St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL

Professional

Both

$216.90

Service Code	HCPCS 70481 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 ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL

Professional

Both

$797.37

Service Code	HCPCS 70481
Min. Negotiated Rate	$598.03
Max. Negotiated Rate	$598.03
Rate for Payer: Cash Price	$215.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$598.03
Rate for Payer: SOMOS Essential	$598.03

CHG CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL

Professional

Both

$446.92

Service Code	HCPCS 70480 TC
Min. Negotiated Rate	$335.19
Max. Negotiated Rate	$335.19
Rate for Payer: Cash Price	$121.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$335.19
Rate for Payer: SOMOS Essential	$335.19

CHG CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL

Professional

Both

$693.95

Service Code	HCPCS 70480
Min. Negotiated Rate	$520.46
Max. Negotiated Rate	$520.46
Rate for Payer: Cash Price	$188.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$520.46
Rate for Payer: SOMOS Essential	$520.46

CHG CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL

Professional

Both

$247.03

Service Code	HCPCS 70480 26
Min. Negotiated Rate	$185.27
Max. Negotiated Rate	$185.27
Rate for Payer: Cash Price	$67.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$185.27
Rate for Payer: SOMOS Essential	$185.27

CHG CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR

Professional

Both

$242.90

Service Code	HCPCS 70482 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 ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR

Professional

Both

$931.18

Service Code	HCPCS 70482
Min. Negotiated Rate	$698.38
Max. Negotiated Rate	$698.38
Rate for Payer: Cash Price	$251.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$698.38
Rate for Payer: SOMOS Essential	$698.38

CHG CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR

Professional

Both

$688.28

Service Code	HCPCS 70482 TC
Min. Negotiated Rate	$516.21
Max. Negotiated Rate	$516.21
Rate for Payer: Cash Price	$185.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$516.21
Rate for Payer: SOMOS Essential	$516.21

CHG CT PELVIS W/CONTRAST MATERIAL

Professional

Both

$767.34

Service Code	HCPCS 72193 TC
Min. Negotiated Rate	$575.50
Max. Negotiated Rate	$575.50
Rate for Payer: Cash Price	$213.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$575.50
Rate for Payer: SOMOS Essential	$575.50

CHG CT PELVIS W/CONTRAST MATERIAL

Professional

Both

$989.42

Service Code	HCPCS 72193
Min. Negotiated Rate	$742.06
Max. Negotiated Rate	$742.06
Rate for Payer: Cash Price	$273.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$742.06
Rate for Payer: SOMOS Essential	$742.06

CHG CT PELVIS W/CONTRAST MATERIAL

Professional

Both

$222.08

Service Code	HCPCS 72193 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

CHG CT PELVIS W/O CONTRAST MATERIAL

Professional

Both

$208.99

Service Code	HCPCS 72192 26
Min. Negotiated Rate	$156.74
Max. Negotiated Rate	$156.74
Rate for Payer: Cash Price	$56.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$156.74
Rate for Payer: SOMOS Essential	$156.74

CHG CT PELVIS W/O CONTRAST MATERIAL

Professional

Both

$373.63

Service Code	HCPCS 72192 TC
Min. Negotiated Rate	$280.22
Max. Negotiated Rate	$280.22
Rate for Payer: Cash Price	$100.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$280.22
Rate for Payer: SOMOS Essential	$280.22

CHG CT PELVIS W/O CONTRAST MATERIAL

Professional

Both

$582.61

Service Code	HCPCS 72192
Min. Negotiated Rate	$436.96
Max. Negotiated Rate	$436.96
Rate for Payer: Cash Price	$157.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$436.96
Rate for Payer: SOMOS Essential	$436.96

CHG CT PELVIS W/O & W/CONTRAST MATERIAL

Professional

Both

$232.47

Service Code	HCPCS 72194 26
Min. Negotiated Rate	$174.35
Max. Negotiated Rate	$174.35
Rate for Payer: Cash Price	$62.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$174.35
Rate for Payer: SOMOS Essential	$174.35

CHG CT PELVIS W/O & W/CONTRAST MATERIAL

Professional

Both

$1,001.25

Service Code	HCPCS 72194
Min. Negotiated Rate	$750.94
Max. Negotiated Rate	$750.94
Rate for Payer: Cash Price	$302.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$750.94
Rate for Payer: SOMOS Essential	$750.94

CHG CT PELVIS W/O & W/CONTRAST MATERIAL

Professional

Both

$768.78

Service Code	HCPCS 72194 TC
Min. Negotiated Rate	$576.58
Max. Negotiated Rate	$576.58
Rate for Payer: Cash Price	$239.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$576.58
Rate for Payer: SOMOS Essential	$576.58

CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL

Professional

Both

$811.27

Service Code	HCPCS 70491
Min. Negotiated Rate	$608.45
Max. Negotiated Rate	$608.45
Rate for Payer: Cash Price	$218.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$608.45
Rate for Payer: SOMOS Essential	$608.45

CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL

Professional

Both

$545.97

Service Code	HCPCS 70491 TC
Min. Negotiated Rate	$409.48
Max. Negotiated Rate	$409.48
Rate for Payer: Cash Price	$147.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$409.48
Rate for Payer: SOMOS Essential	$409.48

CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL

Professional

Both

$265.30

Service Code	HCPCS 70491 26
Min. Negotiated Rate	$198.98
Max. Negotiated Rate	$198.98
Rate for Payer: Cash Price	$71.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$198.98
Rate for Payer: SOMOS Essential	$198.98

CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL

Professional

Both

$656.57

Service Code	HCPCS 70490
Min. Negotiated Rate	$492.43
Max. Negotiated Rate	$492.43
Rate for Payer: Cash Price	$177.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$492.43
Rate for Payer: SOMOS Essential	$492.43

CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL

Professional

Both

$409.54

Service Code	HCPCS 70490 TC
Min. Negotiated Rate	$307.16
Max. Negotiated Rate	$307.16
Rate for Payer: Cash Price	$110.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$307.16
Rate for Payer: SOMOS Essential	$307.16

CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL

Professional

Both

$247.03

Service Code	HCPCS 70490 26
Min. Negotiated Rate	$185.27
Max. Negotiated Rate	$185.27
Rate for Payer: Cash Price	$66.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$185.27
Rate for Payer: SOMOS Essential	$185.27

CHG CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL

Professional

Both

$666.72

Service Code	HCPCS 70492 TC
Min. Negotiated Rate	$500.04
Max. Negotiated Rate	$500.04
Rate for Payer: Cash Price	$178.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$500.04
Rate for Payer: SOMOS Essential	$500.04

CHG CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL

Professional

Both

$974.89

Service Code	HCPCS 70492
Min. Negotiated Rate	$731.17
Max. Negotiated Rate	$731.17
Rate for Payer: Cash Price	$262.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$731.17
Rate for Payer: SOMOS Essential	$731.17

Know your out-of-pocket cost for care.

All Charges