St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG US GUIDANCE CHORIONIC VILLUS SAMPLING IMG S&I

Professional

Both

$124.04

Service Code	HCPCS 76945 26
Min. Negotiated Rate	$93.03
Max. Negotiated Rate	$93.03
Rate for Payer: Cash Price	$34.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$93.03
Rate for Payer: SOMOS Essential	$93.03

CHG US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION

Professional

Both

$117.74

Service Code	HCPCS 76965 TC
Min. Negotiated Rate	$88.30
Max. Negotiated Rate	$88.30
Rate for Payer: Cash Price	$32.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$88.30
Rate for Payer: SOMOS Essential	$88.30

CHG US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION

Professional

Both

$382.76

Service Code	HCPCS 76965
Min. Negotiated Rate	$287.07
Max. Negotiated Rate	$287.07
Rate for Payer: Cash Price	$106.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$287.07
Rate for Payer: SOMOS Essential	$287.07

CHG US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION

Professional

Both

$265.02

Service Code	HCPCS 76965 26
Min. Negotiated Rate	$198.76
Max. Negotiated Rate	$198.76
Rate for Payer: Cash Price	$73.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$198.76
Rate for Payer: SOMOS Essential	$198.76

CHG US GUIDANCE NEEDLE PLACEMENT IMG S&I

Professional

Both

$244.23

Service Code	HCPCS 76942
Min. Negotiated Rate	$183.17
Max. Negotiated Rate	$183.17
Rate for Payer: Cash Price	$66.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$183.17
Rate for Payer: SOMOS Essential	$183.17

CHG US GUIDANCE NEEDLE PLACEMENT IMG S&I

Professional

Both

$122.05

Service Code	HCPCS 76942 TC
Min. Negotiated Rate	$91.54
Max. Negotiated Rate	$91.54
Rate for Payer: Cash Price	$33.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$91.54
Rate for Payer: SOMOS Essential	$91.54

CHG US GUIDANCE NEEDLE PLACEMENT IMG S&I

Professional

Both

$122.19

Service Code	HCPCS 76942 26
Min. Negotiated Rate	$91.64
Max. Negotiated Rate	$91.64
Rate for Payer: Cash Price	$32.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$91.64
Rate for Payer: SOMOS Essential	$91.64

CHG US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ

Professional

Both

$514.47

Service Code	HCPCS 76885
Min. Negotiated Rate	$385.85
Max. Negotiated Rate	$385.85
Rate for Payer: Cash Price	$158.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$385.85
Rate for Payer: SOMOS Essential	$385.85

CHG US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ

Professional

Both

$372.05

Service Code	HCPCS 76885 TC
Min. Negotiated Rate	$279.04
Max. Negotiated Rate	$279.04
Rate for Payer: Cash Price	$119.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$279.04
Rate for Payer: SOMOS Essential	$279.04

CHG US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ

Professional

Both

$142.45

Service Code	HCPCS 76885 26
Min. Negotiated Rate	$106.84
Max. Negotiated Rate	$106.84
Rate for Payer: Cash Price	$38.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$106.84
Rate for Payer: SOMOS Essential	$106.84

CHG US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ

Professional

Both

$432.01

Service Code	HCPCS 76886
Min. Negotiated Rate	$324.01
Max. Negotiated Rate	$324.01
Rate for Payer: Cash Price	$115.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$324.01
Rate for Payer: SOMOS Essential	$324.01

CHG US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ

Professional

Both

$121.66

Service Code	HCPCS 76886 26
Min. Negotiated Rate	$91.24
Max. Negotiated Rate	$91.24
Rate for Payer: Cash Price	$32.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$91.24
Rate for Payer: SOMOS Essential	$91.24

CHG US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ

Professional

Both

$310.35

Service Code	HCPCS 76886 TC
Min. Negotiated Rate	$232.76
Max. Negotiated Rate	$232.76
Rate for Payer: Cash Price	$83.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$232.76
Rate for Payer: SOMOS Essential	$232.76

CHG US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I

Professional

Both

$561.86

Service Code	HCPCS 76941
Min. Negotiated Rate	$421.40
Max. Negotiated Rate	$421.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$421.40
Rate for Payer: SOMOS Essential	$421.40

CHG US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I

Professional

Both

$308.32

Service Code	HCPCS 76941 TC
Min. Negotiated Rate	$231.24
Max. Negotiated Rate	$231.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$231.24
Rate for Payer: SOMOS Essential	$231.24

CHG US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I

Professional

Both

$253.54

Service Code	HCPCS 76941 26
Min. Negotiated Rate	$190.16
Max. Negotiated Rate	$190.16
Rate for Payer: Cash Price	$69.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$190.16
Rate for Payer: SOMOS Essential	$190.16

CHG US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG

Professional

Both

$133.32

Service Code	HCPCS 76882 26
Min. Negotiated Rate	$99.99
Max. Negotiated Rate	$99.99
Rate for Payer: Cash Price	$36.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$99.99
Rate for Payer: SOMOS Essential	$99.99

CHG US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG

Professional

Both

$41.55

Service Code	HCPCS 76882 TC
Min. Negotiated Rate	$31.16
Max. Negotiated Rate	$31.16
Rate for Payer: Cash Price	$36.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31.16
Rate for Payer: SOMOS Essential	$31.16

CHG US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG

Professional

Both

$174.86

Service Code	HCPCS 76882
Min. Negotiated Rate	$131.14
Max. Negotiated Rate	$131.14
Rate for Payer: Cash Price	$72.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$131.14
Rate for Payer: SOMOS Essential	$131.14

CHG US &MNTR PARENCHYMAL TISSUE ABLATION

Professional

Both

$422.14

Service Code	HCPCS 76940 26
Min. Negotiated Rate	$316.60
Max. Negotiated Rate	$316.60
Rate for Payer: Cash Price	$113.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$316.60
Rate for Payer: SOMOS Essential	$316.60

CHG US &MNTR PARENCHYMAL TISSUE ABLATION

Professional

Both

$783.58

Service Code	HCPCS 76940
Min. Negotiated Rate	$587.68
Max. Negotiated Rate	$587.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$587.68
Rate for Payer: SOMOS Essential	$587.68

CHG US &MNTR PARENCHYMAL TISSUE ABLATION

Professional

Both

$361.45

Service Code	HCPCS 76940 TC
Min. Negotiated Rate	$271.09
Max. Negotiated Rate	$271.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$271.09
Rate for Payer: SOMOS Essential	$271.09

CHG US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY

Professional

Both

$295.75

Service Code	HCPCS 76883
Min. Negotiated Rate	$221.81
Max. Negotiated Rate	$221.81
Rate for Payer: Cash Price	$80.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$221.81
Rate for Payer: SOMOS Essential	$221.81

CHG US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY

Professional

Both

$231.21

Service Code	HCPCS 76883 26
Min. Negotiated Rate	$173.41
Max. Negotiated Rate	$173.41
Rate for Payer: Cash Price	$63.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$173.41
Rate for Payer: SOMOS Essential	$173.41

CHG US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY

Professional

Both

$64.54

Service Code	HCPCS 76883 TC
Min. Negotiated Rate	$48.40
Max. Negotiated Rate	$48.40
Rate for Payer: Cash Price	$17.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$48.40
Rate for Payer: SOMOS Essential	$48.40

Know your out-of-pocket cost for care.

All Charges