St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS

Professional

Both

$172.38

Service Code	HCPCS 73522 TC
Min. Negotiated Rate	$129.28
Max. Negotiated Rate	$129.28
Rate for Payer: Cash Price	$47.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$129.28
Rate for Payer: SOMOS Essential	$129.28

CHG RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS

Professional

Both

$265.55

Service Code	HCPCS 73523
Min. Negotiated Rate	$199.16
Max. Negotiated Rate	$199.16
Rate for Payer: Cash Price	$72.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$199.16
Rate for Payer: SOMOS Essential	$199.16

CHG RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS

Professional

Both

$203.98

Service Code	HCPCS 73523 TC
Min. Negotiated Rate	$152.98
Max. Negotiated Rate	$152.98
Rate for Payer: Cash Price	$55.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$152.98
Rate for Payer: SOMOS Essential	$152.98

CHG RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS

Professional

Both

$61.57

Service Code	HCPCS 73523 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 HIP UNILATERAL WITH PELVIS 1 VIEW

Professional

Both

$104.79

Service Code	HCPCS 73501 TC
Min. Negotiated Rate	$78.59
Max. Negotiated Rate	$78.59
Rate for Payer: Cash Price	$28.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$78.59
Rate for Payer: SOMOS Essential	$78.59

CHG RADEX HIP UNILATERAL WITH PELVIS 1 VIEW

Professional

Both

$36.79

Service Code	HCPCS 73501 26
Min. Negotiated Rate	$27.59
Max. Negotiated Rate	$27.59
Rate for Payer: Cash Price	$10.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27.59
Rate for Payer: SOMOS Essential	$27.59

CHG RADEX HIP UNILATERAL WITH PELVIS 1 VIEW

Professional

Both

$141.58

Service Code	HCPCS 73501
Min. Negotiated Rate	$106.18
Max. Negotiated Rate	$106.18
Rate for Payer: Cash Price	$38.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$106.18
Rate for Payer: SOMOS Essential	$106.18

CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS

Professional

Both

$43.23

Service Code	HCPCS 73502 26
Min. Negotiated Rate	$32.42
Max. Negotiated Rate	$32.42
Rate for Payer: Cash Price	$11.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32.42
Rate for Payer: SOMOS Essential	$32.42

CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS

Professional

Both

$157.99

Service Code	HCPCS 73502 TC
Min. Negotiated Rate	$118.49
Max. Negotiated Rate	$118.49
Rate for Payer: Cash Price	$43.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$118.49
Rate for Payer: SOMOS Essential	$118.49

CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS

Professional

Both

$201.22

Service Code	HCPCS 73502
Min. Negotiated Rate	$150.92
Max. Negotiated Rate	$150.92
Rate for Payer: Cash Price	$55.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$150.92
Rate for Payer: SOMOS Essential	$150.92

CHG RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS

Professional

Both

$52.36

Service Code	HCPCS 73503 26
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$39.27
Rate for Payer: Cash Price	$14.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39.27
Rate for Payer: SOMOS Essential	$39.27

CHG RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS

Professional

Both

$253.47

Service Code	HCPCS 73503
Min. Negotiated Rate	$190.10
Max. Negotiated Rate	$190.10
Rate for Payer: Cash Price	$70.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$190.10
Rate for Payer: SOMOS Essential	$190.10

CHG RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS

Professional

Both

$201.11

Service Code	HCPCS 73503 TC
Min. Negotiated Rate	$150.83
Max. Negotiated Rate	$150.83
Rate for Payer: Cash Price	$55.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$150.83
Rate for Payer: SOMOS Essential	$150.83

CHG RADEX HUMERUS MINIMUM 2 VIEWS

Professional

Both

$139.09

Service Code	HCPCS 73060
Min. Negotiated Rate	$104.32
Max. Negotiated Rate	$104.32
Rate for Payer: Cash Price	$37.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$104.32
Rate for Payer: SOMOS Essential	$104.32

CHG RADEX HUMERUS MINIMUM 2 VIEWS

Professional

Both

$106.23

Service Code	HCPCS 73060 TC
Min. Negotiated Rate	$79.67
Max. Negotiated Rate	$79.67
Rate for Payer: Cash Price	$28.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$79.67
Rate for Payer: SOMOS Essential	$79.67

CHG RADEX HUMERUS MINIMUM 2 VIEWS

Professional

Both

$32.83

Service Code	HCPCS 73060 26
Min. Negotiated Rate	$24.62
Max. Negotiated Rate	$24.62
Rate for Payer: Cash Price	$8.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24.62
Rate for Payer: SOMOS Essential	$24.62

CHG RADEX INTERNAL AUDITORY MEATI COMPLETE

Professional

Both

$68.32

Service Code	HCPCS 70134 26
Min. Negotiated Rate	$51.24
Max. Negotiated Rate	$51.24
Rate for Payer: Cash Price	$18.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$51.24
Rate for Payer: SOMOS Essential	$51.24

CHG RADEX INTERNAL AUDITORY MEATI COMPLETE

Professional

Both

$193.94

Service Code	HCPCS 70134 TC
Min. Negotiated Rate	$145.46
Max. Negotiated Rate	$145.46
Rate for Payer: Cash Price	$53.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$145.46
Rate for Payer: SOMOS Essential	$145.46

CHG RADEX INTERNAL AUDITORY MEATI COMPLETE

Professional

Both

$262.26

Service Code	HCPCS 70134
Min. Negotiated Rate	$196.70
Max. Negotiated Rate	$196.70
Rate for Payer: Cash Price	$72.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$196.70
Rate for Payer: SOMOS Essential	$196.70

CHG RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS

Professional

Both

$31.40

Service Code	HCPCS 73592 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 LOWER EXTREMITY INFANT MINIMUM 2 VIEWS

Professional

Both

$104.79

Service Code	HCPCS 73592 TC
Min. Negotiated Rate	$78.59
Max. Negotiated Rate	$78.59
Rate for Payer: Cash Price	$28.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$78.59
Rate for Payer: SOMOS Essential	$78.59

CHG RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS

Professional

Both

$136.19

Service Code	HCPCS 73592
Min. Negotiated Rate	$102.14
Max. Negotiated Rate	$102.14
Rate for Payer: Cash Price	$37.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$102.14
Rate for Payer: SOMOS Essential	$102.14

CHG RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE

Professional

Both

$66.75

Service Code	HCPCS 70130 26
Min. Negotiated Rate	$50.06
Max. Negotiated Rate	$50.06
Rate for Payer: Cash Price	$17.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$50.06
Rate for Payer: SOMOS Essential	$50.06

CHG RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE

Professional

Both

$201.11

Service Code	HCPCS 70130 TC
Min. Negotiated Rate	$150.83
Max. Negotiated Rate	$150.83
Rate for Payer: Cash Price	$54.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$150.83
Rate for Payer: SOMOS Essential	$150.83

CHG RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE

Professional

Both

$267.86

Service Code	HCPCS 70130
Min. Negotiated Rate	$200.90
Max. Negotiated Rate	$200.90
Rate for Payer: Cash Price	$72.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$200.90
Rate for Payer: SOMOS Essential	$200.90

Know your out-of-pocket cost for care.

All Charges