St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG UROGRAPHY NFS DRIP &/BOLUS W/NEPHROTOMOGRAPHY

Professional

Both

$92.72

Service Code	HCPCS 74415 26
Min. Negotiated Rate	$69.54
Max. Negotiated Rate	$69.54
Rate for Payer: Cash Price	$25.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$69.54
Rate for Payer: SOMOS Essential	$69.54

CHG UROGRAPHY NFS DRIP &/BOLUS W/NEPHROTOMOGRAPHY

Professional

Both

$667.45

Service Code	HCPCS 74415
Min. Negotiated Rate	$500.59
Max. Negotiated Rate	$500.59
Rate for Payer: Cash Price	$176.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$500.59
Rate for Payer: SOMOS Essential	$500.59

CHG UROGRAPHY NFS DRIP &/BOLUS W/NEPHROTOMOGRAPHY

Professional

Both

$574.74

Service Code	HCPCS 74415 TC
Min. Negotiated Rate	$431.06
Max. Negotiated Rate	$431.06
Rate for Payer: Cash Price	$151.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$431.06
Rate for Payer: SOMOS Essential	$431.06

CHG UROGRAPHY RETROGRADE WITH/WO KUB

Professional

Both

$96.46

Service Code	HCPCS 74420 26
Min. Negotiated Rate	$72.34
Max. Negotiated Rate	$72.34
Rate for Payer: Cash Price	$26.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$72.34
Rate for Payer: SOMOS Essential	$72.34

CHG UROGRAPHY RETROGRADE WITH/WO KUB

Professional

Both

$229.85

Service Code	HCPCS 74420 TC
Min. Negotiated Rate	$172.39
Max. Negotiated Rate	$172.39
Rate for Payer: Cash Price	$63.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$172.39
Rate for Payer: SOMOS Essential	$172.39

CHG UROGRAPHY RETROGRADE WITH/WO KUB

Professional

Both

$326.34

Service Code	HCPCS 74420
Min. Negotiated Rate	$244.76
Max. Negotiated Rate	$244.76
Rate for Payer: Cash Price	$90.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$244.76
Rate for Payer: SOMOS Essential	$244.76

CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA

Professional

Both

$457.77

Service Code	HCPCS 76706
Min. Negotiated Rate	$343.33
Max. Negotiated Rate	$343.33
Rate for Payer: Cash Price	$124.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$343.33
Rate for Payer: SOMOS Essential	$343.33

CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA

Professional

Both

$107.14

Service Code	HCPCS 76706 26
Min. Negotiated Rate	$80.36
Max. Negotiated Rate	$80.36
Rate for Payer: Cash Price	$28.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$80.36
Rate for Payer: SOMOS Essential	$80.36

CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA

Professional

Both

$350.60

Service Code	HCPCS 76706 TC
Min. Negotiated Rate	$262.95
Max. Negotiated Rate	$262.95
Rate for Payer: Cash Price	$95.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$262.95
Rate for Payer: SOMOS Essential	$262.95

CHG US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION

Professional

Both

$496.06

Service Code	HCPCS 76700
Min. Negotiated Rate	$372.04
Max. Negotiated Rate	$372.04
Rate for Payer: Cash Price	$134.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$372.04
Rate for Payer: SOMOS Essential	$372.04

CHG US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION

Professional

Both

$154.07

Service Code	HCPCS 76700 26
Min. Negotiated Rate	$115.55
Max. Negotiated Rate	$115.55
Rate for Payer: Cash Price	$41.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$115.55
Rate for Payer: SOMOS Essential	$115.55

CHG US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION

Professional

Both

$341.99

Service Code	HCPCS 76700 TC
Min. Negotiated Rate	$256.49
Max. Negotiated Rate	$256.49
Rate for Payer: Cash Price	$93.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$256.49
Rate for Payer: SOMOS Essential	$256.49

CHG US ABDOMINAL REAL TIME W/IMAGE LIMITED

Professional

Both

$261.49

Service Code	HCPCS 76705 TC
Min. Negotiated Rate	$196.12
Max. Negotiated Rate	$196.12
Rate for Payer: Cash Price	$70.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$196.12
Rate for Payer: SOMOS Essential	$196.12

