St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME

Professional

Both

$122.05

Service Code	HCPCS 76000 TC
Min. Negotiated Rate	$91.54
Max. Negotiated Rate	$91.54
Rate for Payer: Cash Price	$33.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$91.54
Rate for Payer: SOMOS Essential	$91.54

CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME

Professional

Both

$65.77

Service Code	HCPCS 76000 26
Min. Negotiated Rate	$49.33
Max. Negotiated Rate	$49.33
Rate for Payer: Cash Price	$16.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$49.33
Rate for Payer: SOMOS Essential	$49.33

CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME

Professional

Both

$187.81

Service Code	HCPCS 76000
Min. Negotiated Rate	$140.86
Max. Negotiated Rate	$140.86
Rate for Payer: Cash Price	$49.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$140.86
Rate for Payer: SOMOS Essential	$140.86

CHG GASTRIC EMPTYING IMAGING STUDY

Professional

Both

$1,321.15

Service Code	HCPCS 78264
Min. Negotiated Rate	$990.86
Max. Negotiated Rate	$990.86
Rate for Payer: Cash Price	$354.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$990.86
Rate for Payer: SOMOS Essential	$990.86

CHG GASTRIC EMPTYING IMAGING STUDY

Professional

Both

$1,172.43

Service Code	HCPCS 78264 TC
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$879.32
Rate for Payer: Cash Price	$314.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$879.32
Rate for Payer: SOMOS Essential	$879.32

CHG GASTRIC EMPTYING IMAGING STUDY

Professional

Both

$148.72

Service Code	HCPCS 78264 26
Min. Negotiated Rate	$111.54
Max. Negotiated Rate	$111.54
Rate for Payer: Cash Price	$40.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$111.54
Rate for Payer: SOMOS Essential	$111.54

CHG GASTRIC EMPTYNG IMAG STD W/SM BWL TRANSIT

Professional

Both

$181.13

Service Code	HCPCS 78265 26
Min. Negotiated Rate	$135.85
Max. Negotiated Rate	$135.85
Rate for Payer: Cash Price	$49.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$135.85
Rate for Payer: SOMOS Essential	$135.85

CHG GASTRIC EMPTYNG IMAG STD W/SM BWL TRANSIT

Professional

Both

$1,563.17

Service Code	HCPCS 78265
Min. Negotiated Rate	$1,172.38
Max. Negotiated Rate	$1,172.38
Rate for Payer: Cash Price	$421.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,172.38
Rate for Payer: SOMOS Essential	$1,172.38

CHG GASTRIC EMPTYNG IMAG STD W/SM BWL TRANSIT

Professional

Both

$1,382.05

Service Code	HCPCS 78265 TC
Min. Negotiated Rate	$1,036.54
Max. Negotiated Rate	$1,036.54
Rate for Payer: Cash Price	$371.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,036.54
Rate for Payer: SOMOS Essential	$1,036.54

CHG GASTRIC MUCOSA IMAGING

Professional

Both

$104.97

Service Code	HCPCS 78261 26
Min. Negotiated Rate	$78.73
Max. Negotiated Rate	$78.73
Rate for Payer: Cash Price	$29.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$78.73
Rate for Payer: SOMOS Essential	$78.73

CHG GASTRIC MUCOSA IMAGING

Professional

Both

$698.08

Service Code	HCPCS 78261 TC
Min. Negotiated Rate	$523.56
Max. Negotiated Rate	$523.56
Rate for Payer: Cash Price	$187.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$523.56
Rate for Payer: SOMOS Essential	$523.56

CHG GASTRIC MUCOSA IMAGING

Professional

Both

$803.04

Service Code	HCPCS 78261
Min. Negotiated Rate	$602.28
Max. Negotiated Rate	$602.28
Rate for Payer: Cash Price	$216.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$602.28
Rate for Payer: SOMOS Essential	$602.28

