St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG THYROID CARCINOMA METASTASES IMG WHOLE BODY

Professional

Both

$1,245.09

Service Code	HCPCS 78018
Min. Negotiated Rate	$933.82
Max. Negotiated Rate	$933.82
Rate for Payer: Cash Price	$332.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$933.82
Rate for Payer: SOMOS Essential	$933.82

CHG THYROID CARCINOMA METASTASES UPTAKE

Professional

Both

$103.64

Service Code	HCPCS 78020 26
Min. Negotiated Rate	$77.73
Max. Negotiated Rate	$77.73
Rate for Payer: Cash Price	$28.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$77.73
Rate for Payer: SOMOS Essential	$77.73

CHG THYROID CARCINOMA METASTASES UPTAKE

Professional

Both

$331.91

Service Code	HCPCS 78020
Min. Negotiated Rate	$248.93
Max. Negotiated Rate	$248.93
Rate for Payer: Cash Price	$90.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$248.93
Rate for Payer: SOMOS Essential	$248.93

CHG THYROID CARCINOMA METASTASES UPTAKE

Professional

Both

$228.27

Service Code	HCPCS 78020 TC
Min. Negotiated Rate	$171.20
Max. Negotiated Rate	$171.20
Rate for Payer: Cash Price	$62.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$171.20
Rate for Payer: SOMOS Essential	$171.20

CHG THYROID IMAGING WITH VASCULAR FLOW

Professional

Both

$70.49

Service Code	HCPCS 78013 26
Min. Negotiated Rate	$52.87
Max. Negotiated Rate	$52.87
Rate for Payer: Cash Price	$18.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$52.87
Rate for Payer: SOMOS Essential	$52.87

CHG THYROID IMAGING WITH VASCULAR FLOW

Professional

Both

$698.08

Service Code	HCPCS 78013 TC
Min. Negotiated Rate	$523.56
Max. Negotiated Rate	$523.56
Rate for Payer: Cash Price	$182.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$523.56
Rate for Payer: SOMOS Essential	$523.56

CHG THYROID IMAGING WITH VASCULAR FLOW

Professional

Both

$768.57

Service Code	HCPCS 78013
Min. Negotiated Rate	$576.43
Max. Negotiated Rate	$576.43
Rate for Payer: Cash Price	$201.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$576.43
Rate for Payer: SOMOS Essential	$576.43

CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT

Professional

Both

$350.84

Service Code	HCPCS 78012
Min. Negotiated Rate	$263.13
Max. Negotiated Rate	$263.13
Rate for Payer: Cash Price	$95.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$263.13
Rate for Payer: SOMOS Essential	$263.13

CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT

Professional

Both

$315.70

Service Code	HCPCS 78012 TC
Min. Negotiated Rate	$236.78
Max. Negotiated Rate	$236.78
Rate for Payer: Cash Price	$85.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$236.78
Rate for Payer: SOMOS Essential	$236.78

CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT

Professional

Both

$35.18

Service Code	HCPCS 78012 26
Min. Negotiated Rate	$26.38
Max. Negotiated Rate	$26.38
Rate for Payer: Cash Price	$9.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26.38
Rate for Payer: SOMOS Essential	$26.38

CHG THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS

Professional

Both

$955.92

Service Code	HCPCS 78014
Min. Negotiated Rate	$716.94
Max. Negotiated Rate	$716.94
Rate for Payer: Cash Price	$255.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$716.94
Rate for Payer: SOMOS Essential	$716.94

CHG THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS

Professional

Both

$92.54

Service Code	HCPCS 78014 26
Min. Negotiated Rate	$69.40
Max. Negotiated Rate	$69.40
Rate for Payer: Cash Price	$24.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$69.40
Rate for Payer: SOMOS Essential	$69.40

CHG THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS

Professional

Both

$863.38

Service Code	HCPCS 78014 TC
Min. Negotiated Rate	$647.54
Max. Negotiated Rate	$647.54
Rate for Payer: Cash Price	$230.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$647.54
Rate for Payer: SOMOS Essential	$647.54

