St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG SPLENOPORTOGRAPY RS&I

Professional

Both

$2,741.66

Service Code	HCPCS 75810
Min. Negotiated Rate	$2,056.24
Max. Negotiated Rate	$2,056.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,056.24
Rate for Payer: SOMOS Essential	$2,056.24

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

CHG STEREOTACTIC BODY RADIATION DELIVERY

Professional

Both

$4,352.43

Service Code	HCPCS 77373
Min. Negotiated Rate	$3,264.32
Max. Negotiated Rate	$3,264.32
Rate for Payer: Cash Price	$1,178.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,264.32
Rate for Payer: SOMOS Essential	$3,264.32

CHG STEREOTACTIC BODY RADIATION MANAGEMENT

Professional

Both

$2,642.75

Service Code	HCPCS 77435
Min. Negotiated Rate	$1,982.06
Max. Negotiated Rate	$1,982.06
Rate for Payer: Cash Price	$722.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,982.06
Rate for Payer: SOMOS Essential	$1,982.06

CHG STERETCTC RADIATION TX MANAGEMENT CRANIAL LESION

Professional

Both

$1,748.39

Service Code	HCPCS 77432
Min. Negotiated Rate	$1,311.29
Max. Negotiated Rate	$1,311.29
Rate for Payer: Cash Price	$477.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,311.29
Rate for Payer: SOMOS Essential	$1,311.29

CHG SUPERVISION HANDLING LOADING RADIATION SOURCE

Professional

Both

$77.35

Service Code	HCPCS 77790
Min. Negotiated Rate	$58.01
Max. Negotiated Rate	$58.01
Rate for Payer: Cash Price	$21.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$58.01
Rate for Payer: SOMOS Essential	$58.01

CHG SURFACE APPLIC LOW DOSE RATE RADIONUCLIDE SOURCE

Professional

Both

$311.68

Service Code	HCPCS 77789 TC
Min. Negotiated Rate	$233.76
Max. Negotiated Rate	$233.76
Rate for Payer: Cash Price	$87.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$233.76
Rate for Payer: SOMOS Essential	$233.76

CHG SURFACE APPLIC LOW DOSE RATE RADIONUCLIDE SOURCE

Professional

Both

$239.96

Service Code	HCPCS 77789 26
Min. Negotiated Rate	$179.97
Max. Negotiated Rate	$179.97
Rate for Payer: Cash Price	$66.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$179.97
Rate for Payer: SOMOS Essential	$179.97

CHG SURFACE APPLIC LOW DOSE RATE RADIONUCLIDE SOURCE

Professional

Both

$551.64

Service Code	HCPCS 77789
Min. Negotiated Rate	$413.73
Max. Negotiated Rate	$413.73
Rate for Payer: Cash Price	$153.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$413.73
Rate for Payer: SOMOS Essential	$413.73

CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON

Professional

Both

$155.00

Service Code	HCPCS 86480
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Cash Price	$61.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$116.25
Rate for Payer: SOMOS Essential	$116.25

CHG TBS DXA/OTHER IMG CALCULATION W/I&R FX RISK

Professional

Both

$174.13

Service Code	HCPCS 77089
Min. Negotiated Rate	$130.60
Max. Negotiated Rate	$130.60
Rate for Payer: Cash Price	$47.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$130.60
Rate for Payer: SOMOS Essential	$130.60

CHG TBS INTERPRETATION & REPORT FX RISK BY OTHER QHP

Professional

Both

$39.27

Service Code	HCPCS 77092
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 TBS TECHL PREP&TRANSMIS DATA ALYS PFRMD ELSEWHR

Professional

Both

$12.81

Service Code	HCPCS 77090
Min. Negotiated Rate	$9.61
Max. Negotiated Rate	$9.61
Rate for Payer: Cash Price	$3.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.61
Rate for Payer: SOMOS Essential	$9.61

CHG TBS TECHNICAL CALCULATION ONLY

Professional

Both

$122.05

Service Code	HCPCS 77091
Min. Negotiated Rate	$91.54
Max. Negotiated Rate	$91.54
Rate for Payer: Cash Price	$33.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$91.54
Rate for Payer: SOMOS Essential	$91.54

CHG TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY

Professional

Both

$613.13

Service Code	HCPCS 77307 26
Min. Negotiated Rate	$459.85
Max. Negotiated Rate	$459.85
Rate for Payer: Cash Price	$167.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$459.85
Rate for Payer: SOMOS Essential	$459.85

CHG TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY

Professional

Both

$581.63

Service Code	HCPCS 77307 TC
Min. Negotiated Rate	$436.22
Max. Negotiated Rate	$436.22
Rate for Payer: Cash Price	$161.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$436.22
Rate for Payer: SOMOS Essential	$436.22

CHG TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY

Professional

Both

$1,194.76

Service Code	HCPCS 77307
Min. Negotiated Rate	$896.07
Max. Negotiated Rate	$896.07
Rate for Payer: Cash Price	$329.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$896.07
Rate for Payer: SOMOS Essential	$896.07

CHG TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION

Professional

Both

$321.72

Service Code	HCPCS 77306 TC
Min. Negotiated Rate	$241.29
Max. Negotiated Rate	$241.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$241.29
Rate for Payer: SOMOS Essential	$241.29

CHG TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION

Professional

Both

$618.42

Service Code	HCPCS 77306
Min. Negotiated Rate	$463.82
Max. Negotiated Rate	$463.82
Rate for Payer: Cash Price	$170.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$463.82
Rate for Payer: SOMOS Essential	$463.82

CHG TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION

Professional

Both

$296.70

Service Code	HCPCS 77306 26
Min. Negotiated Rate	$222.52
Max. Negotiated Rate	$222.52
Rate for Payer: Cash Price	$81.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$222.52
Rate for Payer: SOMOS Essential	$222.52

CHG TEMPOROMANDBLE JT ARTHROGRAPHY RS&I

Professional

Both

$255.75

Service Code	HCPCS 70332 TC
Min. Negotiated Rate	$191.81
Max. Negotiated Rate	$191.81
Rate for Payer: Cash Price	$67.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$191.81
Rate for Payer: SOMOS Essential	$191.81

CHG TEMPOROMANDBLE JT ARTHROGRAPHY RS&I

Professional

Both

$107.35

Service Code	HCPCS 70332 26
Min. Negotiated Rate	$80.51
Max. Negotiated Rate	$80.51
Rate for Payer: Cash Price	$28.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$80.51
Rate for Payer: SOMOS Essential	$80.51

CHG TEMPOROMANDBLE JT ARTHROGRAPHY RS&I

Professional

Both

$363.06

Service Code	HCPCS 70332
Min. Negotiated Rate	$272.30
Max. Negotiated Rate	$272.30
Rate for Payer: Cash Price	$95.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$272.30
Rate for Payer: SOMOS Essential	$272.30

CHG TESTICULAR IMAGING WITH VASCULAR FLOW

Professional

Both

$721.07

Service Code	HCPCS 78761 TC
Min. Negotiated Rate	$540.80
Max. Negotiated Rate	$540.80
Rate for Payer: Cash Price	$193.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$540.80
Rate for Payer: SOMOS Essential	$540.80

CHG TESTICULAR IMAGING WITH VASCULAR FLOW

Professional

Both

$137.24

Service Code	HCPCS 78761 26
Min. Negotiated Rate	$102.93
Max. Negotiated Rate	$102.93
Rate for Payer: Cash Price	$37.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$102.93
Rate for Payer: SOMOS Essential	$102.93

Know your out-of-pocket cost for care.

All Charges