St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG VENOGRAPHY EPIDURAL RS&I

Professional

Both

$219.59

Service Code	HCPCS 75872 26
Min. Negotiated Rate	$164.69
Max. Negotiated Rate	$164.69
Rate for Payer: Cash Price	$59.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$164.69
Rate for Payer: SOMOS Essential	$164.69

CHG VENOGRAPHY EPIDURAL RS&I

Professional

Both

$327.46

Service Code	HCPCS 75872 TC
Min. Negotiated Rate	$245.60
Max. Negotiated Rate	$245.60
Rate for Payer: Cash Price	$88.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$245.60
Rate for Payer: SOMOS Essential	$245.60

CHG VENOGRAPHY EPIDURAL RS&I

Professional

Both

$547.05

Service Code	HCPCS 75872
Min. Negotiated Rate	$410.29
Max. Negotiated Rate	$410.29
Rate for Payer: Cash Price	$148.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$410.29
Rate for Payer: SOMOS Essential	$410.29

CHG VENOGRAPHY EXTREMITY BILATERAL RS&I

Professional

Both

$561.61

Service Code	HCPCS 75822
Min. Negotiated Rate	$421.21
Max. Negotiated Rate	$421.21
Rate for Payer: Cash Price	$153.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$421.21
Rate for Payer: SOMOS Essential	$421.21

CHG VENOGRAPHY EXTREMITY BILATERAL RS&I

Professional

Both

$283.05

Service Code	HCPCS 75822 TC
Min. Negotiated Rate	$212.29
Max. Negotiated Rate	$212.29
Rate for Payer: Cash Price	$77.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$212.29
Rate for Payer: SOMOS Essential	$212.29

CHG VENOGRAPHY EXTREMITY BILATERAL RS&I

Professional

Both

$278.57

Service Code	HCPCS 75822 26
Min. Negotiated Rate	$208.93
Max. Negotiated Rate	$208.93
Rate for Payer: Cash Price	$76.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$208.93
Rate for Payer: SOMOS Essential	$208.93

CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I

Professional

Both

$200.83

Service Code	HCPCS 75820 26
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$150.62
Rate for Payer: Cash Price	$54.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$150.62
Rate for Payer: SOMOS Essential	$150.62

CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I

Professional

Both

$462.32

Service Code	HCPCS 75820
Min. Negotiated Rate	$346.74
Max. Negotiated Rate	$346.74
Rate for Payer: Cash Price	$124.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$346.74
Rate for Payer: SOMOS Essential	$346.74

CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I

Professional

Both

$261.49

Service Code	HCPCS 75820 TC
Min. Negotiated Rate	$196.12
Max. Negotiated Rate	$196.12
Rate for Payer: Cash Price	$70.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$196.12
Rate for Payer: SOMOS Essential	$196.12

CHG VENOGRAPHY ORBITAL RS&I

Professional

Both

$136.01

Service Code	HCPCS 75880 26
Min. Negotiated Rate	$102.01
Max. Negotiated Rate	$102.01
Rate for Payer: Cash Price	$36.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$102.01
Rate for Payer: SOMOS Essential	$102.01

CHG VENOGRAPHY ORBITAL RS&I

Professional

Both

$326.03

Service Code	HCPCS 75880 TC
Min. Negotiated Rate	$244.52
Max. Negotiated Rate	$244.52
Rate for Payer: Cash Price	$88.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$244.52
Rate for Payer: SOMOS Essential	$244.52

CHG VENOGRAPHY ORBITAL RS&I

Professional

Both

$462.04

Service Code	HCPCS 75880
Min. Negotiated Rate	$346.53
Max. Negotiated Rate	$346.53
Rate for Payer: Cash Price	$125.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$346.53
Rate for Payer: SOMOS Essential	$346.53

CHG VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I

Professional

Both

$630.91

Service Code	HCPCS 75833
Min. Negotiated Rate	$473.18
Max. Negotiated Rate	$473.18
Rate for Payer: Cash Price	$172.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$473.18
Rate for Payer: SOMOS Essential	$473.18

CHG VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I

Professional

Both

$338.98

Service Code	HCPCS 75833 TC
Min. Negotiated Rate	$254.24
Max. Negotiated Rate	$254.24
Rate for Payer: Cash Price	$93.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$254.24
Rate for Payer: SOMOS Essential	$254.24

CHG VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I

Professional

Both

$291.94

Service Code	HCPCS 75833 26
Min. Negotiated Rate	$218.96
Max. Negotiated Rate	$218.96
Rate for Payer: Cash Price	$78.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$218.96
Rate for Payer: SOMOS Essential	$218.96

CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I

Professional

Both

$513.42

Service Code	HCPCS 75831
Min. Negotiated Rate	$385.06
Max. Negotiated Rate	$385.06
Rate for Payer: Cash Price	$138.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$385.06
Rate for Payer: SOMOS Essential	$385.06

CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I

Professional

Both

$213.26

Service Code	HCPCS 75831 26
Min. Negotiated Rate	$159.94
Max. Negotiated Rate	$159.94
Rate for Payer: Cash Price	$56.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$159.94
Rate for Payer: SOMOS Essential	$159.94

CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I

Professional

Both

$300.16

Service Code	HCPCS 75831 TC
Min. Negotiated Rate	$225.12
Max. Negotiated Rate	$225.12
Rate for Payer: Cash Price	$81.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$225.12
Rate for Payer: SOMOS Essential	$225.12

CHG VENOGRAPHY SUPERIOR SAGITTAL SINUS RS&I

Professional

Both

$680.51

Service Code	HCPCS 75870
Min. Negotiated Rate	$510.38
Max. Negotiated Rate	$510.38
Rate for Payer: Cash Price	$182.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$510.38
Rate for Payer: SOMOS Essential	$510.38

CHG VENOGRAPHY SUPERIOR SAGITTAL SINUS RS&I

Professional

Both

$253.86

Service Code	HCPCS 75870 26
Min. Negotiated Rate	$190.40
Max. Negotiated Rate	$190.40
Rate for Payer: Cash Price	$66.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$190.40
Rate for Payer: SOMOS Essential	$190.40

CHG VENOGRAPHY SUPERIOR SAGITTAL SINUS RS&I

Professional

Both

$426.65

Service Code	HCPCS 75870 TC
Min. Negotiated Rate	$319.99
Max. Negotiated Rate	$319.99
Rate for Payer: Cash Price	$115.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$319.99
Rate for Payer: SOMOS Essential	$319.99

CHG VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I

Professional

Both

$317.42

Service Code	HCPCS 75860 TC
Min. Negotiated Rate	$238.06
Max. Negotiated Rate	$238.06
Rate for Payer: Cash Price	$86.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$238.06
Rate for Payer: SOMOS Essential	$238.06

CHG VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I

Professional

Both

$220.47

Service Code	HCPCS 75860 26
Min. Negotiated Rate	$165.35
Max. Negotiated Rate	$165.35
Rate for Payer: Cash Price	$58.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$165.35
Rate for Payer: SOMOS Essential	$165.35

CHG VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I

Professional

Both

$537.88

Service Code	HCPCS 75860
Min. Negotiated Rate	$403.41
Max. Negotiated Rate	$403.41
Rate for Payer: Cash Price	$145.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$403.41
Rate for Payer: SOMOS Essential	$403.41

CHG VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&

Professional

Both

$444.85

Service Code	HCPCS 75893
Min. Negotiated Rate	$333.64
Max. Negotiated Rate	$333.64
Rate for Payer: Cash Price	$123.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$333.64
Rate for Payer: SOMOS Essential	$333.64

Know your out-of-pocket cost for care.

All Charges