St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

CHG CT HEAD/BRAIN W/CONTRAST MATERIAL

Professional

Both

$431.10

Service Code	HCPCS 70460 TC
Min. Negotiated Rate	$323.32
Max. Negotiated Rate	$323.32
Rate for Payer: Cash Price	$116.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$323.32
Rate for Payer: SOMOS Essential	$323.32

CHG CT HEAD/BRAIN W/CONTRAST MATERIAL

Professional

Both

$216.90

Service Code	HCPCS 70460 26
Min. Negotiated Rate	$162.68
Max. Negotiated Rate	$162.68
Rate for Payer: Cash Price	$58.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$162.68
Rate for Payer: SOMOS Essential	$162.68

CHG CT HEAD/BRAIN W/CONTRAST MATERIAL

Professional

Both

$647.99

Service Code	HCPCS 70460
Min. Negotiated Rate	$485.99
Max. Negotiated Rate	$485.99
Rate for Payer: Cash Price	$175.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$485.99
Rate for Payer: SOMOS Essential	$485.99

CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL

Professional

Both

$301.74

Service Code	HCPCS 70450 TC
Min. Negotiated Rate	$226.30
Max. Negotiated Rate	$226.30
Rate for Payer: Cash Price	$81.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$226.30
Rate for Payer: SOMOS Essential	$226.30

CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL

Professional

Both

$161.98

Service Code	HCPCS 70450 26
Min. Negotiated Rate	$121.48
Max. Negotiated Rate	$121.48
Rate for Payer: Cash Price	$43.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$121.48
Rate for Payer: SOMOS Essential	$121.48

CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL

Professional

Both

$463.72

Service Code	HCPCS 70450
Min. Negotiated Rate	$347.79
Max. Negotiated Rate	$347.79
Rate for Payer: Cash Price	$125.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$347.79
Rate for Payer: SOMOS Essential	$347.79

CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL

Professional

Both

$520.10

Service Code	HCPCS 70470 TC
Min. Negotiated Rate	$390.08
Max. Negotiated Rate	$390.08
Rate for Payer: Cash Price	$139.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$390.08
Rate for Payer: SOMOS Essential	$390.08

CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL

Professional

Both

$244.34

Service Code	HCPCS 70470 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 HEAD/BRAIN W/O & W/CONTRAST MATERIAL

Professional

Both

$764.44

Service Code	HCPCS 70470
Min. Negotiated Rate	$573.33
Max. Negotiated Rate	$573.33
Rate for Payer: Cash Price	$206.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$573.33
Rate for Payer: SOMOS Essential	$573.33

CHG CT HEART C+ CARDIAC STRUX&MORPH CGEN HRT DS

Professional

Both

$481.60

Service Code	HCPCS 75573 26
Min. Negotiated Rate	$361.20
Max. Negotiated Rate	$361.20
Rate for Payer: Cash Price	$131.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$361.20
Rate for Payer: SOMOS Essential	$361.20

CHG CT HEART C+ CARDIAC STRUX&MORPH CGEN HRT DS

Professional

Both

$1,252.97

Service Code	HCPCS 75573
Min. Negotiated Rate	$939.73
Max. Negotiated Rate	$939.73
Rate for Payer: Cash Price	$359.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$939.73
Rate for Payer: SOMOS Essential	$939.73

CHG CT HEART C+ CARDIAC STRUX&MORPH CGEN HRT DS

Professional

Both

$771.37

Service Code	HCPCS 75573 TC
Min. Negotiated Rate	$578.53
Max. Negotiated Rate	$578.53
Rate for Payer: Cash Price	$228.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$578.53
Rate for Payer: SOMOS Essential	$578.53

CHG CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH

Professional

Both

$330.19

Service Code	HCPCS 75572 26
Min. Negotiated Rate	$247.64
Max. Negotiated Rate	$247.64
Rate for Payer: Cash Price	$89.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$247.64
Rate for Payer: SOMOS Essential	$247.64

CHG CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH

Professional

Both

$663.57

Service Code	HCPCS 75572 TC
Min. Negotiated Rate	$497.68
Max. Negotiated Rate	$497.68
Rate for Payer: Cash Price	$180.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$497.68
Rate for Payer: SOMOS Essential	$497.68

CHG CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH

Professional

Both

$993.76

Service Code	HCPCS 75572
Min. Negotiated Rate	$745.32
Max. Negotiated Rate	$745.32
Rate for Payer: Cash Price	$269.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$745.32
Rate for Payer: SOMOS Essential	$745.32

CHG CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM

Professional

Both

$326.17

Service Code	HCPCS 75571 TC
Min. Negotiated Rate	$244.63
Max. Negotiated Rate	$244.63
Rate for Payer: Cash Price	$89.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$244.63
Rate for Payer: SOMOS Essential	$244.63

CHG CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM

Professional

Both

$439.95

Service Code	HCPCS 75571
Min. Negotiated Rate	$329.96
Max. Negotiated Rate	$329.96
Rate for Payer: Cash Price	$119.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$329.96
Rate for Payer: SOMOS Essential	$329.96

CHG CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM

Professional

Both

$113.79

Service Code	HCPCS 75571 26
Min. Negotiated Rate	$85.34
Max. Negotiated Rate	$85.34
Rate for Payer: Cash Price	$29.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$85.34
Rate for Payer: SOMOS Essential	$85.34

CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY

Professional

Both

$553.04

Service Code	HCPCS 76380
Min. Negotiated Rate	$414.78
Max. Negotiated Rate	$414.78
Rate for Payer: Cash Price	$155.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$414.78
Rate for Payer: SOMOS Essential	$414.78

CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY

Professional

Both

$369.29

Service Code	HCPCS 76380 TC
Min. Negotiated Rate	$276.97
Max. Negotiated Rate	$276.97
Rate for Payer: Cash Price	$105.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$276.97
Rate for Payer: SOMOS Essential	$276.97

CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY

Professional

Both

$183.72

Service Code	HCPCS 76380 26
Min. Negotiated Rate	$137.79
Max. Negotiated Rate	$137.79
Rate for Payer: Cash Price	$49.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$137.79
Rate for Payer: SOMOS Essential	$137.79

CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL

Professional

Both

$511.46

Service Code	HCPCS 73701 TC
Min. Negotiated Rate	$383.60
Max. Negotiated Rate	$383.60
Rate for Payer: Cash Price	$137.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$383.60
Rate for Payer: SOMOS Essential	$383.60

CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL

Professional

Both

$733.57

Service Code	HCPCS 73701
Min. Negotiated Rate	$550.18
Max. Negotiated Rate	$550.18
Rate for Payer: Cash Price	$198.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$550.18
Rate for Payer: SOMOS Essential	$550.18

CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL

Professional

Both

$222.08

Service Code	HCPCS 73701 26
Min. Negotiated Rate	$166.56
Max. Negotiated Rate	$166.56
Rate for Payer: Cash Price	$60.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$166.56
Rate for Payer: SOMOS Essential	$166.56

Know your out-of-pocket cost for care.

All Charges