St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY

Professional

Both

$70.11

Service Code	HCPCS 88300
Min. Negotiated Rate	$52.58
Max. Negotiated Rate	$52.58
Rate for Payer: Cash Price	$19.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$52.58
Rate for Payer: SOMOS Essential	$52.58

CHG LIPID PANEL

Professional

Both

$33.47

Service Code	HCPCS 80061
Min. Negotiated Rate	$25.10
Max. Negotiated Rate	$25.10
Rate for Payer: Cash Price	$13.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25.10
Rate for Payer: SOMOS Essential	$25.10

CHG LIVER IMAGING STATIC ONLY

Professional

Both

$80.71

Service Code	HCPCS 78201 26
Min. Negotiated Rate	$60.53
Max. Negotiated Rate	$60.53
Rate for Payer: Cash Price	$21.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$60.53
Rate for Payer: SOMOS Essential	$60.53

CHG LIVER IMAGING STATIC ONLY

Professional

Both

$689.43

Service Code	HCPCS 78201 TC
Min. Negotiated Rate	$517.07
Max. Negotiated Rate	$517.07
Rate for Payer: Cash Price	$186.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$517.07
Rate for Payer: SOMOS Essential	$517.07

CHG LIVER IMAGING STATIC ONLY

Professional

Both

$770.14

Service Code	HCPCS 78201
Min. Negotiated Rate	$577.60
Max. Negotiated Rate	$577.60
Rate for Payer: Cash Price	$207.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$577.60
Rate for Payer: SOMOS Essential	$577.60

CHG LIVER IMAGING W/VASCULAR FLOW

Professional

Both

$92.37

Service Code	HCPCS 78202 26
Min. Negotiated Rate	$69.28
Max. Negotiated Rate	$69.28
Rate for Payer: Cash Price	$25.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$69.28
Rate for Payer: SOMOS Essential	$69.28

CHG LIVER IMAGING W/VASCULAR FLOW

Professional

Both

$746.94

Service Code	HCPCS 78202 TC
Min. Negotiated Rate	$560.20
Max. Negotiated Rate	$560.20
Rate for Payer: Cash Price	$202.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$560.20
Rate for Payer: SOMOS Essential	$560.20

CHG LIVER IMAGING W/VASCULAR FLOW

Professional

Both

$839.30

Service Code	HCPCS 78202
Min. Negotiated Rate	$629.48
Max. Negotiated Rate	$629.48
Rate for Payer: Cash Price	$228.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$629.48
Rate for Payer: SOMOS Essential	$629.48

CHG LIVER & SPLEEN IMAGING STATIC ONLY

Professional

Both

$792.23

Service Code	HCPCS 78215
Min. Negotiated Rate	$594.17
Max. Negotiated Rate	$594.17
Rate for Payer: Cash Price	$213.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$594.17
Rate for Payer: SOMOS Essential	$594.17

CHG LIVER & SPLEEN IMAGING STATIC ONLY

Professional

Both

$700.95

Service Code	HCPCS 78215 TC
Min. Negotiated Rate	$525.71
Max. Negotiated Rate	$525.71
Rate for Payer: Cash Price	$189.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$525.71
Rate for Payer: SOMOS Essential	$525.71

CHG LIVER & SPLEEN IMAGING STATIC ONLY

Professional

Both

$91.28

Service Code	HCPCS 78215 26
Min. Negotiated Rate	$68.46
Max. Negotiated Rate	$68.46
Rate for Payer: Cash Price	$24.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$68.46
Rate for Payer: SOMOS Essential	$68.46

CHG LIVER & SPLEEN IMAGING W/VASCULAR FLOW

Professional

Both

$445.06

Service Code	HCPCS 78216 TC
Min. Negotiated Rate	$333.80
Max. Negotiated Rate	$333.80
Rate for Payer: Cash Price	$121.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$333.80
Rate for Payer: SOMOS Essential	$333.80

CHG LIVER & SPLEEN IMAGING W/VASCULAR FLOW

Professional

Both

$108.22

Service Code	HCPCS 78216 26
Min. Negotiated Rate	$81.16
Max. Negotiated Rate	$81.16
Rate for Payer: Cash Price	$27.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$81.16
Rate for Payer: SOMOS Essential	$81.16

