St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ

Professional

Both

$170.73

Service Code	HCPCS 78469 26
Min. Negotiated Rate	$128.05
Max. Negotiated Rate	$128.05
Rate for Payer: Cash Price	$46.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$128.05
Rate for Payer: SOMOS Essential	$128.05

CHG MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ

Professional

Both

$888.93

Service Code	HCPCS 78469
Min. Negotiated Rate	$666.70
Max. Negotiated Rate	$666.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$666.70
Rate for Payer: SOMOS Essential	$666.70

CHG NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE

Professional

Both

$1,056.16

Service Code	HCPCS 77750 26
Min. Negotiated Rate	$792.12
Max. Negotiated Rate	$792.12
Rate for Payer: Cash Price	$290.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$792.12
Rate for Payer: SOMOS Essential	$792.12

CHG NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE

Professional

Both

$562.94

Service Code	HCPCS 77750 TC
Min. Negotiated Rate	$422.20
Max. Negotiated Rate	$422.20
Rate for Payer: Cash Price	$157.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$422.20
Rate for Payer: SOMOS Essential	$422.20

CHG NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE

Professional

Both

$1,619.10

Service Code	HCPCS 77750
Min. Negotiated Rate	$1,214.32
Max. Negotiated Rate	$1,214.32
Rate for Payer: Cash Price	$447.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,214.32
Rate for Payer: SOMOS Essential	$1,214.32

CHG NJX RP LOCLZJ NON-IMG PROBE STUDY INTRAVENOUS

Professional

Both

$168.88

Service Code	HCPCS 78808
Min. Negotiated Rate	$126.66
Max. Negotiated Rate	$126.66
Rate for Payer: Cash Price	$46.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$126.66
Rate for Payer: SOMOS Essential	$126.66

CHG NONCARDIAC VASCULAR FLOW IMAGING

Professional

Both

$848.02

Service Code	HCPCS 78445
Min. Negotiated Rate	$636.02
Max. Negotiated Rate	$636.02
Rate for Payer: Cash Price	$222.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$636.02
Rate for Payer: SOMOS Essential	$636.02

CHG NONCARDIAC VASCULAR FLOW IMAGING

Professional

Both

$99.65

Service Code	HCPCS 78445 26
Min. Negotiated Rate	$74.74
Max. Negotiated Rate	$74.74
Rate for Payer: Cash Price	$27.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$74.74
Rate for Payer: SOMOS Essential	$74.74

CHG NONCARDIAC VASCULAR FLOW IMAGING

Professional

Both

$748.37

Service Code	HCPCS 78445 TC
Min. Negotiated Rate	$561.28
Max. Negotiated Rate	$561.28
Rate for Payer: Cash Price	$195.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$561.28
Rate for Payer: SOMOS Essential	$561.28

CHG NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS

Professional

Both

$6,142.43

Service Code	HCPCS 77301 TC
Min. Negotiated Rate	$4,606.82
Max. Negotiated Rate	$4,606.82
Rate for Payer: Cash Price	$1,692.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,606.82
Rate for Payer: SOMOS Essential	$4,606.82

CHG NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS

Professional

Both

$1,691.76

Service Code	HCPCS 77301 26
Min. Negotiated Rate	$1,268.82
Max. Negotiated Rate	$1,268.82
Rate for Payer: Cash Price	$463.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,268.82
Rate for Payer: SOMOS Essential	$1,268.82

CHG NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS

Professional

Both

$7,834.19

Service Code	HCPCS 77301
Min. Negotiated Rate	$5,875.64
Max. Negotiated Rate	$5,875.64
Rate for Payer: Cash Price	$2,156.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,875.64
Rate for Payer: SOMOS Essential	$5,875.64

CHG OF CYSTOSTOMY TUBE, SIMPLE

Facility

$711.45

Service Code	HCPCS 51705
Hospital Charge Code	30305598
Hospital Revenue Code	510
Rate for Payer: Cash Price	$285.81

CHG OF CYSTOSTOMY TUBE, SIMPLE

Facility

$711.45

Service Code	HCPCS 51705
Hospital Charge Code	30305921
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$285.81
Rate for Payer: Aetna Government	$285.81
Rate for Payer: Affinity Essential Plan 1&2	$200.07
Rate for Payer: Affinity Essential Plan 3&4	$200.07
Rate for Payer: Affinity Medicaid/CHP/HARP	$200.07
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$285.81
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$285.81
Rate for Payer: Cash Price	$285.81
Rate for Payer: Cash Price	$285.81
Rate for Payer: Cash Price	$285.81
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$285.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$285.81
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$242.94
Rate for Payer: Fidelis Essential Plan QHP	$254.37
Rate for Payer: Fidelis Medicare Advantage	$285.81
Rate for Payer: Fidelis Qualified Health Plan	$254.37
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$355.72
Rate for Payer: Hamaspik Choice Inc Medicare	$285.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$285.81
Rate for Payer: Humana Medicare	$291.53
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$285.81
Rate for Payer: Senior Whole Health Medicare Advantage	$285.81
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$285.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$285.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$228.65
Rate for Payer: Wellcare Medicare	$271.52

