St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I

Professional

Both

$257.18

Service Code	HCPCS 75809 TC
Min. Negotiated Rate	$192.88
Max. Negotiated Rate	$192.88
Rate for Payer: Cash Price	$70.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$192.88
Rate for Payer: SOMOS Essential	$192.88

CHG SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I

Professional

Both

$95.69

Service Code	HCPCS 75809 26
Min. Negotiated Rate	$71.77
Max. Negotiated Rate	$71.77
Rate for Payer: Cash Price	$24.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$71.77
Rate for Payer: SOMOS Essential	$71.77

CHG SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I

Professional

Both

$352.87

Service Code	HCPCS 75809
Min. Negotiated Rate	$264.65
Max. Negotiated Rate	$264.65
Rate for Payer: Cash Price	$95.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$264.65
Rate for Payer: SOMOS Essential	$264.65

CHG SIALOGRAPHY RS&I

Professional

Both

$434.00

Service Code	HCPCS 70390 TC
Min. Negotiated Rate	$325.50
Max. Negotiated Rate	$325.50
Rate for Payer: Cash Price	$115.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$325.50
Rate for Payer: SOMOS Essential	$325.50

CHG SIALOGRAPHY RS&I

Professional

Both

$73.19

Service Code	HCPCS 70390 26
Min. Negotiated Rate	$54.89
Max. Negotiated Rate	$54.89
Rate for Payer: Cash Price	$19.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$54.89
Rate for Payer: SOMOS Essential	$54.89

CHG SIALOGRAPHY RS&I

Professional

Both

$507.19

Service Code	HCPCS 70390
Min. Negotiated Rate	$380.39
Max. Negotiated Rate	$380.39
Rate for Payer: Cash Price	$135.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$380.39
Rate for Payer: SOMOS Essential	$380.39

CHG SKIN TEST CANDIDA

Professional

Both

$31.89

Service Code	HCPCS 86485
Min. Negotiated Rate	$23.92
Max. Negotiated Rate	$23.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23.92
Rate for Payer: SOMOS Essential	$23.92

CHG SKIN TEST COCCIDIOIDOMYCOSIS

Professional

Both

$336.25

Service Code	HCPCS 86490
Min. Negotiated Rate	$252.19
Max. Negotiated Rate	$252.19
Rate for Payer: Cash Price	$90.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$252.19
Rate for Payer: SOMOS Essential	$252.19

CHG SKIN TEST HISTOPLASMOSIS

Professional

Both

$32.94

Service Code	HCPCS 86510
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$24.70
Rate for Payer: Cash Price	$9.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24.70
Rate for Payer: SOMOS Essential	$24.70

CHG SKIN TEST TUBERCULOSIS INTRADERMAL

Professional

Both

$44.42

Service Code	HCPCS 86580
Min. Negotiated Rate	$33.31
Max. Negotiated Rate	$33.31
Rate for Payer: Cash Price	$12.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33.31
Rate for Payer: SOMOS Essential	$33.31

CHG SMR PRIM SRC SPEC STAIN BODIES/PARASITS

Professional

Both

$69.20

Service Code	HCPCS 87207 26
Min. Negotiated Rate	$51.90
Max. Negotiated Rate	$51.90
Rate for Payer: Cash Price	$19.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$51.90
Rate for Payer: SOMOS Essential	$51.90

CHG SPEC DOSIM ONLY PRESCRIBED TREATING PHYS

Professional

Both

$267.82

Service Code	HCPCS 77331
Min. Negotiated Rate	$200.87
Max. Negotiated Rate	$200.87
Rate for Payer: Cash Price	$73.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$200.87
Rate for Payer: SOMOS Essential	$200.87

CHG SPEC DOSIM ONLY PRESCRIBED TREATING PHYS

Professional

Both

$83.23

Service Code	HCPCS 77331 TC
Min. Negotiated Rate	$62.42
Max. Negotiated Rate	$62.42
Rate for Payer: Cash Price	$23.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$62.42
Rate for Payer: SOMOS Essential	$62.42

