St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG ADRENAL IMAGING CORTEX &/MEDULLA

Professional

Both

$1,787.42

Service Code	HCPCS 78075
Min. Negotiated Rate	$1,340.57
Max. Negotiated Rate	$1,340.57
Rate for Payer: Cash Price	$477.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,340.57
Rate for Payer: SOMOS Essential	$1,340.57

CHG ADRENAL IMAGING CORTEX &/MEDULLA

Professional

Both

$1,644.97

Service Code	HCPCS 78075 TC
Min. Negotiated Rate	$1,233.73
Max. Negotiated Rate	$1,233.73
Rate for Payer: Cash Price	$438.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,233.73
Rate for Payer: SOMOS Essential	$1,233.73

CHG ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I

Professional

Both

$473.83

Service Code	HCPCS 75733 TC
Min. Negotiated Rate	$355.37
Max. Negotiated Rate	$355.37
Rate for Payer: Cash Price	$133.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$355.37
Rate for Payer: SOMOS Essential	$355.37

CHG ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I

Professional

Both

$713.51

Service Code	HCPCS 75733
Min. Negotiated Rate	$535.13
Max. Negotiated Rate	$535.13
Rate for Payer: Cash Price	$199.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$535.13
Rate for Payer: SOMOS Essential	$535.13

CHG ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I

Professional

Both

$239.72

Service Code	HCPCS 75733 26
Min. Negotiated Rate	$179.79
Max. Negotiated Rate	$179.79
Rate for Payer: Cash Price	$65.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$179.79
Rate for Payer: SOMOS Essential	$179.79

CHG ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I

Professional

Both

$651.70

Service Code	HCPCS 75731
Min. Negotiated Rate	$488.77
Max. Negotiated Rate	$488.77
Rate for Payer: Cash Price	$177.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$488.77
Rate for Payer: SOMOS Essential	$488.77

CHG ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I

Professional

Both

$219.59

Service Code	HCPCS 75731 26
Min. Negotiated Rate	$164.69
Max. Negotiated Rate	$164.69
Rate for Payer: Cash Price	$59.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$164.69
Rate for Payer: SOMOS Essential	$164.69

CHG ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I

Professional

Both

$432.15

Service Code	HCPCS 75731 TC
Min. Negotiated Rate	$324.11
Max. Negotiated Rate	$324.11
Rate for Payer: Cash Price	$118.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$324.11
Rate for Payer: SOMOS Essential	$324.11

CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I

Professional

Both

$690.76

Service Code	HCPCS 75716
Min. Negotiated Rate	$518.07
Max. Negotiated Rate	$518.07
Rate for Payer: Cash Price	$188.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$518.07
Rate for Payer: SOMOS Essential	$518.07

CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I

Professional

Both

$379.09

Service Code	HCPCS 75716 26
Min. Negotiated Rate	$284.32
Max. Negotiated Rate	$284.32
Rate for Payer: Cash Price	$103.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$284.32
Rate for Payer: SOMOS Essential	$284.32

CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I

Professional

Both

$311.68

Service Code	HCPCS 75716 TC
Min. Negotiated Rate	$233.76
Max. Negotiated Rate	$233.76
Rate for Payer: Cash Price	$85.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$233.76
Rate for Payer: SOMOS Essential	$233.76

CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I

Professional

Both

$345.52

Service Code	HCPCS 75710 26
Min. Negotiated Rate	$259.14
Max. Negotiated Rate	$259.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$259.14
Rate for Payer: SOMOS Essential	$259.14

CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I

Professional

Both

$645.68

Service Code	HCPCS 75710
Min. Negotiated Rate	$484.26
Max. Negotiated Rate	$484.26
Rate for Payer: Cash Price	$174.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$484.26
Rate for Payer: SOMOS Essential	$484.26

CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I

Professional

Both

$300.16

Service Code	HCPCS 75710 TC
Min. Negotiated Rate	$225.12
Max. Negotiated Rate	$225.12
Rate for Payer: Cash Price	$81.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$225.12
Rate for Payer: SOMOS Essential	$225.12

CHG ANGIOGRAPHY INTERNAL MAMMARY RS&I

Professional

Both

$695.45

Service Code	HCPCS 75756
Min. Negotiated Rate	$521.59
Max. Negotiated Rate	$521.59
Rate for Payer: Cash Price	$192.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$521.59
Rate for Payer: SOMOS Essential	$521.59

CHG ANGIOGRAPHY INTERNAL MAMMARY RS&I

Professional

Both

$466.62

Service Code	HCPCS 75756 TC
Min. Negotiated Rate	$349.96
Max. Negotiated Rate	$349.96
Rate for Payer: Cash Price	$131.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$349.96
Rate for Payer: SOMOS Essential	$349.96

CHG ANGIOGRAPHY INTERNAL MAMMARY RS&I

Professional

Both

$228.80

Service Code	HCPCS 75756 26
Min. Negotiated Rate	$171.60
Max. Negotiated Rate	$171.60
Rate for Payer: Cash Price	$60.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$171.60
Rate for Payer: SOMOS Essential	$171.60

CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I

Professional

Both

$397.64

Service Code	HCPCS 75736 TC
Min. Negotiated Rate	$298.23
Max. Negotiated Rate	$298.23
Rate for Payer: Cash Price	$109.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$298.23
Rate for Payer: SOMOS Essential	$298.23

CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I

Professional

Both

$612.33

Service Code	HCPCS 75736
Min. Negotiated Rate	$459.25
Max. Negotiated Rate	$459.25
Rate for Payer: Cash Price	$166.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$459.25
Rate for Payer: SOMOS Essential	$459.25

CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I

Professional

Both

$214.69

Service Code	HCPCS 75736 26
Min. Negotiated Rate	$161.02
Max. Negotiated Rate	$161.02
Rate for Payer: Cash Price	$57.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$161.02
Rate for Payer: SOMOS Essential	$161.02

CHG ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I

Professional

Both

$311.19

Service Code	HCPCS 75743 26
Min. Negotiated Rate	$233.39
Max. Negotiated Rate	$233.39
Rate for Payer: Cash Price	$84.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$233.39
Rate for Payer: SOMOS Essential	$233.39

CHG ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I

Professional

Both

$625.73

Service Code	HCPCS 75743
Min. Negotiated Rate	$469.30
Max. Negotiated Rate	$469.30
Rate for Payer: Cash Price	$169.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$469.30
Rate for Payer: SOMOS Essential	$469.30

CHG ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I

Professional

Both

$314.55

Service Code	HCPCS 75743 TC
Min. Negotiated Rate	$235.91
Max. Negotiated Rate	$235.91
Rate for Payer: Cash Price	$85.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$235.91
Rate for Payer: SOMOS Essential	$235.91

CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I

Professional

Both

$308.77

Service Code	HCPCS 75741 TC
Min. Negotiated Rate	$231.58
Max. Negotiated Rate	$231.58
Rate for Payer: Cash Price	$83.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$231.58
Rate for Payer: SOMOS Essential	$231.58

CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I

Professional

Both

$554.86

Service Code	HCPCS 75741
Min. Negotiated Rate	$416.14
Max. Negotiated Rate	$416.14
Rate for Payer: Cash Price	$149.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$416.14
Rate for Payer: SOMOS Essential	$416.14

Know your out-of-pocket cost for care.

All Charges