St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG CT CERVICAL SPINE W/CONTRAST MATERIAL

Professional

Both

$741.06

Service Code	HCPCS 72126
Min. Negotiated Rate	$555.80
Max. Negotiated Rate	$555.80
Rate for Payer: Cash Price	$200.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$555.80
Rate for Payer: SOMOS Essential	$555.80

CHG CT CERVICAL SPINE W/CONTRAST MATERIAL

Professional

Both

$232.47

Service Code	HCPCS 72126 26
Min. Negotiated Rate	$174.35
Max. Negotiated Rate	$174.35
Rate for Payer: Cash Price	$63.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$174.35
Rate for Payer: SOMOS Essential	$174.35

CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL

Professional

Both

$377.93

Service Code	HCPCS 72125 TC
Min. Negotiated Rate	$283.45
Max. Negotiated Rate	$283.45
Rate for Payer: Cash Price	$102.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$283.45
Rate for Payer: SOMOS Essential	$283.45

CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL

Professional

Both

$187.95

Service Code	HCPCS 72125 26
Min. Negotiated Rate	$140.96
Max. Negotiated Rate	$140.96
Rate for Payer: Cash Price	$51.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$140.96
Rate for Payer: SOMOS Essential	$140.96

CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL

Professional

Both

$565.88

Service Code	HCPCS 72125
Min. Negotiated Rate	$424.41
Max. Negotiated Rate	$424.41
Rate for Payer: Cash Price	$154.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$424.41
Rate for Payer: SOMOS Essential	$424.41

CHG CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL

Professional

Both

$870.80

Service Code	HCPCS 72127
Min. Negotiated Rate	$653.10
Max. Negotiated Rate	$653.10
Rate for Payer: Cash Price	$235.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$653.10
Rate for Payer: SOMOS Essential	$653.10

CHG CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL

Professional

Both

$242.90

Service Code	HCPCS 72127 26
Min. Negotiated Rate	$182.18
Max. Negotiated Rate	$182.18
Rate for Payer: Cash Price	$65.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$182.18
Rate for Payer: SOMOS Essential	$182.18

CHG CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL

Professional

Both

$627.90

Service Code	HCPCS 72127 TC
Min. Negotiated Rate	$470.92
Max. Negotiated Rate	$470.92
Rate for Payer: Cash Price	$169.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$470.92
Rate for Payer: SOMOS Essential	$470.92

CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST

Professional

Both

$767.34

Service Code	HCPCS 74262 TC
Min. Negotiated Rate	$575.50
Max. Negotiated Rate	$575.50
Rate for Payer: Cash Price	$427.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$575.50
Rate for Payer: SOMOS Essential	$575.50

CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST

Professional

Both

$476.77

Service Code	HCPCS 74262 26
Min. Negotiated Rate	$357.58
Max. Negotiated Rate	$357.58
Rate for Payer: Cash Price	$129.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$357.58
Rate for Payer: SOMOS Essential	$357.58

CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST

Professional

Both

$1,244.11

Service Code	HCPCS 74262
Min. Negotiated Rate	$933.08
Max. Negotiated Rate	$933.08
Rate for Payer: Cash Price	$556.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$933.08
Rate for Payer: SOMOS Essential	$933.08

CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST

Professional

Both

$454.13

Service Code	HCPCS 74261 TC
Min. Negotiated Rate	$340.60
Max. Negotiated Rate	$340.60
Rate for Payer: Cash Price	$370.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$340.60
Rate for Payer: SOMOS Essential	$340.60

CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST

Professional

Both

$458.50

Service Code	HCPCS 74261 26
Min. Negotiated Rate	$343.88
Max. Negotiated Rate	$343.88
Rate for Payer: Cash Price	$124.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$343.88
Rate for Payer: SOMOS Essential	$343.88

CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST

Professional

Both

$912.59

Service Code	HCPCS 74261
Min. Negotiated Rate	$684.44
Max. Negotiated Rate	$684.44
Rate for Payer: Cash Price	$494.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$684.44
Rate for Payer: SOMOS Essential	$684.44

CHG CT GUIDANCE &MONITORING VISC TISS ABLATION

Professional

Both

$2,672.39

Service Code	HCPCS 77013
Min. Negotiated Rate	$2,004.29
Max. Negotiated Rate	$2,004.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,004.29
Rate for Payer: SOMOS Essential	$2,004.29

CHG CT GUIDANCE &MONITORING VISC TISS ABLATION

Professional

Both

$734.90

Service Code	HCPCS 77013 26
Min. Negotiated Rate	$551.18
Max. Negotiated Rate	$551.18
Rate for Payer: Cash Price	$199.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$551.18
Rate for Payer: SOMOS Essential	$551.18

CHG CT GUIDANCE &MONITORING VISC TISS ABLATION

Professional

Both

$1,937.50

Service Code	HCPCS 77013 TC
Min. Negotiated Rate	$1,453.12
Max. Negotiated Rate	$1,453.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,453.12
Rate for Payer: SOMOS Essential	$1,453.12

CHG CT GUIDANCE NEEDLE PLACEMENT

Professional

Both

$284.24

Service Code	HCPCS 77012 26
Min. Negotiated Rate	$213.18
Max. Negotiated Rate	$213.18
Rate for Payer: Cash Price	$76.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$213.18
Rate for Payer: SOMOS Essential	$213.18

CHG CT GUIDANCE NEEDLE PLACEMENT

Professional

Both

$311.82

Service Code	HCPCS 77012 TC
Min. Negotiated Rate	$233.86
Max. Negotiated Rate	$233.86
Rate for Payer: Cash Price	$83.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$233.86
Rate for Payer: SOMOS Essential	$233.86

CHG CT GUIDANCE NEEDLE PLACEMENT

Professional

Both

$596.02

Service Code	HCPCS 77012
Min. Negotiated Rate	$447.02
Max. Negotiated Rate	$447.02
Rate for Payer: Cash Price	$159.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$447.02
Rate for Payer: SOMOS Essential	$447.02

CHG CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT

Professional

Both

$180.67

Service Code	HCPCS 77014 26
Min. Negotiated Rate	$135.50
Max. Negotiated Rate	$135.50
Rate for Payer: Cash Price	$49.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$135.50
Rate for Payer: SOMOS Essential	$135.50

CHG CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT

Professional

Both

$329.04

Service Code	HCPCS 77014 TC
Min. Negotiated Rate	$246.78
Max. Negotiated Rate	$246.78
Rate for Payer: Cash Price	$89.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$246.78
Rate for Payer: SOMOS Essential	$246.78

CHG CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT

Professional

Both

$509.71

Service Code	HCPCS 77014
Min. Negotiated Rate	$382.28
Max. Negotiated Rate	$382.28
Rate for Payer: Cash Price	$138.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$382.28
Rate for Payer: SOMOS Essential	$382.28

CHG CT GUIDANCE STEREOTACTIC LOCALIZATION

Professional

Both

$704.24

Service Code	HCPCS 77011 TC
Min. Negotiated Rate	$528.18
Max. Negotiated Rate	$528.18
Rate for Payer: Cash Price	$189.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$528.18
Rate for Payer: SOMOS Essential	$528.18

CHG CT GUIDANCE STEREOTACTIC LOCALIZATION

Professional

Both

$251.06

Service Code	HCPCS 77011 26
Min. Negotiated Rate	$188.30
Max. Negotiated Rate	$188.30
Rate for Payer: Cash Price	$68.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$188.30
Rate for Payer: SOMOS Essential	$188.30

Know your out-of-pocket cost for care.

All Charges