St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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 THORACIC SPINE W/CONTRAST MATERIAL

Professional

Both

$748.13

Service Code	HCPCS 72129
Min. Negotiated Rate	$561.10
Max. Negotiated Rate	$561.10
Rate for Payer: Cash Price	$202.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$561.10
Rate for Payer: SOMOS Essential	$561.10

CHG CT THORACIC SPINE W/CONTRAST MATERIAL

Professional

Both

$512.93

Service Code	HCPCS 72129 TC
Min. Negotiated Rate	$384.70
Max. Negotiated Rate	$384.70
Rate for Payer: Cash Price	$138.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$384.70
Rate for Payer: SOMOS Essential	$384.70

CHG CT THORACIC SPINE W/CONTRAST MATERIAL

Professional

Both

$235.20

Service Code	HCPCS 72129 26
Min. Negotiated Rate	$176.40
Max. Negotiated Rate	$176.40
Rate for Payer: Cash Price	$63.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$176.40
Rate for Payer: SOMOS Essential	$176.40

CHG CT THORACIC SPINE W/O CONTRAST MATERIAL

Professional

Both

$565.88

Service Code	HCPCS 72128
Min. Negotiated Rate	$424.41
Max. Negotiated Rate	$424.41
Rate for Payer: Cash Price	$153.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$424.41
Rate for Payer: SOMOS Essential	$424.41

CHG CT THORACIC SPINE W/O CONTRAST MATERIAL

Professional

Both

$377.93

Service Code	HCPCS 72128 TC
Min. Negotiated Rate	$283.45
Max. Negotiated Rate	$283.45
Rate for Payer: Cash Price	$102.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$283.45
Rate for Payer: SOMOS Essential	$283.45

CHG CT THORACIC SPINE W/O CONTRAST MATERIAL

Professional

Both

$187.95

Service Code	HCPCS 72128 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 THORACIC SPINE W/O & W/CONTRAST MATERIAL

Professional

Both

$879.45

Service Code	HCPCS 72130
Min. Negotiated Rate	$659.59
Max. Negotiated Rate	$659.59
Rate for Payer: Cash Price	$236.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$659.59
Rate for Payer: SOMOS Essential	$659.59

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

Professional

Both

$244.34

Service Code	HCPCS 72130 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 THORACIC SPINE W/O & W/CONTRAST MATERIAL

Professional

Both

$635.11

Service Code	HCPCS 72130 TC
Min. Negotiated Rate	$476.33
Max. Negotiated Rate	$476.33
Rate for Payer: Cash Price	$170.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$476.33
Rate for Payer: SOMOS Essential	$476.33

CHG CT UPPER EXTREMITY W/CONTRAST MATERIAL

Professional

Both

$222.08

Service Code	HCPCS 73201 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 UPPER EXTREMITY W/CONTRAST MATERIAL

Professional

Both

$891.66

Service Code	HCPCS 73201
Min. Negotiated Rate	$668.74
Max. Negotiated Rate	$668.74
Rate for Payer: Cash Price	$239.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$668.74
Rate for Payer: SOMOS Essential	$668.74

CHG CT UPPER EXTREMITY W/CONTRAST MATERIAL

Professional

Both

$669.59

Service Code	HCPCS 73201 TC
Min. Negotiated Rate	$502.19
Max. Negotiated Rate	$502.19
Rate for Payer: Cash Price	$179.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$502.19
Rate for Payer: SOMOS Essential	$502.19

CHG CT UPPER EXTREMITY W/O CONTRAST MATERIAL

Professional

Both

$455.56

Service Code	HCPCS 73200 TC
Min. Negotiated Rate	$341.67
Max. Negotiated Rate	$341.67
Rate for Payer: Cash Price	$140.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$341.67
Rate for Payer: SOMOS Essential	$341.67

CHG CT UPPER EXTREMITY W/O CONTRAST MATERIAL

Professional

Both

$643.48

Service Code	HCPCS 73200
Min. Negotiated Rate	$482.61
Max. Negotiated Rate	$482.61
Rate for Payer: Cash Price	$191.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$482.61
Rate for Payer: SOMOS Essential	$482.61

CHG CT UPPER EXTREMITY W/O CONTRAST MATERIAL

Professional

Both

$187.95

Service Code	HCPCS 73200 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 UPPER EXTREMITY W/O & W/CONTRAST MATERIAL

Professional

Both

$232.47

Service Code	HCPCS 73202 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 UPPER EXTREMITY W/O & W/CONTRAST MATERIAL

Professional

Both

$767.34

Service Code	HCPCS 73202 TC
Min. Negotiated Rate	$575.50
Max. Negotiated Rate	$575.50
Rate for Payer: Cash Price	$234.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$575.50
Rate for Payer: SOMOS Essential	$575.50

CHG CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL

Professional

Both

$999.81

Service Code	HCPCS 73202
Min. Negotiated Rate	$749.86
Max. Negotiated Rate	$749.86
Rate for Payer: Cash Price	$297.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$749.86
Rate for Payer: SOMOS Essential	$749.86

CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL

Professional

Both

$32.32

Service Code	HCPCS 87077
Min. Negotiated Rate	$24.24
Max. Negotiated Rate	$24.24
Rate for Payer: Cash Price	$8.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24.24
Rate for Payer: SOMOS Essential	$24.24

CHG CYSTOGRAPHY MINIMUM 3 VIEWS RS&I

Professional

Both

$114.87

Service Code	HCPCS 74430 TC
Min. Negotiated Rate	$86.15
Max. Negotiated Rate	$86.15
Rate for Payer: Cash Price	$31.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$86.15
Rate for Payer: SOMOS Essential	$86.15

CHG CYSTOGRAPHY MINIMUM 3 VIEWS RS&I

Professional

Both

$61.36

Service Code	HCPCS 74430 26
Min. Negotiated Rate	$46.02
Max. Negotiated Rate	$46.02
Rate for Payer: Cash Price	$16.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$46.02
Rate for Payer: SOMOS Essential	$46.02

CHG CYSTOGRAPHY MINIMUM 3 VIEWS RS&I

Professional

Both

$176.23

Service Code	HCPCS 74430
Min. Negotiated Rate	$132.17
Max. Negotiated Rate	$132.17
Rate for Payer: Cash Price	$48.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$132.17
Rate for Payer: SOMOS Essential	$132.17

CHG CYTOPATHOLOGY FORENSIC

Professional

Both

$54.01

Service Code	HCPCS 88125 26
Min. Negotiated Rate	$40.51
Max. Negotiated Rate	$40.51
Rate for Payer: Cash Price	$14.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$40.51
Rate for Payer: SOMOS Essential	$40.51

CHG CYTOPATHOLOGY FORENSIC

Professional

Both

$118.55

Service Code	HCPCS 88125
Min. Negotiated Rate	$88.91
Max. Negotiated Rate	$88.91
Rate for Payer: Cash Price	$33.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$88.91
Rate for Payer: SOMOS Essential	$88.91

Know your out-of-pocket cost for care.

All Charges