St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP

Professional

Both

$1,217.20

Service Code	HCPCS 75635
Min. Negotiated Rate	$912.90
Max. Negotiated Rate	$912.90
Rate for Payer: Cash Price	$490.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$912.90
Rate for Payer: SOMOS Essential	$912.90

CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL

Professional

Both

$1,350.41

Service Code	HCPCS 74177
Min. Negotiated Rate	$1,012.81
Max. Negotiated Rate	$1,012.81
Rate for Payer: Cash Price	$361.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,012.81
Rate for Payer: SOMOS Essential	$1,012.81

CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL

Professional

Both

$1,000.23

Service Code	HCPCS 74177 TC
Min. Negotiated Rate	$750.17
Max. Negotiated Rate	$750.17
Rate for Payer: Cash Price	$267.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$750.17
Rate for Payer: SOMOS Essential	$750.17

CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL

Professional

Both

$350.18

Service Code	HCPCS 74177 26
Min. Negotiated Rate	$262.64
Max. Negotiated Rate	$262.64
Rate for Payer: Cash Price	$94.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$262.64
Rate for Payer: SOMOS Essential	$262.64

CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL

Professional

Both

$335.86

Service Code	HCPCS 74176 26
Min. Negotiated Rate	$251.90
Max. Negotiated Rate	$251.90
Rate for Payer: Cash Price	$90.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$251.90
Rate for Payer: SOMOS Essential	$251.90

CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL

Professional

Both

$799.89

Service Code	HCPCS 74176
Min. Negotiated Rate	$599.92
Max. Negotiated Rate	$599.92
Rate for Payer: Cash Price	$216.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$599.92
Rate for Payer: SOMOS Essential	$599.92

CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL

Professional

Both

$464.03

Service Code	HCPCS 74176 TC
Min. Negotiated Rate	$348.02
Max. Negotiated Rate	$348.02
Rate for Payer: Cash Price	$125.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$348.02
Rate for Payer: SOMOS Essential	$348.02

CHG CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE

Professional

Both

$382.62

Service Code	HCPCS 74178 26
Min. Negotiated Rate	$286.96
Max. Negotiated Rate	$286.96
Rate for Payer: Cash Price	$103.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$286.96
Rate for Payer: SOMOS Essential	$286.96

CHG CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE

Professional

Both

$1,510.78

Service Code	HCPCS 74178
Min. Negotiated Rate	$1,133.08
Max. Negotiated Rate	$1,133.08
Rate for Payer: Cash Price	$405.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,133.08
Rate for Payer: SOMOS Essential	$1,133.08

CHG CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE

Professional

Both

$1,128.16

Service Code	HCPCS 74178 TC
Min. Negotiated Rate	$846.12
Max. Negotiated Rate	$846.12
Rate for Payer: Cash Price	$302.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$846.12
Rate for Payer: SOMOS Essential	$846.12

CHG CT ABDOMEN W/CONTRAST MATERIAL

Professional

Both

$767.34

Service Code	HCPCS 74160 TC
Min. Negotiated Rate	$575.50
Max. Negotiated Rate	$575.50
Rate for Payer: Cash Price	$212.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$575.50
Rate for Payer: SOMOS Essential	$575.50

CHG CT ABDOMEN W/CONTRAST MATERIAL

Professional

Both

$244.34

Service Code	HCPCS 74160 26
Min. Negotiated Rate	$183.26
Max. Negotiated Rate	$183.26
Rate for Payer: Cash Price	$66.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$183.26
Rate for Payer: SOMOS Essential	$183.26

CHG CT ABDOMEN W/CONTRAST MATERIAL

Professional

Both

$1,011.68

Service Code	HCPCS 74160
Min. Negotiated Rate	$758.76
Max. Negotiated Rate	$758.76
Rate for Payer: Cash Price	$278.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$758.76
Rate for Payer: SOMOS Essential	$758.76

CHG CT ABDOMEN W/O CONTRAST MATERIAL

Professional

Both

$227.29

Service Code	HCPCS 74150 26
Min. Negotiated Rate	$170.47
Max. Negotiated Rate	$170.47
Rate for Payer: Cash Price	$61.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$170.47
Rate for Payer: SOMOS Essential	$170.47

CHG CT ABDOMEN W/O CONTRAST MATERIAL

Professional

Both

$369.29

Service Code	HCPCS 74150 TC
Min. Negotiated Rate	$276.97
Max. Negotiated Rate	$276.97
Rate for Payer: Cash Price	$99.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$276.97
Rate for Payer: SOMOS Essential	$276.97

CHG CT ABDOMEN W/O CONTRAST MATERIAL

Professional

Both

$596.58

Service Code	HCPCS 74150
Min. Negotiated Rate	$447.44
Max. Negotiated Rate	$447.44
Rate for Payer: Cash Price	$161.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$447.44
Rate for Payer: SOMOS Essential	$447.44

CHG CT ABDOMEN W/O & W/CONTRAST MATERIAL

Professional

Both

$1,035.16

Service Code	HCPCS 74170
Min. Negotiated Rate	$776.37
Max. Negotiated Rate	$776.37
Rate for Payer: Cash Price	$313.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$776.37
Rate for Payer: SOMOS Essential	$776.37

CHG CT ABDOMEN W/O & W/CONTRAST MATERIAL

Professional

Both

$266.39

Service Code	HCPCS 74170 26
Min. Negotiated Rate	$199.79
Max. Negotiated Rate	$199.79
Rate for Payer: Cash Price	$72.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$199.79
Rate for Payer: SOMOS Essential	$199.79

CHG CT ABDOMEN W/O & W/CONTRAST MATERIAL

Professional

Both

$768.78

Service Code	HCPCS 74170 TC
Min. Negotiated Rate	$576.58
Max. Negotiated Rate	$576.58
Rate for Payer: Cash Price	$240.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$576.58
Rate for Payer: SOMOS Essential	$576.58

CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST

Professional

Both

$768.64

Service Code	HCPCS 75574 TC
Min. Negotiated Rate	$576.48
Max. Negotiated Rate	$576.48
Rate for Payer: Cash Price	$258.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$576.48
Rate for Payer: SOMOS Essential	$576.48

CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST

Professional

Both

$452.87

Service Code	HCPCS 75574 26
Min. Negotiated Rate	$339.65
Max. Negotiated Rate	$339.65
Rate for Payer: Cash Price	$123.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$339.65
Rate for Payer: SOMOS Essential	$339.65

CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST

Professional

Both

$1,221.54

Service Code	HCPCS 75574
Min. Negotiated Rate	$916.16
Max. Negotiated Rate	$916.16
Rate for Payer: Cash Price	$381.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$916.16
Rate for Payer: SOMOS Essential	$916.16

CHG CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG

Professional

Both

$1,684.94

Service Code	HCPCS 74174
Min. Negotiated Rate	$1,263.70
Max. Negotiated Rate	$1,263.70
Rate for Payer: Cash Price	$454.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,263.70
Rate for Payer: SOMOS Essential	$1,263.70

CHG CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG

Professional

Both

$1,265.88

Service Code	HCPCS 74174 TC
Min. Negotiated Rate	$949.41
Max. Negotiated Rate	$949.41
Rate for Payer: Cash Price	$340.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$949.41
Rate for Payer: SOMOS Essential	$949.41

CHG CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG

Professional

Both

$419.06

Service Code	HCPCS 74174 26
Min. Negotiated Rate	$314.30
Max. Negotiated Rate	$314.30
Rate for Payer: Cash Price	$113.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$314.30
Rate for Payer: SOMOS Essential	$314.30

Know your out-of-pocket cost for care.

All Charges