St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG PET IMAGING WHOLE BODY

Professional

Both

$360.08

Service Code	HCPCS 78813 26
Min. Negotiated Rate	$270.06
Max. Negotiated Rate	$270.06
Rate for Payer: Cash Price	$99.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$270.06
Rate for Payer: SOMOS Essential	$270.06

CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED

Professional

Both

$9.00

Service Code	HCPCS 83986
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6.75
Rate for Payer: Cash Price	$3.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6.75
Rate for Payer: SOMOS Essential	$6.75

CHG PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES

Professional

Both

$36.05

Service Code	HCPCS 78111 26
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$27.04
Rate for Payer: Cash Price	$9.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27.04
Rate for Payer: SOMOS Essential	$27.04

CHG PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES

Professional

Both

$281.19

Service Code	HCPCS 78111 TC
Min. Negotiated Rate	$210.89
Max. Negotiated Rate	$210.89
Rate for Payer: Cash Price	$76.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$210.89
Rate for Payer: SOMOS Essential	$210.89

CHG PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES

Professional

Both

$317.24

Service Code	HCPCS 78111
Min. Negotiated Rate	$237.93
Max. Negotiated Rate	$237.93
Rate for Payer: Cash Price	$86.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$237.93
Rate for Payer: SOMOS Essential	$237.93

CHG PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE

Professional

Both

$30.84

Service Code	HCPCS 78110 26
Min. Negotiated Rate	$23.13
Max. Negotiated Rate	$23.13
Rate for Payer: Cash Price	$8.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23.13
Rate for Payer: SOMOS Essential	$23.13

CHG PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE

Professional

Both

$268.24

Service Code	HCPCS 78110 TC
Min. Negotiated Rate	$201.18
Max. Negotiated Rate	$201.18
Rate for Payer: Cash Price	$73.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$201.18
Rate for Payer: SOMOS Essential	$201.18

CHG PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE

Professional

Both

$299.11

Service Code	HCPCS 78110
Min. Negotiated Rate	$224.33
Max. Negotiated Rate	$224.33
Rate for Payer: Cash Price	$81.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$224.33
Rate for Payer: SOMOS Essential	$224.33

CHG PLATELET AGGREGATION IN VITRO EACH AGENT

Professional

Both

$69.20

Service Code	HCPCS 85576 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 PLATELET SURVIVAL STUDY

Professional

Both

$528.26

Service Code	HCPCS 78191
Min. Negotiated Rate	$396.20
Max. Negotiated Rate	$396.20
Rate for Payer: Cash Price	$145.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$396.20
Rate for Payer: SOMOS Essential	$396.20

CHG PLATELET SURVIVAL STUDY

Professional

Both

$93.52

Service Code	HCPCS 78191 26
Min. Negotiated Rate	$70.14
Max. Negotiated Rate	$70.14
Rate for Payer: Cash Price	$25.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70.14
Rate for Payer: SOMOS Essential	$70.14

CHG PLATELET SURVIVAL STUDY

Professional

Both

$434.74

Service Code	HCPCS 78191 TC
Min. Negotiated Rate	$326.06
Max. Negotiated Rate	$326.06
Rate for Payer: Cash Price	$119.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$326.06
Rate for Payer: SOMOS Essential	$326.06

CHG PLMT DSTL XTN PRSTH EVASC DESC THORAC AORTA RS&I

Professional

Both

$1,387.72

Service Code	HCPCS 75959 TC
Min. Negotiated Rate	$1,040.79
Max. Negotiated Rate	$1,040.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,040.79
Rate for Payer: SOMOS Essential	$1,040.79

CHG PLMT DSTL XTN PRSTH EVASC DESC THORAC AORTA RS&I

Professional

Both

$2,107.42

Service Code	HCPCS 75959
Min. Negotiated Rate	$1,580.56
Max. Negotiated Rate	$1,580.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,580.56
Rate for Payer: SOMOS Essential	$1,580.56

CHG PLMT DSTL XTN PRSTH EVASC DESC THORAC AORTA RS&I

Professional

Both

$719.71

Service Code	HCPCS 75959 26
Min. Negotiated Rate	$539.78
Max. Negotiated Rate	$539.78
Rate for Payer: Cash Price	$192.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$539.78
Rate for Payer: SOMOS Essential	$539.78

CHG PLMT PROX XTN PRSTH EVASC DESC THORAC AORTA RS&I

Professional

Both

$822.64

Service Code	HCPCS 75958 26
Min. Negotiated Rate	$616.98
Max. Negotiated Rate	$616.98
Rate for Payer: Cash Price	$216.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$616.98
Rate for Payer: SOMOS Essential	$616.98

CHG PLMT PROX XTN PRSTH EVASC DESC THORAC AORTA RS&I

Professional

Both

$1,585.89

Service Code	HCPCS 75958 TC
Min. Negotiated Rate	$1,189.42
Max. Negotiated Rate	$1,189.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,189.42
Rate for Payer: SOMOS Essential	$1,189.42

CHG PLMT PROX XTN PRSTH EVASC DESC THORAC AORTA RS&I

Professional

Both

$2,408.53

Service Code	HCPCS 75958
Min. Negotiated Rate	$1,806.40
Max. Negotiated Rate	$1,806.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,806.40
Rate for Payer: SOMOS Essential	$1,806.40

CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI

Professional

Both

$69.20

Service Code	HCPCS 84166 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 PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM

Professional

Both

$69.20

Service Code	HCPCS 84165 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 PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL

Professional

Both

$69.20

Service Code	HCPCS 84182 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 PROTEIN WESTRN BLOT I&R BLOOD/OTHER FLUID

Professional

Both

$69.20

Service Code	HCPCS 84181 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 PROTHROMBIN TIME

Professional

Both

$10.72

Service Code	HCPCS 85610
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$8.04
Rate for Payer: Cash Price	$4.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.04
Rate for Payer: SOMOS Essential	$8.04

CHG PROTON TX DELIVERY COMPLEX

Professional

Both

$4,177.78

Service Code	HCPCS 77525
Min. Negotiated Rate	$3,133.34
Max. Negotiated Rate	$3,133.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,133.34
Rate for Payer: SOMOS Essential	$3,133.34

CHG PROTON TX DELIVERY INTERMEDIATE

Professional

Both

$3,924.10

Service Code	HCPCS 77523
Min. Negotiated Rate	$2,943.08
Max. Negotiated Rate	$2,943.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,943.08
Rate for Payer: SOMOS Essential	$2,943.08

Know your out-of-pocket cost for care.

All Charges