St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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 LYMPHATICS & LYMPH NODES IMAGING

Professional

Both

$1,186.82

Service Code	HCPCS 78195 TC
Min. Negotiated Rate	$890.12
Max. Negotiated Rate	$890.12
Rate for Payer: Cash Price	$318.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$890.12
Rate for Payer: SOMOS Essential	$890.12

CHG LYMPHATICS & LYMPH NODES IMAGING

Professional

Both

$1,409.59

Service Code	HCPCS 78195
Min. Negotiated Rate	$1,057.19
Max. Negotiated Rate	$1,057.19
Rate for Payer: Cash Price	$379.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,057.19
Rate for Payer: SOMOS Essential	$1,057.19

CHG LYMPHATICS & LYMPH NODES IMAGING

Professional

Both

$222.78

Service Code	HCPCS 78195 26
Min. Negotiated Rate	$167.08
Max. Negotiated Rate	$167.08
Rate for Payer: Cash Price	$60.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$167.08
Rate for Payer: SOMOS Essential	$167.08

CHG MAGNETIC RESONANCE ELASTOGRAPHY

Professional

Both

$211.68

Service Code	HCPCS 76391 26
Min. Negotiated Rate	$158.76
Max. Negotiated Rate	$158.76
Rate for Payer: Cash Price	$57.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$158.76
Rate for Payer: SOMOS Essential	$158.76

CHG MAGNETIC RESONANCE ELASTOGRAPHY

Professional

Both

$899.96

Service Code	HCPCS 76391
Min. Negotiated Rate	$674.97
Max. Negotiated Rate	$674.97
Rate for Payer: Cash Price	$240.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$674.97
Rate for Payer: SOMOS Essential	$674.97

CHG MAGNETIC RESONANCE ELASTOGRAPHY

Professional

Both

$688.28

Service Code	HCPCS 76391 TC
Min. Negotiated Rate	$516.21
Max. Negotiated Rate	$516.21
Rate for Payer: Cash Price	$183.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$516.21
Rate for Payer: SOMOS Essential	$516.21

CHG MAMMARY DUCTOGRAM OR GALACTOGRAM MULTIPLE

Professional

Both

$208.29

Service Code	HCPCS 77054 TC
Min. Negotiated Rate	$156.22
Max. Negotiated Rate	$156.22
Rate for Payer: Cash Price	$57.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$156.22
Rate for Payer: SOMOS Essential	$156.22

CHG MAMMARY DUCTOGRAM OR GALACTOGRAM MULTIPLE

Professional

Both

$293.13

Service Code	HCPCS 77054
Min. Negotiated Rate	$219.85
Max. Negotiated Rate	$219.85
Rate for Payer: Cash Price	$80.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$219.85
Rate for Payer: SOMOS Essential	$219.85

CHG MAMMARY DUCTOGRAM OR GALACTOGRAM MULTIPLE

Professional

Both

$84.84

Service Code	HCPCS 77054 26
Min. Negotiated Rate	$63.63
Max. Negotiated Rate	$63.63
Rate for Payer: Cash Price	$23.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$63.63
Rate for Payer: SOMOS Essential	$63.63

CHG MAMMARY DUCTOGRAM OR GALACTOGRAM SINGLE

Professional

Both

$69.27

Service Code	HCPCS 77053 26
Min. Negotiated Rate	$51.95
Max. Negotiated Rate	$51.95
Rate for Payer: Cash Price	$18.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$51.95
Rate for Payer: SOMOS Essential	$51.95

CHG MAMMARY DUCTOGRAM OR GALACTOGRAM SINGLE

Professional

Both

$227.22

Service Code	HCPCS 77053
Min. Negotiated Rate	$170.42
Max. Negotiated Rate	$170.42
Rate for Payer: Cash Price	$62.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$170.42
Rate for Payer: SOMOS Essential	$170.42

