St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG RADEX ELBOW ARTHROGRAPHY RS&I

Professional

Both

$111.65

Service Code	HCPCS 73085 26
Min. Negotiated Rate	$83.74
Max. Negotiated Rate	$83.74
Rate for Payer: Cash Price	$28.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$83.74
Rate for Payer: SOMOS Essential	$83.74

CHG RADEX ELBOW ARTHROGRAPHY RS&I

Professional

Both

$367.85

Service Code	HCPCS 73085 TC
Min. Negotiated Rate	$275.89
Max. Negotiated Rate	$275.89
Rate for Payer: Cash Price	$88.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$275.89
Rate for Payer: SOMOS Essential	$275.89

CHG RADEX ELBOW ARTHROGRAPHY RS&I

Professional

Both

$479.50

Service Code	HCPCS 73085
Min. Negotiated Rate	$359.62
Max. Negotiated Rate	$359.62
Rate for Payer: Cash Price	$116.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$359.62
Rate for Payer: SOMOS Essential	$359.62

CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS

Professional

Both

$106.23

Service Code	HCPCS 73080 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 ELBOW COMPLETE MINIMUM 3 VIEWS

Professional

Both

$140.32

Service Code	HCPCS 73080
Min. Negotiated Rate	$105.24
Max. Negotiated Rate	$105.24
Rate for Payer: Cash Price	$38.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$105.24
Rate for Payer: SOMOS Essential	$105.24

CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS

Professional

Both

$34.09

Service Code	HCPCS 73080 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 ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW

Professional

Both

$132.13

Service Code	HCPCS 72081 TC
Min. Negotiated Rate	$99.10
Max. Negotiated Rate	$99.10
Rate for Payer: Cash Price	$35.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$99.10
Rate for Payer: SOMOS Essential	$99.10

CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW

Professional

Both

$49.67

Service Code	HCPCS 72081 26
Min. Negotiated Rate	$37.25
Max. Negotiated Rate	$37.25
Rate for Payer: Cash Price	$13.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37.25
Rate for Payer: SOMOS Essential	$37.25

CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW

Professional

Both

$181.79

Service Code	HCPCS 72081
Min. Negotiated Rate	$136.34
Max. Negotiated Rate	$136.34
Rate for Payer: Cash Price	$49.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$136.34
Rate for Payer: SOMOS Essential	$136.34

CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW

Professional

Both

$301.46

Service Code	HCPCS 72082
Min. Negotiated Rate	$226.10
Max. Negotiated Rate	$226.10
Rate for Payer: Cash Price	$82.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$226.10
Rate for Payer: SOMOS Essential	$226.10

CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW

Professional

Both

$239.93

Service Code	HCPCS 72082 TC
Min. Negotiated Rate	$179.95
Max. Negotiated Rate	$179.95
Rate for Payer: Cash Price	$65.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$179.95
Rate for Payer: SOMOS Essential	$179.95

CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW

Professional

Both

$61.57

Service Code	HCPCS 72082 26
Min. Negotiated Rate	$46.18
Max. Negotiated Rate	$46.18
Rate for Payer: Cash Price	$16.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$46.18
Rate for Payer: SOMOS Essential	$46.18

CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW

Professional

Both

$336.81

Service Code	HCPCS 72083
Min. Negotiated Rate	$252.61
Max. Negotiated Rate	$252.61
Rate for Payer: Cash Price	$92.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$252.61
Rate for Payer: SOMOS Essential	$252.61

CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW

Professional

Both

$68.15

Service Code	HCPCS 72083 26
Min. Negotiated Rate	$51.11
Max. Negotiated Rate	$51.11
Rate for Payer: Cash Price	$18.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$51.11
Rate for Payer: SOMOS Essential	$51.11

CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW

Professional

Both

$268.66

Service Code	HCPCS 72083 TC
Min. Negotiated Rate	$201.50
Max. Negotiated Rate	$201.50
Rate for Payer: Cash Price	$73.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$201.50
Rate for Payer: SOMOS Essential	$201.50

CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW

Professional

Both

$81.27

Service Code	HCPCS 72084 26
Min. Negotiated Rate	$60.95
Max. Negotiated Rate	$60.95
Rate for Payer: Cash Price	$21.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$60.95
Rate for Payer: SOMOS Essential	$60.95

CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW

Professional

Both

$425.99

Service Code	HCPCS 72084
Min. Negotiated Rate	$319.49
Max. Negotiated Rate	$319.49
Rate for Payer: Cash Price	$115.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$319.49
Rate for Payer: SOMOS Essential	$319.49

CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW

Professional

Both

$344.72

Service Code	HCPCS 72084 TC
Min. Negotiated Rate	$258.54
Max. Negotiated Rate	$258.54
Rate for Payer: Cash Price	$93.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$258.54
Rate for Payer: SOMOS Essential	$258.54

CHG RADEX FACIAL BONES < 3 VIEWS

Professional

Both

$39.48

Service Code	HCPCS 70140 26
Min. Negotiated Rate	$29.61
Max. Negotiated Rate	$29.61
Rate for Payer: Cash Price	$10.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29.61
Rate for Payer: SOMOS Essential	$29.61

CHG RADEX FACIAL BONES < 3 VIEWS

Professional

Both

$138.53

Service Code	HCPCS 70140
Min. Negotiated Rate	$103.90
Max. Negotiated Rate	$103.90
Rate for Payer: Cash Price	$37.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$103.90
Rate for Payer: SOMOS Essential	$103.90

CHG RADEX FACIAL BONES < 3 VIEWS

Professional

Both

$99.05

Service Code	HCPCS 70140 TC
Min. Negotiated Rate	$74.29
Max. Negotiated Rate	$74.29
Rate for Payer: Cash Price	$26.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$74.29
Rate for Payer: SOMOS Essential	$74.29

CHG RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS

Professional

Both

$200.48

Service Code	HCPCS 70150
Min. Negotiated Rate	$150.36
Max. Negotiated Rate	$150.36
Rate for Payer: Cash Price	$55.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$150.36
Rate for Payer: SOMOS Essential	$150.36

CHG RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS

Professional

Both

$49.67

Service Code	HCPCS 70150 26
Min. Negotiated Rate	$37.25
Max. Negotiated Rate	$37.25
Rate for Payer: Cash Price	$13.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37.25
Rate for Payer: SOMOS Essential	$37.25

CHG RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS

Professional

Both

$150.82

Service Code	HCPCS 70150 TC
Min. Negotiated Rate	$113.12
Max. Negotiated Rate	$113.12
Rate for Payer: Cash Price	$41.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$113.12
Rate for Payer: SOMOS Essential	$113.12

CHG RADEX FINGR MINIMUM 2 VIEWS

Professional

Both

$164.08

Service Code	HCPCS 73140
Min. Negotiated Rate	$123.06
Max. Negotiated Rate	$123.06
Rate for Payer: Cash Price	$45.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$123.06
Rate for Payer: SOMOS Essential	$123.06

Know your out-of-pocket cost for care.

All Charges