St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG ELECTRON MICROSCOPY DIAGNOSTIC

Professional

Both

$2,011.91

Service Code	HCPCS 88348
Min. Negotiated Rate	$1,508.93
Max. Negotiated Rate	$1,508.93
Rate for Payer: Cash Price	$566.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,508.93
Rate for Payer: SOMOS Essential	$1,508.93

CHG ELECTRON MICROSCOPY DIAGNOSTIC

Professional

Both

$1,715.25

Service Code	HCPCS 88348 TC
Min. Negotiated Rate	$1,286.44
Max. Negotiated Rate	$1,286.44
Rate for Payer: Cash Price	$485.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,286.44
Rate for Payer: SOMOS Essential	$1,286.44

CHG ELECTRON MICROSCOPY DIAGNOSTIC

Professional

Both

$296.66

Service Code	HCPCS 88348 26
Min. Negotiated Rate	$222.50
Max. Negotiated Rate	$222.50
Rate for Payer: Cash Price	$81.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$222.50
Rate for Payer: SOMOS Essential	$222.50

CHG ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I

Professional

Both

$638.02

Service Code	HCPCS 74328 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 ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I

Professional

Both

$91.67

Service Code	HCPCS 74328 26
Min. Negotiated Rate	$68.75
Max. Negotiated Rate	$68.75
Rate for Payer: Cash Price	$25.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$68.75
Rate for Payer: SOMOS Essential	$68.75

CHG ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I

Professional

Both

$729.68

Service Code	HCPCS 74328
Min. Negotiated Rate	$547.26
Max. Negotiated Rate	$547.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$547.26
Rate for Payer: SOMOS Essential	$547.26

CHG ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I

Professional

Both

$527.56

Service Code	HCPCS 74329 TC
Min. Negotiated Rate	$395.67
Max. Negotiated Rate	$395.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$395.67
Rate for Payer: SOMOS Essential	$395.67

CHG ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I

Professional

Both

$620.66

Service Code	HCPCS 74329
Min. Negotiated Rate	$465.50
Max. Negotiated Rate	$465.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$465.50
Rate for Payer: SOMOS Essential	$465.50

CHG ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I

Professional

Both

$93.10

Service Code	HCPCS 74329 26
Min. Negotiated Rate	$69.82
Max. Negotiated Rate	$69.82
Rate for Payer: Cash Price	$25.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$69.82
Rate for Payer: SOMOS Essential	$69.82

CHG ESOPHAGEAL MOTILITY

Professional

Both

$860.65

Service Code	HCPCS 78258
Min. Negotiated Rate	$645.49
Max. Negotiated Rate	$645.49
Rate for Payer: Cash Price	$231.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$645.49
Rate for Payer: SOMOS Essential	$645.49

CHG ESOPHAGEAL MOTILITY

Professional

Both

$725.38

Service Code	HCPCS 78258 TC
Min. Negotiated Rate	$544.04
Max. Negotiated Rate	$544.04
Rate for Payer: Cash Price	$195.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$544.04
Rate for Payer: SOMOS Essential	$544.04

CHG ESOPHAGEAL MOTILITY

Professional

Both

$135.24

Service Code	HCPCS 78258 26
Min. Negotiated Rate	$101.43
Max. Negotiated Rate	$101.43
Rate for Payer: Cash Price	$35.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$101.43
Rate for Payer: SOMOS Essential	$101.43

CHG EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I

Professional

Both

$1,240.37

Service Code	HCPCS 75957 26
Min. Negotiated Rate	$930.28
Max. Negotiated Rate	$930.28
Rate for Payer: Cash Price	$331.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$930.28
Rate for Payer: SOMOS Essential	$930.28

CHG EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I

Professional

Both

$2,377.03

Service Code	HCPCS 75957 TC
Min. Negotiated Rate	$1,782.77
Max. Negotiated Rate	$1,782.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,782.77
Rate for Payer: SOMOS Essential	$1,782.77

CHG EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I

Professional

Both

$3,617.39

Service Code	HCPCS 75957
Min. Negotiated Rate	$2,713.04
Max. Negotiated Rate	$2,713.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,713.04
Rate for Payer: SOMOS Essential	$2,713.04

CHG EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I

Professional

Both

$4,225.06

Service Code	HCPCS 75956
Min. Negotiated Rate	$3,168.80
Max. Negotiated Rate	$3,168.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,168.80
Rate for Payer: SOMOS Essential	$3,168.80

CHG EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I

Professional

Both

$2,778.58

Service Code	HCPCS 75956 TC
Min. Negotiated Rate	$2,083.94
Max. Negotiated Rate	$2,083.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,083.94
Rate for Payer: SOMOS Essential	$2,083.94

CHG EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I

Professional

Both

$1,446.48

Service Code	HCPCS 75956 26
Min. Negotiated Rate	$1,084.86
Max. Negotiated Rate	$1,084.86
Rate for Payer: Cash Price	$385.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,084.86
Rate for Payer: SOMOS Essential	$1,084.86

CHG FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING

Professional

Both

$491.51

Service Code	HCPCS 76818
Min. Negotiated Rate	$368.63
Max. Negotiated Rate	$368.63
Rate for Payer: Cash Price	$136.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$368.63
Rate for Payer: SOMOS Essential	$368.63

CHG FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING

Professional

Both

$290.08

Service Code	HCPCS 76818 TC
Min. Negotiated Rate	$217.56
Max. Negotiated Rate	$217.56
Rate for Payer: Cash Price	$82.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$217.56
Rate for Payer: SOMOS Essential	$217.56

CHG FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING

Professional

Both

$201.39

Service Code	HCPCS 76818 26
Min. Negotiated Rate	$151.04
Max. Negotiated Rate	$151.04
Rate for Payer: Cash Price	$53.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$151.04
Rate for Payer: SOMOS Essential	$151.04

CHG FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING

Professional

Both

$143.61

Service Code	HCPCS 76819 26
Min. Negotiated Rate	$107.71
Max. Negotiated Rate	$107.71
Rate for Payer: Cash Price	$39.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$107.71
Rate for Payer: SOMOS Essential	$107.71

CHG FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING

Professional

Both

$351.89

Service Code	HCPCS 76819
Min. Negotiated Rate	$263.92
Max. Negotiated Rate	$263.92
Rate for Payer: Cash Price	$98.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$263.92
Rate for Payer: SOMOS Essential	$263.92

CHG FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING

Professional

Both

$208.29

Service Code	HCPCS 76819 TC
Min. Negotiated Rate	$156.22
Max. Negotiated Rate	$156.22
Rate for Payer: Cash Price	$59.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$156.22
Rate for Payer: SOMOS Essential	$156.22

CHG FETAL MRI W/PLACNTL MATRNL PLVC IMG EA ADDL GES

Professional

Both

$874.20

Service Code	HCPCS 74713
Min. Negotiated Rate	$655.65
Max. Negotiated Rate	$655.65
Rate for Payer: Cash Price	$234.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$655.65
Rate for Payer: SOMOS Essential	$655.65

Know your out-of-pocket cost for care.

All Charges