St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG CISTERNOGRAPHY POSITIVE CONTRAST RS&I

Professional

Both

$714.46

Service Code	HCPCS 70015
Min. Negotiated Rate	$535.84
Max. Negotiated Rate	$535.84
Rate for Payer: Cash Price	$192.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$535.84
Rate for Payer: SOMOS Essential	$535.84

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

CHG CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I

Professional

Both

$750.72

Service Code	HCPCS 74330
Min. Negotiated Rate	$563.04
Max. Negotiated Rate	$563.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$563.04
Rate for Payer: SOMOS Essential	$563.04

CHG CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I

Professional

Both

$112.70

Service Code	HCPCS 74330 26
Min. Negotiated Rate	$84.52
Max. Negotiated Rate	$84.52
Rate for Payer: Cash Price	$29.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$84.52
Rate for Payer: SOMOS Essential	$84.52

CHG CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I

Professional

Both

$638.02

Service Code	HCPCS 74330 TC
Min. Negotiated Rate	$478.52
Max. Negotiated Rate	$478.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$478.52
Rate for Payer: SOMOS Essential	$478.52

CHG COAGJ/FBRNLYS ASSAY WHOLE BLOOD ADDITIVE PER DAY

Professional

Both

$77.70

Service Code	HCPCS 85396
Min. Negotiated Rate	$58.28
Max. Negotiated Rate	$58.28
Rate for Payer: Cash Price	$21.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$58.28
Rate for Payer: SOMOS Essential	$58.28

CHG COAGULATION TIME ACTIVATED

Professional

Both

$17.12

Service Code	HCPCS 85347
Min. Negotiated Rate	$12.84
Max. Negotiated Rate	$12.84
Rate for Payer: Cash Price	$4.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$12.84
Rate for Payer: SOMOS Essential	$12.84

CHG COMPREHENSIVE METABOLIC PANEL

Professional

Both

$26.40

Service Code	HCPCS 80053
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$19.80
Rate for Payer: Cash Price	$10.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19.80
Rate for Payer: SOMOS Essential	$19.80

CHG COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-

Professional

Both

$207.76

Service Code	HCPCS 71271 26
Min. Negotiated Rate	$155.82
Max. Negotiated Rate	$155.82
Rate for Payer: Cash Price	$56.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$155.82
Rate for Payer: SOMOS Essential	$155.82

CHG COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-

Professional

Both

$395.19

Service Code	HCPCS 71271 TC
Min. Negotiated Rate	$296.39
Max. Negotiated Rate	$296.39
Rate for Payer: Cash Price	$106.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$296.39
Rate for Payer: SOMOS Essential	$296.39

CHG COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-

Professional

Both

$602.91

Service Code	HCPCS 71271
Min. Negotiated Rate	$452.18
Max. Negotiated Rate	$452.18
Rate for Payer: Cash Price	$163.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$452.18
Rate for Payer: SOMOS Essential	$452.18

CHG CONSLTJ COMPRE RVW RECORD REPRT REFERRED MATRL

Professional

Both

$526.37

Service Code	HCPCS 88325
Min. Negotiated Rate	$394.78
Max. Negotiated Rate	$394.78
Rate for Payer: Cash Price	$144.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$394.78
Rate for Payer: SOMOS Essential	$394.78

CHG CONSLTJ&REPRT REFERRED MATRL REQUIRING PREPJ SLD

Professional

Both

$454.62

Service Code	HCPCS 88323
Min. Negotiated Rate	$340.96
Max. Negotiated Rate	$340.96
Rate for Payer: Cash Price	$128.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$340.96
Rate for Payer: SOMOS Essential	$340.96

CHG CONSLTJ&REPRT REFERRED MATRL REQUIRING PREPJ SLD

Professional

Both

$122.05

Service Code	HCPCS 88323 TC
Min. Negotiated Rate	$91.54
Max. Negotiated Rate	$91.54
Rate for Payer: Cash Price	$35.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$91.54
Rate for Payer: SOMOS Essential	$91.54

CHG CONSLTJ&REPRT REFERRED MATRL REQUIRING PREPJ SLD

Professional

Both

$332.57

Service Code	HCPCS 88323 26
Min. Negotiated Rate	$249.43
Max. Negotiated Rate	$249.43
Rate for Payer: Cash Price	$92.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$249.43
Rate for Payer: SOMOS Essential	$249.43

CHG CONSLTJ&REPRT REFERRED SLIDES PREPARED ELSEWHERE

Professional

Both

$332.43

Service Code	HCPCS 88321
Min. Negotiated Rate	$249.32
Max. Negotiated Rate	$249.32
Rate for Payer: Cash Price	$90.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$249.32
Rate for Payer: SOMOS Essential	$249.32

CHG CONTINUING MEDICAL PHYSICS CONSLTJ PR WK

Professional

Both

$381.26

Service Code	HCPCS 77336
Min. Negotiated Rate	$285.94
Max. Negotiated Rate	$285.94
Rate for Payer: Cash Price	$106.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$285.94
Rate for Payer: SOMOS Essential	$285.94

CHG CORPORA CAVERNOSOGRAPY RS&I

Professional

Both

$227.96

Service Code	HCPCS 74445 TC
Min. Negotiated Rate	$170.97
Max. Negotiated Rate	$170.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$170.97
Rate for Payer: SOMOS Essential	$170.97

CHG CORPORA CAVERNOSOGRAPY RS&I

Professional

Both

$209.79

Service Code	HCPCS 74445 26
Min. Negotiated Rate	$157.34
Max. Negotiated Rate	$157.34
Rate for Payer: Cash Price	$57.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$157.34
Rate for Payer: SOMOS Essential	$157.34

CHG CORPORA CAVERNOSOGRAPY RS&I

Professional

Both

$437.75

Service Code	HCPCS 74445
Min. Negotiated Rate	$328.31
Max. Negotiated Rate	$328.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$328.31
Rate for Payer: SOMOS Essential	$328.31

CHG CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC

Professional

Both

$165.03

Service Code	HCPCS 70371 26
Min. Negotiated Rate	$123.77
Max. Negotiated Rate	$123.77
Rate for Payer: Cash Price	$45.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$123.77
Rate for Payer: SOMOS Essential	$123.77

CHG CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC

Professional

Both

$293.13

Service Code	HCPCS 70371 TC
Min. Negotiated Rate	$219.85
Max. Negotiated Rate	$219.85
Rate for Payer: Cash Price	$80.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$219.85
Rate for Payer: SOMOS Essential	$219.85

CHG CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC

Professional

Both

$458.15

Service Code	HCPCS 70371
Min. Negotiated Rate	$343.61
Max. Negotiated Rate	$343.61
Rate for Payer: Cash Price	$126.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$343.61
Rate for Payer: SOMOS Essential	$343.61

CHG CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP

Professional

Both

$1,217.20

Service Code	HCPCS 75635
Min. Negotiated Rate	$912.90
Max. Negotiated Rate	$912.90
Rate for Payer: Cash Price	$490.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$912.90
Rate for Payer: SOMOS Essential	$912.90

CHG CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP

Professional

Both

$767.34

Service Code	HCPCS 75635 TC
Min. Negotiated Rate	$575.50
Max. Negotiated Rate	$575.50
Rate for Payer: Cash Price	$367.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$575.50
Rate for Payer: SOMOS Essential	$575.50

Know your out-of-pocket cost for care.

All Charges