St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS

Professional

Both

$129.22

Service Code	HCPCS 71101 TC
Min. Negotiated Rate	$96.92
Max. Negotiated Rate	$96.92
Rate for Payer: Cash Price	$35.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$96.92
Rate for Payer: SOMOS Essential	$96.92

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

CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS

Professional

Both

$140.32

Service Code	HCPCS 72220
Min. Negotiated Rate	$105.24
Max. Negotiated Rate	$105.24
Rate for Payer: Cash Price	$38.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$105.24
Rate for Payer: SOMOS Essential	$105.24

CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS

Professional

Both

$106.23

Service Code	HCPCS 72220 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 SACRUM & COCCYX MINIMUM 2 VIEWS

Professional

Both

$34.09

Service Code	HCPCS 72220 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 SCAPULA COMPLETE

Professional

Both

$65.98

Service Code	HCPCS 73010 TC
Min. Negotiated Rate	$49.48
Max. Negotiated Rate	$49.48
Rate for Payer: Cash Price	$18.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$49.48
Rate for Payer: SOMOS Essential	$49.48

CHG RADEX SCAPULA COMPLETE

Professional

Both

$35.53

Service Code	HCPCS 73010 26
Min. Negotiated Rate	$26.65
Max. Negotiated Rate	$26.65
Rate for Payer: Cash Price	$9.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26.65
Rate for Payer: SOMOS Essential	$26.65

CHG RADEX SCAPULA COMPLETE

Professional

Both

$101.50

Service Code	HCPCS 73010
Min. Negotiated Rate	$76.12
Max. Negotiated Rate	$76.12
Rate for Payer: Cash Price	$28.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$76.12
Rate for Payer: SOMOS Essential	$76.12

CHG RADEX SHOULDER 1 VIEW

Professional

Both

$63.11

Service Code	HCPCS 73020 TC
Min. Negotiated Rate	$47.33
Max. Negotiated Rate	$47.33
Rate for Payer: Cash Price	$17.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$47.33
Rate for Payer: SOMOS Essential	$47.33

CHG RADEX SHOULDER 1 VIEW

Professional

Both

$93.28

Service Code	HCPCS 73020
Min. Negotiated Rate	$69.96
Max. Negotiated Rate	$69.96
Rate for Payer: Cash Price	$25.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$69.96
Rate for Payer: SOMOS Essential	$69.96

CHG RADEX SHOULDER 1 VIEW

Professional

Both

$30.14

Service Code	HCPCS 73020 26
Min. Negotiated Rate	$22.60
Max. Negotiated Rate	$22.60
Rate for Payer: Cash Price	$8.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22.60
Rate for Payer: SOMOS Essential	$22.60

CHG RADEX SHOULDER ARTHROGRAPHY RS&I

Professional

Both

$110.22

Service Code	HCPCS 73040 26
Min. Negotiated Rate	$82.66
Max. Negotiated Rate	$82.66
Rate for Payer: Cash Price	$29.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$82.66
Rate for Payer: SOMOS Essential	$82.66

CHG RADEX SHOULDER ARTHROGRAPHY RS&I

Professional

Both

$455.56

Service Code	HCPCS 73040 TC
Min. Negotiated Rate	$341.67
Max. Negotiated Rate	$341.67
Rate for Payer: Cash Price	$124.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$341.67
Rate for Payer: SOMOS Essential	$341.67

CHG RADEX SHOULDER ARTHROGRAPHY RS&I

Professional

Both

$565.74

Service Code	HCPCS 73040
Min. Negotiated Rate	$424.30
Max. Negotiated Rate	$424.30
Rate for Payer: Cash Price	$153.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$424.30
Rate for Payer: SOMOS Essential	$424.30

CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS

Professional

Both

$36.79

Service Code	HCPCS 73030 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 SHOULDER COMPLETE MINIMUM 2 VIEWS

Professional

Both

$148.75

Service Code	HCPCS 73030
Min. Negotiated Rate	$111.56
Max. Negotiated Rate	$111.56
Rate for Payer: Cash Price	$40.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$111.56
Rate for Payer: SOMOS Essential	$111.56

CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS

Professional

Both

$112.00

Service Code	HCPCS 73030 TC
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$84.00
Rate for Payer: Cash Price	$30.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$84.00
Rate for Payer: SOMOS Essential	$84.00

CHG RADEX SINUSES PARANASAL <3 VIEWS

Professional

Both

$104.79

Service Code	HCPCS 70210 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 SINUSES PARANASAL <3 VIEWS

Professional

Both

$138.88

Service Code	HCPCS 70210
Min. Negotiated Rate	$104.16
Max. Negotiated Rate	$104.16
Rate for Payer: Cash Price	$37.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$104.16
Rate for Payer: SOMOS Essential	$104.16

CHG RADEX SINUSES PARANASAL <3 VIEWS

Professional

Both

$34.09

Service Code	HCPCS 70210 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 SINUSES PARANASAL COMPL MINIMUM 3 VIEWS

Professional

Both

$160.97

Service Code	HCPCS 70220
Min. Negotiated Rate	$120.73
Max. Negotiated Rate	$120.73
Rate for Payer: Cash Price	$43.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$120.73
Rate for Payer: SOMOS Essential	$120.73

CHG RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS

Professional

Both

$119.18

Service Code	HCPCS 70220 TC
Min. Negotiated Rate	$89.38
Max. Negotiated Rate	$89.38
Rate for Payer: Cash Price	$32.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$89.38
Rate for Payer: SOMOS Essential	$89.38

CHG RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS

Professional

Both

$41.79

Service Code	HCPCS 70220 26
Min. Negotiated Rate	$31.34
Max. Negotiated Rate	$31.34
Rate for Payer: Cash Price	$11.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31.34
Rate for Payer: SOMOS Essential	$31.34

CHG RADEX SPINE 1 VIEW SPECIFY LEVEL

Professional

Both

$74.62

Service Code	HCPCS 72020 TC
Min. Negotiated Rate	$55.96
Max. Negotiated Rate	$55.96
Rate for Payer: Cash Price	$19.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$55.96
Rate for Payer: SOMOS Essential	$55.96

CHG RADEX SPINE 1 VIEW SPECIFY LEVEL

Professional

Both

$31.40

Service Code	HCPCS 72020 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

Know your out-of-pocket cost for care.

All Charges