St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG MRI PELVIS W/O CONTRAST MATERIAL

Professional

Both

$280.95

Service Code	HCPCS 72195 26
Min. Negotiated Rate	$210.71
Max. Negotiated Rate	$210.71
Rate for Payer: Cash Price	$76.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$210.71
Rate for Payer: SOMOS Essential	$210.71

CHG MRI PELVIS W/O CONTRAST MATERIAL

Professional

Both

$735.74

Service Code	HCPCS 72195 TC
Min. Negotiated Rate	$551.80
Max. Negotiated Rate	$551.80
Rate for Payer: Cash Price	$197.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$551.80
Rate for Payer: SOMOS Essential	$551.80

CHG MRI PELVIS W/O & W/CONTRAST MATERIAL

Professional

Both

$419.20

Service Code	HCPCS 72197 26
Min. Negotiated Rate	$314.40
Max. Negotiated Rate	$314.40
Rate for Payer: Cash Price	$113.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$314.40
Rate for Payer: SOMOS Essential	$314.40

CHG MRI PELVIS W/O & W/CONTRAST MATERIAL

Professional

Both

$1,079.02

Service Code	HCPCS 72197 TC
Min. Negotiated Rate	$809.26
Max. Negotiated Rate	$809.26
Rate for Payer: Cash Price	$287.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$809.26
Rate for Payer: SOMOS Essential	$809.26

CHG MRI PELVIS W/O & W/CONTRAST MATERIAL

Professional

Both

$1,498.21

Service Code	HCPCS 72197
Min. Negotiated Rate	$1,123.66
Max. Negotiated Rate	$1,123.66
Rate for Payer: Cash Price	$401.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,123.66
Rate for Payer: SOMOS Essential	$1,123.66

CHG MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL

Professional

Both

$345.17

Service Code	HCPCS 72142 26
Min. Negotiated Rate	$258.88
Max. Negotiated Rate	$258.88
Rate for Payer: Cash Price	$93.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$258.88
Rate for Payer: SOMOS Essential	$258.88

CHG MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL

Professional

Both

$875.14

Service Code	HCPCS 72142 TC
Min. Negotiated Rate	$656.36
Max. Negotiated Rate	$656.36
Rate for Payer: Cash Price	$235.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$656.36
Rate for Payer: SOMOS Essential	$656.36

CHG MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL

Professional

Both

$1,220.35

Service Code	HCPCS 72142
Min. Negotiated Rate	$915.26
Max. Negotiated Rate	$915.26
Rate for Payer: Cash Price	$329.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$915.26
Rate for Payer: SOMOS Essential	$915.26

CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL

Professional

Both

$554.61

Service Code	HCPCS 72141 TC
Min. Negotiated Rate	$415.96
Max. Negotiated Rate	$415.96
Rate for Payer: Cash Price	$149.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$415.96
Rate for Payer: SOMOS Essential	$415.96

CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL

Professional

Both

$284.87

Service Code	HCPCS 72141 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 SPINAL CANAL CERVICAL W/O CONTRAST MATRL

Professional

Both

$839.48

Service Code	HCPCS 72141
Min. Negotiated Rate	$629.61
Max. Negotiated Rate	$629.61
Rate for Payer: Cash Price	$226.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$629.61
Rate for Payer: SOMOS Essential	$629.61

CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL

Professional

Both

$978.39

Service Code	HCPCS 72156 TC
Min. Negotiated Rate	$733.79
Max. Negotiated Rate	$733.79
Rate for Payer: Cash Price	$262.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$733.79
Rate for Payer: SOMOS Essential	$733.79

CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL

Professional

Both

$1,417.33

Service Code	HCPCS 72156
Min. Negotiated Rate	$1,063.00
Max. Negotiated Rate	$1,063.00
Rate for Payer: Cash Price	$381.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,063.00
Rate for Payer: SOMOS Essential	$1,063.00

CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL

Professional

Both

$438.97

Service Code	HCPCS 72156 26
Min. Negotiated Rate	$329.23
Max. Negotiated Rate	$329.23
Rate for Payer: Cash Price	$119.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$329.23
Rate for Payer: SOMOS Essential	$329.23

CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL

Professional

Both

$343.74

Service Code	HCPCS 72149 26
Min. Negotiated Rate	$257.80
Max. Negotiated Rate	$257.80
Rate for Payer: Cash Price	$93.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$257.80
Rate for Payer: SOMOS Essential	$257.80

CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL

Professional

Both

$855.02

Service Code	HCPCS 72149 TC
Min. Negotiated Rate	$641.26
Max. Negotiated Rate	$641.26
Rate for Payer: Cash Price	$230.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$641.26
Rate for Payer: SOMOS Essential	$641.26

CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL

Professional

Both

$1,198.79

Service Code	HCPCS 72149
Min. Negotiated Rate	$899.09
Max. Negotiated Rate	$899.09
Rate for Payer: Cash Price	$323.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$899.09
Rate for Payer: SOMOS Essential	$899.09

CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL

Professional

Both

$842.35

Service Code	HCPCS 72148
Min. Negotiated Rate	$631.76
Max. Negotiated Rate	$631.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$631.76
Rate for Payer: SOMOS Essential	$631.76

CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL

Professional

Both

$557.48

Service Code	HCPCS 72148 TC
Min. Negotiated Rate	$418.11
Max. Negotiated Rate	$418.11
Rate for Payer: Cash Price	$150.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$418.11
Rate for Payer: SOMOS Essential	$418.11

CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL

Professional

Both

$284.87

Service Code	HCPCS 72148 26
Min. Negotiated Rate	$213.65
Max. Negotiated Rate	$213.65
Rate for Payer: Cash Price	$77.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$213.65
Rate for Payer: SOMOS Essential	$213.65

CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL

Professional

Both

$438.97

Service Code	HCPCS 72158 26
Min. Negotiated Rate	$329.23
Max. Negotiated Rate	$329.23
Rate for Payer: Cash Price	$119.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$329.23
Rate for Payer: SOMOS Essential	$329.23

CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL

Professional

Both

$975.52

Service Code	HCPCS 72158 TC
Min. Negotiated Rate	$731.64
Max. Negotiated Rate	$731.64
Rate for Payer: Cash Price	$261.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$731.64
Rate for Payer: SOMOS Essential	$731.64

CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL

Professional

Both

$1,414.46

Service Code	HCPCS 72158
Min. Negotiated Rate	$1,060.84
Max. Negotiated Rate	$1,060.84
Rate for Payer: Cash Price	$380.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,060.84
Rate for Payer: SOMOS Essential	$1,060.84

CHG MRI SPINAL CANAL THORACIC W/CONTRAST MATRL

Professional

Both

$866.53

Service Code	HCPCS 72147 TC
Min. Negotiated Rate	$649.90
Max. Negotiated Rate	$649.90
Rate for Payer: Cash Price	$233.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$649.90
Rate for Payer: SOMOS Essential	$649.90

CHG MRI SPINAL CANAL THORACIC W/CONTRAST MATRL

Professional

Both

$1,210.27

Service Code	HCPCS 72147
Min. Negotiated Rate	$907.70
Max. Negotiated Rate	$907.70
Rate for Payer: Cash Price	$325.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$907.70
Rate for Payer: SOMOS Essential	$907.70

Know your out-of-pocket cost for care.

All Charges