St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS

Professional

Both

$130.69

Service Code	HCPCS 70160 TC
Min. Negotiated Rate	$98.02
Max. Negotiated Rate	$98.02
Rate for Payer: Cash Price	$35.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$98.02
Rate for Payer: SOMOS Essential	$98.02

CHG RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS

Professional

Both

$34.09

Service Code	HCPCS 70160 26
Min. Negotiated Rate	$25.57
Max. Negotiated Rate	$25.57
Rate for Payer: Cash Price	$8.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25.57
Rate for Payer: SOMOS Essential	$25.57

CHG RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS

Professional

Both

$164.78

Service Code	HCPCS 70160
Min. Negotiated Rate	$123.58
Max. Negotiated Rate	$123.58
Rate for Payer: Cash Price	$44.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$123.58
Rate for Payer: SOMOS Essential	$123.58

CHG RADEX OPTIC FORAMINA

Professional

Both

$161.14

Service Code	HCPCS 70190
Min. Negotiated Rate	$120.86
Max. Negotiated Rate	$120.86
Rate for Payer: Cash Price	$43.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$120.86
Rate for Payer: SOMOS Essential	$120.86

CHG RADEX OPTIC FORAMINA

Professional

Both

$117.74

Service Code	HCPCS 70190 TC
Min. Negotiated Rate	$88.30
Max. Negotiated Rate	$88.30
Rate for Payer: Cash Price	$32.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$88.30
Rate for Payer: SOMOS Essential	$88.30

CHG RADEX OPTIC FORAMINA

Professional

Both

$43.40

Service Code	HCPCS 70190 26
Min. Negotiated Rate	$32.55
Max. Negotiated Rate	$32.55
Rate for Payer: Cash Price	$11.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32.55
Rate for Payer: SOMOS Essential	$32.55

CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS

Professional

Both

$150.82

Service Code	HCPCS 70200 TC
Min. Negotiated Rate	$113.12
Max. Negotiated Rate	$113.12
Rate for Payer: Cash Price	$41.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$113.12
Rate for Payer: SOMOS Essential	$113.12

CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS

Professional

Both

$204.40

Service Code	HCPCS 70200
Min. Negotiated Rate	$153.30
Max. Negotiated Rate	$153.30
Rate for Payer: Cash Price	$55.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$153.30
Rate for Payer: SOMOS Essential	$153.30

CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS

Professional

Both

$53.62

Service Code	HCPCS 70200 26
Min. Negotiated Rate	$40.22
Max. Negotiated Rate	$40.22
Rate for Payer: Cash Price	$14.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$40.22
Rate for Payer: SOMOS Essential	$40.22

CHG RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ

Professional

Both

$369.29

Service Code	HCPCS 70370 TC
Min. Negotiated Rate	$276.97
Max. Negotiated Rate	$276.97
Rate for Payer: Cash Price	$106.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$276.97
Rate for Payer: SOMOS Essential	$276.97

CHG RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ

Professional

Both

$429.24

Service Code	HCPCS 70370
Min. Negotiated Rate	$321.93
Max. Negotiated Rate	$321.93
Rate for Payer: Cash Price	$123.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$321.93
Rate for Payer: SOMOS Essential	$321.93

CHG RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ

Professional

Both

$59.92

Service Code	HCPCS 70370 26
Min. Negotiated Rate	$44.94
Max. Negotiated Rate	$44.94
Rate for Payer: Cash Price	$16.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44.94
Rate for Payer: SOMOS Essential	$44.94

CHG RADEX RENAL CYST STUDY TRANSLUMBAR RS&I

Professional

Both

$356.09

Service Code	HCPCS 74470
Min. Negotiated Rate	$267.07
Max. Negotiated Rate	$267.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$267.07
Rate for Payer: SOMOS Essential	$267.07

CHG RADEX RENAL CYST STUDY TRANSLUMBAR RS&I

Professional

Both

$253.09

Service Code	HCPCS 74470 TC
Min. Negotiated Rate	$189.82
Max. Negotiated Rate	$189.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$189.82
Rate for Payer: SOMOS Essential	$189.82

CHG RADEX RENAL CYST STUDY TRANSLUMBAR RS&I

Professional

Both

$103.01

Service Code	HCPCS 74470 26
Min. Negotiated Rate	$77.26
Max. Negotiated Rate	$77.26
Rate for Payer: Cash Price	$27.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$77.26
Rate for Payer: SOMOS Essential	$77.26

CHG RADEX RIBS BILATERAL 3 VIEWS

Professional

Both

$54.88

Service Code	HCPCS 71110 26
Min. Negotiated Rate	$41.16
Max. Negotiated Rate	$41.16
Rate for Payer: Cash Price	$15.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41.16
Rate for Payer: SOMOS Essential	$41.16

CHG RADEX RIBS BILATERAL 3 VIEWS

Professional

Both

$186.97

Service Code	HCPCS 71110
Min. Negotiated Rate	$140.23
Max. Negotiated Rate	$140.23
Rate for Payer: Cash Price	$51.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$140.23
Rate for Payer: SOMOS Essential	$140.23

CHG RADEX RIBS BILATERAL 3 VIEWS

Professional

Both

$132.13

Service Code	HCPCS 71110 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 RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS

Professional

Both

$62.79

Service Code	HCPCS 71111 26
Min. Negotiated Rate	$47.09
Max. Negotiated Rate	$47.09
Rate for Payer: Cash Price	$17.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$47.09
Rate for Payer: SOMOS Essential	$47.09

CHG RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS

Professional

Both

$162.30

Service Code	HCPCS 71111 TC
Min. Negotiated Rate	$121.72
Max. Negotiated Rate	$121.72
Rate for Payer: Cash Price	$44.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$121.72
Rate for Payer: SOMOS Essential	$121.72

CHG RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS

Professional

Both

$225.09

Service Code	HCPCS 71111
Min. Negotiated Rate	$168.82
Max. Negotiated Rate	$168.82
Rate for Payer: Cash Price	$61.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$168.82
Rate for Payer: SOMOS Essential	$168.82

CHG RADEX RIBS UNILATERAL 2 VIEWS

Professional

Both

$43.23

Service Code	HCPCS 71100 26
Min. Negotiated Rate	$32.42
Max. Negotiated Rate	$32.42
Rate for Payer: Cash Price	$11.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32.42
Rate for Payer: SOMOS Essential	$32.42

CHG RADEX RIBS UNILATERAL 2 VIEWS

Professional

Both

$114.87

Service Code	HCPCS 71100 TC
Min. Negotiated Rate	$86.15
Max. Negotiated Rate	$86.15
Rate for Payer: Cash Price	$31.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$86.15
Rate for Payer: SOMOS Essential	$86.15

CHG RADEX RIBS UNILATERAL 2 VIEWS

Professional

Both

$158.10

Service Code	HCPCS 71100
Min. Negotiated Rate	$118.58
Max. Negotiated Rate	$118.58
Rate for Payer: Cash Price	$42.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$118.58
Rate for Payer: SOMOS Essential	$118.58

CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS

Professional

Both

$50.93

Service Code	HCPCS 71101 26
Min. Negotiated Rate	$38.20
Max. Negotiated Rate	$38.20
Rate for Payer: Cash Price	$13.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38.20
Rate for Payer: SOMOS Essential	$38.20

Know your out-of-pocket cost for care.

All Charges