St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

Professional

Both

$301.74

Service Code	HCPCS 76816 TC
Min. Negotiated Rate	$226.30
Max. Negotiated Rate	$226.30
Rate for Payer: Cash Price	$82.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$226.30
Rate for Payer: SOMOS Essential	$226.30

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

Professional

Both

$159.36

Service Code	HCPCS 76816 26
Min. Negotiated Rate	$119.52
Max. Negotiated Rate	$119.52
Rate for Payer: Cash Price	$43.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$119.52
Rate for Payer: SOMOS Essential	$119.52

CHG US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG

Professional

Both

$248.54

Service Code	HCPCS 76817 TC
Min. Negotiated Rate	$186.40
Max. Negotiated Rate	$186.40
Rate for Payer: Cash Price	$67.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$186.40
Rate for Payer: SOMOS Essential	$186.40

CHG US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG

Professional

Both

$393.68

Service Code	HCPCS 76817
Min. Negotiated Rate	$295.26
Max. Negotiated Rate	$295.26
Rate for Payer: Cash Price	$106.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$295.26
Rate for Payer: SOMOS Essential	$295.26

CHG US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG

Professional

Both

$145.15

Service Code	HCPCS 76817 26
Min. Negotiated Rate	$108.86
Max. Negotiated Rate	$108.86
Rate for Payer: Cash Price	$39.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$108.86
Rate for Payer: SOMOS Essential	$108.86

CHG US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION

Professional

Both

$355.29

Service Code	HCPCS 76811 26
Min. Negotiated Rate	$266.47
Max. Negotiated Rate	$266.47
Rate for Payer: Cash Price	$97.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$266.47
Rate for Payer: SOMOS Essential	$266.47

CHG US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION

Professional

Both

$732.80

Service Code	HCPCS 76811
Min. Negotiated Rate	$549.60
Max. Negotiated Rate	$549.60
Rate for Payer: Cash Price	$202.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$549.60
Rate for Payer: SOMOS Essential	$549.60

CHG US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION

Professional

Both

$377.51

Service Code	HCPCS 76811 TC
Min. Negotiated Rate	$283.13
Max. Negotiated Rate	$283.13
Rate for Payer: Cash Price	$104.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$283.13
Rate for Payer: SOMOS Essential	$283.13

CHG US, RETROPERITNL ABD, LTD

Professional

Both

$137.87

Service Code	HCPCS 76775 TC
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$103.40
Rate for Payer: Cash Price	$38.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$103.40
Rate for Payer: SOMOS Essential	$103.40

CHG US, RETROPERITNL ABD, LTD

Professional

Both

$112.35

Service Code	HCPCS 76775 26
Min. Negotiated Rate	$84.26
Max. Negotiated Rate	$84.26
Rate for Payer: Cash Price	$29.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$84.26
Rate for Payer: SOMOS Essential	$84.26

CHG US, RETROPERITNL ABD, LTD

Professional

Both

$250.22

Service Code	HCPCS 76775
Min. Negotiated Rate	$187.66
Max. Negotiated Rate	$187.66
Rate for Payer: Cash Price	$68.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$187.66
Rate for Payer: SOMOS Essential	$187.66

CHG US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE

Professional

Both

$321.86

Service Code	HCPCS 76770 TC
Min. Negotiated Rate	$241.40
Max. Negotiated Rate	$241.40
Rate for Payer: Cash Price	$87.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$241.40
Rate for Payer: SOMOS Essential	$241.40

CHG US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE

Professional

Both

$462.88

Service Code	HCPCS 76770
Min. Negotiated Rate	$347.16
Max. Negotiated Rate	$347.16
Rate for Payer: Cash Price	$125.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$347.16
Rate for Payer: SOMOS Essential	$347.16

CHG US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE

Professional

Both

$141.02

Service Code	HCPCS 76770 26
Min. Negotiated Rate	$105.76
Max. Negotiated Rate	$105.76
Rate for Payer: Cash Price	$38.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$105.76
Rate for Payer: SOMOS Essential	$105.76

CHG US SCROTUM & CONTENTS

Professional

Both

$431.66

Service Code	HCPCS 76870
Min. Negotiated Rate	$323.74
Max. Negotiated Rate	$323.74
Rate for Payer: Cash Price	$115.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$323.74
Rate for Payer: SOMOS Essential	$323.74

CHG US SCROTUM & CONTENTS

Professional

Both

$307.48

Service Code	HCPCS 76870 TC
Min. Negotiated Rate	$230.61
Max. Negotiated Rate	$230.61
Rate for Payer: Cash Price	$83.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$230.61
Rate for Payer: SOMOS Essential	$230.61

CHG US SCROTUM & CONTENTS

Professional

Both

$124.18

Service Code	HCPCS 76870 26
Min. Negotiated Rate	$93.14
Max. Negotiated Rate	$93.14
Rate for Payer: Cash Price	$32.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$93.14
Rate for Payer: SOMOS Essential	$93.14

CHG US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM

Professional

Both

$366.42

Service Code	HCPCS 76536 TC
Min. Negotiated Rate	$274.82
Max. Negotiated Rate	$274.82
Rate for Payer: Cash Price	$99.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$274.82
Rate for Payer: SOMOS Essential	$274.82

CHG US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM

Professional

Both

$477.68

Service Code	HCPCS 76536
Min. Negotiated Rate	$358.26
Max. Negotiated Rate	$358.26
Rate for Payer: Cash Price	$128.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$358.26
Rate for Payer: SOMOS Essential	$358.26

CHG US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM

Professional

Both

$111.27

Service Code	HCPCS 76536 26
Min. Negotiated Rate	$83.45
Max. Negotiated Rate	$83.45
Rate for Payer: Cash Price	$29.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$83.45
Rate for Payer: SOMOS Essential	$83.45

CHG US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX

Professional

Both

$733.53

Service Code	HCPCS 76873
Min. Negotiated Rate	$550.15
Max. Negotiated Rate	$550.15
Rate for Payer: Cash Price	$202.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$550.15
Rate for Payer: SOMOS Essential	$550.15

CHG US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX

Professional

Both

$429.52

Service Code	HCPCS 76873 TC
Min. Negotiated Rate	$322.14
Max. Negotiated Rate	$322.14
Rate for Payer: Cash Price	$118.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$322.14
Rate for Payer: SOMOS Essential	$322.14

CHG US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX

Professional

Both

$303.98

Service Code	HCPCS 76873 26
Min. Negotiated Rate	$227.98
Max. Negotiated Rate	$227.98
Rate for Payer: Cash Price	$83.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$227.98
Rate for Payer: SOMOS Essential	$227.98

CHG US TRANSRECTAL

Professional

Both

$126.39

Service Code	HCPCS 76872 26
Min. Negotiated Rate	$94.79
Max. Negotiated Rate	$94.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$94.79
Rate for Payer: SOMOS Essential	$94.79

CHG US TRANSRECTAL

Professional

Both

$454.13

Service Code	HCPCS 76872 TC
Min. Negotiated Rate	$340.60
Max. Negotiated Rate	$340.60
Rate for Payer: Cash Price	$200.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$340.60
Rate for Payer: SOMOS Essential	$340.60

Know your out-of-pocket cost for care.

All Charges