CHG OF CYSTOSTOMY TUBE, SIMPLE

Facility

$711.45

Service Code	HCPCS 51705
Hospital Charge Code	30105921
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$285.81
Rate for Payer: Aetna Government	$285.81
Rate for Payer: Affinity Essential Plan 1&2	$200.07
Rate for Payer: Affinity Essential Plan 3&4	$200.07
Rate for Payer: Affinity Medicaid/CHP/HARP	$200.07
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$285.81
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$285.81
Rate for Payer: Cash Price	$285.81
Rate for Payer: Cash Price	$285.81
Rate for Payer: Cash Price	$285.81
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$285.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$285.81
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$242.94
Rate for Payer: Fidelis Essential Plan QHP	$254.37
Rate for Payer: Fidelis Medicare Advantage	$285.81
Rate for Payer: Fidelis Qualified Health Plan	$254.37
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$355.72
Rate for Payer: Hamaspik Choice Inc Medicare	$285.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$285.81
Rate for Payer: Humana Medicare	$291.53
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$285.81
Rate for Payer: Senior Whole Health Medicare Advantage	$285.81
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$285.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$285.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$228.65
Rate for Payer: Wellcare Medicare	$271.52

CHG OF CYSTOSTOMY TUBE, SIMPLE

Facility

$711.45

Service Code	HCPCS 51705
Hospital Charge Code	30305598
Hospital Revenue Code	510
Min. Negotiated Rate	$200.07
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$285.81
Rate for Payer: Aetna Government	$285.81
Rate for Payer: Affinity Essential Plan 1&2	$200.07
Rate for Payer: Affinity Essential Plan 3&4	$200.07
Rate for Payer: Affinity Medicaid/CHP/HARP	$200.07
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$285.81
Rate for Payer: Cash Price	$285.81
Rate for Payer: Cash Price	$285.81
Rate for Payer: Cash Price	$285.81
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$285.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$285.81
Rate for Payer: Fidelis Essential Plan Aliesa	$242.94
Rate for Payer: Fidelis Essential Plan QHP	$254.37
Rate for Payer: Fidelis Medicare Advantage	$285.81
Rate for Payer: Fidelis Qualified Health Plan	$254.37
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$355.72
Rate for Payer: Hamaspik Choice Inc Medicare	$285.81
Rate for Payer: Healthfirst Medicare Advantage	$242.94
Rate for Payer: Healthfirst QHP	$285.81
Rate for Payer: Humana Medicare	$291.53
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$285.81
Rate for Payer: Senior Whole Health Medicare Advantage	$285.81
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$285.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$285.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$228.65
Rate for Payer: Wellcare Medicare	$271.52

CHG OF CYSTOSTOMY TUBE, SIMPLE

Facility

$711.45

Service Code	HCPCS 51705
Hospital Charge Code	30105921
Hospital Revenue Code	450
Rate for Payer: Cash Price	$285.81

CHG OF CYSTOSTOMY TUBE, SIMPLE

Facility

$711.45

Service Code	HCPCS 51705
Hospital Charge Code	30305921
Hospital Revenue Code	450
Rate for Payer: Cash Price	$285.81

CHG OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL

Professional

Both

$162.30

Service Code	HCPCS 76519 TC
Min. Negotiated Rate	$121.72
Max. Negotiated Rate	$121.72
Rate for Payer: Cash Price	$45.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$121.72
Rate for Payer: SOMOS Essential	$121.72

CHG OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL

Professional

Both

$281.54

Service Code	HCPCS 76519
Min. Negotiated Rate	$211.16
Max. Negotiated Rate	$211.16
Rate for Payer: Cash Price	$78.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$211.16
Rate for Payer: SOMOS Essential	$211.16

CHG OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL

Professional

Both

$119.25

Service Code	HCPCS 76519 26
Min. Negotiated Rate	$89.44
Max. Negotiated Rate	$89.44
Rate for Payer: Cash Price	$32.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$89.44
Rate for Payer: SOMOS Essential	$89.44

CHG OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN

Professional

Both

$195.02

Service Code	HCPCS 76516
Min. Negotiated Rate	$146.26
Max. Negotiated Rate	$146.26
Rate for Payer: Cash Price	$53.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$146.26
Rate for Payer: SOMOS Essential	$146.26

CHG OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN

Professional

Both

$88.76

Service Code	HCPCS 76516 26
Min. Negotiated Rate	$66.57
Max. Negotiated Rate	$66.57
Rate for Payer: Cash Price	$24.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$66.57
Rate for Payer: SOMOS Essential	$66.57

CHG OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN

Professional

Both

$106.23

Service Code	HCPCS 76516 TC
Min. Negotiated Rate	$79.67
Max. Negotiated Rate	$79.67
Rate for Payer: Cash Price	$29.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$79.67
Rate for Payer: SOMOS Essential	$79.67

CHG OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION

Professional

Both

$125.86

Service Code	HCPCS 76529 26
Min. Negotiated Rate	$94.40
Max. Negotiated Rate	$94.40
Rate for Payer: Cash Price	$35.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$94.40
Rate for Payer: SOMOS Essential	$94.40

Know your out-of-pocket cost for care.

All Charges