St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG TESTICULAR IMAGING WITH VASCULAR FLOW

Professional

Both

$858.31

Service Code	HCPCS 78761
Min. Negotiated Rate	$643.73
Max. Negotiated Rate	$643.73
Rate for Payer: Cash Price	$230.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$643.73
Rate for Payer: SOMOS Essential	$643.73

CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ

Professional

Both

$1,085.07

Service Code	HCPCS 74283
Min. Negotiated Rate	$813.80
Max. Negotiated Rate	$813.80
Rate for Payer: Cash Price	$293.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$813.80
Rate for Payer: SOMOS Essential	$813.80

CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ

Professional

Both

$682.68

Service Code	HCPCS 74283 TC
Min. Negotiated Rate	$512.01
Max. Negotiated Rate	$512.01
Rate for Payer: Cash Price	$184.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$512.01
Rate for Payer: SOMOS Essential	$512.01

CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ

Professional

Both

$402.40

Service Code	HCPCS 74283 26
Min. Negotiated Rate	$301.80
Max. Negotiated Rate	$301.80
Rate for Payer: Cash Price	$109.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$301.80
Rate for Payer: SOMOS Essential	$301.80

CHG THERAPEUTIC RADIOLOGY PORT IMAGES(S)

Professional

Both

$60.24

Service Code	HCPCS 77417
Min. Negotiated Rate	$45.18
Max. Negotiated Rate	$45.18
Rate for Payer: Cash Price	$17.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$45.18
Rate for Payer: SOMOS Essential	$45.18

CHG THERAPEUTIC RADIOLOGY TX PLANNING COMPLEX

Professional

Both

$696.01

Service Code	HCPCS 77263
Min. Negotiated Rate	$522.01
Max. Negotiated Rate	$522.01
Rate for Payer: Cash Price	$188.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$522.01
Rate for Payer: SOMOS Essential	$522.01

CHG THERAPEUTIC RADIOLOGY TX PLANNING INTERMEDIATE

Professional

Both

$442.61

Service Code	HCPCS 77262
Min. Negotiated Rate	$331.96
Max. Negotiated Rate	$331.96
Rate for Payer: Cash Price	$121.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$331.96
Rate for Payer: SOMOS Essential	$331.96

CHG THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE

Professional

Both

$288.23

Service Code	HCPCS 77261
Min. Negotiated Rate	$216.17
Max. Negotiated Rate	$216.17
Rate for Payer: Cash Price	$79.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$216.17
Rate for Payer: SOMOS Essential	$216.17

CHG THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX

Professional

Both

$332.43

Service Code	HCPCS 77290 26
Min. Negotiated Rate	$249.32
Max. Negotiated Rate	$249.32
Rate for Payer: Cash Price	$91.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$249.32
Rate for Payer: SOMOS Essential	$249.32

CHG THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX

Professional

Both

$1,929.20

Service Code	HCPCS 77290
Min. Negotiated Rate	$1,446.90
Max. Negotiated Rate	$1,446.90
Rate for Payer: Cash Price	$523.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,446.90
Rate for Payer: SOMOS Essential	$1,446.90

CHG THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX

Professional

Both

$1,596.77

Service Code	HCPCS 77290 TC
Min. Negotiated Rate	$1,197.58
Max. Negotiated Rate	$1,197.58
Rate for Payer: Cash Price	$432.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,197.58
Rate for Payer: SOMOS Essential	$1,197.58

CHG THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED

Professional

Both

$1,658.58

Service Code	HCPCS 77285 TC
Min. Negotiated Rate	$1,243.94
Max. Negotiated Rate	$1,243.94
Rate for Payer: Cash Price	$453.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,243.94
Rate for Payer: SOMOS Essential	$1,243.94

CHG THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED

Professional

Both

$1,887.31

Service Code	HCPCS 77285
Min. Negotiated Rate	$1,415.48
Max. Negotiated Rate	$1,415.48
Rate for Payer: Cash Price	$516.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,415.48
Rate for Payer: SOMOS Essential	$1,415.48

