St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG RP THERAPY INTRAVENOUS ADMINISTRATION

Professional

Both

$605.05

Service Code	HCPCS 79101
Min. Negotiated Rate	$453.79
Max. Negotiated Rate	$453.79
Rate for Payer: Cash Price	$164.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$453.79
Rate for Payer: SOMOS Essential	$453.79

CHG RP THERAPY ORAL ADMINISTRATION

Professional

Both

$556.26

Service Code	HCPCS 79005
Min. Negotiated Rate	$417.20
Max. Negotiated Rate	$417.20
Rate for Payer: Cash Price	$151.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$417.20
Rate for Payer: SOMOS Essential	$417.20

CHG RP THERAPY ORAL ADMINISTRATION

Professional

Both

$222.53

Service Code	HCPCS 79005 TC
Min. Negotiated Rate	$166.90
Max. Negotiated Rate	$166.90
Rate for Payer: Cash Price	$60.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$166.90
Rate for Payer: SOMOS Essential	$166.90

CHG RP THERAPY ORAL ADMINISTRATION

Professional

Both

$333.73

Service Code	HCPCS 79005 26
Min. Negotiated Rate	$250.30
Max. Negotiated Rate	$250.30
Rate for Payer: Cash Price	$90.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$250.30
Rate for Payer: SOMOS Essential	$250.30

CHG RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS

Professional

Both

$421.58

Service Code	HCPCS 79403 26
Min. Negotiated Rate	$316.18
Max. Negotiated Rate	$316.18
Rate for Payer: Cash Price	$119.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$316.18
Rate for Payer: SOMOS Essential	$316.18

CHG RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS

Professional

Both

$407.68

Service Code	HCPCS 79403 TC
Min. Negotiated Rate	$305.76
Max. Negotiated Rate	$305.76
Rate for Payer: Cash Price	$119.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$305.76
Rate for Payer: SOMOS Essential	$305.76

CHG RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS

Professional

Both

$829.26

Service Code	HCPCS 79403
Min. Negotiated Rate	$621.94
Max. Negotiated Rate	$621.94
Rate for Payer: Cash Price	$239.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$621.94
Rate for Payer: SOMOS Essential	$621.94

CHG SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER

Professional

Both

$493.71

Service Code	HCPCS 76831
Min. Negotiated Rate	$370.28
Max. Negotiated Rate	$370.28
Rate for Payer: Cash Price	$134.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$370.28
Rate for Payer: SOMOS Essential	$370.28

CHG SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER

Professional

Both

$357.81

Service Code	HCPCS 76831 TC
Min. Negotiated Rate	$268.36
Max. Negotiated Rate	$268.36
Rate for Payer: Cash Price	$97.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$268.36
Rate for Payer: SOMOS Essential	$268.36

CHG SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER

Professional

Both

$135.91

Service Code	HCPCS 76831 26
Min. Negotiated Rate	$101.93
Max. Negotiated Rate	$101.93
Rate for Payer: Cash Price	$37.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$101.93
Rate for Payer: SOMOS Essential	$101.93

CHG SALIVARY GLAND FUNCTION STUDY

Professional

Both

$436.24

Service Code	HCPCS 78232
Min. Negotiated Rate	$327.18
Max. Negotiated Rate	$327.18
Rate for Payer: Cash Price	$119.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$327.18
Rate for Payer: SOMOS Essential	$327.18

CHG SALIVARY GLAND FUNCTION STUDY

Professional

Both

$73.12

Service Code	HCPCS 78232 26
Min. Negotiated Rate	$54.84
Max. Negotiated Rate	$54.84
Rate for Payer: Cash Price	$19.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$54.84
Rate for Payer: SOMOS Essential	$54.84

CHG SALIVARY GLAND FUNCTION STUDY

Professional

Both

$363.13

Service Code	HCPCS 78232 TC
Min. Negotiated Rate	$272.35
Max. Negotiated Rate	$272.35
Rate for Payer: Cash Price	$99.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$272.35
Rate for Payer: SOMOS Essential	$272.35

