St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U

Professional

Both

$204.51

Service Code	HCPCS 76857
Min. Negotiated Rate	$153.38
Max. Negotiated Rate	$153.38
Rate for Payer: Cash Price	$56.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$153.38
Rate for Payer: SOMOS Essential	$153.38

CHG US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U

Professional

Both

$93.98

Service Code	HCPCS 76857 26
Min. Negotiated Rate	$70.48
Max. Negotiated Rate	$70.48
Rate for Payer: Cash Price	$25.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70.48
Rate for Payer: SOMOS Essential	$70.48

CHG US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U

Professional

Both

$110.57

Service Code	HCPCS 76857 TC
Min. Negotiated Rate	$82.93
Max. Negotiated Rate	$82.93
Rate for Payer: Cash Price	$31.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$82.93
Rate for Payer: SOMOS Essential	$82.93

CHG US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE

Professional

Both

$317.56

Service Code	HCPCS 76856 TC
Min. Negotiated Rate	$238.17
Max. Negotiated Rate	$238.17
Rate for Payer: Cash Price	$86.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$238.17
Rate for Payer: SOMOS Essential	$238.17

CHG US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE

Professional

Both

$133.32

Service Code	HCPCS 76856 26
Min. Negotiated Rate	$99.99
Max. Negotiated Rate	$99.99
Rate for Payer: Cash Price	$35.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$99.99
Rate for Payer: SOMOS Essential	$99.99

CHG US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE

Professional

Both

$450.84

Service Code	HCPCS 76856
Min. Negotiated Rate	$338.13
Max. Negotiated Rate	$338.13
Rate for Payer: Cash Price	$122.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$338.13
Rate for Payer: SOMOS Essential	$338.13

CHG US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT

Professional

Both

$497.04

Service Code	HCPCS 76801
Min. Negotiated Rate	$372.78
Max. Negotiated Rate	$372.78
Rate for Payer: Cash Price	$135.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$372.78
Rate for Payer: SOMOS Essential	$372.78

CHG US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT

Professional

Both

$308.91

Service Code	HCPCS 76801 TC
Min. Negotiated Rate	$231.68
Max. Negotiated Rate	$231.68
Rate for Payer: Cash Price	$83.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$231.68
Rate for Payer: SOMOS Essential	$231.68

CHG US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT

Professional

Both

$188.13

Service Code	HCPCS 76801 26
Min. Negotiated Rate	$141.10
Max. Negotiated Rate	$141.10
Rate for Payer: Cash Price	$51.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$141.10
Rate for Payer: SOMOS Essential	$141.10

CHG US PREGNANT UTERUS LIMITED 1/> FETUSES

Professional

Both

$126.84

Service Code	HCPCS 76815 26
Min. Negotiated Rate	$95.13
Max. Negotiated Rate	$95.13
Rate for Payer: Cash Price	$33.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$95.13
Rate for Payer: SOMOS Essential	$95.13

CHG US PREGNANT UTERUS LIMITED 1/> FETUSES

Professional

Both

$219.80

Service Code	HCPCS 76815 TC
Min. Negotiated Rate	$164.85
Max. Negotiated Rate	$164.85
Rate for Payer: Cash Price	$59.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$164.85
Rate for Payer: SOMOS Essential	$164.85

CHG US PREGNANT UTERUS LIMITED 1/> FETUSES

Professional

Both

$346.64

Service Code	HCPCS 76815
Min. Negotiated Rate	$259.98
Max. Negotiated Rate	$259.98
Rate for Payer: Cash Price	$93.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$259.98
Rate for Payer: SOMOS Essential	$259.98

CHG US PREG UTERUS 14 WK TRANSABDL EACH GESTATION

Professional

Both

$160.90

Service Code	HCPCS 76802 26
Min. Negotiated Rate	$120.68
Max. Negotiated Rate	$120.68
Rate for Payer: Cash Price	$43.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$120.68
Rate for Payer: SOMOS Essential	$120.68

CHG US PREG UTERUS 14 WK TRANSABDL EACH GESTATION

Professional

Both

$92.02

Service Code	HCPCS 76802 TC
Min. Negotiated Rate	$69.02
Max. Negotiated Rate	$69.02
Rate for Payer: Cash Price	$24.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$69.02
Rate for Payer: SOMOS Essential	$69.02

CHG US PREG UTERUS 14 WK TRANSABDL EACH GESTATION

Professional

Both

$252.91

Service Code	HCPCS 76802
Min. Negotiated Rate	$189.68
Max. Negotiated Rate	$189.68
Rate for Payer: Cash Price	$67.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$189.68
Rate for Payer: SOMOS Essential	$189.68

CHG US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO

Professional

Both

$369.29

Service Code	HCPCS 76810
Min. Negotiated Rate	$276.97
Max. Negotiated Rate	$276.97
Rate for Payer: Cash Price	$99.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$276.97
Rate for Payer: SOMOS Essential	$276.97

CHG US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO

Professional

Both

$180.99

Service Code	HCPCS 76810 TC
Min. Negotiated Rate	$135.74
Max. Negotiated Rate	$135.74
Rate for Payer: Cash Price	$48.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$135.74
Rate for Payer: SOMOS Essential	$135.74

CHG US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO

Professional

Both

$188.30

Service Code	HCPCS 76810 26
Min. Negotiated Rate	$141.22
Max. Negotiated Rate	$141.22
Rate for Payer: Cash Price	$50.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$141.22
Rate for Payer: SOMOS Essential	$141.22

CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION

Professional

Both

$575.96

Service Code	HCPCS 76805
Min. Negotiated Rate	$431.97
Max. Negotiated Rate	$431.97
Rate for Payer: Cash Price	$156.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$431.97
Rate for Payer: SOMOS Essential	$431.97

CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION

Professional

Both

$386.40

Service Code	HCPCS 76805 TC
Min. Negotiated Rate	$289.80
Max. Negotiated Rate	$289.80
Rate for Payer: Cash Price	$105.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$289.80
Rate for Payer: SOMOS Essential	$289.80

CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION

Professional

Both

$189.56

Service Code	HCPCS 76805 26
Min. Negotiated Rate	$142.17
Max. Negotiated Rate	$142.17
Rate for Payer: Cash Price	$51.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$142.17
Rate for Payer: SOMOS Essential	$142.17

CHG US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT

Professional

Both

$801.43

Service Code	HCPCS 76812
Min. Negotiated Rate	$601.07
Max. Negotiated Rate	$601.07
Rate for Payer: Cash Price	$219.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$601.07
Rate for Payer: SOMOS Essential	$601.07

CHG US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT

Professional

Both

$468.34

Service Code	HCPCS 76812 TC
Min. Negotiated Rate	$351.26
Max. Negotiated Rate	$351.26
Rate for Payer: Cash Price	$127.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$351.26
Rate for Payer: SOMOS Essential	$351.26

CHG US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT

Professional

Both

$333.06

Service Code	HCPCS 76812 26
Min. Negotiated Rate	$249.80
Max. Negotiated Rate	$249.80
Rate for Payer: Cash Price	$91.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$249.80
Rate for Payer: SOMOS Essential	$249.80

CHG US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS

Professional

Both

$461.09

Service Code	HCPCS 76816
Min. Negotiated Rate	$345.82
Max. Negotiated Rate	$345.82
Rate for Payer: Cash Price	$126.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$345.82
Rate for Payer: SOMOS Essential	$345.82

Know your out-of-pocket cost for care.

All Charges