St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER

Professional

Both

$1,300.50

Service Code	HCPCS 78226
Min. Negotiated Rate	$975.38
Max. Negotiated Rate	$975.38
Rate for Payer: Cash Price	$348.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$975.38
Rate for Payer: SOMOS Essential	$975.38

CHG HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER

Professional

Both

$1,160.95

Service Code	HCPCS 78226 TC
Min. Negotiated Rate	$870.71
Max. Negotiated Rate	$870.71
Rate for Payer: Cash Price	$310.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$870.71
Rate for Payer: SOMOS Essential	$870.71

CHG HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ

Professional

Both

$1,581.72

Service Code	HCPCS 78227 TC
Min. Negotiated Rate	$1,186.29
Max. Negotiated Rate	$1,186.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,186.29
Rate for Payer: SOMOS Essential	$1,186.29

CHG HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ

Professional

Both

$1,749.93

Service Code	HCPCS 78227
Min. Negotiated Rate	$1,312.45
Max. Negotiated Rate	$1,312.45
Rate for Payer: Cash Price	$467.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,312.45
Rate for Payer: SOMOS Essential	$1,312.45

CHG HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ

Professional

Both

$168.25

Service Code	HCPCS 78227 26
Min. Negotiated Rate	$126.19
Max. Negotiated Rate	$126.19
Rate for Payer: Cash Price	$45.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$126.19
Rate for Payer: SOMOS Essential	$126.19

CHG HGB GLYCOSYLATED DEVICE CLEARED FDA HOME USE

Professional

Both

$38.84

Service Code	HCPCS 83037
Min. Negotiated Rate	$29.13
Max. Negotiated Rate	$29.13
Rate for Payer: Cash Price	$9.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29.13
Rate for Payer: SOMOS Essential	$29.13

CHG HYPERTHERMIA EXTERNAL GENERATED DEEP

Professional

Both

$438.48

Service Code	HCPCS 77605 26
Min. Negotiated Rate	$328.86
Max. Negotiated Rate	$328.86
Rate for Payer: Cash Price	$117.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$328.86
Rate for Payer: SOMOS Essential	$328.86

CHG HYPERTHERMIA EXTERNAL GENERATED DEEP

Professional

Both

$4,160.77

Service Code	HCPCS 77605
Min. Negotiated Rate	$3,120.58
Max. Negotiated Rate	$3,120.58
Rate for Payer: Cash Price	$1,115.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,120.58
Rate for Payer: SOMOS Essential	$3,120.58

CHG HYPERTHERMIA EXTERNAL GENERATED DEEP

Professional

Both

$3,722.29

Service Code	HCPCS 77605 TC
Min. Negotiated Rate	$2,791.72
Max. Negotiated Rate	$2,791.72
Rate for Payer: Cash Price	$998.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,791.72
Rate for Payer: SOMOS Essential	$2,791.72

CHG HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL

Professional

Both

$286.86

Service Code	HCPCS 77600 26
Min. Negotiated Rate	$215.14
Max. Negotiated Rate	$215.14
Rate for Payer: Cash Price	$78.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$215.14
Rate for Payer: SOMOS Essential	$215.14

CHG HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL

Professional

Both

$2,268.35

Service Code	HCPCS 77600
Min. Negotiated Rate	$1,701.26
Max. Negotiated Rate	$1,701.26
Rate for Payer: Cash Price	$639.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,701.26
Rate for Payer: SOMOS Essential	$1,701.26

CHG HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL

Professional

Both

$1,981.49

Service Code	HCPCS 77600 TC
Min. Negotiated Rate	$1,486.12
Max. Negotiated Rate	$1,486.12
Rate for Payer: Cash Price	$560.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,486.12
Rate for Payer: SOMOS Essential	$1,486.12

CHG HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS

Professional

Both

$4,639.36

Service Code	HCPCS 77615
Min. Negotiated Rate	$3,479.52
Max. Negotiated Rate	$3,479.52
Rate for Payer: Cash Price	$1,263.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,479.52
Rate for Payer: SOMOS Essential	$3,479.52

