St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION

Professional

Both

$234.19

Service Code	HCPCS 76529 TC
Min. Negotiated Rate	$175.64
Max. Negotiated Rate	$175.64
Rate for Payer: Cash Price	$63.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$175.64
Rate for Payer: SOMOS Essential	$175.64

CHG OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION

Professional

Both

$360.05

Service Code	HCPCS 76529
Min. Negotiated Rate	$270.04
Max. Negotiated Rate	$270.04
Rate for Payer: Cash Price	$98.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$270.04
Rate for Payer: SOMOS Essential	$270.04

CHG OPHTHALMIC US DX B-SCAN&QUAN A-SCAN SM PT ENCTR

Professional

Both

$153.65

Service Code	HCPCS 76510 26
Min. Negotiated Rate	$115.24
Max. Negotiated Rate	$115.24
Rate for Payer: Cash Price	$42.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$115.24
Rate for Payer: SOMOS Essential	$115.24

CHG OPHTHALMIC US DX B-SCAN&QUAN A-SCAN SM PT ENCTR

Professional

Both

$132.13

Service Code	HCPCS 76510 TC
Min. Negotiated Rate	$99.10
Max. Negotiated Rate	$99.10
Rate for Payer: Cash Price	$35.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$99.10
Rate for Payer: SOMOS Essential	$99.10

CHG OPHTHALMIC US DX B-SCAN&QUAN A-SCAN SM PT ENCTR

Professional

Both

$285.78

Service Code	HCPCS 76510
Min. Negotiated Rate	$214.34
Max. Negotiated Rate	$214.34
Rate for Payer: Cash Price	$78.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$214.34
Rate for Payer: SOMOS Essential	$214.34

CHG OPHTHALMIC US DX B-SCAN W/WO NON-QUAN A-SCAN

Professional

Both

$197.79

Service Code	HCPCS 76512
Min. Negotiated Rate	$148.34
Max. Negotiated Rate	$148.34
Rate for Payer: Cash Price	$54.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$148.34
Rate for Payer: SOMOS Essential	$148.34

CHG OPHTHALMIC US DX B-SCAN W/WO NON-QUAN A-SCAN

Professional

Both

$120.30

Service Code	HCPCS 76512 26
Min. Negotiated Rate	$90.22
Max. Negotiated Rate	$90.22
Rate for Payer: Cash Price	$33.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$90.22
Rate for Payer: SOMOS Essential	$90.22

CHG OPHTHALMIC US DX B-SCAN W/WO NON-QUAN A-SCAN

Professional

Both

$77.49

Service Code	HCPCS 76512 TC
Min. Negotiated Rate	$58.12
Max. Negotiated Rate	$58.12
Rate for Payer: Cash Price	$21.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$58.12
Rate for Payer: SOMOS Essential	$58.12

CHG OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI

Professional

Both

$31.78

Service Code	HCPCS 76514 26
Min. Negotiated Rate	$23.84
Max. Negotiated Rate	$23.84
Rate for Payer: Cash Price	$8.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23.84
Rate for Payer: SOMOS Essential	$23.84

CHG OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI

Professional

Both

$17.12

Service Code	HCPCS 76514 TC
Min. Negotiated Rate	$12.84
Max. Negotiated Rate	$12.84
Rate for Payer: Cash Price	$4.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$12.84
Rate for Payer: SOMOS Essential	$12.84

CHG OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI

Professional

Both

$48.90

Service Code	HCPCS 76514
Min. Negotiated Rate	$36.68
Max. Negotiated Rate	$36.68
Rate for Payer: Cash Price	$13.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36.68
Rate for Payer: SOMOS Essential	$36.68

CHG OPHTHALMIC US DX QUANTITATIVE A-SCAN ONLY

Professional

Both

$235.13

Service Code	HCPCS 76511
Min. Negotiated Rate	$176.35
Max. Negotiated Rate	$176.35
Rate for Payer: Cash Price	$64.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$176.35
Rate for Payer: SOMOS Essential	$176.35