CHG SPEC DOSIM ONLY PRESCRIBED TREATING PHYS

Professional

Both

$184.59

Service Code	HCPCS 77331 26
Min. Negotiated Rate	$138.44
Max. Negotiated Rate	$138.44
Rate for Payer: Cash Price	$50.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$138.44
Rate for Payer: SOMOS Essential	$138.44

CHG SPECIAL TREATMENT PROCEDURE

Professional

Both

$142.03

Service Code	HCPCS 77470 TC
Min. Negotiated Rate	$106.52
Max. Negotiated Rate	$106.52
Rate for Payer: Cash Price	$42.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$106.52
Rate for Payer: SOMOS Essential	$106.52

CHG SPECIAL TREATMENT PROCEDURE

Professional

Both

$574.60

Service Code	HCPCS 77470
Min. Negotiated Rate	$430.95
Max. Negotiated Rate	$430.95
Rate for Payer: Cash Price	$160.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$430.95
Rate for Payer: SOMOS Essential	$430.95

CHG SPECIAL TREATMENT PROCEDURE

Professional

Both

$432.57

Service Code	HCPCS 77470 26
Min. Negotiated Rate	$324.43
Max. Negotiated Rate	$324.43
Rate for Payer: Cash Price	$118.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$324.43
Rate for Payer: SOMOS Essential	$324.43

CHG SPEC MEDICAL RADJ PHYSICS CONSLTJ

Professional

Both

$614.74

Service Code	HCPCS 77370
Min. Negotiated Rate	$461.06
Max. Negotiated Rate	$461.06
Rate for Payer: Cash Price	$174.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$461.06
Rate for Payer: SOMOS Essential	$461.06

CHG SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY

Professional

Both

$201.81

Service Code	HCPCS 77321 26
Min. Negotiated Rate	$151.36
Max. Negotiated Rate	$151.36
Rate for Payer: Cash Price	$55.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$151.36
Rate for Payer: SOMOS Essential	$151.36

CHG SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY

Professional

Both

$391.41

Service Code	HCPCS 77321
Min. Negotiated Rate	$293.56
Max. Negotiated Rate	$293.56
Rate for Payer: Cash Price	$108.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$293.56
Rate for Payer: SOMOS Essential	$293.56

CHG SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY

Professional

Both

$189.60

Service Code	HCPCS 77321 TC
Min. Negotiated Rate	$142.20
Max. Negotiated Rate	$142.20
Rate for Payer: Cash Price	$52.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$142.20
Rate for Payer: SOMOS Essential	$142.20

CHG SPLEEN IMAGING ONLY W/WO VASCULAR FLOW

Professional

Both

$617.58

Service Code	HCPCS 78185 TC
Min. Negotiated Rate	$463.19
Max. Negotiated Rate	$463.19
Rate for Payer: Cash Price	$164.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$463.19
Rate for Payer: SOMOS Essential	$463.19

CHG SPLEEN IMAGING ONLY W/WO VASCULAR FLOW

Professional

Both

$62.90

Service Code	HCPCS 78185 26
Min. Negotiated Rate	$47.17
Max. Negotiated Rate	$47.17
Rate for Payer: Cash Price	$16.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$47.17
Rate for Payer: SOMOS Essential	$47.17

CHG SPLEEN IMAGING ONLY W/WO VASCULAR FLOW

Professional

Both

$680.47

Service Code	HCPCS 78185
Min. Negotiated Rate	$510.35
Max. Negotiated Rate	$510.35
Rate for Payer: Cash Price	$181.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$510.35
Rate for Payer: SOMOS Essential	$510.35

CHG SPLENOPORTOGRAPY RS&I

Professional

Both

$2,544.19

Service Code	HCPCS 75810 TC
Min. Negotiated Rate	$1,908.14
Max. Negotiated Rate	$1,908.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,908.14
Rate for Payer: SOMOS Essential	$1,908.14

Know your out-of-pocket cost for care.

All Charges