St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY

Professional

Both

$441.18

Service Code	HCPCS 74230 TC
Min. Negotiated Rate	$330.88
Max. Negotiated Rate	$330.88
Rate for Payer: Cash Price	$117.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$330.88
Rate for Payer: SOMOS Essential	$330.88

CHG RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH

Professional

Both

$182.42

Service Code	HCPCS 70320 TC
Min. Negotiated Rate	$136.82
Max. Negotiated Rate	$136.82
Rate for Payer: Cash Price	$50.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$136.82
Rate for Payer: SOMOS Essential	$136.82

CHG RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH

Professional

Both

$43.23

Service Code	HCPCS 70320 26
Min. Negotiated Rate	$32.42
Max. Negotiated Rate	$32.42
Rate for Payer: Cash Price	$11.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32.42
Rate for Payer: SOMOS Essential	$32.42

CHG RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH

Professional

Both

$225.65

Service Code	HCPCS 70320
Min. Negotiated Rate	$169.24
Max. Negotiated Rate	$169.24
Rate for Payer: Cash Price	$62.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$169.24
Rate for Payer: SOMOS Essential	$169.24

CHG RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH

Professional

Both

$31.40

Service Code	HCPCS 70310 26
Min. Negotiated Rate	$23.55
Max. Negotiated Rate	$23.55
Rate for Payer: Cash Price	$8.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23.55
Rate for Payer: SOMOS Essential	$23.55

CHG RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH

Professional

Both

$137.87

Service Code	HCPCS 70310 TC
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$103.40
Rate for Payer: Cash Price	$38.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$103.40
Rate for Payer: SOMOS Essential	$103.40

CHG RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH

Professional

Both

$169.26

Service Code	HCPCS 70310
Min. Negotiated Rate	$126.94
Max. Negotiated Rate	$126.94
Rate for Payer: Cash Price	$47.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$126.94
Rate for Payer: SOMOS Essential	$126.94

CHG RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY

Professional

Both

$599.34

Service Code	HCPCS 74246
Min. Negotiated Rate	$449.50
Max. Negotiated Rate	$449.50
Rate for Payer: Cash Price	$161.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$449.50
Rate for Payer: SOMOS Essential	$449.50

CHG RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY

Professional

Both

$169.68

Service Code	HCPCS 74246 26
Min. Negotiated Rate	$127.26
Max. Negotiated Rate	$127.26
Rate for Payer: Cash Price	$46.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$127.26
Rate for Payer: SOMOS Essential	$127.26

CHG RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY

Professional

Both

$429.66

Service Code	HCPCS 74246 TC
Min. Negotiated Rate	$322.24
Max. Negotiated Rate	$322.24
Rate for Payer: Cash Price	$114.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$322.24
Rate for Payer: SOMOS Essential	$322.24

CHG RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY

Professional

Both

$375.06

Service Code	HCPCS 74240 TC
Min. Negotiated Rate	$281.30
Max. Negotiated Rate	$281.30
Rate for Payer: Cash Price	$100.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$281.30
Rate for Payer: SOMOS Essential	$281.30

CHG RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY

Professional

Both

$529.31

Service Code	HCPCS 74240
Min. Negotiated Rate	$396.98
Max. Negotiated Rate	$396.98
Rate for Payer: Cash Price	$142.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$396.98
Rate for Payer: SOMOS Essential	$396.98

CHG RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY

Professional

Both

$154.28

Service Code	HCPCS 74240 26
Min. Negotiated Rate	$115.71
Max. Negotiated Rate	$115.71
Rate for Payer: Cash Price	$41.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$115.71
Rate for Payer: SOMOS Essential	$115.71

CHG RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY

Professional

Both

$219.80

Service Code	HCPCS 74248 TC
Min. Negotiated Rate	$164.85
Max. Negotiated Rate	$164.85
Rate for Payer: Cash Price	$58.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$164.85
Rate for Payer: SOMOS Essential	$164.85

CHG RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY

Professional

Both

$354.34

Service Code	HCPCS 74248
Min. Negotiated Rate	$265.76
Max. Negotiated Rate	$265.76
Rate for Payer: Cash Price	$95.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$265.76
Rate for Payer: SOMOS Essential	$265.76

CHG RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY

Professional

Both

$134.54

Service Code	HCPCS 74248 26
Min. Negotiated Rate	$100.90
Max. Negotiated Rate	$100.90
Rate for Payer: Cash Price	$36.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$100.90
Rate for Payer: SOMOS Essential	$100.90

CHG RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY

Professional

Both

$534.21

Service Code	HCPCS 78660 TC
Min. Negotiated Rate	$400.66
Max. Negotiated Rate	$400.66
Rate for Payer: Cash Price	$132.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$400.66
Rate for Payer: SOMOS Essential	$400.66

CHG RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY

Professional

Both

$82.04

Service Code	HCPCS 78660 26
Min. Negotiated Rate	$61.53
Max. Negotiated Rate	$61.53
Rate for Payer: Cash Price	$22.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$61.53
Rate for Payer: SOMOS Essential	$61.53

CHG RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY

Professional

Both

$616.25

Service Code	HCPCS 78660
Min. Negotiated Rate	$462.19
Max. Negotiated Rate	$462.19
Rate for Payer: Cash Price	$155.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$462.19
Rate for Payer: SOMOS Essential	$462.19

CHG RADIOPHARMACEUTICAL QUANTIFICATION MEAS 1 AREA

Professional

Both

$84.46

Service Code	HCPCS 78835 26
Min. Negotiated Rate	$63.34
Max. Negotiated Rate	$63.34
Rate for Payer: Cash Price	$22.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$63.34
Rate for Payer: SOMOS Essential	$63.34

CHG RADIOPHARMACEUTICAL QUANTIFICATION MEAS 1 AREA

Professional

Both

$308.91

Service Code	HCPCS 78835 TC
Min. Negotiated Rate	$231.68
Max. Negotiated Rate	$231.68
Rate for Payer: Cash Price	$80.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$231.68
Rate for Payer: SOMOS Essential	$231.68

CHG RADIOPHARMACEUTICAL QUANTIFICATION MEAS 1 AREA

Professional

Both

$393.40

Service Code	HCPCS 78835
Min. Negotiated Rate	$295.05
Max. Negotiated Rate	$295.05
Rate for Payer: Cash Price	$103.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$295.05
Rate for Payer: SOMOS Essential	$295.05

CHG RED CELL SURVIVAL STUDY

Professional

Both

$434.74

Service Code	HCPCS 78130 TC
Min. Negotiated Rate	$326.06
Max. Negotiated Rate	$326.06
Rate for Payer: Cash Price	$119.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$326.06
Rate for Payer: SOMOS Essential	$326.06

CHG RED CELL SURVIVAL STUDY

Professional

Both

$528.26

Service Code	HCPCS 78130
Min. Negotiated Rate	$396.20
Max. Negotiated Rate	$396.20
Rate for Payer: Cash Price	$145.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$396.20
Rate for Payer: SOMOS Essential	$396.20

CHG RED CELL SURVIVAL STUDY

Professional

Both

$93.52

Service Code	HCPCS 78130 26
Min. Negotiated Rate	$70.14
Max. Negotiated Rate	$70.14
Rate for Payer: Cash Price	$25.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70.14
Rate for Payer: SOMOS Essential	$70.14

Know your out-of-pocket cost for care.

All Charges