St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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 HDR RDNCL NTRSTL/INTRCAV BRACHYTX >12 CHANNELS

Professional

Both

$2,664.20

Service Code	HCPCS 77772 TC
Min. Negotiated Rate	$1,998.15
Max. Negotiated Rate	$1,998.15
Rate for Payer: Cash Price	$740.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,998.15
Rate for Payer: SOMOS Essential	$1,998.15

CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX >12 CHANNELS

Professional

Both

$1,131.83

Service Code	HCPCS 77772 26
Min. Negotiated Rate	$848.87
Max. Negotiated Rate	$848.87
Rate for Payer: Cash Price	$311.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$848.87
Rate for Payer: SOMOS Essential	$848.87

CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX >12 CHANNELS

Professional

Both

$3,796.03

Service Code	HCPCS 77772
Min. Negotiated Rate	$2,847.02
Max. Negotiated Rate	$2,847.02
Rate for Payer: Cash Price	$1,051.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,847.02
Rate for Payer: SOMOS Essential	$2,847.02

CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL

Professional

Both

$411.32

Service Code	HCPCS 77770 26
Min. Negotiated Rate	$308.49
Max. Negotiated Rate	$308.49
Rate for Payer: Cash Price	$113.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$308.49
Rate for Payer: SOMOS Essential	$308.49

CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL

Professional

Both

$1,054.55

Service Code	HCPCS 77770 TC
Min. Negotiated Rate	$790.91
Max. Negotiated Rate	$790.91
Rate for Payer: Cash Price	$292.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$790.91
Rate for Payer: SOMOS Essential	$790.91

CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL

Professional

Both

$1,465.87

Service Code	HCPCS 77770
Min. Negotiated Rate	$1,099.40
Max. Negotiated Rate	$1,099.40
Rate for Payer: Cash Price	$405.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,099.40
Rate for Payer: SOMOS Essential	$1,099.40

CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 2-12 CHANNEL

Professional

Both

$807.07

Service Code	HCPCS 77771 26
Min. Negotiated Rate	$605.30
Max. Negotiated Rate	$605.30
Rate for Payer: Cash Price	$220.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$605.30
Rate for Payer: SOMOS Essential	$605.30

CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 2-12 CHANNEL

Professional

Both

$2,547.93

Service Code	HCPCS 77771
Min. Negotiated Rate	$1,910.95
Max. Negotiated Rate	$1,910.95
Rate for Payer: Cash Price	$703.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,910.95
Rate for Payer: SOMOS Essential	$1,910.95

CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 2-12 CHANNEL

Professional

Both

$1,740.87

Service Code	HCPCS 77771 TC
Min. Negotiated Rate	$1,305.65
Max. Negotiated Rate	$1,305.65
Rate for Payer: Cash Price	$483.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,305.65
Rate for Payer: SOMOS Essential	$1,305.65

CHG HDR RDNCL SKN SURF BRACHYTX LES <2CM/1 CHAN

Professional

Both

$838.95

Service Code	HCPCS 77767 TC
Min. Negotiated Rate	$629.21
Max. Negotiated Rate	$629.21
Rate for Payer: Cash Price	$231.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$629.21
Rate for Payer: SOMOS Essential	$629.21

CHG HDR RDNCL SKN SURF BRACHYTX LES <2CM/1 CHAN

Professional

Both

$1,060.47

Service Code	HCPCS 77767
Min. Negotiated Rate	$795.35
Max. Negotiated Rate	$795.35
Rate for Payer: Cash Price	$292.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$795.35
Rate for Payer: SOMOS Essential	$795.35

CHG HDR RDNCL SKN SURF BRACHYTX LES <2CM/1 CHAN

Professional

Both

$221.52

Service Code	HCPCS 77767 26
Min. Negotiated Rate	$166.14
Max. Negotiated Rate	$166.14
Rate for Payer: Cash Price	$60.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$166.14
Rate for Payer: SOMOS Essential	$166.14

CHG HDR RDNCL SK SRF BRCHYTX LES >2CM&2CHAN/MLT LES

Professional

Both

$296.70

Service Code	HCPCS 77768 26
Min. Negotiated Rate	$222.52
Max. Negotiated Rate	$222.52
Rate for Payer: Cash Price	$81.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$222.52
Rate for Payer: SOMOS Essential	$222.52

CHG HDR RDNCL SK SRF BRCHYTX LES >2CM&2CHAN/MLT LES

Professional

Both

$1,256.85

Service Code	HCPCS 77768 TC
Min. Negotiated Rate	$942.64
Max. Negotiated Rate	$942.64
Rate for Payer: Cash Price	$347.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$942.64
Rate for Payer: SOMOS Essential	$942.64

CHG HDR RDNCL SK SRF BRCHYTX LES >2CM&2CHAN/MLT LES

Professional

Both

$1,553.55

Service Code	HCPCS 77768
Min. Negotiated Rate	$1,165.16
Max. Negotiated Rate	$1,165.16
Rate for Payer: Cash Price	$428.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,165.16
Rate for Payer: SOMOS Essential	$1,165.16

CHG HEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESIS

Professional

Both

$69.20

Service Code	HCPCS 83020 26
Min. Negotiated Rate	$51.90
Max. Negotiated Rate	$51.90
Rate for Payer: Cash Price	$19.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$51.90
Rate for Payer: SOMOS Essential	$51.90

CHG HEMOGLOBIN GLYCOSYLATED A1C

Professional

Both

$24.27

Service Code	HCPCS 83036
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$18.20
Rate for Payer: Cash Price	$9.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18.20
Rate for Payer: SOMOS Essential	$18.20

CHG HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I

Professional

Both

$525.21

Service Code	HCPCS 75889
Min. Negotiated Rate	$393.91
Max. Negotiated Rate	$393.91
Rate for Payer: Cash Price	$142.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$393.91
Rate for Payer: SOMOS Essential	$393.91

CHG HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I

Professional

Both

$209.23

Service Code	HCPCS 75889 26
Min. Negotiated Rate	$156.92
Max. Negotiated Rate	$156.92
Rate for Payer: Cash Price	$56.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$156.92
Rate for Payer: SOMOS Essential	$156.92

CHG HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I

Professional

Both

$315.98

Service Code	HCPCS 75889 TC
Min. Negotiated Rate	$236.98
Max. Negotiated Rate	$236.98
Rate for Payer: Cash Price	$85.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$236.98
Rate for Payer: SOMOS Essential	$236.98

CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I

Professional

Both

$209.37

Service Code	HCPCS 75891 26
Min. Negotiated Rate	$157.03
Max. Negotiated Rate	$157.03
Rate for Payer: Cash Price	$56.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$157.03
Rate for Payer: SOMOS Essential	$157.03

CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I

Professional

Both

$317.42

Service Code	HCPCS 75891 TC
Min. Negotiated Rate	$238.06
Max. Negotiated Rate	$238.06
Rate for Payer: Cash Price	$86.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$238.06
Rate for Payer: SOMOS Essential	$238.06

CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I

Professional

Both

$526.79

Service Code	HCPCS 75891
Min. Negotiated Rate	$395.09
Max. Negotiated Rate	$395.09
Rate for Payer: Cash Price	$143.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$395.09
Rate for Payer: SOMOS Essential	$395.09

CHG HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER

Professional

Both

$139.58

Service Code	HCPCS 78226 26
Min. Negotiated Rate	$104.68
Max. Negotiated Rate	$104.68
Rate for Payer: Cash Price	$38.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$104.68
Rate for Payer: SOMOS Essential	$104.68

Know your out-of-pocket cost for care.

All Charges