St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I

Professional

Both

$218.89

Service Code	HCPCS 75605 26
Min. Negotiated Rate	$164.17
Max. Negotiated Rate	$164.17
Rate for Payer: Cash Price	$59.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$164.17
Rate for Payer: SOMOS Essential	$164.17

CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I

Professional

Both

$295.86

Service Code	HCPCS 75605 TC
Min. Negotiated Rate	$221.90
Max. Negotiated Rate	$221.90
Rate for Payer: Cash Price	$81.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$221.90
Rate for Payer: SOMOS Essential	$221.90

CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I

Professional

Both

$514.71

Service Code	HCPCS 75605
Min. Negotiated Rate	$386.03
Max. Negotiated Rate	$386.03
Rate for Payer: Cash Price	$140.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$386.03
Rate for Payer: SOMOS Essential	$386.03

CHG AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I

Professional

Both

$800.31

Service Code	HCPCS 75600
Min. Negotiated Rate	$600.23
Max. Negotiated Rate	$600.23
Rate for Payer: Cash Price	$214.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$600.23
Rate for Payer: SOMOS Essential	$600.23

CHG AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I

Professional

Both

$698.36

Service Code	HCPCS 75600 TC
Min. Negotiated Rate	$523.77
Max. Negotiated Rate	$523.77
Rate for Payer: Cash Price	$188.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$523.77
Rate for Payer: SOMOS Essential	$523.77

CHG AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I

Professional

Both

$101.96

Service Code	HCPCS 75600 26
Min. Negotiated Rate	$76.47
Max. Negotiated Rate	$76.47
Rate for Payer: Cash Price	$26.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$76.47
Rate for Payer: SOMOS Essential	$76.47

CHG AQMBF PET REST AND PHARMACOLOGIC STRESS

Professional

Both

$567.25

Service Code	HCPCS 78434
Min. Negotiated Rate	$425.44
Max. Negotiated Rate	$425.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$425.44
Rate for Payer: SOMOS Essential	$425.44

CHG AQMBF PET REST AND PHARMACOLOGIC STRESS

Professional

Both

$114.56

Service Code	HCPCS 78434 26
Min. Negotiated Rate	$85.92
Max. Negotiated Rate	$85.92
Rate for Payer: Cash Price	$31.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$85.92
Rate for Payer: SOMOS Essential	$85.92

CHG AQMBF PET REST AND PHARMACOLOGIC STRESS

Professional

Both

$452.69

Service Code	HCPCS 78434 TC
Min. Negotiated Rate	$339.52
Max. Negotiated Rate	$339.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$339.52
Rate for Payer: SOMOS Essential	$339.52

CHG ASSAY OF THYROID STIMULATING HORMONE TSH

Professional

Both

$42.00

Service Code	HCPCS 84443
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$31.50
Rate for Payer: Cash Price	$16.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31.50
Rate for Payer: SOMOS Essential	$31.50

CHG BASIC METABOLIC PANEL CALCIUM TOTAL

Professional

Both

$21.15

Service Code	HCPCS 80048
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$15.86
Rate for Payer: Cash Price	$8.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15.86
Rate for Payer: SOMOS Essential	$15.86

CHG BASIC RADIATION DOSIMETRY CALCULATION

Professional

Both

$143.61

Service Code	HCPCS 77300 TC
Min. Negotiated Rate	$107.71
Max. Negotiated Rate	$107.71
Rate for Payer: Cash Price	$39.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$107.71
Rate for Payer: SOMOS Essential	$107.71

CHG BASIC RADIATION DOSIMETRY CALCULATION

Professional

Both

$134.61

Service Code	HCPCS 77300 26
Min. Negotiated Rate	$100.96
Max. Negotiated Rate	$100.96
Rate for Payer: Cash Price	$36.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$100.96
Rate for Payer: SOMOS Essential	$100.96

CHG BASIC RADIATION DOSIMETRY CALCULATION

Professional

Both

$278.22

Service Code	HCPCS 77300
Min. Negotiated Rate	$208.66
Max. Negotiated Rate	$208.66
Rate for Payer: Cash Price	$75.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$208.66
Rate for Payer: SOMOS Essential	$208.66

CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER

Professional

Both

$11.00

Service Code	HCPCS 82270
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$8.25
Rate for Payer: Cash Price	$4.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.25
Rate for Payer: SOMOS Essential	$8.25

CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES

Professional

Both

$21.28

Service Code	HCPCS 82271
Min. Negotiated Rate	$15.96
Max. Negotiated Rate	$15.96
Rate for Payer: Cash Price	$5.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15.96
Rate for Payer: SOMOS Essential	$15.96

CHG BLOOD SMEAR PERIPHERAL INTERP PHYS W/WRIT REPORT

Professional

Both

$98.95

Service Code	HCPCS 85060
Min. Negotiated Rate	$74.21
Max. Negotiated Rate	$74.21
Rate for Payer: Cash Price	$26.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$74.21
Rate for Payer: SOMOS Essential	$74.21

CHG BONE AGE STUDIES

Professional

Both

$36.61

Service Code	HCPCS 77072 26
Min. Negotiated Rate	$27.46
Max. Negotiated Rate	$27.46
Rate for Payer: Cash Price	$10.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27.46
Rate for Payer: SOMOS Essential	$27.46

CHG BONE AGE STUDIES

Professional

Both

$111.20

Service Code	HCPCS 77072
Min. Negotiated Rate	$83.40
Max. Negotiated Rate	$83.40
Rate for Payer: Cash Price	$30.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$83.40
Rate for Payer: SOMOS Essential	$83.40

CHG BONE AGE STUDIES

Professional

Both

$74.62

Service Code	HCPCS 77072 TC
Min. Negotiated Rate	$55.96
Max. Negotiated Rate	$55.96
Rate for Payer: Cash Price	$20.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$55.96
Rate for Payer: SOMOS Essential	$55.96

CHG BONE &/JOINT IMAGING 3 PHASE STUDY

Professional

Both

$1,191.12

Service Code	HCPCS 78315 TC
Min. Negotiated Rate	$893.34
Max. Negotiated Rate	$893.34
Rate for Payer: Cash Price	$319.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$893.34
Rate for Payer: SOMOS Essential	$893.34

CHG BONE &/JOINT IMAGING 3 PHASE STUDY

Professional

Both

$1,380.16

Service Code	HCPCS 78315
Min. Negotiated Rate	$1,035.12
Max. Negotiated Rate	$1,035.12
Rate for Payer: Cash Price	$371.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,035.12
Rate for Payer: SOMOS Essential	$1,035.12

CHG BONE &/JOINT IMAGING 3 PHASE STUDY

Professional

Both

$189.00

Service Code	HCPCS 78315 26
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$141.75
Rate for Payer: Cash Price	$52.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$141.75
Rate for Payer: SOMOS Essential	$141.75

CHG BONE &/JOINT IMAGING LIMITED AREA

Professional

Both

$120.23

Service Code	HCPCS 78300 26
Min. Negotiated Rate	$90.17
Max. Negotiated Rate	$90.17
Rate for Payer: Cash Price	$31.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$90.17
Rate for Payer: SOMOS Essential	$90.17

Know your out-of-pocket cost for care.

All Charges