St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG RED CELL VOLUME DETERMINATION SPX 1 SAMPLING

Professional

Both

$37.31

Service Code	HCPCS 78120 26
Min. Negotiated Rate	$27.98
Max. Negotiated Rate	$27.98
Rate for Payer: Cash Price	$10.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27.98
Rate for Payer: SOMOS Essential	$27.98

CHG RED CELL VOLUME DETERMINATION SPX 1 SAMPLING

Professional

Both

$305.55

Service Code	HCPCS 78120
Min. Negotiated Rate	$229.16
Max. Negotiated Rate	$229.16
Rate for Payer: Cash Price	$83.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$229.16
Rate for Payer: SOMOS Essential	$229.16

CHG RED CELL VOLUME DETERMINATION SPX 1 SAMPLING

Professional

Both

$268.24

Service Code	HCPCS 78120 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 RED CELL VOLUME DETERMINATION SPX MULT SAMPLINGS

Professional

Both

$281.19

Service Code	HCPCS 78121 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 RED CELL VOLUME DETERMINATION SPX MULT SAMPLINGS

Professional

Both

$331.21

Service Code	HCPCS 78121
Min. Negotiated Rate	$248.41
Max. Negotiated Rate	$248.41
Rate for Payer: Cash Price	$90.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$248.41
Rate for Payer: SOMOS Essential	$248.41

CHG RED CELL VOLUME DETERMINATION SPX MULT SAMPLINGS

Professional

Both

$50.02

Service Code	HCPCS 78121 26
Min. Negotiated Rate	$37.52
Max. Negotiated Rate	$37.52
Rate for Payer: Cash Price	$13.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37.52
Rate for Payer: SOMOS Essential	$37.52

CHG RESPIRATORY MOTION MANAGEMENT SIMULATION

Professional

Both

$1,755.32

Service Code	HCPCS 77293
Min. Negotiated Rate	$1,316.49
Max. Negotiated Rate	$1,316.49
Rate for Payer: Cash Price	$475.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,316.49
Rate for Payer: SOMOS Essential	$1,316.49

CHG RESPIRATORY MOTION MANAGEMENT SIMULATION

Professional

Both

$421.89

Service Code	HCPCS 77293 26
Min. Negotiated Rate	$316.42
Max. Negotiated Rate	$316.42
Rate for Payer: Cash Price	$116.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$316.42
Rate for Payer: SOMOS Essential	$316.42

CHG RESPIRATORY MOTION MANAGEMENT SIMULATION

Professional

Both

$1,333.43

Service Code	HCPCS 77293 TC
Min. Negotiated Rate	$1,000.07
Max. Negotiated Rate	$1,000.07
Rate for Payer: Cash Price	$359.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,000.07
Rate for Payer: SOMOS Essential	$1,000.07

CHG RMVL FB ESOPHAGEAL W/USE BALLOON CATH RS&I

Professional

Both

$670.53

Service Code	HCPCS 74235
Min. Negotiated Rate	$502.90
Max. Negotiated Rate	$502.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$502.90
Rate for Payer: SOMOS Essential	$502.90

CHG RMVL FB ESOPHAGEAL W/USE BALLOON CATH RS&I

Professional

Both

$441.81

Service Code	HCPCS 74235 TC
Min. Negotiated Rate	$331.36
Max. Negotiated Rate	$331.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$331.36
Rate for Payer: SOMOS Essential	$331.36

CHG RMVL FB ESOPHAGEAL W/USE BALLOON CATH RS&I

Professional

Both

$228.73

Service Code	HCPCS 74235 26
Min. Negotiated Rate	$171.55
Max. Negotiated Rate	$171.55
Rate for Payer: Cash Price	$61.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$171.55
Rate for Payer: SOMOS Essential	$171.55

CHG RP LOCLZJ TUM PLNR 1 AREA SINGLE DAY IMAGING

Professional

Both

$889.25

Service Code	HCPCS 78800 TC
Min. Negotiated Rate	$666.94
Max. Negotiated Rate	$666.94
Rate for Payer: Cash Price	$239.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$666.94
Rate for Payer: SOMOS Essential	$666.94

CHG RP LOCLZJ TUM PLNR 1 AREA SINGLE DAY IMAGING

Professional

Both

$1,011.99

Service Code	HCPCS 78800
Min. Negotiated Rate	$758.99
Max. Negotiated Rate	$758.99
Rate for Payer: Cash Price	$273.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$758.99
Rate for Payer: SOMOS Essential	$758.99

