St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY

Professional

Both

$118.97

Service Code	HCPCS 78635 26
Min. Negotiated Rate	$89.23
Max. Negotiated Rate	$89.23
Rate for Payer: Cash Price	$31.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$89.23
Rate for Payer: SOMOS Essential	$89.23

CHG CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY

Professional

Both

$1,353.24

Service Code	HCPCS 78635
Min. Negotiated Rate	$1,014.93
Max. Negotiated Rate	$1,014.93
Rate for Payer: Cash Price	$363.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,014.93
Rate for Payer: SOMOS Essential	$1,014.93

CHG CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY

Professional

Both

$1,234.24

Service Code	HCPCS 78635 TC
Min. Negotiated Rate	$925.68
Max. Negotiated Rate	$925.68
Rate for Payer: Cash Price	$331.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$925.68
Rate for Payer: SOMOS Essential	$925.68

CHG CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATIO

Professional

Both

$1,081.96

Service Code	HCPCS 78650
Min. Negotiated Rate	$811.47
Max. Negotiated Rate	$811.47
Rate for Payer: Cash Price	$290.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$811.47
Rate for Payer: SOMOS Essential	$811.47

CHG CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATIO

Professional

Both

$93.52

Service Code	HCPCS 78650 26
Min. Negotiated Rate	$70.14
Max. Negotiated Rate	$70.14
Rate for Payer: Cash Price	$25.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70.14
Rate for Payer: SOMOS Essential	$70.14

CHG CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATIO

Professional

Both

$988.44

Service Code	HCPCS 78650 TC
Min. Negotiated Rate	$741.33
Max. Negotiated Rate	$741.33
Rate for Payer: Cash Price	$265.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$741.33
Rate for Payer: SOMOS Essential	$741.33

CHG CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I

Professional

Both

$405.13

Service Code	HCPCS 75984
Min. Negotiated Rate	$303.85
Max. Negotiated Rate	$303.85
Rate for Payer: Cash Price	$110.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$303.85
Rate for Payer: SOMOS Essential	$303.85

CHG CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I

Professional

Both

$255.75

Service Code	HCPCS 75984 TC
Min. Negotiated Rate	$191.81
Max. Negotiated Rate	$191.81
Rate for Payer: Cash Price	$68.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$191.81
Rate for Payer: SOMOS Essential	$191.81

CHG CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I

Professional

Both

$149.42

Service Code	HCPCS 75984 26
Min. Negotiated Rate	$112.06
Max. Negotiated Rate	$112.06
Rate for Payer: Cash Price	$41.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$112.06
Rate for Payer: SOMOS Essential	$112.06

CHG CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I

Professional

Both

$261.28

Service Code	HCPCS 74300
Min. Negotiated Rate	$195.96
Max. Negotiated Rate	$195.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$195.96
Rate for Payer: SOMOS Essential	$195.96

CHG CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I

Professional

Both

$207.62

Service Code	HCPCS 74300 TC
Min. Negotiated Rate	$155.72
Max. Negotiated Rate	$155.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$155.72
Rate for Payer: SOMOS Essential	$155.72

CHG CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I

Professional

Both

$53.66

Service Code	HCPCS 74300 26
Min. Negotiated Rate	$40.24
Max. Negotiated Rate	$40.24
Rate for Payer: Cash Price	$14.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$40.24
Rate for Payer: SOMOS Essential	$40.24

CHG CHOLANGIO&/PANCREATOGRAPHY ADDL SET INTRAOP RS

Professional

Both

$155.61

Service Code	HCPCS 74301
Min. Negotiated Rate	$116.71
Max. Negotiated Rate	$116.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$116.71
Rate for Payer: SOMOS Essential	$116.71

CHG CHOLANGIO&/PANCREATOGRAPHY ADDL SET INTRAOP RS

Professional

Both

$40.53

Service Code	HCPCS 74301 26
Min. Negotiated Rate	$30.40
Max. Negotiated Rate	$30.40
Rate for Payer: Cash Price	$10.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30.40
Rate for Payer: SOMOS Essential	$30.40

CHG CHOLANGIO&/PANCREATOGRAPHY ADDL SET INTRAOP RS

Professional

Both

$115.08

Service Code	HCPCS 74301 TC
Min. Negotiated Rate	$86.31
Max. Negotiated Rate	$86.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$86.31
Rate for Payer: SOMOS Essential	$86.31

CHG CHOLECYSTOGRAPHY ORAL CONTRST

Professional

Both

$62.79

Service Code	HCPCS 74290 26
Min. Negotiated Rate	$47.09
Max. Negotiated Rate	$47.09
Rate for Payer: Cash Price	$16.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$47.09
Rate for Payer: SOMOS Essential	$47.09

CHG CHOLECYSTOGRAPHY ORAL CONTRST

Professional

Both

$374.61

Service Code	HCPCS 74290
Min. Negotiated Rate	$280.96
Max. Negotiated Rate	$280.96
Rate for Payer: Cash Price	$99.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$280.96
Rate for Payer: SOMOS Essential	$280.96

CHG CHOLECYSTOGRAPHY ORAL CONTRST

Professional

Both

$311.82

Service Code	HCPCS 74290 TC
Min. Negotiated Rate	$233.86
Max. Negotiated Rate	$233.86
Rate for Payer: Cash Price	$82.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$233.86
Rate for Payer: SOMOS Essential	$233.86

CHG CINERADIOGRAPY/VIDRADIOGRAPY ROUTINE EXAMINATION

Professional

Both

$50.93

Service Code	HCPCS 76125 26
Min. Negotiated Rate	$38.20
Max. Negotiated Rate	$38.20
Rate for Payer: Cash Price	$14.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38.20
Rate for Payer: SOMOS Essential	$38.20

CHG CINERADIOGRAPY/VIDRADIOGRAPY ROUTINE EXAMINATION

Professional

Both

$159.64

Service Code	HCPCS 76125 TC
Min. Negotiated Rate	$119.73
Max. Negotiated Rate	$119.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$119.73
Rate for Payer: SOMOS Essential	$119.73

CHG CINERADIOGRAPY/VIDRADIOGRAPY ROUTINE EXAMINATION

Professional

Both

$210.56

Service Code	HCPCS 76125
Min. Negotiated Rate	$157.92
Max. Negotiated Rate	$157.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$157.92
Rate for Payer: SOMOS Essential	$157.92

CHG CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC

Professional

Both

$505.47

Service Code	HCPCS 76120
Min. Negotiated Rate	$379.10
Max. Negotiated Rate	$379.10
Rate for Payer: Cash Price	$138.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$379.10
Rate for Payer: SOMOS Essential	$379.10

CHG CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC

Professional

Both

$80.12

Service Code	HCPCS 76120 26
Min. Negotiated Rate	$60.09
Max. Negotiated Rate	$60.09
Rate for Payer: Cash Price	$21.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$60.09
Rate for Payer: SOMOS Essential	$60.09

CHG CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC

Professional

Both

$425.36

Service Code	HCPCS 76120 TC
Min. Negotiated Rate	$319.02
Max. Negotiated Rate	$319.02
Rate for Payer: Cash Price	$116.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$319.02
Rate for Payer: SOMOS Essential	$319.02

CHG CISTERNOGRAPHY POSITIVE CONTRAST RS&I

Professional

Both

$228.73

Service Code	HCPCS 70015 26
Min. Negotiated Rate	$171.55
Max. Negotiated Rate	$171.55
Rate for Payer: Cash Price	$61.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$171.55
Rate for Payer: SOMOS Essential	$171.55

Know your out-of-pocket cost for care.

All Charges