CHG MAMMARY DUCTOGRAM OR GALACTOGRAM SINGLE

Professional

Both

$157.99

Service Code	HCPCS 77053 TC
Min. Negotiated Rate	$118.49
Max. Negotiated Rate	$118.49
Rate for Payer: Cash Price	$43.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$118.49
Rate for Payer: SOMOS Essential	$118.49

CHG MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS

Professional

Both

$237.27

Service Code	HCPCS 77071
Min. Negotiated Rate	$177.95
Max. Negotiated Rate	$177.95
Rate for Payer: Cash Price	$64.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$177.95
Rate for Payer: SOMOS Essential	$177.95

CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I

Professional

Both

$77.04

Service Code	HCPCS 75902 26
Min. Negotiated Rate	$57.78
Max. Negotiated Rate	$57.78
Rate for Payer: Cash Price	$19.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$57.78
Rate for Payer: SOMOS Essential	$57.78

CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I

Professional

Both

$390.29

Service Code	HCPCS 75902
Min. Negotiated Rate	$292.72
Max. Negotiated Rate	$292.72
Rate for Payer: Cash Price	$102.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$292.72
Rate for Payer: SOMOS Essential	$292.72

CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I

Professional

Both

$313.25

Service Code	HCPCS 75902 TC
Min. Negotiated Rate	$234.94
Max. Negotiated Rate	$234.94
Rate for Payer: Cash Price	$82.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$234.94
Rate for Payer: SOMOS Essential	$234.94

CHG MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I

Professional

Both

$903.91

Service Code	HCPCS 75901 TC
Min. Negotiated Rate	$677.93
Max. Negotiated Rate	$677.93
Rate for Payer: Cash Price	$242.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$677.93
Rate for Payer: SOMOS Essential	$677.93

CHG MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I

Professional

Both

$92.44

Service Code	HCPCS 75901 26
Min. Negotiated Rate	$69.33
Max. Negotiated Rate	$69.33
Rate for Payer: Cash Price	$24.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$69.33
Rate for Payer: SOMOS Essential	$69.33

CHG MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I

Professional

Both

$996.35

Service Code	HCPCS 75901
Min. Negotiated Rate	$747.26
Max. Negotiated Rate	$747.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$747.26
Rate for Payer: SOMOS Essential	$747.26

CHG MEDICAL PHYSICS DOSE EVAL RADIATION EXPOS W/RPRT

Professional

Both

$3,990.60

Service Code	HCPCS 76145
Min. Negotiated Rate	$2,992.95
Max. Negotiated Rate	$2,992.95
Rate for Payer: Cash Price	$1,088.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,992.95
Rate for Payer: SOMOS Essential	$2,992.95

CHG MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN

Professional

Both

$907.13

Service Code	HCPCS 77338 26
Min. Negotiated Rate	$680.35
Max. Negotiated Rate	$680.35
Rate for Payer: Cash Price	$248.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$680.35
Rate for Payer: SOMOS Essential	$680.35

CHG MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN

Professional

Both

$1,039.64

Service Code	HCPCS 77338 TC
Min. Negotiated Rate	$779.73
Max. Negotiated Rate	$779.73
Rate for Payer: Cash Price	$290.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$779.73
Rate for Payer: SOMOS Essential	$779.73

CHG MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN

Professional

Both

$1,946.77

Service Code	HCPCS 77338
Min. Negotiated Rate	$1,460.08
Max. Negotiated Rate	$1,460.08
Rate for Payer: Cash Price	$539.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,460.08
Rate for Payer: SOMOS Essential	$1,460.08

CHG MORPHOMETRIC ANALYSIS SKELETAL MUSCLE

Professional

Both

$571.97

Service Code	HCPCS 88355
Min. Negotiated Rate	$428.98
Max. Negotiated Rate	$428.98
Rate for Payer: Cash Price	$141.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$428.98
Rate for Payer: SOMOS Essential	$428.98

Know your out-of-pocket cost for care.

All Charges