CHG GASTROESOPHAGEAL REFLUX STUDY

Professional

Both

$857.64

Service Code	HCPCS 78262 TC
Min. Negotiated Rate	$643.23
Max. Negotiated Rate	$643.23
Rate for Payer: Cash Price	$230.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$643.23
Rate for Payer: SOMOS Essential	$643.23

CHG GASTROESOPHAGEAL REFLUX STUDY

Professional

Both

$989.70

Service Code	HCPCS 78262
Min. Negotiated Rate	$742.28
Max. Negotiated Rate	$742.28
Rate for Payer: Cash Price	$265.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$742.28
Rate for Payer: SOMOS Essential	$742.28

CHG GASTROESOPHAGEAL REFLUX STUDY

Professional

Both

$132.06

Service Code	HCPCS 78262 26
Min. Negotiated Rate	$99.04
Max. Negotiated Rate	$99.04
Rate for Payer: Cash Price	$35.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$99.04
Rate for Payer: SOMOS Essential	$99.04

CHG GASTROINTESTINAL PROTEIN LOSS

Professional

Both

$233.91

Service Code	HCPCS 78282 TC
Min. Negotiated Rate	$175.43
Max. Negotiated Rate	$175.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$175.43
Rate for Payer: SOMOS Essential	$175.43

CHG GASTROINTESTINAL PROTEIN LOSS

Professional

Both

$292.85

Service Code	HCPCS 78282
Min. Negotiated Rate	$219.64
Max. Negotiated Rate	$219.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$219.64
Rate for Payer: SOMOS Essential	$219.64

CHG GASTROINTESTINAL PROTEIN LOSS

Professional

Both

$58.94

Service Code	HCPCS 78282 26
Min. Negotiated Rate	$44.20
Max. Negotiated Rate	$44.20
Rate for Payer: Cash Price	$16.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44.20
Rate for Payer: SOMOS Essential	$44.20

CHG GI ENDOSCOPIC US S&I

Professional

Both

$475.79

Service Code	HCPCS 76975
Min. Negotiated Rate	$356.84
Max. Negotiated Rate	$356.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$356.84
Rate for Payer: SOMOS Essential	$356.84

CHG GI ENDOSCOPIC US S&I

Professional

Both

$311.64

Service Code	HCPCS 76975 TC
Min. Negotiated Rate	$233.73
Max. Negotiated Rate	$233.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$233.73
Rate for Payer: SOMOS Essential	$233.73

CHG GI ENDOSCOPIC US S&I

Professional

Both

$164.15

Service Code	HCPCS 76975 26
Min. Negotiated Rate	$123.11
Max. Negotiated Rate	$123.11
Rate for Payer: Cash Price	$44.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$123.11
Rate for Payer: SOMOS Essential	$123.11

CHG GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE

Professional

Both

$8.00

Service Code	HCPCS 82962
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Cash Price	$3.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6.00
Rate for Payer: SOMOS Essential	$6.00

CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP

Professional

Both

$9.82

Service Code	HCPCS 82947
Min. Negotiated Rate	$7.36
Max. Negotiated Rate	$7.36
Rate for Payer: Cash Price	$3.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7.36
Rate for Payer: SOMOS Essential	$7.36

CHG GSTRC EMPTNG IMAG STD W/SM BWL COL TRNST MLT DAY

Professional

Both

$192.22

Service Code	HCPCS 78266 26
Min. Negotiated Rate	$144.16
Max. Negotiated Rate	$144.16
Rate for Payer: Cash Price	$52.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$144.16
Rate for Payer: SOMOS Essential	$144.16

CHG GSTRC EMPTNG IMAG STD W/SM BWL COL TRNST MLT DAY

Professional

Both

$1,776.81

Service Code	HCPCS 78266
Min. Negotiated Rate	$1,332.61
Max. Negotiated Rate	$1,332.61
Rate for Payer: Cash Price	$479.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,332.61
Rate for Payer: SOMOS Essential	$1,332.61

Know your out-of-pocket cost for care.

All Charges