St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG IN SITU HYBRIDIZATION EA MULTIPLEX PROBE STAIN

Professional

Both

$938.42

Service Code	HCPCS 88366 TC
Min. Negotiated Rate	$703.82
Max. Negotiated Rate	$703.82
Rate for Payer: Cash Price	$250.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$703.82
Rate for Payer: SOMOS Essential	$703.82

CHG IN SITU HYBRIDIZATION EA MULTIPLEX PROBE STAIN

Professional

Both

$1,176.81

Service Code	HCPCS 88366
Min. Negotiated Rate	$882.61
Max. Negotiated Rate	$882.61
Rate for Payer: Cash Price	$315.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$882.61
Rate for Payer: SOMOS Essential	$882.61

CHG INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX

Professional

Both

$1,850.80

Service Code	HCPCS 77778 26
Min. Negotiated Rate	$1,388.10
Max. Negotiated Rate	$1,388.10
Rate for Payer: Cash Price	$508.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,388.10
Rate for Payer: SOMOS Essential	$1,388.10

CHG INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX

Professional

Both

$1,972.78

Service Code	HCPCS 77778 TC
Min. Negotiated Rate	$1,479.58
Max. Negotiated Rate	$1,479.58
Rate for Payer: Cash Price	$551.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,479.58
Rate for Payer: SOMOS Essential	$1,479.58

CHG INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX

Professional

Both

$3,823.54

Service Code	HCPCS 77778
Min. Negotiated Rate	$2,867.66
Max. Negotiated Rate	$2,867.66
Rate for Payer: Cash Price	$1,059.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,867.66
Rate for Payer: SOMOS Essential	$2,867.66

CHG INTESTINE IMAGING

Professional

Both

$1,192.56

Service Code	HCPCS 78290 TC
Min. Negotiated Rate	$894.42
Max. Negotiated Rate	$894.42
Rate for Payer: Cash Price	$318.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$894.42
Rate for Payer: SOMOS Essential	$894.42

CHG INTESTINE IMAGING

Professional

Both

$129.19

Service Code	HCPCS 78290 26
Min. Negotiated Rate	$96.89
Max. Negotiated Rate	$96.89
Rate for Payer: Cash Price	$34.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$96.89
Rate for Payer: SOMOS Essential	$96.89

CHG INTESTINE IMAGING

Professional

Both

$1,321.74

Service Code	HCPCS 78290
Min. Negotiated Rate	$991.30
Max. Negotiated Rate	$991.30
Rate for Payer: Cash Price	$353.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$991.30
Rate for Payer: SOMOS Essential	$991.30

CHG INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX

Professional

Both

$1,830.15

Service Code	HCPCS 77763 26
Min. Negotiated Rate	$1,372.61
Max. Negotiated Rate	$1,372.61
Rate for Payer: Cash Price	$502.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,372.61
Rate for Payer: SOMOS Essential	$1,372.61

CHG INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX

Professional

Both

$3,225.74

Service Code	HCPCS 77763
Min. Negotiated Rate	$2,419.30
Max. Negotiated Rate	$2,419.30
Rate for Payer: Cash Price	$895.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,419.30
Rate for Payer: SOMOS Essential	$2,419.30

CHG INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX

Professional

Both

$1,395.59

Service Code	HCPCS 77763 TC
Min. Negotiated Rate	$1,046.69
Max. Negotiated Rate	$1,046.69
Rate for Payer: Cash Price	$393.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,046.69
Rate for Payer: SOMOS Essential	$1,046.69

CHG INTRACAVITARY RADIATION SOURCE APPLIC INTERMED

Professional

Both

$2,293.76

Service Code	HCPCS 77762
Min. Negotiated Rate	$1,720.32
Max. Negotiated Rate	$1,720.32
Rate for Payer: Cash Price	$635.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,720.32
Rate for Payer: SOMOS Essential	$1,720.32

CHG INTRACAVITARY RADIATION SOURCE APPLIC INTERMED

Professional

Both

$1,078.18

Service Code	HCPCS 77762 TC
Min. Negotiated Rate	$808.64
Max. Negotiated Rate	$808.64
Rate for Payer: Cash Price	$301.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$808.64
Rate for Payer: SOMOS Essential	$808.64

CHG INTRACAVITARY RADIATION SOURCE APPLIC INTERMED

Professional

Both

$1,215.62

Service Code	HCPCS 77762 26
Min. Negotiated Rate	$911.72
Max. Negotiated Rate	$911.72
Rate for Payer: Cash Price	$334.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$911.72
Rate for Payer: SOMOS Essential	$911.72

CHG INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE

Professional

Both

$937.72

Service Code	HCPCS 77761 TC
Min. Negotiated Rate	$703.29
Max. Negotiated Rate	$703.29
Rate for Payer: Cash Price	$262.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$703.29
Rate for Payer: SOMOS Essential	$703.29

CHG INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE

Professional

Both

$1,755.36

Service Code	HCPCS 77761
Min. Negotiated Rate	$1,316.52
Max. Negotiated Rate	$1,316.52
Rate for Payer: Cash Price	$485.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,316.52
Rate for Payer: SOMOS Essential	$1,316.52

CHG INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE

Professional

Both

$817.67

Service Code	HCPCS 77761 26
Min. Negotiated Rate	$613.25
Max. Negotiated Rate	$613.25
Rate for Payer: Cash Price	$223.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$613.25
Rate for Payer: SOMOS Essential	$613.25

CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I

Professional

Both

$108.78

Service Code	HCPCS 74360 26
Min. Negotiated Rate	$81.58
Max. Negotiated Rate	$81.58
Rate for Payer: Cash Price	$30.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$81.58
Rate for Payer: SOMOS Essential	$81.58

CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I

Professional

Both

$746.80

Service Code	HCPCS 74360
Min. Negotiated Rate	$560.10
Max. Negotiated Rate	$560.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$560.10
Rate for Payer: SOMOS Essential	$560.10

CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I

Professional

Both

$638.02

Service Code	HCPCS 74360 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 INTRAOPERATIVE RADIATION TREATMENT MANAGEMENT

Professional

Both

$1,314.95

Service Code	HCPCS 77469
Min. Negotiated Rate	$986.21
Max. Negotiated Rate	$986.21
Rate for Payer: Cash Price	$359.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$986.21
Rate for Payer: SOMOS Essential	$986.21

CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I

Professional

Both

$636.55

Service Code	HCPCS 74340
Min. Negotiated Rate	$477.41
Max. Negotiated Rate	$477.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$477.41
Rate for Payer: SOMOS Essential	$477.41

CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I

Professional

Both

$530.67

Service Code	HCPCS 74340 TC
Min. Negotiated Rate	$398.00
Max. Negotiated Rate	$398.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$398.00
Rate for Payer: SOMOS Essential	$398.00

CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I

Professional

Both

$105.88

Service Code	HCPCS 74340 26
Min. Negotiated Rate	$79.41
Max. Negotiated Rate	$79.41
Rate for Payer: Cash Price	$27.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$79.41
Rate for Payer: SOMOS Essential	$79.41

CHG JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS

Professional

Both

$200.48

Service Code	HCPCS 77077
Min. Negotiated Rate	$150.36
Max. Negotiated Rate	$150.36
Rate for Payer: Cash Price	$54.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$150.36
Rate for Payer: SOMOS Essential	$150.36

Know your out-of-pocket cost for care.

All Charges