St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG RADEX SPINE 1 VIEW SPECIFY LEVEL

Professional

Both

$106.02

Service Code	HCPCS 72020
Min. Negotiated Rate	$79.52
Max. Negotiated Rate	$79.52
Rate for Payer: Cash Price	$28.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$79.52
Rate for Payer: SOMOS Essential	$79.52

CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS

Professional

Both

$43.23

Service Code	HCPCS 72040 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 SPINE CERVICAL 2 OR 3 VIEWS

Professional

Both

$169.58

Service Code	HCPCS 72040
Min. Negotiated Rate	$127.18
Max. Negotiated Rate	$127.18
Rate for Payer: Cash Price	$46.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$127.18
Rate for Payer: SOMOS Essential	$127.18

CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS

Professional

Both

$126.35

Service Code	HCPCS 72040 TC
Min. Negotiated Rate	$94.76
Max. Negotiated Rate	$94.76
Rate for Payer: Cash Price	$34.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$94.76
Rate for Payer: SOMOS Essential	$94.76

CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS

Professional

Both

$175.25

Service Code	HCPCS 72050 TC
Min. Negotiated Rate	$131.44
Max. Negotiated Rate	$131.44
Rate for Payer: Cash Price	$48.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$131.44
Rate for Payer: SOMOS Essential	$131.44

CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS

Professional

Both

$227.61

Service Code	HCPCS 72050
Min. Negotiated Rate	$170.71
Max. Negotiated Rate	$170.71
Rate for Payer: Cash Price	$62.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$170.71
Rate for Payer: SOMOS Essential	$170.71

CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS

Professional

Both

$52.36

Service Code	HCPCS 72050 26
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$39.27
Rate for Payer: Cash Price	$13.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39.27
Rate for Payer: SOMOS Essential	$39.27

CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS

Professional

Both

$267.16

Service Code	HCPCS 72052
Min. Negotiated Rate	$200.37
Max. Negotiated Rate	$200.37
Rate for Payer: Cash Price	$73.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$200.37
Rate for Payer: SOMOS Essential	$200.37

CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS

Professional

Both

$208.29

Service Code	HCPCS 72052 TC
Min. Negotiated Rate	$156.22
Max. Negotiated Rate	$156.22
Rate for Payer: Cash Price	$57.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$156.22
Rate for Payer: SOMOS Essential	$156.22

CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS

Professional

Both

$58.87

Service Code	HCPCS 72052 26
Min. Negotiated Rate	$44.15
Max. Negotiated Rate	$44.15
Rate for Payer: Cash Price	$16.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44.15
Rate for Payer: SOMOS Essential	$44.15

CHG RADEX SPINE LUMBOSACRAL 2/3 VIEWS

Professional

Both

$171.01

Service Code	HCPCS 72100
Min. Negotiated Rate	$128.26
Max. Negotiated Rate	$128.26
Rate for Payer: Cash Price	$46.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$128.26
Rate for Payer: SOMOS Essential	$128.26

CHG RADEX SPINE LUMBOSACRAL 2/3 VIEWS

Professional

Both

$127.79

Service Code	HCPCS 72100 TC
Min. Negotiated Rate	$95.84
Max. Negotiated Rate	$95.84
Rate for Payer: Cash Price	$34.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$95.84
Rate for Payer: SOMOS Essential	$95.84

CHG RADEX SPINE LUMBOSACRAL 2/3 VIEWS

Professional

Both

$43.23

Service Code	HCPCS 72100 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 SPINE LUMBOSACRAL MINIMUM 4 VIEWS

Professional

Both

$49.67

Service Code	HCPCS 72110 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 SPINE LUMBOSACRAL MINIMUM 4 VIEWS

Professional

Both

$169.47

Service Code	HCPCS 72110 TC
Min. Negotiated Rate	$127.10
Max. Negotiated Rate	$127.10
Rate for Payer: Cash Price	$46.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$127.10
Rate for Payer: SOMOS Essential	$127.10

CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS

Professional

Both

$219.17

Service Code	HCPCS 72110
Min. Negotiated Rate	$164.38
Max. Negotiated Rate	$164.38
Rate for Payer: Cash Price	$60.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$164.38
Rate for Payer: SOMOS Essential	$164.38

CHG RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS

Professional

Both

$130.69

Service Code	HCPCS 72120 TC
Min. Negotiated Rate	$98.02
Max. Negotiated Rate	$98.02
Rate for Payer: Cash Price	$35.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$98.02
Rate for Payer: SOMOS Essential	$98.02

CHG RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS

Professional

Both

$173.92

Service Code	HCPCS 72120
Min. Negotiated Rate	$130.44
Max. Negotiated Rate	$130.44
Rate for Payer: Cash Price	$47.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$130.44
Rate for Payer: SOMOS Essential	$130.44

CHG RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS

Professional

Both

$43.23

Service Code	HCPCS 72120 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 SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6

Professional

Both

$265.72

Service Code	HCPCS 72114
Min. Negotiated Rate	$199.29
Max. Negotiated Rate	$199.29
Rate for Payer: Cash Price	$71.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$199.29
Rate for Payer: SOMOS Essential	$199.29

CHG RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6

Professional

Both

$205.42

Service Code	HCPCS 72114 TC
Min. Negotiated Rate	$154.06
Max. Negotiated Rate	$154.06
Rate for Payer: Cash Price	$55.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$154.06
Rate for Payer: SOMOS Essential	$154.06

CHG RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6

Professional

Both

$60.31

Service Code	HCPCS 72114 26
Min. Negotiated Rate	$45.23
Max. Negotiated Rate	$45.23
Rate for Payer: Cash Price	$16.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$45.23
Rate for Payer: SOMOS Essential	$45.23

CHG RADEX SPINE THORACIC 2 VIEWS

Professional

Both

$101.92

Service Code	HCPCS 72070 TC
Min. Negotiated Rate	$76.44
Max. Negotiated Rate	$76.44
Rate for Payer: Cash Price	$27.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$76.44
Rate for Payer: SOMOS Essential	$76.44

CHG RADEX SPINE THORACIC 2 VIEWS

Professional

Both

$39.27

Service Code	HCPCS 72070 26
Min. Negotiated Rate	$29.45
Max. Negotiated Rate	$29.45
Rate for Payer: Cash Price	$10.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29.45
Rate for Payer: SOMOS Essential	$29.45

CHG RADEX SPINE THORACIC 2 VIEWS

Professional

Both

$141.23

Service Code	HCPCS 72070
Min. Negotiated Rate	$105.92
Max. Negotiated Rate	$105.92
Rate for Payer: Cash Price	$38.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$105.92
Rate for Payer: SOMOS Essential	$105.92

Know your out-of-pocket cost for care.

All Charges