St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG ULTRASOUND TRGT DYNAMIC MICROBUBBLE EA ADDL LES

Professional

Both

$550.41

Service Code	HCPCS 76979 TC
Min. Negotiated Rate	$412.81
Max. Negotiated Rate	$412.81
Rate for Payer: Cash Price	$121.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$412.81
Rate for Payer: SOMOS Essential	$412.81

CHG ULTRASOUND TRGT DYNAMIC MICROBUBBLE EA ADDL LES

Professional

Both

$161.98

Service Code	HCPCS 76979 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 URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM

Professional

Both

$771.37

Service Code	HCPCS 78740 TC
Min. Negotiated Rate	$578.53
Max. Negotiated Rate	$578.53
Rate for Payer: Cash Price	$218.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$578.53
Rate for Payer: SOMOS Essential	$578.53

CHG URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM

Professional

Both

$874.13

Service Code	HCPCS 78740
Min. Negotiated Rate	$655.60
Max. Negotiated Rate	$655.60
Rate for Payer: Cash Price	$246.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$655.60
Rate for Payer: SOMOS Essential	$655.60

CHG URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM

Professional

Both

$102.73

Service Code	HCPCS 78740 26
Min. Negotiated Rate	$77.05
Max. Negotiated Rate	$77.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$77.05
Rate for Payer: SOMOS Essential	$77.05

CHG URETHROCYSTOGRAPHY RETROGRADE RS&I

Professional

Both

$295.12

Service Code	HCPCS 74450 TC
Min. Negotiated Rate	$221.34
Max. Negotiated Rate	$221.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$221.34
Rate for Payer: SOMOS Essential	$221.34

CHG URETHROCYSTOGRAPHY RETROGRADE RS&I

Professional

Both

$64.05

Service Code	HCPCS 74450 26
Min. Negotiated Rate	$48.04
Max. Negotiated Rate	$48.04
Rate for Payer: Cash Price	$16.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$48.04
Rate for Payer: SOMOS Essential	$48.04

CHG URETHROCYSTOGRAPHY RETROGRADE RS&I

Professional

Both

$359.17

Service Code	HCPCS 74450
Min. Negotiated Rate	$269.38
Max. Negotiated Rate	$269.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$269.38
Rate for Payer: SOMOS Essential	$269.38

CHG URETHROCYSTOGRAPHY VOIDING RS&I

Professional

Both

$387.98

Service Code	HCPCS 74455 TC
Min. Negotiated Rate	$290.98
Max. Negotiated Rate	$290.98
Rate for Payer: Cash Price	$104.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$290.98
Rate for Payer: SOMOS Essential	$290.98

CHG URETHROCYSTOGRAPHY VOIDING RS&I

Professional

Both

$449.30

Service Code	HCPCS 74455
Min. Negotiated Rate	$336.98
Max. Negotiated Rate	$336.98
Rate for Payer: Cash Price	$121.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$336.98
Rate for Payer: SOMOS Essential	$336.98

CHG URETHROCYSTOGRAPHY VOIDING RS&I

Professional

Both

$61.32

Service Code	HCPCS 74455 26
Min. Negotiated Rate	$45.99
Max. Negotiated Rate	$45.99
Rate for Payer: Cash Price	$16.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$45.99
Rate for Payer: SOMOS Essential	$45.99

CHG URINARY BLADDER RESIDUAL STUDY

Professional

Both

$264.36

Service Code	HCPCS 78730 TC
Min. Negotiated Rate	$198.27
Max. Negotiated Rate	$198.27
Rate for Payer: Cash Price	$72.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$198.27
Rate for Payer: SOMOS Essential	$198.27

CHG URINARY BLADDER RESIDUAL STUDY

Professional

Both

$291.76

Service Code	HCPCS 78730
Min. Negotiated Rate	$218.82
Max. Negotiated Rate	$218.82
Rate for Payer: Cash Price	$80.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$218.82
Rate for Payer: SOMOS Essential	$218.82

CHG URINARY BLADDER RESIDUAL STUDY

Professional

Both

$27.41

Service Code	HCPCS 78730 26
Min. Negotiated Rate	$20.56
Max. Negotiated Rate	$20.56
Rate for Payer: Cash Price	$7.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20.56
Rate for Payer: SOMOS Essential	$20.56

CHG URINE ALBUMIN QUANTITATIVE

Professional

Both

$14.45

Service Code	HCPCS 82043
Min. Negotiated Rate	$10.84
Max. Negotiated Rate	$10.84
Rate for Payer: Cash Price	$5.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10.84
Rate for Payer: SOMOS Essential	$10.84

CHG URINE ALBUMIN SEMIQUANTITATIVE

Professional

Both

$24.92

Service Code	HCPCS 82044
Min. Negotiated Rate	$18.69
Max. Negotiated Rate	$18.69
Rate for Payer: Cash Price	$6.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18.69
Rate for Payer: SOMOS Essential	$18.69

CHG URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS

Professional

Both

$21.52

Service Code	HCPCS 81025
Min. Negotiated Rate	$16.14
Max. Negotiated Rate	$16.14
Rate for Payer: Cash Price	$8.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16.14
Rate for Payer: SOMOS Essential	$16.14

CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY

Professional

Both

$5.62

Service Code	HCPCS 81003
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$4.22
Rate for Payer: Cash Price	$2.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4.22
Rate for Payer: SOMOS Essential	$4.22

CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP

Professional

Both

$8.70

Service Code	HCPCS 81002
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$6.52
Rate for Payer: Cash Price	$3.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6.52
Rate for Payer: SOMOS Essential	$6.52

CHG UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE

Professional

Both

$91.28

Service Code	HCPCS 74410 26
Min. Negotiated Rate	$68.46
Max. Negotiated Rate	$68.46
Rate for Payer: Cash Price	$25.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$68.46
Rate for Payer: SOMOS Essential	$68.46

CHG UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE

Professional

Both

$607.08

Service Code	HCPCS 74410
Min. Negotiated Rate	$455.31
Max. Negotiated Rate	$455.31
Rate for Payer: Cash Price	$165.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$455.31
Rate for Payer: SOMOS Essential	$455.31

CHG UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE

Professional

Both

$515.80

Service Code	HCPCS 74410 TC
Min. Negotiated Rate	$386.85
Max. Negotiated Rate	$386.85
Rate for Payer: Cash Price	$140.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$386.85
Rate for Payer: SOMOS Essential	$386.85

CHG UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY

Professional

Both

$588.11

Service Code	HCPCS 74400
Min. Negotiated Rate	$441.08
Max. Negotiated Rate	$441.08
Rate for Payer: Cash Price	$158.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$441.08
Rate for Payer: SOMOS Essential	$441.08

CHG UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY

Professional

Both

$491.33

Service Code	HCPCS 74400 TC
Min. Negotiated Rate	$368.50
Max. Negotiated Rate	$368.50
Rate for Payer: Cash Price	$132.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$368.50
Rate for Payer: SOMOS Essential	$368.50

CHG UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY

Professional

Both

$96.74

Service Code	HCPCS 74400 26
Min. Negotiated Rate	$72.56
Max. Negotiated Rate	$72.56
Rate for Payer: Cash Price	$25.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$72.56
Rate for Payer: SOMOS Essential	$72.56

Know your out-of-pocket cost for care.

All Charges