St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING

Professional

Both

$540.58

Service Code	HCPCS 75559 26
Min. Negotiated Rate	$405.44
Max. Negotiated Rate	$405.44
Rate for Payer: Cash Price	$148.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$405.44
Rate for Payer: SOMOS Essential	$405.44

CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING

Professional

Both

$1,635.69

Service Code	HCPCS 75559
Min. Negotiated Rate	$1,226.77
Max. Negotiated Rate	$1,226.77
Rate for Payer: Cash Price	$442.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,226.77
Rate for Payer: SOMOS Essential	$1,226.77

CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING

Professional

Both

$1,095.08

Service Code	HCPCS 75559 TC
Min. Negotiated Rate	$821.31
Max. Negotiated Rate	$821.31
Rate for Payer: Cash Price	$294.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$821.31
Rate for Payer: SOMOS Essential	$821.31

CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ

Professional

Both

$1,116.64

Service Code	HCPCS 75561 TC
Min. Negotiated Rate	$837.48
Max. Negotiated Rate	$837.48
Rate for Payer: Cash Price	$299.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$837.48
Rate for Payer: SOMOS Essential	$837.48

CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ

Professional

Both

$1,604.65

Service Code	HCPCS 75561
Min. Negotiated Rate	$1,203.49
Max. Negotiated Rate	$1,203.49
Rate for Payer: Cash Price	$432.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,203.49
Rate for Payer: SOMOS Essential	$1,203.49

CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ

Professional

Both

$488.01

Service Code	HCPCS 75561 26
Min. Negotiated Rate	$366.01
Max. Negotiated Rate	$366.01
Rate for Payer: Cash Price	$132.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$366.01
Rate for Payer: SOMOS Essential	$366.01

CHG CARDIAC MRI W/W/O CONTRAST W/STRESS

Professional

Both

$549.75

Service Code	HCPCS 75563 26
Min. Negotiated Rate	$412.31
Max. Negotiated Rate	$412.31
Rate for Payer: Cash Price	$151.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$412.31
Rate for Payer: SOMOS Essential	$412.31

CHG CARDIAC MRI W/W/O CONTRAST W/STRESS

Professional

Both

$1,314.74

Service Code	HCPCS 75563 TC
Min. Negotiated Rate	$986.06
Max. Negotiated Rate	$986.06
Rate for Payer: Cash Price	$351.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$986.06
Rate for Payer: SOMOS Essential	$986.06

CHG CARDIAC MRI W/W/O CONTRAST W/STRESS

Professional

Both

$1,864.49

Service Code	HCPCS 75563
Min. Negotiated Rate	$1,398.37
Max. Negotiated Rate	$1,398.37
Rate for Payer: Cash Price	$503.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,398.37
Rate for Payer: SOMOS Essential	$1,398.37

CHG CARDIAC SHUNT DETECTION

Professional

Both

$607.50

Service Code	HCPCS 78428 TC
Min. Negotiated Rate	$455.62
Max. Negotiated Rate	$455.62
Rate for Payer: Cash Price	$164.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$455.62
Rate for Payer: SOMOS Essential	$455.62

CHG CARDIAC SHUNT DETECTION

Professional

Both

$752.08

Service Code	HCPCS 78428
Min. Negotiated Rate	$564.06
Max. Negotiated Rate	$564.06
Rate for Payer: Cash Price	$202.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$564.06
Rate for Payer: SOMOS Essential	$564.06

CHG CARDIAC SHUNT DETECTION

Professional

Both

$144.59

Service Code	HCPCS 78428 26
Min. Negotiated Rate	$108.44
Max. Negotiated Rate	$108.44
Rate for Payer: Cash Price	$38.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$108.44
Rate for Payer: SOMOS Essential	$108.44

CHG CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM

Professional

Both

$1,336.90

Service Code	HCPCS 78414
Min. Negotiated Rate	$1,002.68
Max. Negotiated Rate	$1,002.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,002.68
Rate for Payer: SOMOS Essential	$1,002.68

CHG CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM

Professional

Both

$1,254.79

Service Code	HCPCS 78414 TC
Min. Negotiated Rate	$941.09
Max. Negotiated Rate	$941.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$941.09
Rate for Payer: SOMOS Essential	$941.09

CHG CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM

Professional

Both

$82.11

Service Code	HCPCS 78414 26
Min. Negotiated Rate	$61.58
Max. Negotiated Rate	$61.58
Rate for Payer: Cash Price	$22.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$61.58
Rate for Payer: SOMOS Essential	$61.58

CHG CELL ENUMERATION IMMUNE SELECTJ & ID PHYS INTERP

Professional

Both

$130.69

Service Code	HCPCS 86153 26
Min. Negotiated Rate	$98.02
Max. Negotiated Rate	$98.02
Rate for Payer: Cash Price	$35.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$98.02
Rate for Payer: SOMOS Essential	$98.02

CHG CEPHALOGRAM ORTHODONTIC

Professional

Both

$35.81

Service Code	HCPCS 70350 TC
Min. Negotiated Rate	$26.86
Max. Negotiated Rate	$26.86
Rate for Payer: Cash Price	$10.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26.86
Rate for Payer: SOMOS Essential	$26.86

CHG CEPHALOGRAM ORTHODONTIC

Professional

Both

$69.90

Service Code	HCPCS 70350
Min. Negotiated Rate	$52.42
Max. Negotiated Rate	$52.42
Rate for Payer: Cash Price	$19.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$52.42
Rate for Payer: SOMOS Essential	$52.42

CHG CEPHALOGRAM ORTHODONTIC

Professional

Both

$34.09

Service Code	HCPCS 70350 26
Min. Negotiated Rate	$25.57
Max. Negotiated Rate	$25.57
Rate for Payer: Cash Price	$9.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25.57
Rate for Payer: SOMOS Essential	$25.57

CHG CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY

Professional

Both

$129.19

Service Code	HCPCS 78630 26
Min. Negotiated Rate	$96.89
Max. Negotiated Rate	$96.89
Rate for Payer: Cash Price	$34.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$96.89
Rate for Payer: SOMOS Essential	$96.89

CHG CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY

Professional

Both

$1,219.89

Service Code	HCPCS 78630 TC
Min. Negotiated Rate	$914.92
Max. Negotiated Rate	$914.92
Rate for Payer: Cash Price	$327.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$914.92
Rate for Payer: SOMOS Essential	$914.92

CHG CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY

Professional

Both

$1,349.04

Service Code	HCPCS 78630
Min. Negotiated Rate	$1,011.78
Max. Negotiated Rate	$1,011.78
Rate for Payer: Cash Price	$361.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,011.78
Rate for Payer: SOMOS Essential	$1,011.78

CHG CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ

Professional

Both

$1,186.82

Service Code	HCPCS 78645 TC
Min. Negotiated Rate	$890.12
Max. Negotiated Rate	$890.12
Rate for Payer: Cash Price	$318.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$890.12
Rate for Payer: SOMOS Essential	$890.12

CHG CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ

Professional

Both

$1,289.54

Service Code	HCPCS 78645
Min. Negotiated Rate	$967.16
Max. Negotiated Rate	$967.16
Rate for Payer: Cash Price	$347.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$967.16
Rate for Payer: SOMOS Essential	$967.16

CHG CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ

Professional

Both

$102.73

Service Code	HCPCS 78645 26
Min. Negotiated Rate	$77.05
Max. Negotiated Rate	$77.05
Rate for Payer: Cash Price	$28.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$77.05
Rate for Payer: SOMOS Essential	$77.05

Know your out-of-pocket cost for care.

All Charges