CHG LIVER & SPLEEN IMAGING W/VASCULAR FLOW

Professional

Both

$553.28

Service Code	HCPCS 78216
Min. Negotiated Rate	$414.96
Max. Negotiated Rate	$414.96
Rate for Payer: Cash Price	$149.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$414.96
Rate for Payer: SOMOS Essential	$414.96

CHG LYMPHANGIOGRAPHY EXTREMITY ONLY BILATERAL RS&I

Professional

Both

$1,320.59

Service Code	HCPCS 75803
Min. Negotiated Rate	$990.44
Max. Negotiated Rate	$990.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$990.44
Rate for Payer: SOMOS Essential	$990.44

CHG LYMPHANGIOGRAPHY EXTREMITY ONLY BILATERAL RS&I

Professional

Both

$224.77

Service Code	HCPCS 75803 26
Min. Negotiated Rate	$168.58
Max. Negotiated Rate	$168.58
Rate for Payer: Cash Price	$61.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$168.58
Rate for Payer: SOMOS Essential	$168.58

CHG LYMPHANGIOGRAPHY EXTREMITY ONLY BILATERAL RS&I

Professional

Both

$1,095.82

Service Code	HCPCS 75803 TC
Min. Negotiated Rate	$821.86
Max. Negotiated Rate	$821.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$821.86
Rate for Payer: SOMOS Essential	$821.86

CHG LYMPHANGIOGRAPHY EXTREMITY ONLY UNILATERAL RS&I

Professional

Both

$180.29

Service Code	HCPCS 75801 26
Min. Negotiated Rate	$135.22
Max. Negotiated Rate	$135.22
Rate for Payer: Cash Price	$48.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$135.22
Rate for Payer: SOMOS Essential	$135.22

CHG LYMPHANGIOGRAPHY EXTREMITY ONLY UNILATERAL RS&I

Professional

Both

$1,276.10

Service Code	HCPCS 75801
Min. Negotiated Rate	$957.08
Max. Negotiated Rate	$957.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$957.08
Rate for Payer: SOMOS Essential	$957.08

CHG LYMPHANGIOGRAPHY EXTREMITY ONLY UNILATERAL RS&I

Professional

Both

$1,095.82

Service Code	HCPCS 75801 TC
Min. Negotiated Rate	$821.86
Max. Negotiated Rate	$821.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$821.86
Rate for Payer: SOMOS Essential	$821.86

CHG LYMPHANGIOGRAPHY PELVIC/ABDOMINAL BILATERAL RS&I

Professional

Both

$212.98

Service Code	HCPCS 75807 26
Min. Negotiated Rate	$159.74
Max. Negotiated Rate	$159.74
Rate for Payer: Cash Price	$57.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$159.74
Rate for Payer: SOMOS Essential	$159.74

CHG LYMPHANGIOGRAPHY PELVIC/ABDOMINAL BILATERAL RS&I

Professional

Both

$1,025.68

Service Code	HCPCS 75807 TC
Min. Negotiated Rate	$769.26
Max. Negotiated Rate	$769.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$769.26
Rate for Payer: SOMOS Essential	$769.26

CHG LYMPHANGIOGRAPHY PELVIC/ABDOMINAL BILATERAL RS&I

Professional

Both

$1,238.65

Service Code	HCPCS 75807
Min. Negotiated Rate	$928.99
Max. Negotiated Rate	$928.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$928.99
Rate for Payer: SOMOS Essential	$928.99

CHG LYMPHANGIOGRAPHY PELVIC/ABDOMINAL UNILAT RS&I

Professional

Both

$155.51

Service Code	HCPCS 75805 26
Min. Negotiated Rate	$116.63
Max. Negotiated Rate	$116.63
Rate for Payer: Cash Price	$42.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$116.63
Rate for Payer: SOMOS Essential	$116.63

CHG LYMPHANGIOGRAPHY PELVIC/ABDOMINAL UNILAT RS&I

Professional

Both

$1,235.92

Service Code	HCPCS 75805 TC
Min. Negotiated Rate	$926.94
Max. Negotiated Rate	$926.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$926.94
Rate for Payer: SOMOS Essential	$926.94

Know your out-of-pocket cost for care.

All Charges