St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG MYELOGRAPY 2/MORE REGIONS RS&I

Professional

Both

$429.66

Service Code	HCPCS 72270 TC
Min. Negotiated Rate	$322.24
Max. Negotiated Rate	$322.24
Rate for Payer: Cash Price	$104.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$322.24
Rate for Payer: SOMOS Essential	$322.24

CHG MYELOGRAPY 2/MORE REGIONS RS&I

Professional

Both

$695.91

Service Code	HCPCS 72270
Min. Negotiated Rate	$521.93
Max. Negotiated Rate	$521.93
Rate for Payer: Cash Price	$176.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$521.93
Rate for Payer: SOMOS Essential	$521.93

CHG MYELOGRAPY 2/MORE REGIONS RS&I

Professional

Both

$266.25

Service Code	HCPCS 72270 26
Min. Negotiated Rate	$199.69
Max. Negotiated Rate	$199.69
Rate for Payer: Cash Price	$71.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$199.69
Rate for Payer: SOMOS Essential	$199.69

CHG MYELOGRAPY LUMBOSACRAL RS&I

Professional

Both

$159.46

Service Code	HCPCS 72265 26
Min. Negotiated Rate	$119.60
Max. Negotiated Rate	$119.60
Rate for Payer: Cash Price	$43.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$119.60
Rate for Payer: SOMOS Essential	$119.60

CHG MYELOGRAPY LUMBOSACRAL RS&I

Professional

Both

$464.07

Service Code	HCPCS 72265
Min. Negotiated Rate	$348.05
Max. Negotiated Rate	$348.05
Rate for Payer: Cash Price	$125.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$348.05
Rate for Payer: SOMOS Essential	$348.05

CHG MYELOGRAPY LUMBOSACRAL RS&I

Professional

Both

$304.61

Service Code	HCPCS 72265 TC
Min. Negotiated Rate	$228.46
Max. Negotiated Rate	$228.46
Rate for Payer: Cash Price	$82.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$228.46
Rate for Payer: SOMOS Essential	$228.46

CHG MYELOGRAPY POST FOSSA RS&I

Professional

Both

$242.38

Service Code	HCPCS 70010
Min. Negotiated Rate	$181.78
Max. Negotiated Rate	$181.78
Rate for Payer: Cash Price	$64.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$181.78
Rate for Payer: SOMOS Essential	$181.78

CHG MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN

Professional

Both

$746.55

Service Code	HCPCS 78466
Min. Negotiated Rate	$559.91
Max. Negotiated Rate	$559.91
Rate for Payer: Cash Price	$194.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$559.91
Rate for Payer: SOMOS Essential	$559.91

CHG MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN

Professional

Both

$133.32

Service Code	HCPCS 78466 26
Min. Negotiated Rate	$99.99
Max. Negotiated Rate	$99.99
Rate for Payer: Cash Price	$34.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$99.99
Rate for Payer: SOMOS Essential	$99.99

CHG MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN

Professional

Both

$613.27

Service Code	HCPCS 78466 TC
Min. Negotiated Rate	$459.95
Max. Negotiated Rate	$459.95
Rate for Payer: Cash Price	$160.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$459.95
Rate for Payer: SOMOS Essential	$459.95

CHG MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS

Professional

Both

$183.65

Service Code	HCPCS 78453 26
Min. Negotiated Rate	$137.74
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$48.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$137.74
Rate for Payer: SOMOS Essential	$137.74

CHG MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS

Professional

Both

$981.26

Service Code	HCPCS 78453 TC
Min. Negotiated Rate	$735.94
Max. Negotiated Rate	$735.94
Rate for Payer: Cash Price	$262.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$735.94
Rate for Payer: SOMOS Essential	$735.94

CHG MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS

Professional

Both

$1,164.87

Service Code	HCPCS 78453
Min. Negotiated Rate	$873.65
Max. Negotiated Rate	$873.65
Rate for Payer: Cash Price	$311.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$873.65
Rate for Payer: SOMOS Essential	$873.65

CHG MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES

Professional

Both

$1,486.84

Service Code	HCPCS 78454 TC
Min. Negotiated Rate	$1,115.13
Max. Negotiated Rate	$1,115.13
Rate for Payer: Cash Price	$397.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,115.13
Rate for Payer: SOMOS Essential	$1,115.13

CHG MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES

Professional

Both

$255.99

Service Code	HCPCS 78454 26
Min. Negotiated Rate	$191.99
Max. Negotiated Rate	$191.99
Rate for Payer: Cash Price	$69.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$191.99
Rate for Payer: SOMOS Essential	$191.99

CHG MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES

Professional

Both

$1,742.83

Service Code	HCPCS 78454
Min. Negotiated Rate	$1,307.12
Max. Negotiated Rate	$1,307.12
Rate for Payer: Cash Price	$466.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,307.12
Rate for Payer: SOMOS Essential	$1,307.12

CHG MYOCARDIAL SPECT MULTIPLE STUDIES

Professional

Both

$299.81

Service Code	HCPCS 78452 26
Min. Negotiated Rate	$224.86
Max. Negotiated Rate	$224.86
Rate for Payer: Cash Price	$81.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$224.86
Rate for Payer: SOMOS Essential	$224.86

CHG MYOCARDIAL SPECT MULTIPLE STUDIES

Professional

Both

$1,571.64

Service Code	HCPCS 78452 TC
Min. Negotiated Rate	$1,178.73
Max. Negotiated Rate	$1,178.73
Rate for Payer: Cash Price	$424.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,178.73
Rate for Payer: SOMOS Essential	$1,178.73

CHG MYOCARDIAL SPECT MULTIPLE STUDIES

Professional

Both

$1,871.45

Service Code	HCPCS 78452
Min. Negotiated Rate	$1,403.59
Max. Negotiated Rate	$1,403.59
Rate for Payer: Cash Price	$506.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,403.59
Rate for Payer: SOMOS Essential	$1,403.59

CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS

Professional

Both

$1,343.30

Service Code	HCPCS 78451
Min. Negotiated Rate	$1,007.48
Max. Negotiated Rate	$1,007.48
Rate for Payer: Cash Price	$365.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,007.48
Rate for Payer: SOMOS Essential	$1,007.48

CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS

Professional

Both

$1,091.93

Service Code	HCPCS 78451 TC
Min. Negotiated Rate	$818.95
Max. Negotiated Rate	$818.95
Rate for Payer: Cash Price	$295.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$818.95
Rate for Payer: SOMOS Essential	$818.95

CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS

Professional

Both

$251.34

Service Code	HCPCS 78451 26
Min. Negotiated Rate	$188.50
Max. Negotiated Rate	$188.50
Rate for Payer: Cash Price	$69.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$188.50
Rate for Payer: SOMOS Essential	$188.50

CHG MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ

Professional

Both

$144.48

Service Code	HCPCS 78468 26
Min. Negotiated Rate	$108.36
Max. Negotiated Rate	$108.36
Rate for Payer: Cash Price	$40.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$108.36
Rate for Payer: SOMOS Essential	$108.36

CHG MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ

Professional

Both

$636.27

Service Code	HCPCS 78468 TC
Min. Negotiated Rate	$477.20
Max. Negotiated Rate	$477.20
Rate for Payer: Cash Price	$173.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$477.20
Rate for Payer: SOMOS Essential	$477.20

CHG MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ

Professional

Both

$780.75

Service Code	HCPCS 78468
Min. Negotiated Rate	$585.56
Max. Negotiated Rate	$585.56
Rate for Payer: Cash Price	$214.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$585.56
Rate for Payer: SOMOS Essential	$585.56

Know your out-of-pocket cost for care.

All Charges