St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS

Professional

Both

$66.92

Service Code	HCPCS 77077 26
Min. Negotiated Rate	$50.19
Max. Negotiated Rate	$50.19
Rate for Payer: Cash Price	$18.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$50.19
Rate for Payer: SOMOS Essential	$50.19

CHG JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS

Professional

Both

$133.56

Service Code	HCPCS 77077 TC
Min. Negotiated Rate	$100.17
Max. Negotiated Rate	$100.17
Rate for Payer: Cash Price	$36.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$100.17
Rate for Payer: SOMOS Essential	$100.17

CHG KIDNEY FUNCJ STUDY NON-IMG RADIOISOTOPIC STUDY

Professional

Both

$416.33

Service Code	HCPCS 78725 TC
Min. Negotiated Rate	$312.25
Max. Negotiated Rate	$312.25
Rate for Payer: Cash Price	$95.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$312.25
Rate for Payer: SOMOS Essential	$312.25

CHG KIDNEY FUNCJ STUDY NON-IMG RADIOISOTOPIC STUDY

Professional

Both

$485.35

Service Code	HCPCS 78725
Min. Negotiated Rate	$364.01
Max. Negotiated Rate	$364.01
Rate for Payer: Cash Price	$113.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$364.01
Rate for Payer: SOMOS Essential	$364.01

CHG KIDNEY FUNCJ STUDY NON-IMG RADIOISOTOPIC STUDY

Professional

Both

$69.02

Service Code	HCPCS 78725 26
Min. Negotiated Rate	$51.76
Max. Negotiated Rate	$51.76
Rate for Payer: Cash Price	$18.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$51.76
Rate for Payer: SOMOS Essential	$51.76

CHG KIDNEY IMAGING MORPHOLOGY

Professional

Both

$607.50

Service Code	HCPCS 78700 TC
Min. Negotiated Rate	$455.62
Max. Negotiated Rate	$455.62
Rate for Payer: Cash Price	$163.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$455.62
Rate for Payer: SOMOS Essential	$455.62

CHG KIDNEY IMAGING MORPHOLOGY

Professional

Both

$690.90

Service Code	HCPCS 78700
Min. Negotiated Rate	$518.18
Max. Negotiated Rate	$518.18
Rate for Payer: Cash Price	$186.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$518.18
Rate for Payer: SOMOS Essential	$518.18

CHG KIDNEY IMAGING MORPHOLOGY

Professional

Both

$83.41

Service Code	HCPCS 78700 26
Min. Negotiated Rate	$62.56
Max. Negotiated Rate	$62.56
Rate for Payer: Cash Price	$22.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$62.56
Rate for Payer: SOMOS Essential	$62.56

CHG KIDNEY IMAGING MORPHOOGY W/VASCULAR FLOW

Professional

Both

$92.72

Service Code	HCPCS 78701 26
Min. Negotiated Rate	$69.54
Max. Negotiated Rate	$69.54
Rate for Payer: Cash Price	$25.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$69.54
Rate for Payer: SOMOS Essential	$69.54

CHG KIDNEY IMAGING MORPHOOGY W/VASCULAR FLOW

Professional

Both

$814.52

Service Code	HCPCS 78701 TC
Min. Negotiated Rate	$610.89
Max. Negotiated Rate	$610.89
Rate for Payer: Cash Price	$219.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$610.89
Rate for Payer: SOMOS Essential	$610.89

CHG KIDNEY IMAGING MORPHOOGY W/VASCULAR FLOW

Professional

Both

$907.24

Service Code	HCPCS 78701
Min. Negotiated Rate	$680.43
Max. Negotiated Rate	$680.43
Rate for Payer: Cash Price	$244.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$680.43
Rate for Payer: SOMOS Essential	$680.43

CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX

Professional

Both

$932.75

Service Code	HCPCS 78707
Min. Negotiated Rate	$699.56
Max. Negotiated Rate	$699.56
Rate for Payer: Cash Price	$251.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$699.56
Rate for Payer: SOMOS Essential	$699.56

CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX

Professional

Both

$757.02

Service Code	HCPCS 78707 TC
Min. Negotiated Rate	$567.76
Max. Negotiated Rate	$567.76
Rate for Payer: Cash Price	$203.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$567.76
Rate for Payer: SOMOS Essential	$567.76

CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX

Professional

Both

$175.74

Service Code	HCPCS 78707 26
Min. Negotiated Rate	$131.80
Max. Negotiated Rate	$131.80
Rate for Payer: Cash Price	$47.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$131.80
Rate for Payer: SOMOS Essential	$131.80

CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/RX

Professional

Both

$515.52

Service Code	HCPCS 78708 TC
Min. Negotiated Rate	$386.64
Max. Negotiated Rate	$386.64
Rate for Payer: Cash Price	$142.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$386.64
Rate for Payer: SOMOS Essential	$386.64

CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/RX

Professional

Both

$220.01

Service Code	HCPCS 78708 26
Min. Negotiated Rate	$165.01
Max. Negotiated Rate	$165.01
Rate for Payer: Cash Price	$60.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$165.01
Rate for Payer: SOMOS Essential	$165.01

CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/RX

Professional

Both

$735.49

Service Code	HCPCS 78708
Min. Negotiated Rate	$551.62
Max. Negotiated Rate	$551.62
Rate for Payer: Cash Price	$203.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$551.62
Rate for Payer: SOMOS Essential	$551.62

CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE

Professional

Both

$260.58

Service Code	HCPCS 78709 26
Min. Negotiated Rate	$195.44
Max. Negotiated Rate	$195.44
Rate for Payer: Cash Price	$70.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$195.44
Rate for Payer: SOMOS Essential	$195.44

CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE

Professional

Both

$1,215.31

Service Code	HCPCS 78709 TC
Min. Negotiated Rate	$911.48
Max. Negotiated Rate	$911.48
Rate for Payer: Cash Price	$323.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$911.48
Rate for Payer: SOMOS Essential	$911.48

CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE

Professional

Both

$1,475.88

Service Code	HCPCS 78709
Min. Negotiated Rate	$1,106.91
Max. Negotiated Rate	$1,106.91
Rate for Payer: Cash Price	$394.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,106.91
Rate for Payer: SOMOS Essential	$1,106.91

CHG LABELED RBC SEQUESTRATION DIFFERNTL ORGAN/TISSUE

Professional

Both

$370.34

Service Code	HCPCS 78140 TC
Min. Negotiated Rate	$277.76
Max. Negotiated Rate	$277.76
Rate for Payer: Cash Price	$101.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$277.76
Rate for Payer: SOMOS Essential	$277.76

CHG LABELED RBC SEQUESTRATION DIFFERNTL ORGAN/TISSUE

Professional

Both

$463.82

Service Code	HCPCS 78140
Min. Negotiated Rate	$347.86
Max. Negotiated Rate	$347.86
Rate for Payer: Cash Price	$127.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$347.86
Rate for Payer: SOMOS Essential	$347.86

CHG LABELED RBC SEQUESTRATION DIFFERNTL ORGAN/TISSUE

Professional

Both

$93.52

Service Code	HCPCS 78140 26
Min. Negotiated Rate	$70.14
Max. Negotiated Rate	$70.14
Rate for Payer: Cash Price	$25.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70.14
Rate for Payer: SOMOS Essential	$70.14

CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY

Professional

Both

$18.52

Service Code	HCPCS 88300 26
Min. Negotiated Rate	$13.89
Max. Negotiated Rate	$13.89
Rate for Payer: Cash Price	$4.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$13.89
Rate for Payer: SOMOS Essential	$13.89

CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY

Professional

Both

$51.63

Service Code	HCPCS 88300 TC
Min. Negotiated Rate	$38.72
Max. Negotiated Rate	$38.72
Rate for Payer: Cash Price	$14.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38.72
Rate for Payer: SOMOS Essential	$38.72

Know your out-of-pocket cost for care.

All Charges