St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG US TRANSRECTAL

Professional

Both

$580.51

Service Code	HCPCS 76872
Min. Negotiated Rate	$435.38
Max. Negotiated Rate	$435.38
Rate for Payer: Cash Price	$235.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$435.38
Rate for Payer: SOMOS Essential	$435.38

CHG US TRANSVAGINAL

Professional

Both

$134.75

Service Code	HCPCS 76830 26
Min. Negotiated Rate	$101.06
Max. Negotiated Rate	$101.06
Rate for Payer: Cash Price	$35.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$101.06
Rate for Payer: SOMOS Essential	$101.06

CHG US TRANSVAGINAL

Professional

Both

$512.68

Service Code	HCPCS 76830
Min. Negotiated Rate	$384.51
Max. Negotiated Rate	$384.51
Rate for Payer: Cash Price	$138.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$384.51
Rate for Payer: SOMOS Essential	$384.51

CHG US TRANSVAGINAL

Professional

Both

$377.93

Service Code	HCPCS 76830 TC
Min. Negotiated Rate	$283.45
Max. Negotiated Rate	$283.45
Rate for Payer: Cash Price	$103.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$283.45
Rate for Payer: SOMOS Essential	$283.45

CHG US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN

Professional

Both

$144.94

Service Code	HCPCS 76776 26
Min. Negotiated Rate	$108.70
Max. Negotiated Rate	$108.70
Rate for Payer: Cash Price	$39.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$108.70
Rate for Payer: SOMOS Essential	$108.70

CHG US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN

Professional

Both

$634.87

Service Code	HCPCS 76776
Min. Negotiated Rate	$476.15
Max. Negotiated Rate	$476.15
Rate for Payer: Cash Price	$171.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$476.15
Rate for Payer: SOMOS Essential	$476.15

CHG US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN

Professional

Both

$489.90

Service Code	HCPCS 76776 TC
Min. Negotiated Rate	$367.42
Max. Negotiated Rate	$367.42
Rate for Payer: Cash Price	$132.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$367.42
Rate for Payer: SOMOS Essential	$367.42

CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY

Professional

Both

$109.24

Service Code	HCPCS 76937 TC
Min. Negotiated Rate	$81.93
Max. Negotiated Rate	$81.93
Rate for Payer: Cash Price	$29.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$81.93
Rate for Payer: SOMOS Essential	$81.93

CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY

Professional

Both

$60.03

Service Code	HCPCS 76937 26
Min. Negotiated Rate	$45.02
Max. Negotiated Rate	$45.02
Rate for Payer: Cash Price	$15.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$45.02
Rate for Payer: SOMOS Essential	$45.02

CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY

Professional

Both

$169.26

Service Code	HCPCS 76937
Min. Negotiated Rate	$126.94
Max. Negotiated Rate	$126.94
Rate for Payer: Cash Price	$44.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$126.94
Rate for Payer: SOMOS Essential	$126.94

CHG VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I

Professional

Both

$415.31

Service Code	HCPCS 74440
Min. Negotiated Rate	$311.48
Max. Negotiated Rate	$311.48
Rate for Payer: Cash Price	$113.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$311.48
Rate for Payer: SOMOS Essential	$311.48

CHG VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I

Professional

Both

$69.02

Service Code	HCPCS 74440 26
Min. Negotiated Rate	$51.76
Max. Negotiated Rate	$51.76
Rate for Payer: Cash Price	$18.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$51.76
Rate for Payer: SOMOS Essential	$51.76

CHG VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I

Professional

Both

$346.29

Service Code	HCPCS 74440 TC
Min. Negotiated Rate	$259.72
Max. Negotiated Rate	$259.72
Rate for Payer: Cash Price	$94.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$259.72
Rate for Payer: SOMOS Essential	$259.72

CHG VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I

Professional

Both

$383.53

Service Code	HCPCS 75842 TC
Min. Negotiated Rate	$287.65
Max. Negotiated Rate	$287.65
Rate for Payer: Cash Price	$104.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$287.65
Rate for Payer: SOMOS Essential	$287.65

CHG VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I

Professional

Both

$287.56

Service Code	HCPCS 75842 26
Min. Negotiated Rate	$215.67
Max. Negotiated Rate	$215.67
Rate for Payer: Cash Price	$77.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$215.67
Rate for Payer: SOMOS Essential	$215.67

CHG VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I

Professional

Both

$671.09

Service Code	HCPCS 75842
Min. Negotiated Rate	$503.32
Max. Negotiated Rate	$503.32
Rate for Payer: Cash Price	$182.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$503.32
Rate for Payer: SOMOS Essential	$503.32

CHG VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I

Professional

Both

$219.59

Service Code	HCPCS 75840 26
Min. Negotiated Rate	$164.69
Max. Negotiated Rate	$164.69
Rate for Payer: Cash Price	$59.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$164.69
Rate for Payer: SOMOS Essential	$164.69

CHG VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I

Professional

Both

$547.05

Service Code	HCPCS 75840
Min. Negotiated Rate	$410.29
Max. Negotiated Rate	$410.29
Rate for Payer: Cash Price	$148.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$410.29
Rate for Payer: SOMOS Essential	$410.29

CHG VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I

Professional

Both

$327.46

Service Code	HCPCS 75840 TC
Min. Negotiated Rate	$245.60
Max. Negotiated Rate	$245.60
Rate for Payer: Cash Price	$88.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$245.60
Rate for Payer: SOMOS Essential	$245.60

CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I

Professional

Both

$490.00

Service Code	HCPCS 75825
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$367.50
Rate for Payer: Cash Price	$132.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$367.50
Rate for Payer: SOMOS Essential	$367.50

CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I

Professional

Both

$267.23

Service Code	HCPCS 75825 TC
Min. Negotiated Rate	$200.42
Max. Negotiated Rate	$200.42
Rate for Payer: Cash Price	$72.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$200.42
Rate for Payer: SOMOS Essential	$200.42

CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I

Professional

Both

$222.78

Service Code	HCPCS 75825 26
Min. Negotiated Rate	$167.08
Max. Negotiated Rate	$167.08
Rate for Payer: Cash Price	$59.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$167.08
Rate for Payer: SOMOS Essential	$167.08

CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I

Professional

Both

$287.35

Service Code	HCPCS 75827 TC
Min. Negotiated Rate	$215.51
Max. Negotiated Rate	$215.51
Rate for Payer: Cash Price	$78.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$215.51
Rate for Payer: SOMOS Essential	$215.51

CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I

Professional

Both

$513.00

Service Code	HCPCS 75827
Min. Negotiated Rate	$384.75
Max. Negotiated Rate	$384.75
Rate for Payer: Cash Price	$138.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$384.75
Rate for Payer: SOMOS Essential	$384.75

CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I

Professional

Both

$225.65

Service Code	HCPCS 75827 26
Min. Negotiated Rate	$169.24
Max. Negotiated Rate	$169.24
Rate for Payer: Cash Price	$60.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$169.24
Rate for Payer: SOMOS Essential	$169.24

Know your out-of-pocket cost for care.

All Charges