payer: SOMOS Essential	$232.21

CHG MRI ORBIT FACE & NECK W/CONTRAST MATERIAL

Professional

Both

$1,191.96

Service Code	HCPCS 70542
Min. Negotiated Rate	$893.97
Max. Negotiated Rate	$893.97
Rate for Payer: Cash Price	$320.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$893.97
Rate for Payer: SOMOS Essential	$893.97

CHG MRI ORBIT FACE & NECK W/CONTRAST MATERIAL

Professional

Both

$882.35

Service Code	HCPCS 70542 TC
Min. Negotiated Rate	$661.76
Max. Negotiated Rate	$661.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$661.76
Rate for Payer: SOMOS Essential	$661.76

CHG MRI ORBIT FACE &/NECK W/O CONTRAST

Professional

Both

$1,004.47

Service Code	HCPCS 70540
Min. Negotiated Rate	$753.35
Max. Negotiated Rate	$753.35
Rate for Payer: Cash Price	$270.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$753.35
Rate for Payer: SOMOS Essential	$753.35

CHG MRI ORBIT FACE &/NECK W/O CONTRAST

Professional

Both

$257.25

Service Code	HCPCS 70540 26
Min. Negotiated Rate	$192.94
Max. Negotiated Rate	$192.94
Rate for Payer: Cash Price	$69.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$192.94
Rate for Payer: SOMOS Essential	$192.94

CHG MRI ORBIT FACE &/NECK W/O CONTRAST

Professional

Both

$747.22

Service Code	HCPCS 70540 TC
Min. Negotiated Rate	$560.42
Max. Negotiated Rate	$560.42
Rate for Payer: Cash Price	$200.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$560.42
Rate for Payer: SOMOS Essential	$560.42

CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL

Professional

Both

$1,506.33

Service Code	HCPCS 70543
Min. Negotiated Rate	$1,129.75
Max. Negotiated Rate	$1,129.75
Rate for Payer: Cash Price	$404.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,129.75
Rate for Payer: SOMOS Essential	$1,129.75

CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL

Professional

Both

$1,096.27

Service Code	HCPCS 70543 TC
Min. Negotiated Rate	$822.20
Max. Negotiated Rate	$822.20
Rate for Payer: Cash Price	$293.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$822.20
Rate for Payer: SOMOS Essential	$822.20

CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL

Professional

Both

$410.06

Service Code	HCPCS 70543 26
Min. Negotiated Rate	$307.54
Max. Negotiated Rate	$307.54
Rate for Payer: Cash Price	$111.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$307.54
Rate for Payer: SOMOS Essential	$307.54

CHG MRI PELVIS W/CONTRAST MATERIAL

Professional

Both

$334.60

Service Code	HCPCS 72196 26
Min. Negotiated Rate	$250.95
Max. Negotiated Rate	$250.95
Rate for Payer: Cash Price	$89.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$250.95
Rate for Payer: SOMOS Essential	$250.95

CHG MRI PELVIS W/CONTRAST MATERIAL

Professional

Both

$859.36

Service Code	HCPCS 72196 TC
Min. Negotiated Rate	$644.52
Max. Negotiated Rate	$644.52
Rate for Payer: Cash Price	$230.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$644.52
Rate for Payer: SOMOS Essential	$644.52

CHG MRI PELVIS W/CONTRAST MATERIAL

Professional

Both

$1,193.96

Service Code	HCPCS 72196
Min. Negotiated Rate	$895.47
Max. Negotiated Rate	$895.47
Rate for Payer: Cash Price	$320.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$895.47
Rate for Payer: SOMOS Essential	$895.47

CHG MRI PELVIS W/O CONTRAST MATERIAL

Professional

Both

$1,016.65

Service Code	HCPCS 72195
Min. Negotiated Rate	$762.49
Max. Negotiated Rate	$762.49
Rate for Payer: Cash Price	$273.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$762.49
Rate for Payer: SOMOS Essential	$762.49

Know your out-of-pocket cost for care.

All Charges