CHG TRANSCATHETER BIOPSY RS&I

Professional

Both

$2,330.13

Service Code	HCPCS 75970 TC
Min. Negotiated Rate	$1,747.60
Max. Negotiated Rate	$1,747.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,747.60
Rate for Payer: SOMOS Essential	$1,747.60

CHG TRANSCATHETER BIOPSY RS&I

Professional

Both

$153.44

Service Code	HCPCS 75970 26
Min. Negotiated Rate	$115.08
Max. Negotiated Rate	$115.08
Rate for Payer: Cash Price	$41.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$115.08
Rate for Payer: SOMOS Essential	$115.08

CHG TRANSCATHETER BIOPSY RS&I

Professional

Both

$2,483.57

Service Code	HCPCS 75970
Min. Negotiated Rate	$1,862.68
Max. Negotiated Rate	$1,862.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,862.68
Rate for Payer: SOMOS Essential	$1,862.68

CHG TRANSCATHETER EMBOLIZATION ANY METH RS&I

Professional

Both

$4,877.64

Service Code	HCPCS 75894 TC
Min. Negotiated Rate	$3,658.23
Max. Negotiated Rate	$3,658.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,658.23
Rate for Payer: SOMOS Essential	$3,658.23

CHG TRANSCATHETER EMBOLIZATION ANY METH RS&I

Professional

Both

$311.40

Service Code	HCPCS 75894 26
Min. Negotiated Rate	$233.55
Max. Negotiated Rate	$233.55
Rate for Payer: Cash Price	$83.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$233.55
Rate for Payer: SOMOS Essential	$233.55

CHG TRANSCATHETER EMBOLIZATION ANY METH RS&I

Professional

Both

$5,189.03

Service Code	HCPCS 75894
Min. Negotiated Rate	$3,891.77
Max. Negotiated Rate	$3,891.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,891.77
Rate for Payer: SOMOS Essential	$3,891.77

CHG TRANSCERVICAL CATHJ FALLOPIAN TUBE RS&I

Professional

Both

$118.97

Service Code	HCPCS 74742 26
Min. Negotiated Rate	$89.23
Max. Negotiated Rate	$89.23
Rate for Payer: Cash Price	$31.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$89.23
Rate for Payer: SOMOS Essential	$89.23

CHG TRANSCERVICAL CATHJ FALLOPIAN TUBE RS&I

Professional

Both

$530.01

Service Code	HCPCS 74742 TC
Min. Negotiated Rate	$397.51
Max. Negotiated Rate	$397.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$397.51
Rate for Payer: SOMOS Essential	$397.51

CHG TRANSCERVICAL CATHJ FALLOPIAN TUBE RS&I

Professional

Both

$648.97

Service Code	HCPCS 74742
Min. Negotiated Rate	$486.73
Max. Negotiated Rate	$486.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$486.73
Rate for Payer: SOMOS Essential	$486.73

CHG TX DEVICES DESIGN & CONSTRUCTION COMPLEX

Professional

Both

$521.40

Service Code	HCPCS 77334
Min. Negotiated Rate	$391.05
Max. Negotiated Rate	$391.05
Rate for Payer: Cash Price	$144.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$391.05
Rate for Payer: SOMOS Essential	$391.05

CHG TX DEVICES DESIGN & CONSTRUCTION COMPLEX

Professional

Both

$280.18

Service Code	HCPCS 77334 TC
Min. Negotiated Rate	$210.14
Max. Negotiated Rate	$210.14
Rate for Payer: Cash Price	$77.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$210.14
Rate for Payer: SOMOS Essential	$210.14

CHG TX DEVICES DESIGN & CONSTRUCTION COMPLEX

Professional

Both

$241.22

Service Code	HCPCS 77334 26
Min. Negotiated Rate	$180.92
Max. Negotiated Rate	$180.92
Rate for Payer: Cash Price	$66.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$180.92
Rate for Payer: SOMOS Essential	$180.92

Know your out-of-pocket cost for care.

All Charges