St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I

Professional

Both

$1,090.22

Service Code	HCPCS 75705
Min. Negotiated Rate	$817.66
Max. Negotiated Rate	$817.66
Rate for Payer: Cash Price	$296.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$817.66
Rate for Payer: SOMOS Essential	$817.66

CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I

Professional

Both

$510.02

Service Code	HCPCS 75705 26
Min. Negotiated Rate	$382.52
Max. Negotiated Rate	$382.52
Rate for Payer: Cash Price	$135.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$382.52
Rate for Payer: SOMOS Essential	$382.52

CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I

Professional

Both

$580.20

Service Code	HCPCS 75705 TC
Min. Negotiated Rate	$435.15
Max. Negotiated Rate	$435.15
Rate for Payer: Cash Price	$160.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$435.15
Rate for Payer: SOMOS Essential	$435.15

CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I

Professional

Both

$724.19

Service Code	HCPCS 75726
Min. Negotiated Rate	$543.14
Max. Negotiated Rate	$543.14
Rate for Payer: Cash Price	$194.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$543.14
Rate for Payer: SOMOS Essential	$543.14

CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I

Professional

Both

$386.65

Service Code	HCPCS 75726 26
Min. Negotiated Rate	$289.99
Max. Negotiated Rate	$289.99
Rate for Payer: Cash Price	$102.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$289.99
Rate for Payer: SOMOS Essential	$289.99

CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I

Professional

Both

$337.54

Service Code	HCPCS 75726 TC
Min. Negotiated Rate	$253.16
Max. Negotiated Rate	$253.16
Rate for Payer: Cash Price	$92.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$253.16
Rate for Payer: SOMOS Essential	$253.16

CHG ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS

Professional

Both

$398.76

Service Code	HCPCS 75898 26
Min. Negotiated Rate	$299.07
Max. Negotiated Rate	$299.07
Rate for Payer: Cash Price	$106.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$299.07
Rate for Payer: SOMOS Essential	$299.07

CHG ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS

Professional

Both

$212.94

Service Code	HCPCS 75898 TC
Min. Negotiated Rate	$159.70
Max. Negotiated Rate	$159.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$159.70
Rate for Payer: SOMOS Essential	$159.70

CHG ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS

Professional

Both

$611.70

Service Code	HCPCS 75898
Min. Negotiated Rate	$458.78
Max. Negotiated Rate	$458.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$458.78
Rate for Payer: SOMOS Essential	$458.78

CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I

Professional

Both

$357.67

Service Code	HCPCS 75746 TC
Min. Negotiated Rate	$268.25
Max. Negotiated Rate	$268.25
Rate for Payer: Cash Price	$98.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$268.25
Rate for Payer: SOMOS Essential	$268.25

CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I

Professional

Both

$214.97

Service Code	HCPCS 75746 26
Min. Negotiated Rate	$161.23
Max. Negotiated Rate	$161.23
Rate for Payer: Cash Price	$57.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$161.23
Rate for Payer: SOMOS Essential	$161.23

CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I

Professional

Both

$572.64

Service Code	HCPCS 75746
Min. Negotiated Rate	$429.48
Max. Negotiated Rate	$429.48
Rate for Payer: Cash Price	$155.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$429.48
Rate for Payer: SOMOS Essential	$429.48

CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I

Professional

Both

$222.67

Service Code	HCPCS 75774 TC
Min. Negotiated Rate	$167.00
Max. Negotiated Rate	$167.00
Rate for Payer: Cash Price	$60.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$167.00
Rate for Payer: SOMOS Essential	$167.00

CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I

Professional

Both

$188.65

Service Code	HCPCS 75774 26
Min. Negotiated Rate	$141.49
Max. Negotiated Rate	$141.49
Rate for Payer: Cash Price	$50.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$141.49
Rate for Payer: SOMOS Essential	$141.49

CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I

Professional

Both

$411.32

Service Code	HCPCS 75774
Min. Negotiated Rate	$308.49
Max. Negotiated Rate	$308.49
Rate for Payer: Cash Price	$111.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$308.49
Rate for Payer: SOMOS Essential	$308.49

CHG ANTEGRADE UROGRAPHY RADIOLOGICAL SUPVJ & INTERPJ

Professional

Both

$491.47

Service Code	HCPCS 74425 TC
Min. Negotiated Rate	$368.60
Max. Negotiated Rate	$368.60
Rate for Payer: Cash Price	$132.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$368.60
Rate for Payer: SOMOS Essential	$368.60

CHG ANTEGRADE UROGRAPHY RADIOLOGICAL SUPVJ & INTERPJ

Professional

Both

$95.24

Service Code	HCPCS 74425 26
Min. Negotiated Rate	$71.43
Max. Negotiated Rate	$71.43
Rate for Payer: Cash Price	$25.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$71.43
Rate for Payer: SOMOS Essential	$71.43

CHG ANTEGRADE UROGRAPHY RADIOLOGICAL SUPVJ & INTERPJ

Professional

Both

$586.71

Service Code	HCPCS 74425
Min. Negotiated Rate	$440.03
Max. Negotiated Rate	$440.03
Rate for Payer: Cash Price	$158.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$440.03
Rate for Payer: SOMOS Essential	$440.03

CHG ANTISTREPTOLYSIN O TITER

Professional

Both

$18.00

Service Code	HCPCS 86060
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Cash Price	$7.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$13.50
Rate for Payer: SOMOS Essential	$13.50

CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I

Professional

Both

$278.74

Service Code	HCPCS 75630 TC
Min. Negotiated Rate	$209.06
Max. Negotiated Rate	$209.06
Rate for Payer: Cash Price	$76.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$209.06
Rate for Payer: SOMOS Essential	$209.06

CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I

Professional

Both

$664.44

Service Code	HCPCS 75630
Min. Negotiated Rate	$498.33
Max. Negotiated Rate	$498.33
Rate for Payer: Cash Price	$181.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$498.33
Rate for Payer: SOMOS Essential	$498.33

CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I

Professional

Both

$385.74

Service Code	HCPCS 75630 26
Min. Negotiated Rate	$289.30
Max. Negotiated Rate	$289.30
Rate for Payer: Cash Price	$104.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$289.30
Rate for Payer: SOMOS Essential	$289.30

CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I

Professional

Both

$260.05

Service Code	HCPCS 75625 TC
Min. Negotiated Rate	$195.04
Max. Negotiated Rate	$195.04
Rate for Payer: Cash Price	$70.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$195.04
Rate for Payer: SOMOS Essential	$195.04

CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I

Professional

Both

$542.71

Service Code	HCPCS 75625
Min. Negotiated Rate	$407.03
Max. Negotiated Rate	$407.03
Rate for Payer: Cash Price	$147.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$407.03
Rate for Payer: SOMOS Essential	$407.03

Know your out-of-pocket cost for care.

All Charges