St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL

Professional

Both

$611.66

Service Code	HCPCS 77318 26
Min. Negotiated Rate	$458.75
Max. Negotiated Rate	$458.75
Rate for Payer: Cash Price	$167.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$458.75
Rate for Payer: SOMOS Essential	$458.75

CHG BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL

Professional

Both

$1,319.96

Service Code	HCPCS 77318 TC
Min. Negotiated Rate	$989.97
Max. Negotiated Rate	$989.97
Rate for Payer: Cash Price	$365.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$989.97
Rate for Payer: SOMOS Essential	$989.97

CHG BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL

Professional

Both

$1,364.34

Service Code	HCPCS 77317
Min. Negotiated Rate	$1,023.25
Max. Negotiated Rate	$1,023.25
Rate for Payer: Cash Price	$377.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,023.25
Rate for Payer: SOMOS Essential	$1,023.25

CHG BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL

Professional

Both

$976.68

Service Code	HCPCS 77317 TC
Min. Negotiated Rate	$732.51
Max. Negotiated Rate	$732.51
Rate for Payer: Cash Price	$270.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$732.51
Rate for Payer: SOMOS Essential	$732.51

CHG BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL

Professional

Both

$387.66

Service Code	HCPCS 77317 26
Min. Negotiated Rate	$290.75
Max. Negotiated Rate	$290.75
Rate for Payer: Cash Price	$106.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$290.75
Rate for Payer: SOMOS Essential	$290.75

CHG BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL

Professional

Both

$296.70

Service Code	HCPCS 77316 26
Min. Negotiated Rate	$222.53
Max. Negotiated Rate	$222.53
Rate for Payer: Cash Price	$81.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$222.53
Rate for Payer: SOMOS Essential	$222.53

CHG BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL

Professional

Both

$1,036.46

Service Code	HCPCS 77316
Min. Negotiated Rate	$777.35
Max. Negotiated Rate	$777.35
Rate for Payer: Cash Price	$286.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$777.35
Rate for Payer: SOMOS Essential	$777.35

CHG BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL

Professional

Both

$739.76

Service Code	HCPCS 77316 TC
Min. Negotiated Rate	$554.82
Max. Negotiated Rate	$554.82
Rate for Payer: Cash Price	$205.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$554.82
Rate for Payer: SOMOS Essential	$554.82

CHG BRAIN IMAGING <4 STATIC VIEWS

Professional

Both

$650.62

Service Code	HCPCS 78600 TC
Min. Negotiated Rate	$487.96
Max. Negotiated Rate	$487.96
Rate for Payer: Cash Price	$175.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$487.96
Rate for Payer: SOMOS Essential	$487.96

CHG BRAIN IMAGING <4 STATIC VIEWS

Professional

Both

$732.76

Service Code	HCPCS 78600
Min. Negotiated Rate	$549.57
Max. Negotiated Rate	$549.57
Rate for Payer: Cash Price	$197.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$549.57
Rate for Payer: SOMOS Essential	$549.57

CHG BRAIN IMAGING <4 STATIC VIEWS

Professional

Both

$82.15

Service Code	HCPCS 78600 26
Min. Negotiated Rate	$61.61
Max. Negotiated Rate	$61.61
Rate for Payer: Cash Price	$22.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$61.61
Rate for Payer: SOMOS Essential	$61.61

CHG BRAIN IMAGING <4 STATIC VIEWS W/VASCULAR FLOW

Professional

Both

$93.80

Service Code	HCPCS 78601 26
Min. Negotiated Rate	$70.35
Max. Negotiated Rate	$70.35
Rate for Payer: Cash Price	$25.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70.35
Rate for Payer: SOMOS Essential	$70.35

CHG BRAIN IMAGING <4 STATIC VIEWS W/VASCULAR FLOW

Professional

Both

$870.91

Service Code	HCPCS 78601
Min. Negotiated Rate	$653.18
Max. Negotiated Rate	$653.18
Rate for Payer: Cash Price	$235.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$653.18
Rate for Payer: SOMOS Essential	$653.18