CHG HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS

Professional

Both

$388.92

Service Code	HCPCS 77615 26
Min. Negotiated Rate	$291.69
Max. Negotiated Rate	$291.69
Rate for Payer: Cash Price	$107.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$291.69
Rate for Payer: SOMOS Essential	$291.69

CHG HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS

Professional

Both

$4,250.44

Service Code	HCPCS 77615 TC
Min. Negotiated Rate	$3,187.83
Max. Negotiated Rate	$3,187.83
Rate for Payer: Cash Price	$1,156.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,187.83
Rate for Payer: SOMOS Essential	$3,187.83

CHG HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS

Professional

Both

$274.19

Service Code	HCPCS 77610 26
Min. Negotiated Rate	$205.64
Max. Negotiated Rate	$205.64
Rate for Payer: Cash Price	$76.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$205.64
Rate for Payer: SOMOS Essential	$205.64

CHG HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS

Professional

Both

$2,684.40

Service Code	HCPCS 77610 TC
Min. Negotiated Rate	$2,013.30
Max. Negotiated Rate	$2,013.30
Rate for Payer: Cash Price	$727.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,013.30
Rate for Payer: SOMOS Essential	$2,013.30

CHG HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS

Professional

Both

$2,958.62

Service Code	HCPCS 77610
Min. Negotiated Rate	$2,218.96
Max. Negotiated Rate	$2,218.96
Rate for Payer: Cash Price	$804.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,218.96
Rate for Payer: SOMOS Essential	$2,218.96

CHG HYPERTHERMIA INTRACAVITARY PROBES

Professional

Both

$371.81

Service Code	HCPCS 77620 26
Min. Negotiated Rate	$278.86
Max. Negotiated Rate	$278.86
Rate for Payer: Cash Price	$98.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$278.86
Rate for Payer: SOMOS Essential	$278.86

CHG HYPERTHERMIA INTRACAVITARY PROBES

Professional

Both

$2,780.19

Service Code	HCPCS 77620
Min. Negotiated Rate	$2,085.14
Max. Negotiated Rate	$2,085.14
Rate for Payer: Cash Price	$753.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,085.14
Rate for Payer: SOMOS Essential	$2,085.14

CHG HYPERTHERMIA INTRACAVITARY PROBES

Professional

Both

$2,408.42

Service Code	HCPCS 77620 TC
Min. Negotiated Rate	$1,806.32
Max. Negotiated Rate	$1,806.32
Rate for Payer: Cash Price	$655.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,806.32
Rate for Payer: SOMOS Essential	$1,806.32

CHG HYSTEROSALPINGOGRAPHY RS&I

Professional

Both

$410.87

Service Code	HCPCS 74740
Min. Negotiated Rate	$308.15
Max. Negotiated Rate	$308.15
Rate for Payer: Cash Price	$109.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$308.15
Rate for Payer: SOMOS Essential	$308.15

CHG HYSTEROSALPINGOGRAPHY RS&I

Professional

Both

$337.68

Service Code	HCPCS 74740 TC
Min. Negotiated Rate	$253.26
Max. Negotiated Rate	$253.26
Rate for Payer: Cash Price	$89.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$253.26
Rate for Payer: SOMOS Essential	$253.26

CHG HYSTEROSALPINGOGRAPHY RS&I

Professional

Both

$73.19

Service Code	HCPCS 74740 26
Min. Negotiated Rate	$54.89
Max. Negotiated Rate	$54.89
Rate for Payer: Cash Price	$20.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$54.89
Rate for Payer: SOMOS Essential	$54.89

CHG IAADIADOO INFLUENZA

Professional

Both

$66.20

Service Code	HCPCS 87804
Min. Negotiated Rate	$49.65
Max. Negotiated Rate	$49.65
Rate for Payer: Cash Price	$16.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$49.65
Rate for Payer: SOMOS Essential	$49.65

Know your out-of-pocket cost for care.

All Charges