CHG THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED

Professional

Both

$228.69

Service Code	HCPCS 77285 26
Min. Negotiated Rate	$171.52
Max. Negotiated Rate	$171.52
Rate for Payer: Cash Price	$62.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$171.52
Rate for Payer: SOMOS Essential	$171.52

CHG THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE

Professional

Both

$998.94

Service Code	HCPCS 77280 TC
Min. Negotiated Rate	$749.20
Max. Negotiated Rate	$749.20
Rate for Payer: Cash Price	$273.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$749.20
Rate for Payer: SOMOS Essential	$749.20

CHG THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE

Professional

Both

$154.67

Service Code	HCPCS 77280 26
Min. Negotiated Rate	$116.00
Max. Negotiated Rate	$116.00
Rate for Payer: Cash Price	$41.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$116.00
Rate for Payer: SOMOS Essential	$116.00

CHG THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE

Professional

Both

$1,153.60

Service Code	HCPCS 77280
Min. Negotiated Rate	$865.20
Max. Negotiated Rate	$865.20
Rate for Payer: Cash Price	$315.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$865.20
Rate for Payer: SOMOS Essential	$865.20

CHG THYROID CARCINOMA METASTASES IMG ADDL STUDY

Professional

Both

$979.55

Service Code	HCPCS 78016 TC
Min. Negotiated Rate	$734.66
Max. Negotiated Rate	$734.66
Rate for Payer: Cash Price	$261.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$734.66
Rate for Payer: SOMOS Essential	$734.66

CHG THYROID CARCINOMA METASTASES IMG ADDL STUDY

Professional

Both

$125.58

Service Code	HCPCS 78016 26
Min. Negotiated Rate	$94.18
Max. Negotiated Rate	$94.18
Rate for Payer: Cash Price	$34.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$94.18
Rate for Payer: SOMOS Essential	$94.18

CHG THYROID CARCINOMA METASTASES IMG ADDL STUDY

Professional

Both

$1,105.09

Service Code	HCPCS 78016
Min. Negotiated Rate	$828.82
Max. Negotiated Rate	$828.82
Rate for Payer: Cash Price	$295.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$828.82
Rate for Payer: SOMOS Essential	$828.82

CHG THYROID CARCINOMA METASTASES IMG LMTD AREA

Professional

Both

$797.27

Service Code	HCPCS 78015 TC
Min. Negotiated Rate	$597.95
Max. Negotiated Rate	$597.95
Rate for Payer: Cash Price	$213.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$597.95
Rate for Payer: SOMOS Essential	$597.95

CHG THYROID CARCINOMA METASTASES IMG LMTD AREA

Professional

Both

$928.06

Service Code	HCPCS 78015
Min. Negotiated Rate	$696.04
Max. Negotiated Rate	$696.04
Rate for Payer: Cash Price	$248.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$696.04
Rate for Payer: SOMOS Essential	$696.04

CHG THYROID CARCINOMA METASTASES IMG LMTD AREA

Professional

Both

$130.80

Service Code	HCPCS 78015 26
Min. Negotiated Rate	$98.10
Max. Negotiated Rate	$98.10
Rate for Payer: Cash Price	$34.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$98.10
Rate for Payer: SOMOS Essential	$98.10

CHG THYROID CARCINOMA METASTASES IMG WHOLE BODY

Professional

Both

$156.03

Service Code	HCPCS 78018 26
Min. Negotiated Rate	$117.02
Max. Negotiated Rate	$117.02
Rate for Payer: Cash Price	$41.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$117.02
Rate for Payer: SOMOS Essential	$117.02

CHG THYROID CARCINOMA METASTASES IMG WHOLE BODY

Professional

Both

$1,245.09

Service Code	HCPCS 78018
Min. Negotiated Rate	$933.82
Max. Negotiated Rate	$933.82
Rate for Payer: Cash Price	$332.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$933.82
Rate for Payer: SOMOS Essential	$933.82

Know your out-of-pocket cost for care.

All Charges