CHG BRAIN IMAGING <4 STATIC VIEWS W/VASCULAR FLOW

Professional

Both

$777.14

Service Code	HCPCS 78601 TC
Min. Negotiated Rate	$582.86
Max. Negotiated Rate	$582.86
Rate for Payer: Cash Price	$209.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$582.86
Rate for Payer: SOMOS Essential	$582.86

CHG BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW

Professional

Both

$1,309.56

Service Code	HCPCS 78606
Min. Negotiated Rate	$982.17
Max. Negotiated Rate	$982.17
Rate for Payer: Cash Price	$354.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$982.17
Rate for Payer: SOMOS Essential	$982.17

CHG BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW

Professional

Both

$121.28

Service Code	HCPCS 78606 26
Min. Negotiated Rate	$90.96
Max. Negotiated Rate	$90.96
Rate for Payer: Cash Price	$32.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$90.96
Rate for Payer: SOMOS Essential	$90.96

CHG BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW

Professional

Both

$1,188.25

Service Code	HCPCS 78606 TC
Min. Negotiated Rate	$891.19
Max. Negotiated Rate	$891.19
Rate for Payer: Cash Price	$322.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$891.19
Rate for Payer: SOMOS Essential	$891.19

CHG BRAIN IMAGING MINIMUM 4 STATIC VIEWS

Professional

Both

$104.65

Service Code	HCPCS 78605 26
Min. Negotiated Rate	$78.49
Max. Negotiated Rate	$78.49
Rate for Payer: Cash Price	$27.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$78.49
Rate for Payer: SOMOS Essential	$78.49

CHG BRAIN IMAGING MINIMUM 4 STATIC VIEWS

Professional

Both

$709.56

Service Code	HCPCS 78605 TC
Min. Negotiated Rate	$532.17
Max. Negotiated Rate	$532.17
Rate for Payer: Cash Price	$190.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$532.17
Rate for Payer: SOMOS Essential	$532.17

CHG BRAIN IMAGING MINIMUM 4 STATIC VIEWS

Professional

Both

$814.21

Service Code	HCPCS 78605
Min. Negotiated Rate	$610.66
Max. Negotiated Rate	$610.66
Rate for Payer: Cash Price	$218.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$610.66
Rate for Payer: SOMOS Essential	$610.66

CHG BRAIN IMAGING PET METABOLIC EVALUATION

Professional

Both

$6,592.39

Service Code	HCPCS 78608
Min. Negotiated Rate	$4,944.29
Max. Negotiated Rate	$4,944.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,944.29
Rate for Payer: SOMOS Essential	$4,944.29

CHG BRAIN IMAGING PET METABOLIC EVALUATION

Professional

Both

$6,319.08

Service Code	HCPCS 78608 TC
Min. Negotiated Rate	$4,739.31
Max. Negotiated Rate	$4,739.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,739.31
Rate for Payer: SOMOS Essential	$4,739.31

CHG BRAIN IMAGING PET METABOLIC EVALUATION

Professional

Both

$273.28

Service Code	HCPCS 78608 26
Min. Negotiated Rate	$204.96
Max. Negotiated Rate	$204.96
Rate for Payer: Cash Price	$74.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$204.96
Rate for Payer: SOMOS Essential	$204.96

CHG BRAIN IMAGING VASCULAR FLOW ONLY

Professional

Both

$654.96

Service Code	HCPCS 78610 TC
Min. Negotiated Rate	$491.22
Max. Negotiated Rate	$491.22
Rate for Payer: Cash Price	$175.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$491.22
Rate for Payer: SOMOS Essential	$491.22

CHG BRAIN IMAGING VASCULAR FLOW ONLY

Professional

Both

$711.06

Service Code	HCPCS 78610
Min. Negotiated Rate	$533.29
Max. Negotiated Rate	$533.29
Rate for Payer: Cash Price	$190.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$533.29
Rate for Payer: SOMOS Essential	$533.29

Know your out-of-pocket cost for care.

All Charges