St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG MRI SPINAL CANAL THORACIC W/CONTRAST MATRL

Professional

Both

$343.74

Service Code	HCPCS 72147 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 SPINAL CANAL THORACIC W/O CONTRAST MATRL

Professional

Both

$554.61

Service Code	HCPCS 72146 TC
Min. Negotiated Rate	$415.96
Max. Negotiated Rate	$415.96
Rate for Payer: Cash Price	$149.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$415.96
Rate for Payer: SOMOS Essential	$415.96

CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL

Professional

Both

$284.87

Service Code	HCPCS 72146 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 THORACIC W/O CONTRAST MATRL

Professional

Both

$839.48

Service Code	HCPCS 72146
Min. Negotiated Rate	$629.61
Max. Negotiated Rate	$629.61
Rate for Payer: Cash Price	$226.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$629.61
Rate for Payer: SOMOS Essential	$629.61

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

Professional

Both

$438.97

Service Code	HCPCS 72157 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 THORACIC W/O & W/CONTR MATRL

Professional

Both

$981.26

Service Code	HCPCS 72157 TC
Min. Negotiated Rate	$735.94
Max. Negotiated Rate	$735.94
Rate for Payer: Cash Price	$262.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$735.94
Rate for Payer: SOMOS Essential	$735.94

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

Professional

Both

$1,420.23

Service Code	HCPCS 72157
Min. Negotiated Rate	$1,065.17
Max. Negotiated Rate	$1,065.17
Rate for Payer: Cash Price	$381.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,065.17
Rate for Payer: SOMOS Essential	$1,065.17

CHG MRI TEMPOROMANDIBULAR JOINT

Professional

Both

$898.17

Service Code	HCPCS 70336 TC
Min. Negotiated Rate	$673.63
Max. Negotiated Rate	$673.63
Rate for Payer: Cash Price	$239.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$673.63
Rate for Payer: SOMOS Essential	$673.63

CHG MRI TEMPOROMANDIBULAR JOINT

Professional

Both

$1,180.17

Service Code	HCPCS 70336
Min. Negotiated Rate	$885.13
Max. Negotiated Rate	$885.13
Rate for Payer: Cash Price	$316.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$885.13
Rate for Payer: SOMOS Essential	$885.13

CHG MRI TEMPOROMANDIBULAR JOINT

Professional

Both

$282.00

Service Code	HCPCS 70336 26
Min. Negotiated Rate	$211.50
Max. Negotiated Rate	$211.50
Rate for Payer: Cash Price	$76.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$211.50
Rate for Payer: SOMOS Essential	$211.50

CHG MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL

Professional

Both

$1,484.91

Service Code	HCPCS 73219
Min. Negotiated Rate	$1,113.68
Max. Negotiated Rate	$1,113.68
Rate for Payer: Cash Price	$397.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,113.68
Rate for Payer: SOMOS Essential	$1,113.68

CHG MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL

Professional

Both

$309.61

Service Code	HCPCS 73219 26
Min. Negotiated Rate	$232.21
Max. Negotiated Rate	$232.21
Rate for Payer: Cash Price	$84.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$232.21
Rate for Payer: SOMOS Essential	$232.21

CHG MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL

Professional

Both

$1,175.30

Service Code	HCPCS 73219 TC
Min. Negotiated Rate	$881.48
Max. Negotiated Rate	$881.48
Rate for Payer: Cash Price	$313.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$881.48
Rate for Payer: SOMOS Essential	$881.48

CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL

Professional

Both

$997.08

Service Code	HCPCS 73218 TC
Min. Negotiated Rate	$747.81
Max. Negotiated Rate	$747.81
Rate for Payer: Cash Price	$293.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$747.81
Rate for Payer: SOMOS Essential	$747.81

CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL

Professional

Both

$1,257.17

Service Code	HCPCS 73218
Min. Negotiated Rate	$942.88
Max. Negotiated Rate	$942.88
Rate for Payer: Cash Price	$364.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$942.88
Rate for Payer: SOMOS Essential	$942.88

CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL

Professional

Both

$260.12

Service Code	HCPCS 73218 26
Min. Negotiated Rate	$195.09
Max. Negotiated Rate	$195.09
Rate for Payer: Cash Price	$70.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$195.09
Rate for Payer: SOMOS Essential	$195.09

CHG MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS

Professional

Both

$1,421.14

Service Code	HCPCS 73220 TC
Min. Negotiated Rate	$1,065.86
Max. Negotiated Rate	$1,065.86
Rate for Payer: Cash Price	$379.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,065.86
Rate for Payer: SOMOS Essential	$1,065.86

CHG MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS

Professional

Both

$411.50

Service Code	HCPCS 73220 26
Min. Negotiated Rate	$308.62
Max. Negotiated Rate	$308.62
Rate for Payer: Cash Price	$111.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$308.62
Rate for Payer: SOMOS Essential	$308.62

CHG MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS

Professional

Both

$1,832.64

Service Code	HCPCS 73220
Min. Negotiated Rate	$1,374.48
Max. Negotiated Rate	$1,374.48
Rate for Payer: Cash Price	$490.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,374.48
Rate for Payer: SOMOS Essential	$1,374.48

CHG MYELOGRAPHY CERVICAL RS&I

Professional

Both

$489.48

Service Code	HCPCS 72240
Min. Negotiated Rate	$367.11
Max. Negotiated Rate	$367.11
Rate for Payer: Cash Price	$129.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$367.11
Rate for Payer: SOMOS Essential	$367.11

CHG MYELOGRAPHY CERVICAL RS&I

Professional

Both

$307.48

Service Code	HCPCS 72240 TC
Min. Negotiated Rate	$230.61
Max. Negotiated Rate	$230.61
Rate for Payer: Cash Price	$81.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$230.61
Rate for Payer: SOMOS Essential	$230.61

CHG MYELOGRAPHY CERVICAL RS&I

Professional

Both

$182.00

Service Code	HCPCS 72240 26
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$136.50
Rate for Payer: Cash Price	$48.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$136.50
Rate for Payer: SOMOS Essential	$136.50

CHG MYELOGRAPHY THORACIC RS&I

Professional

Both

$516.39

Service Code	HCPCS 72255
Min. Negotiated Rate	$387.29
Max. Negotiated Rate	$387.29
Rate for Payer: Cash Price	$124.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$387.29
Rate for Payer: SOMOS Essential	$387.29

CHG MYELOGRAPHY THORACIC RS&I

Professional

Both

$195.97

Service Code	HCPCS 72255 26
Min. Negotiated Rate	$146.98
Max. Negotiated Rate	$146.98
Rate for Payer: Cash Price	$47.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$146.98
Rate for Payer: SOMOS Essential	$146.98

CHG MYELOGRAPHY THORACIC RS&I

Professional

Both

$320.43

Service Code	HCPCS 72255 TC
Min. Negotiated Rate	$240.32
Max. Negotiated Rate	$240.32
Rate for Payer: Cash Price	$76.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$240.32
Rate for Payer: SOMOS Essential	$240.32

Know your out-of-pocket cost for care.

All Charges