St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY

Professional

Both

$92.68

Service Code	HCPCS 76820 26
Min. Negotiated Rate	$69.51
Max. Negotiated Rate	$69.51
Rate for Payer: Cash Price	$25.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$69.51
Rate for Payer: SOMOS Essential	$69.51

CHG DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY

Professional

Both

$185.96

Service Code	HCPCS 76820
Min. Negotiated Rate	$139.47
Max. Negotiated Rate	$139.47
Rate for Payer: Cash Price	$50.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$139.47
Rate for Payer: SOMOS Essential	$139.47

CHG DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY

Professional

Both

$93.31

Service Code	HCPCS 76820 TC
Min. Negotiated Rate	$69.98
Max. Negotiated Rate	$69.98
Rate for Payer: Cash Price	$25.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$69.98
Rate for Payer: SOMOS Essential	$69.98

CHG DRUG SCREEN QUANTITATIVE LIDOCAINE

Professional

Both

$37.00

Service Code	HCPCS 80176
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Cash Price	$14.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27.75
Rate for Payer: SOMOS Essential	$27.75

CHG DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL

Professional

Both

$134.02

Service Code	HCPCS 77081
Min. Negotiated Rate	$100.52
Max. Negotiated Rate	$100.52
Rate for Payer: Cash Price	$36.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$100.52
Rate for Payer: SOMOS Essential	$100.52

CHG DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL

Professional

Both

$94.75

Service Code	HCPCS 77081 TC
Min. Negotiated Rate	$71.06
Max. Negotiated Rate	$71.06
Rate for Payer: Cash Price	$26.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$71.06
Rate for Payer: SOMOS Essential	$71.06

CHG DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL

Professional

Both

$39.27

Service Code	HCPCS 77081 26
Min. Negotiated Rate	$29.45
Max. Negotiated Rate	$29.45
Rate for Payer: Cash Price	$10.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29.45
Rate for Payer: SOMOS Essential	$29.45

CHG DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL

Professional

Both

$37.84

Service Code	HCPCS 77080 26
Min. Negotiated Rate	$28.38
Max. Negotiated Rate	$28.38
Rate for Payer: Cash Price	$10.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28.38
Rate for Payer: SOMOS Essential	$28.38

CHG DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL

Professional

Both

$124.92

Service Code	HCPCS 77080 TC
Min. Negotiated Rate	$93.69
Max. Negotiated Rate	$93.69
Rate for Payer: Cash Price	$35.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$93.69
Rate for Payer: SOMOS Essential	$93.69

CHG DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL

Professional

Both

$162.79

Service Code	HCPCS 77080
Min. Negotiated Rate	$122.09
Max. Negotiated Rate	$122.09
Rate for Payer: Cash Price	$45.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$122.09
Rate for Payer: SOMOS Essential	$122.09

CHG DXA BONE DENSITY STUDY AXIAL SKELETON

Professional

Both

$57.58

Service Code	HCPCS 77085 26
Min. Negotiated Rate	$43.18
Max. Negotiated Rate	$43.18
Rate for Payer: Cash Price	$15.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$43.18
Rate for Payer: SOMOS Essential	$43.18

CHG DXA BONE DENSITY STUDY AXIAL SKELETON

Professional

Both

$162.30

Service Code	HCPCS 77085 TC
Min. Negotiated Rate	$121.72
Max. Negotiated Rate	$121.72
Rate for Payer: Cash Price	$46.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$121.72
Rate for Payer: SOMOS Essential	$121.72

CHG DXA BONE DENSITY STUDY AXIAL SKELETON

Professional

Both

$219.87

Service Code	HCPCS 77085
Min. Negotiated Rate	$164.90
Max. Negotiated Rate	$164.90
Rate for Payer: Cash Price	$62.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$164.90
Rate for Payer: SOMOS Essential	$164.90

CHG DX OPHTHALMIC US ANT SEGMENT IMMERSION UNI/BI

Professional

Both

$313.50

Service Code	HCPCS 76513
Min. Negotiated Rate	$235.12
Max. Negotiated Rate	$235.12
Rate for Payer: Cash Price	$86.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$235.12
Rate for Payer: SOMOS Essential	$235.12

CHG DX OPHTHALMIC US ANT SEGMENT IMMERSION UNI/BI

Professional

Both

$126.77

Service Code	HCPCS 76513 26
Min. Negotiated Rate	$95.08
Max. Negotiated Rate	$95.08
Rate for Payer: Cash Price	$34.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$95.08
Rate for Payer: SOMOS Essential	$95.08

CHG DX OPHTHALMIC US ANT SEGMENT IMMERSION UNI/BI

Professional

Both

$186.73

Service Code	HCPCS 76513 TC
Min. Negotiated Rate	$140.05
Max. Negotiated Rate	$140.05
Rate for Payer: Cash Price	$51.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$140.05
Rate for Payer: SOMOS Essential	$140.05

CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING

Professional

Both

$362.11

Service Code	HCPCS 76506 TC
Min. Negotiated Rate	$271.58
Max. Negotiated Rate	$271.58
Rate for Payer: Cash Price	$97.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$271.58
Rate for Payer: SOMOS Essential	$271.58

CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING

Professional

Both

$485.03

Service Code	HCPCS 76506
Min. Negotiated Rate	$363.77
Max. Negotiated Rate	$363.77
Rate for Payer: Cash Price	$132.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$363.77
Rate for Payer: SOMOS Essential	$363.77

CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING

Professional

Both

$122.92

Service Code	HCPCS 76506 26
Min. Negotiated Rate	$92.19
Max. Negotiated Rate	$92.19
Rate for Payer: Cash Price	$34.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$92.19
Rate for Payer: SOMOS Essential	$92.19

CHG ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING

Professional

Both

$800.14

Service Code	HCPCS 76825 TC
Min. Negotiated Rate	$600.10
Max. Negotiated Rate	$600.10
Rate for Payer: Cash Price	$217.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$600.10
Rate for Payer: SOMOS Essential	$600.10

CHG ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING

Professional

Both

$310.66

Service Code	HCPCS 76825 26
Min. Negotiated Rate	$233.00
Max. Negotiated Rate	$233.00
Rate for Payer: Cash Price	$85.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$233.00
Rate for Payer: SOMOS Essential	$233.00

CHG ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING

Professional

Both

$1,110.80

Service Code	HCPCS 76825
Min. Negotiated Rate	$833.10
Max. Negotiated Rate	$833.10
Rate for Payer: Cash Price	$302.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$833.10
Rate for Payer: SOMOS Essential	$833.10

CHG ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD

Professional

Both

$154.00

Service Code	HCPCS 76826 26
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$115.50
Rate for Payer: Cash Price	$42.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$115.50
Rate for Payer: SOMOS Essential	$115.50

CHG ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD

Professional

Both

$666.89

Service Code	HCPCS 76826
Min. Negotiated Rate	$500.17
Max. Negotiated Rate	$500.17
Rate for Payer: Cash Price	$181.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$500.17
Rate for Payer: SOMOS Essential	$500.17

CHG ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD

Professional

Both

$512.93

Service Code	HCPCS 76826 TC
Min. Negotiated Rate	$384.70
Max. Negotiated Rate	$384.70
Rate for Payer: Cash Price	$139.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$384.70
Rate for Payer: SOMOS Essential	$384.70

Know your out-of-pocket cost for care.

All Charges