CHG SALIVARY GLAND IMAGING

Professional

Both

$84.84

Service Code	HCPCS 78230 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 SALIVARY GLAND IMAGING

Professional

Both

$630.49

Service Code	HCPCS 78230 TC
Min. Negotiated Rate	$472.87
Max. Negotiated Rate	$472.87
Rate for Payer: Cash Price	$169.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$472.87
Rate for Payer: SOMOS Essential	$472.87

CHG SALIVARY GLAND IMAGING

Professional

Both

$715.33

Service Code	HCPCS 78230
Min. Negotiated Rate	$536.50
Max. Negotiated Rate	$536.50
Rate for Payer: Cash Price	$192.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$536.50
Rate for Payer: SOMOS Essential	$536.50

CHG SALIVARY GLAND IMAGING SERIAL IMAGES

Professional

Both

$361.69

Service Code	HCPCS 78231 TC
Min. Negotiated Rate	$271.27
Max. Negotiated Rate	$271.27
Rate for Payer: Cash Price	$99.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$271.27
Rate for Payer: SOMOS Essential	$271.27

CHG SALIVARY GLAND IMAGING SERIAL IMAGES

Professional

Both

$442.51

Service Code	HCPCS 78231
Min. Negotiated Rate	$331.88
Max. Negotiated Rate	$331.88
Rate for Payer: Cash Price	$121.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$331.88
Rate for Payer: SOMOS Essential	$331.88

CHG SALIVARY GLAND IMAGING SERIAL IMAGES

Professional

Both

$80.82

Service Code	HCPCS 78231 26
Min. Negotiated Rate	$60.62
Max. Negotiated Rate	$60.62
Rate for Payer: Cash Price	$21.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$60.62
Rate for Payer: SOMOS Essential	$60.62

CHG SCREENING DIGITAL BREAST TOMOSYNTHESIS BI

Professional

Both

$221.24

Service Code	HCPCS 77063
Min. Negotiated Rate	$165.93
Max. Negotiated Rate	$165.93
Rate for Payer: Cash Price	$59.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$165.93
Rate for Payer: SOMOS Essential	$165.93

CHG SCREENING DIGITAL BREAST TOMOSYNTHESIS BI

Professional

Both

$117.71

Service Code	HCPCS 77063 26
Min. Negotiated Rate	$88.28
Max. Negotiated Rate	$88.28
Rate for Payer: Cash Price	$31.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$88.28
Rate for Payer: SOMOS Essential	$88.28

CHG SCREENING DIGITAL BREAST TOMOSYNTHESIS BI

Professional

Both

$103.50

Service Code	HCPCS 77063 TC
Min. Negotiated Rate	$77.62
Max. Negotiated Rate	$77.62
Rate for Payer: Cash Price	$28.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$77.62
Rate for Payer: SOMOS Essential	$77.62

CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD

Professional

Both

$146.37

Service Code	HCPCS 77067 26
Min. Negotiated Rate	$109.78
Max. Negotiated Rate	$109.78
Rate for Payer: Cash Price	$39.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$109.78
Rate for Payer: SOMOS Essential	$109.78

CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD

Professional

Both

$399.49

Service Code	HCPCS 77067 TC
Min. Negotiated Rate	$299.62
Max. Negotiated Rate	$299.62
Rate for Payer: Cash Price	$109.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$299.62
Rate for Payer: SOMOS Essential	$299.62

CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD

Professional

Both

$545.86

Service Code	HCPCS 77067
Min. Negotiated Rate	$409.40
Max. Negotiated Rate	$409.40
Rate for Payer: Cash Price	$148.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$409.40
Rate for Payer: SOMOS Essential	$409.40

Know your out-of-pocket cost for care.

All Charges