St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGIN

Professional

Both

$1,051.68

Service Code	HCPCS 78598 TC
Min. Negotiated Rate	$788.76
Max. Negotiated Rate	$788.76
Rate for Payer: Cash Price	$280.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$788.76
Rate for Payer: SOMOS Essential	$788.76

CHG RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY

Professional

Both

$383.88

Service Code	HCPCS 76100
Min. Negotiated Rate	$287.91
Max. Negotiated Rate	$287.91
Rate for Payer: Cash Price	$103.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$287.91
Rate for Payer: SOMOS Essential	$287.91

CHG RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY

Professional

Both

$115.22

Service Code	HCPCS 76100 26
Min. Negotiated Rate	$86.42
Max. Negotiated Rate	$86.42
Rate for Payer: Cash Price	$30.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$86.42
Rate for Payer: SOMOS Essential	$86.42

CHG RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY

Professional

Both

$268.66

Service Code	HCPCS 76100 TC
Min. Negotiated Rate	$201.50
Max. Negotiated Rate	$201.50
Rate for Payer: Cash Price	$73.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$201.50
Rate for Payer: SOMOS Essential	$201.50

CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I

Professional

Both

$255.26

Service Code	HCPCS 76080
Min. Negotiated Rate	$191.44
Max. Negotiated Rate	$191.44
Rate for Payer: Cash Price	$69.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$191.44
Rate for Payer: SOMOS Essential	$191.44

CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I

Professional

Both

$153.69

Service Code	HCPCS 76080 TC
Min. Negotiated Rate	$115.27
Max. Negotiated Rate	$115.27
Rate for Payer: Cash Price	$41.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$115.27
Rate for Payer: SOMOS Essential	$115.27

CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I

Professional

Both

$101.57

Service Code	HCPCS 76080 26
Min. Negotiated Rate	$76.18
Max. Negotiated Rate	$76.18
Rate for Payer: Cash Price	$27.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$76.18
Rate for Payer: SOMOS Essential	$76.18

CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ

Professional

Both

$122.89

Service Code	HCPCS 73050
Min. Negotiated Rate	$92.17
Max. Negotiated Rate	$92.17
Rate for Payer: Cash Price	$33.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$92.17
Rate for Payer: SOMOS Essential	$92.17

CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ

Professional

Both

$86.10

Service Code	HCPCS 73050 TC
Min. Negotiated Rate	$64.58
Max. Negotiated Rate	$64.58
Rate for Payer: Cash Price	$23.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$64.58
Rate for Payer: SOMOS Essential	$64.58

CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ

Professional

Both

$36.79

Service Code	HCPCS 73050 26
Min. Negotiated Rate	$27.59
Max. Negotiated Rate	$27.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27.59
Rate for Payer: SOMOS Essential	$27.59

CHG RADEX ANKLE ARTHROGRAPHY RS&I

Professional

Both

$445.48

Service Code	HCPCS 73615 TC
Min. Negotiated Rate	$334.11
Max. Negotiated Rate	$334.11
Rate for Payer: Cash Price	$119.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$334.11
Rate for Payer: SOMOS Essential	$334.11

CHG RADEX ANKLE ARTHROGRAPHY RS&I

Professional

Both

$557.13

Service Code	HCPCS 73615
Min. Negotiated Rate	$417.85
Max. Negotiated Rate	$417.85
Rate for Payer: Cash Price	$149.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$417.85
Rate for Payer: SOMOS Essential	$417.85

CHG RADEX ANKLE ARTHROGRAPHY RS&I

Professional

Both

$111.65

Service Code	HCPCS 73615 26
Min. Negotiated Rate	$83.74
Max. Negotiated Rate	$83.74
Rate for Payer: Cash Price	$30.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$83.74
Rate for Payer: SOMOS Essential	$83.74

CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS

Professional

Both

$124.92

Service Code	HCPCS 73610 TC
Min. Negotiated Rate	$93.69
Max. Negotiated Rate	$93.69
Rate for Payer: Cash Price	$33.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$93.69
Rate for Payer: SOMOS Essential	$93.69

CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS

Professional

Both

$34.09

Service Code	HCPCS 73610 26
Min. Negotiated Rate	$25.57
Max. Negotiated Rate	$25.57
Rate for Payer: Cash Price	$9.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25.57
Rate for Payer: SOMOS Essential	$25.57

CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS

Professional

Both

$159.01

Service Code	HCPCS 73610
Min. Negotiated Rate	$119.26
Max. Negotiated Rate	$119.26
Rate for Payer: Cash Price	$42.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$119.26
Rate for Payer: SOMOS Essential	$119.26

CHG RADEX CALCANEUS MINIMUM 2 VIEWS

Professional

Both

$31.40

Service Code	HCPCS 73650 26
Min. Negotiated Rate	$23.55
Max. Negotiated Rate	$23.55
Rate for Payer: Cash Price	$8.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23.55
Rate for Payer: SOMOS Essential	$23.55

CHG RADEX CALCANEUS MINIMUM 2 VIEWS

Professional

Both

$91.88

Service Code	HCPCS 73650 TC
Min. Negotiated Rate	$68.91
Max. Negotiated Rate	$68.91
Rate for Payer: Cash Price	$24.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$68.91
Rate for Payer: SOMOS Essential	$68.91

CHG RADEX CALCANEUS MINIMUM 2 VIEWS

Professional

Both

$123.27

Service Code	HCPCS 73650
Min. Negotiated Rate	$92.45
Max. Negotiated Rate	$92.45
Rate for Payer: Cash Price	$33.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$92.45
Rate for Payer: SOMOS Essential	$92.45

CHG RADEX CLAVICLE COMPLETE

Professional

Both

$139.09

Service Code	HCPCS 73000
Min. Negotiated Rate	$104.32
Max. Negotiated Rate	$104.32
Rate for Payer: Cash Price	$38.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$104.32
Rate for Payer: SOMOS Essential	$104.32

CHG RADEX CLAVICLE COMPLETE

Professional

Both

$106.23

Service Code	HCPCS 73000 TC
Min. Negotiated Rate	$79.67
Max. Negotiated Rate	$79.67
Rate for Payer: Cash Price	$29.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$79.67
Rate for Payer: SOMOS Essential	$79.67

CHG RADEX CLAVICLE COMPLETE

Professional

Both

$32.83

Service Code	HCPCS 73000 26
Min. Negotiated Rate	$24.62
Max. Negotiated Rate	$24.62
Rate for Payer: Cash Price	$8.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24.62
Rate for Payer: SOMOS Essential	$24.62

CHG RADEX ELBOW 2 VIEWS

Professional

Both

$126.14

Service Code	HCPCS 73070
Min. Negotiated Rate	$94.60
Max. Negotiated Rate	$94.60
Rate for Payer: Cash Price	$34.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$94.60
Rate for Payer: SOMOS Essential	$94.60

CHG RADEX ELBOW 2 VIEWS

Professional

Both

$93.31

Service Code	HCPCS 73070 TC
Min. Negotiated Rate	$69.98
Max. Negotiated Rate	$69.98
Rate for Payer: Cash Price	$25.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$69.98
Rate for Payer: SOMOS Essential	$69.98

CHG RADEX ELBOW 2 VIEWS

Professional

Both

$32.83

Service Code	HCPCS 73070 26
Min. Negotiated Rate	$24.62
Max. Negotiated Rate	$24.62
Rate for Payer: Cash Price	$8.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24.62
Rate for Payer: SOMOS Essential	$24.62

Know your out-of-pocket cost for care.

All Charges