CHG US ABDOMINAL REAL TIME W/IMAGE LIMITED

Professional

Both

$376.53

Service Code	HCPCS 76705
Min. Negotiated Rate	$282.40
Max. Negotiated Rate	$282.40
Rate for Payer: Cash Price	$100.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$282.40
Rate for Payer: SOMOS Essential	$282.40

CHG US ABDOMINAL REAL TIME W/IMAGE LIMITED

Professional

Both

$115.05

Service Code	HCPCS 76705 26
Min. Negotiated Rate	$86.29
Max. Negotiated Rate	$86.29
Rate for Payer: Cash Price	$30.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$86.29
Rate for Payer: SOMOS Essential	$86.29

CHG US BONE DENSITY MEAS & INTERP PERIPH ANY METHO

Professional

Both

$31.85

Service Code	HCPCS 76977
Min. Negotiated Rate	$23.89
Max. Negotiated Rate	$23.89
Rate for Payer: Cash Price	$8.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23.89
Rate for Payer: SOMOS Essential	$23.89

CHG US BONE DENSITY MEAS & INTERP PERIPH ANY METHO

Professional

Both

$11.87

Service Code	HCPCS 76977 26
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$8.90
Rate for Payer: Cash Price	$3.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.90
Rate for Payer: SOMOS Essential	$8.90

CHG US BONE DENSITY MEAS & INTERP PERIPH ANY METHO

Professional

Both

$19.99

Service Code	HCPCS 76977 TC
Min. Negotiated Rate	$14.99
Max. Negotiated Rate	$14.99
Rate for Payer: Cash Price	$5.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$14.99
Rate for Payer: SOMOS Essential	$14.99

CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE

Professional

Both

$298.87

Service Code	HCPCS 76641 TC
Min. Negotiated Rate	$224.15
Max. Negotiated Rate	$224.15
Rate for Payer: Cash Price	$80.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$224.15
Rate for Payer: SOMOS Essential	$224.15

CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE

Professional

Both

$440.06

Service Code	HCPCS 76641
Min. Negotiated Rate	$330.04
Max. Negotiated Rate	$330.04
Rate for Payer: Cash Price	$118.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$330.04
Rate for Payer: SOMOS Essential	$330.04

CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE

Professional

Both

$141.19

Service Code	HCPCS 76641 26
Min. Negotiated Rate	$105.89
Max. Negotiated Rate	$105.89
Rate for Payer: Cash Price	$38.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$105.89
Rate for Payer: SOMOS Essential	$105.89

CHG US BREAST UNI REAL TIME WITH IMAGE LIMITED

Professional

Both

$361.90

Service Code	HCPCS 76642
Min. Negotiated Rate	$271.42
Max. Negotiated Rate	$271.42
Rate for Payer: Cash Price	$98.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$271.42
Rate for Payer: SOMOS Essential	$271.42

CHG US BREAST UNI REAL TIME WITH IMAGE LIMITED

Professional

Both

$132.06

Service Code	HCPCS 76642 26
Min. Negotiated Rate	$99.04
Max. Negotiated Rate	$99.04
Rate for Payer: Cash Price	$35.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$99.04
Rate for Payer: SOMOS Essential	$99.04

CHG US BREAST UNI REAL TIME WITH IMAGE LIMITED

Professional

Both

$229.85

Service Code	HCPCS 76642 TC
Min. Negotiated Rate	$172.39
Max. Negotiated Rate	$172.39
Rate for Payer: Cash Price	$62.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$172.39
Rate for Payer: SOMOS Essential	$172.39

CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION

Professional

Both

$127.79

Service Code	HCPCS 76604 TC
Min. Negotiated Rate	$95.84
Max. Negotiated Rate	$95.84
Rate for Payer: Cash Price	$35.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$95.84
Rate for Payer: SOMOS Essential	$95.84

Know your out-of-pocket cost for care.

All Charges