St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG BRAIN IMAGING VASCULAR FLOW ONLY

Professional

Both

$654.96

Service Code	HCPCS 78610 TC
Min. Negotiated Rate	$491.22
Max. Negotiated Rate	$491.22
Rate for Payer: Cash Price	$175.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$491.22
Rate for Payer: SOMOS Essential	$491.22

CHG CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS

Professional

Both

$181.13

Service Code	HCPCS 78472 26
Min. Negotiated Rate	$135.85
Max. Negotiated Rate	$135.85
Rate for Payer: Cash Price	$49.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$135.85
Rate for Payer: SOMOS Essential	$135.85

CHG CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS

Professional

Both

$726.81

Service Code	HCPCS 78472 TC
Min. Negotiated Rate	$545.11
Max. Negotiated Rate	$545.11
Rate for Payer: Cash Price	$195.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$545.11
Rate for Payer: SOMOS Essential	$545.11

CHG CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS

Professional

Both

$907.94

Service Code	HCPCS 78472
Min. Negotiated Rate	$680.96
Max. Negotiated Rate	$680.96
Rate for Payer: Cash Price	$245.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$680.96
Rate for Payer: SOMOS Essential	$680.96

CHG CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT

Professional

Both

$92.54

Service Code	HCPCS 78496 26
Min. Negotiated Rate	$69.40
Max. Negotiated Rate	$69.40
Rate for Payer: Cash Price	$25.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$69.40
Rate for Payer: SOMOS Essential	$69.40

CHG CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT

Professional

Both

$174.34

Service Code	HCPCS 78496
Min. Negotiated Rate	$130.76
Max. Negotiated Rate	$130.76
Rate for Payer: Cash Price	$48.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$130.76
Rate for Payer: SOMOS Essential	$130.76

CHG CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT

Professional

Both

$81.80

Service Code	HCPCS 78496 TC
Min. Negotiated Rate	$61.35
Max. Negotiated Rate	$61.35
Rate for Payer: Cash Price	$22.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$61.35
Rate for Payer: SOMOS Essential	$61.35

CHG CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT

Professional

Both

$266.95

Service Code	HCPCS 78473 26
Min. Negotiated Rate	$200.21
Max. Negotiated Rate	$200.21
Rate for Payer: Cash Price	$73.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$200.21
Rate for Payer: SOMOS Essential	$200.21

CHG CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT

Professional

Both

$877.77

Service Code	HCPCS 78473 TC
Min. Negotiated Rate	$658.33
Max. Negotiated Rate	$658.33
Rate for Payer: Cash Price	$238.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$658.33
Rate for Payer: SOMOS Essential	$658.33

CHG CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT

Professional

Both

$1,144.68

Service Code	HCPCS 78473
Min. Negotiated Rate	$858.51
Max. Negotiated Rate	$858.51
Rate for Payer: Cash Price	$311.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$858.51
Rate for Payer: SOMOS Essential	$858.51

CHG CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT

Professional

Both

$218.93

Service Code	HCPCS 78494 26
Min. Negotiated Rate	$164.20
Max. Negotiated Rate	$164.20
Rate for Payer: Cash Price	$59.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$164.20
Rate for Payer: SOMOS Essential	$164.20

CHG CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT

Professional

Both

$909.79

Service Code	HCPCS 78494
Min. Negotiated Rate	$682.34
Max. Negotiated Rate	$682.34
Rate for Payer: Cash Price	$246.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$682.34
Rate for Payer: SOMOS Essential	$682.34

CHG CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT

Professional

Both

$690.87

Service Code	HCPCS 78494 TC
Min. Negotiated Rate	$518.15
Max. Negotiated Rate	$518.15
Rate for Payer: Cash Price	$186.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$518.15
Rate for Payer: SOMOS Essential	$518.15

CHG CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT

Professional

Both

$182.56

Service Code	HCPCS 78481 26
Min. Negotiated Rate	$136.92
Max. Negotiated Rate	$136.92
Rate for Payer: Cash Price	$49.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$136.92
Rate for Payer: SOMOS Essential	$136.92

CHG CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT

Professional

Both

$527.00

Service Code	HCPCS 78481 TC
Min. Negotiated Rate	$395.25
Max. Negotiated Rate	$395.25
Rate for Payer: Cash Price	$142.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$395.25
Rate for Payer: SOMOS Essential	$395.25

CHG CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT

Professional

Both

$709.56

Service Code	HCPCS 78481
Min. Negotiated Rate	$532.17
Max. Negotiated Rate	$532.17
Rate for Payer: Cash Price	$192.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$532.17
Rate for Payer: SOMOS Essential	$532.17

CHG CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT

Professional

Both

$949.20

Service Code	HCPCS 78483
Min. Negotiated Rate	$711.90
Max. Negotiated Rate	$711.90
Rate for Payer: Cash Price	$257.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$711.90
Rate for Payer: SOMOS Essential	$711.90

CHG CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT

Professional

Both

$268.38

Service Code	HCPCS 78483 26
Min. Negotiated Rate	$201.28
Max. Negotiated Rate	$201.28
Rate for Payer: Cash Price	$74.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$201.28
Rate for Payer: SOMOS Essential	$201.28

CHG CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT

Professional

Both

$680.82

Service Code	HCPCS 78483 TC
Min. Negotiated Rate	$510.62
Max. Negotiated Rate	$510.62
Rate for Payer: Cash Price	$183.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$510.62
Rate for Payer: SOMOS Essential	$510.62

CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING

Professional

Both

$153.83

Service Code	HCPCS 75565 TC
Min. Negotiated Rate	$115.37
Max. Negotiated Rate	$115.37
Rate for Payer: Cash Price	$41.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$115.37
Rate for Payer: SOMOS Essential	$115.37

CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING

Professional

Both

$200.80

Service Code	HCPCS 75565
Min. Negotiated Rate	$150.60
Max. Negotiated Rate	$150.60
Rate for Payer: Cash Price	$54.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$150.60
Rate for Payer: SOMOS Essential	$150.60

CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING

Professional

Both

$46.97

Service Code	HCPCS 75565 26
Min. Negotiated Rate	$35.23
Max. Negotiated Rate	$35.23
Rate for Payer: Cash Price	$12.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35.23
Rate for Payer: SOMOS Essential	$35.23

CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST

Professional

Both

$441.00

Service Code	HCPCS 75557 26
Min. Negotiated Rate	$330.75
Max. Negotiated Rate	$330.75
Rate for Payer: Cash Price	$120.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$330.75
Rate for Payer: SOMOS Essential	$330.75

CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST

Professional

Both

$1,221.29

Service Code	HCPCS 75557
Min. Negotiated Rate	$915.97
Max. Negotiated Rate	$915.97
Rate for Payer: Cash Price	$329.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$915.97
Rate for Payer: SOMOS Essential	$915.97

CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST

Professional

Both

$780.29

Service Code	HCPCS 75557 TC
Min. Negotiated Rate	$585.22
Max. Negotiated Rate	$585.22
Rate for Payer: Cash Price	$209.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$585.22
Rate for Payer: SOMOS Essential	$585.22

Know your out-of-pocket cost for care.

All Charges