CHG OPHTHALMIC US DX QUANTITATIVE A-SCAN ONLY

Professional

Both

$94.75

Service Code	HCPCS 76511 TC
Min. Negotiated Rate	$71.06
Max. Negotiated Rate	$71.06
Rate for Payer: Cash Price	$26.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$71.06
Rate for Payer: SOMOS Essential	$71.06

CHG OPHTHALMIC US DX QUANTITATIVE A-SCAN ONLY

Professional

Both

$140.39

Service Code	HCPCS 76511 26
Min. Negotiated Rate	$105.29
Max. Negotiated Rate	$105.29
Rate for Payer: Cash Price	$38.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$105.29
Rate for Payer: SOMOS Essential	$105.29

CHG ORTHOPANTOGRAM

Professional

Both

$39.27

Service Code	HCPCS 70355 26
Min. Negotiated Rate	$29.45
Max. Negotiated Rate	$29.45
Rate for Payer: Cash Price	$10.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29.45
Rate for Payer: SOMOS Essential	$29.45

CHG ORTHOPANTOGRAM

Professional

Both

$76.51

Service Code	HCPCS 70355
Min. Negotiated Rate	$57.38
Max. Negotiated Rate	$57.38
Rate for Payer: Cash Price	$21.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$57.38
Rate for Payer: SOMOS Essential	$57.38

CHG ORTHOPANTOGRAM

Professional

Both

$37.24

Service Code	HCPCS 70355 TC
Min. Negotiated Rate	$27.93
Max. Negotiated Rate	$27.93
Rate for Payer: Cash Price	$10.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27.93
Rate for Payer: SOMOS Essential	$27.93

CHG PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT

Professional

Both

$1,445.57

Service Code	HCPCS 78072 TC
Min. Negotiated Rate	$1,084.18
Max. Negotiated Rate	$1,084.18
Rate for Payer: Cash Price	$384.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,084.18
Rate for Payer: SOMOS Essential	$1,084.18

CHG PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT

Professional

Both

$1,735.69

Service Code	HCPCS 78072
Min. Negotiated Rate	$1,301.77
Max. Negotiated Rate	$1,301.77
Rate for Payer: Cash Price	$464.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,301.77
Rate for Payer: SOMOS Essential	$1,301.77

CHG PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT

Professional

Both

$290.12

Service Code	HCPCS 78072 26
Min. Negotiated Rate	$217.59
Max. Negotiated Rate	$217.59
Rate for Payer: Cash Price	$79.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$217.59
Rate for Payer: SOMOS Essential	$217.59

CHG PARATHYROID PLANAR IMAGING

Professional

Both

$1,022.95

Service Code	HCPCS 78070 TC
Min. Negotiated Rate	$767.21
Max. Negotiated Rate	$767.21
Rate for Payer: Cash Price	$275.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$767.21
Rate for Payer: SOMOS Essential	$767.21

CHG PARATHYROID PLANAR IMAGING

Professional

Both

$1,172.89

Service Code	HCPCS 78070
Min. Negotiated Rate	$879.67
Max. Negotiated Rate	$879.67
Rate for Payer: Cash Price	$316.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$879.67
Rate for Payer: SOMOS Essential	$879.67

CHG PARATHYROID PLANAR IMAGING

Professional

Both

$149.94

Service Code	HCPCS 78070 26
Min. Negotiated Rate	$112.46
Max. Negotiated Rate	$112.46
Rate for Payer: Cash Price	$41.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$112.46
Rate for Payer: SOMOS Essential	$112.46

CHG PARATHYROID PLANAR IMAGING W/WO SUBTRACTION

Professional

Both

$1,396.64

Service Code	HCPCS 78071
Min. Negotiated Rate	$1,047.48
Max. Negotiated Rate	$1,047.48
Rate for Payer: Cash Price	$374.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,047.48
Rate for Payer: SOMOS Essential	$1,047.48

CHG PARATHYROID PLANAR IMAGING W/WO SUBTRACTION

Professional

Both

$1,172.43

Service Code	HCPCS 78071 TC
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$879.32
Rate for Payer: Cash Price	$313.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$879.32
Rate for Payer: SOMOS Essential	$879.32

Know your out-of-pocket cost for care.

All Charges