St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST

Professional

Both

$375.06

Service Code	HCPCS 71250 TC
Min. Negotiated Rate	$281.30
Max. Negotiated Rate	$281.30
Rate for Payer: Cash Price	$101.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$281.30
Rate for Payer: SOMOS Essential	$281.30

CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI

Professional

Both

$481.43

Service Code	HCPCS 77066 TC
Min. Negotiated Rate	$361.07
Max. Negotiated Rate	$361.07
Rate for Payer: Cash Price	$132.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$361.07
Rate for Payer: SOMOS Essential	$361.07

CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI

Professional

Both

$669.38

Service Code	HCPCS 77066
Min. Negotiated Rate	$502.04
Max. Negotiated Rate	$502.04
Rate for Payer: Cash Price	$184.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$502.04
Rate for Payer: SOMOS Essential	$502.04

CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI

Professional

Both

$187.95

Service Code	HCPCS 77066 26
Min. Negotiated Rate	$140.96
Max. Negotiated Rate	$140.96
Rate for Payer: Cash Price	$51.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$140.96
Rate for Payer: SOMOS Essential	$140.96

CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI

Professional

Both

$377.93

Service Code	HCPCS 77065 TC
Min. Negotiated Rate	$283.45
Max. Negotiated Rate	$283.45
Rate for Payer: Cash Price	$103.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$283.45
Rate for Payer: SOMOS Essential	$283.45

CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI

Professional

Both

$532.00

Service Code	HCPCS 77065
Min. Negotiated Rate	$399.00
Max. Negotiated Rate	$399.00
Rate for Payer: Cash Price	$145.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$399.00
Rate for Payer: SOMOS Essential	$399.00

CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI

Professional

Both

$154.07

Service Code	HCPCS 77065 26
Min. Negotiated Rate	$115.55
Max. Negotiated Rate	$115.55
Rate for Payer: Cash Price	$42.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$115.55
Rate for Payer: SOMOS Essential	$115.55

CHG DILATION URETERS/URETHRA RS&I

Professional

Both

$156.59

Service Code	HCPCS 74485 26
Min. Negotiated Rate	$117.44
Max. Negotiated Rate	$117.44
Rate for Payer: Cash Price	$42.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$117.44
Rate for Payer: SOMOS Essential	$117.44

CHG DILATION URETERS/URETHRA RS&I

Professional

Both

$505.75

Service Code	HCPCS 74485
Min. Negotiated Rate	$379.31
Max. Negotiated Rate	$379.31
Rate for Payer: Cash Price	$137.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$379.31
Rate for Payer: SOMOS Essential	$379.31

CHG DILATION URETERS/URETHRA RS&I

Professional

Both

$349.16

Service Code	HCPCS 74485 TC
Min. Negotiated Rate	$261.87
Max. Negotiated Rate	$261.87
Rate for Payer: Cash Price	$95.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$261.87
Rate for Payer: SOMOS Essential	$261.87

CHG DISKOGRAPY CERVICAL/THORACIC RS&I

Professional

Both

$220.92

Service Code	HCPCS 72285 26
Min. Negotiated Rate	$165.69
Max. Negotiated Rate	$165.69
Rate for Payer: Cash Price	$60.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$165.69
Rate for Payer: SOMOS Essential	$165.69

CHG DISKOGRAPY CERVICAL/THORACIC RS&I

Professional

Both

$318.99

Service Code	HCPCS 72285 TC
Min. Negotiated Rate	$239.24
Max. Negotiated Rate	$239.24
Rate for Payer: Cash Price	$91.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$239.24
Rate for Payer: SOMOS Essential	$239.24

CHG DISKOGRAPY CERVICAL/THORACIC RS&I

Professional

Both

$539.91

Service Code	HCPCS 72285
Min. Negotiated Rate	$404.93
Max. Negotiated Rate	$404.93
Rate for Payer: Cash Price	$151.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$404.93
Rate for Payer: SOMOS Essential	$404.93

CHG DISKOGRAPY LUMBAR RS&I

Professional

Both

$310.35

Service Code	HCPCS 72295 TC
Min. Negotiated Rate	$232.76
Max. Negotiated Rate	$232.76
Rate for Payer: Cash Price	$85.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$232.76
Rate for Payer: SOMOS Essential	$232.76

CHG DISKOGRAPY LUMBAR RS&I

Professional

Both

$469.81

Service Code	HCPCS 72295
Min. Negotiated Rate	$352.36
Max. Negotiated Rate	$352.36
Rate for Payer: Cash Price	$128.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$352.36
Rate for Payer: SOMOS Essential	$352.36

CHG DISKOGRAPY LUMBAR RS&I

Professional

Both

$159.46

Service Code	HCPCS 72295 26
Min. Negotiated Rate	$119.60
Max. Negotiated Rate	$119.60
Rate for Payer: Cash Price	$43.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$119.60
Rate for Payer: SOMOS Essential	$119.60

CHG DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT

Professional

Both

$103.08

Service Code	HCPCS 76828 26
Min. Negotiated Rate	$77.31
Max. Negotiated Rate	$77.31
Rate for Payer: Cash Price	$28.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$77.31
Rate for Payer: SOMOS Essential	$77.31

CHG DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT

Professional

Both

$203.56

Service Code	HCPCS 76828
Min. Negotiated Rate	$152.67
Max. Negotiated Rate	$152.67
Rate for Payer: Cash Price	$55.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$152.67
Rate for Payer: SOMOS Essential	$152.67

CHG DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT

Professional

Both

$100.49

Service Code	HCPCS 76828 TC
Min. Negotiated Rate	$75.37
Max. Negotiated Rate	$75.37
Rate for Payer: Cash Price	$26.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$75.37
Rate for Payer: SOMOS Essential	$75.37

CHG DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE

Professional

Both

$293.62

Service Code	HCPCS 76827
Min. Negotiated Rate	$220.22
Max. Negotiated Rate	$220.22
Rate for Payer: Cash Price	$80.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$220.22
Rate for Payer: SOMOS Essential	$220.22

CHG DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE

Professional

Both

$109.73

Service Code	HCPCS 76827 26
Min. Negotiated Rate	$82.30
Max. Negotiated Rate	$82.30
Rate for Payer: Cash Price	$30.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$82.30
Rate for Payer: SOMOS Essential	$82.30

CHG DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE

Professional

Both

$183.86

Service Code	HCPCS 76827 TC
Min. Negotiated Rate	$137.90
Max. Negotiated Rate	$137.90
Rate for Payer: Cash Price	$50.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$137.90
Rate for Payer: SOMOS Essential	$137.90

CHG DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART

Professional

Both

$131.95

Service Code	HCPCS 76821 26
Min. Negotiated Rate	$98.96
Max. Negotiated Rate	$98.96
Rate for Payer: Cash Price	$36.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$98.96
Rate for Payer: SOMOS Essential	$98.96

CHG DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART

Professional

Both

$373.31

Service Code	HCPCS 76821
Min. Negotiated Rate	$279.98
Max. Negotiated Rate	$279.98
Rate for Payer: Cash Price	$102.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$279.98
Rate for Payer: SOMOS Essential	$279.98

CHG DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART

Professional

Both

$241.36

Service Code	HCPCS 76821 TC
Min. Negotiated Rate	$181.02
Max. Negotiated Rate	$181.02
Rate for Payer: Cash Price	$66.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$181.02
Rate for Payer: SOMOS Essential	$181.02

Know your out-of-pocket cost for care.

All Charges