St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG PROTON TX DELIVERY SIMPLE W/COMPENSATION

Professional

Both

$3,308.13

Service Code	HCPCS 77522
Min. Negotiated Rate	$2,481.10
Max. Negotiated Rate	$2,481.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,481.10
Rate for Payer: SOMOS Essential	$2,481.10

CHG PROTON TX DELIVERY SIMPLE W/O COMPENSATION

Professional

Both

$3,221.51

Service Code	HCPCS 77520
Min. Negotiated Rate	$2,416.13
Max. Negotiated Rate	$2,416.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,416.13
Rate for Payer: SOMOS Essential	$2,416.13

CHG PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I

Professional

Both

$1,023.16

Service Code	HCPCS 74363 TC
Min. Negotiated Rate	$767.37
Max. Negotiated Rate	$767.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$767.37
Rate for Payer: SOMOS Essential	$767.37

CHG PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I

Professional

Both

$1,188.88

Service Code	HCPCS 74363
Min. Negotiated Rate	$891.66
Max. Negotiated Rate	$891.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$891.66
Rate for Payer: SOMOS Essential	$891.66

CHG PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I

Professional

Both

$165.73

Service Code	HCPCS 74363 26
Min. Negotiated Rate	$124.30
Max. Negotiated Rate	$124.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$124.30
Rate for Payer: SOMOS Essential	$124.30

CHG PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I

Professional

Both

$576.87

Service Code	HCPCS 75885
Min. Negotiated Rate	$432.65
Max. Negotiated Rate	$432.65
Rate for Payer: Cash Price	$157.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$432.65
Rate for Payer: SOMOS Essential	$432.65

CHG PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I

Professional

Both

$314.55

Service Code	HCPCS 75885 TC
Min. Negotiated Rate	$235.91
Max. Negotiated Rate	$235.91
Rate for Payer: Cash Price	$85.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$235.91
Rate for Payer: SOMOS Essential	$235.91

CHG PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I

Professional

Both

$262.36

Service Code	HCPCS 75885 26
Min. Negotiated Rate	$196.77
Max. Negotiated Rate	$196.77
Rate for Payer: Cash Price	$71.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$196.77
Rate for Payer: SOMOS Essential	$196.77

CHG PRQ TRANSHEPATC PORTOGRAPY W/O HEMODYN EVL INTRP

Professional

Both

$318.85

Service Code	HCPCS 75887 TC
Min. Negotiated Rate	$239.14
Max. Negotiated Rate	$239.14
Rate for Payer: Cash Price	$86.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$239.14
Rate for Payer: SOMOS Essential	$239.14

CHG PRQ TRANSHEPATC PORTOGRAPY W/O HEMODYN EVL INTRP

Professional

Both

$585.52

Service Code	HCPCS 75887
Min. Negotiated Rate	$439.14
Max. Negotiated Rate	$439.14
Rate for Payer: Cash Price	$158.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$439.14
Rate for Payer: SOMOS Essential	$439.14

CHG PRQ TRANSHEPATC PORTOGRAPY W/O HEMODYN EVL INTRP

Professional

Both

$266.67

Service Code	HCPCS 75887 26
Min. Negotiated Rate	$200.00
Max. Negotiated Rate	$200.00
Rate for Payer: Cash Price	$71.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$200.00
Rate for Payer: SOMOS Essential	$200.00

CHG PULMONARY PERFUSION IMAGING PARTICULATE

Professional

Both

$948.33

Service Code	HCPCS 78580
Min. Negotiated Rate	$711.25
Max. Negotiated Rate	$711.25
Rate for Payer: Cash Price	$254.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$711.25
Rate for Payer: SOMOS Essential	$711.25

CHG PULMONARY PERFUSION IMAGING PARTICULATE

Professional

Both

$808.75

Service Code	HCPCS 78580 TC
Min. Negotiated Rate	$606.56
Max. Negotiated Rate	$606.56
Rate for Payer: Cash Price	$216.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$606.56
Rate for Payer: SOMOS Essential	$606.56