CHG RP LOCLZJ TUM PLNR 1 AREA SINGLE DAY IMAGING

Professional

Both

$122.75

Service Code	HCPCS 78800 26
Min. Negotiated Rate	$92.06
Max. Negotiated Rate	$92.06
Rate for Payer: Cash Price	$34.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$92.06
Rate for Payer: SOMOS Essential	$92.06

CHG RP LOCLZJ TUM PLNR 2+AREA 1+D IMG/1 AREA IMG>2+D

Professional

Both

$136.89

Service Code	HCPCS 78801 26
Min. Negotiated Rate	$102.67
Max. Negotiated Rate	$102.67
Rate for Payer: Cash Price	$37.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$102.67
Rate for Payer: SOMOS Essential	$102.67

CHG RP LOCLZJ TUM PLNR 2+AREA 1+D IMG/1 AREA IMG>2+D

Professional

Both

$959.70

Service Code	HCPCS 78801 TC
Min. Negotiated Rate	$719.78
Max. Negotiated Rate	$719.78
Rate for Payer: Cash Price	$255.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$719.78
Rate for Payer: SOMOS Essential	$719.78

CHG RP LOCLZJ TUM PLNR 2+AREA 1+D IMG/1 AREA IMG>2+D

Professional

Both

$1,096.55

Service Code	HCPCS 78801
Min. Negotiated Rate	$822.41
Max. Negotiated Rate	$822.41
Rate for Payer: Cash Price	$292.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$822.41
Rate for Payer: SOMOS Essential	$822.41

CHG RP LOCLZJ TUM PLNR WHOLE BODY 2+ DAYS IMAGING

Professional

Both

$2,403.84

Service Code	HCPCS 78804 TC
Min. Negotiated Rate	$1,802.88
Max. Negotiated Rate	$1,802.88
Rate for Payer: Cash Price	$638.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,802.88
Rate for Payer: SOMOS Essential	$1,802.88

CHG RP LOCLZJ TUM PLNR WHOLE BODY 2+ DAYS IMAGING

Professional

Both

$184.87

Service Code	HCPCS 78804 26
Min. Negotiated Rate	$138.65
Max. Negotiated Rate	$138.65
Rate for Payer: Cash Price	$50.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$138.65
Rate for Payer: SOMOS Essential	$138.65

CHG RP LOCLZJ TUM PLNR WHOLE BODY 2+ DAYS IMAGING

Professional

Both

$2,588.71

Service Code	HCPCS 78804
Min. Negotiated Rate	$1,941.53
Max. Negotiated Rate	$1,941.53
Rate for Payer: Cash Price	$689.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,941.53
Rate for Payer: SOMOS Essential	$1,941.53

CHG RP LOCLZJ TUM PLNR WHOLE BODY SINGLE DAY IMAGING

Professional

Both

$1,237.60

Service Code	HCPCS 78802
Min. Negotiated Rate	$928.20
Max. Negotiated Rate	$928.20
Rate for Payer: Cash Price	$329.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$928.20
Rate for Payer: SOMOS Essential	$928.20

CHG RP LOCLZJ TUM PLNR WHOLE BODY SINGLE DAY IMAGING

Professional

Both

$1,089.06

Service Code	HCPCS 78802 TC
Min. Negotiated Rate	$816.80
Max. Negotiated Rate	$816.80
Rate for Payer: Cash Price	$289.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$816.80
Rate for Payer: SOMOS Essential	$816.80

CHG RP LOCLZJ TUM PLNR WHOLE BODY SINGLE DAY IMAGING

Professional

Both

$148.51

Service Code	HCPCS 78802 26
Min. Negotiated Rate	$111.38
Max. Negotiated Rate	$111.38
Rate for Payer: Cash Price	$40.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$111.38
Rate for Payer: SOMOS Essential	$111.38

CHG RP LOCLZJ TUM SPECT 1 AREA/ACQUISJ 1 DAY IMG

Professional

Both

$197.79

Service Code	HCPCS 78803 26
Min. Negotiated Rate	$148.34
Max. Negotiated Rate	$148.34
Rate for Payer: Cash Price	$54.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$148.34
Rate for Payer: SOMOS Essential	$148.34

Know your out-of-pocket cost for care.

All Charges