CHG PULMONARY PERFUSION IMAGING PARTICULATE

Professional

Both

$139.58

Service Code	HCPCS 78580 26
Min. Negotiated Rate	$104.68
Max. Negotiated Rate	$104.68
Rate for Payer: Cash Price	$37.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$104.68
Rate for Payer: SOMOS Essential	$104.68

CHG PULMONARY VENTILATION IMAGING

Professional

Both

$666.44

Service Code	HCPCS 78579 TC
Min. Negotiated Rate	$499.83
Max. Negotiated Rate	$499.83
Rate for Payer: Cash Price	$177.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$499.83
Rate for Payer: SOMOS Essential	$499.83

CHG PULMONARY VENTILATION IMAGING

Professional

Both

$91.28

Service Code	HCPCS 78579 26
Min. Negotiated Rate	$68.46
Max. Negotiated Rate	$68.46
Rate for Payer: Cash Price	$24.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$68.46
Rate for Payer: SOMOS Essential	$68.46

CHG PULMONARY VENTILATION IMAGING

Professional

Both

$757.72

Service Code	HCPCS 78579
Min. Negotiated Rate	$568.29
Max. Negotiated Rate	$568.29
Rate for Payer: Cash Price	$202.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$568.29
Rate for Payer: SOMOS Essential	$568.29

CHG PULMONARY VENTILATION & PERFUSION IMAGING

Professional

Both

$1,321.71

Service Code	HCPCS 78582
Min. Negotiated Rate	$991.28
Max. Negotiated Rate	$991.28
Rate for Payer: Cash Price	$355.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$991.28
Rate for Payer: SOMOS Essential	$991.28

CHG PULMONARY VENTILATION & PERFUSION IMAGING

Professional

Both

$196.70

Service Code	HCPCS 78582 26
Min. Negotiated Rate	$147.52
Max. Negotiated Rate	$147.52
Rate for Payer: Cash Price	$54.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$147.52
Rate for Payer: SOMOS Essential	$147.52

CHG PULMONARY VENTILATION & PERFUSION IMAGING

Professional

Both

$1,125.01

Service Code	HCPCS 78582 TC
Min. Negotiated Rate	$843.76
Max. Negotiated Rate	$843.76
Rate for Payer: Cash Price	$300.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$843.76
Rate for Payer: SOMOS Essential	$843.76

CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING

Professional

Both

$805.84

Service Code	HCPCS 78597
Min. Negotiated Rate	$604.38
Max. Negotiated Rate	$604.38
Rate for Payer: Cash Price	$214.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$604.38
Rate for Payer: SOMOS Essential	$604.38

CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING

Professional

Both

$136.50

Service Code	HCPCS 78597 26
Min. Negotiated Rate	$102.38
Max. Negotiated Rate	$102.38
Rate for Payer: Cash Price	$36.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$102.38
Rate for Payer: SOMOS Essential	$102.38

CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING

Professional

Both

$669.31

Service Code	HCPCS 78597 TC
Min. Negotiated Rate	$501.98
Max. Negotiated Rate	$501.98
Rate for Payer: Cash Price	$178.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$501.98
Rate for Payer: SOMOS Essential	$501.98

CHG QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGIN

Professional

Both

$156.21

Service Code	HCPCS 78598 26
Min. Negotiated Rate	$117.16
Max. Negotiated Rate	$117.16
Rate for Payer: Cash Price	$41.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$117.16
Rate for Payer: SOMOS Essential	$117.16

CHG QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGIN

Professional

Both

$1,207.92

Service Code	HCPCS 78598
Min. Negotiated Rate	$905.94
Max. Negotiated Rate	$905.94
Rate for Payer: Cash Price	$322.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$905.94
Rate for Payer: SOMOS Essential	$905.94

Know your out-of-pocket cost for care.

All Charges