St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG RADEX SPINE THORACIC 3 VIEWS

Professional

Both

$43.05

Service Code	HCPCS 72072 26
Min. Negotiated Rate	$32.29
Max. Negotiated Rate	$32.29
Rate for Payer: Cash Price	$11.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32.29
Rate for Payer: SOMOS Essential	$32.29

CHG RADEX SPINE THORACIC 3 VIEWS

Professional

Both

$167.97

Service Code	HCPCS 72072
Min. Negotiated Rate	$125.98
Max. Negotiated Rate	$125.98
Rate for Payer: Cash Price	$46.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$125.98
Rate for Payer: SOMOS Essential	$125.98

CHG RADEX SPINE THORACIC 3 VIEWS

Professional

Both

$124.92

Service Code	HCPCS 72072 TC
Min. Negotiated Rate	$93.69
Max. Negotiated Rate	$93.69
Rate for Payer: Cash Price	$34.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$93.69
Rate for Payer: SOMOS Essential	$93.69

CHG RADEX SPINE THORACIC MINIMUM 4 VIEWS

Professional

Both

$189.18

Service Code	HCPCS 72074
Min. Negotiated Rate	$141.88
Max. Negotiated Rate	$141.88
Rate for Payer: Cash Price	$52.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$141.88
Rate for Payer: SOMOS Essential	$141.88

CHG RADEX SPINE THORACIC MINIMUM 4 VIEWS

Professional

Both

$142.17

Service Code	HCPCS 72074 TC
Min. Negotiated Rate	$106.63
Max. Negotiated Rate	$106.63
Rate for Payer: Cash Price	$39.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$106.63
Rate for Payer: SOMOS Essential	$106.63

CHG RADEX SPINE THORACIC MINIMUM 4 VIEWS

Professional

Both

$46.97

Service Code	HCPCS 72074 26
Min. Negotiated Rate	$35.23
Max. Negotiated Rate	$35.23
Rate for Payer: Cash Price	$12.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35.23
Rate for Payer: SOMOS Essential	$35.23

CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS

Professional

Both

$148.23

Service Code	HCPCS 72080
Min. Negotiated Rate	$111.17
Max. Negotiated Rate	$111.17
Rate for Payer: Cash Price	$40.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$111.17
Rate for Payer: SOMOS Essential	$111.17

CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS

Professional

Both

$107.66

Service Code	HCPCS 72080 TC
Min. Negotiated Rate	$80.74
Max. Negotiated Rate	$80.74
Rate for Payer: Cash Price	$29.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$80.74
Rate for Payer: SOMOS Essential	$80.74

CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS

Professional

Both

$40.53

Service Code	HCPCS 72080 26
Min. Negotiated Rate	$30.40
Max. Negotiated Rate	$30.40
Rate for Payer: Cash Price	$11.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30.40
Rate for Payer: SOMOS Essential	$30.40

CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS

Professional

Both

$135.00

Service Code	HCPCS 71130 TC
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$101.25
Rate for Payer: Cash Price	$36.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$101.25
Rate for Payer: SOMOS Essential	$101.25

CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS

Professional

Both

$176.79

Service Code	HCPCS 71130
Min. Negotiated Rate	$132.59
Max. Negotiated Rate	$132.59
Rate for Payer: Cash Price	$48.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$132.59
Rate for Payer: SOMOS Essential	$132.59

CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS

Professional

Both

$41.79

Service Code	HCPCS 71130 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 STERNUM MINIMUM 2 VIEWS

Professional

Both

$106.23

Service Code	HCPCS 71120 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 STERNUM MINIMUM 2 VIEWS

Professional

Both

$144.10

Service Code	HCPCS 71120
Min. Negotiated Rate	$108.08
Max. Negotiated Rate	$108.08
Rate for Payer: Cash Price	$39.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$108.08
Rate for Payer: SOMOS Essential	$108.08

CHG RADEX STERNUM MINIMUM 2 VIEWS

Professional

Both

$37.84

Service Code	HCPCS 71120 26
Min. Negotiated Rate	$28.38
Max. Negotiated Rate	$28.38
Rate for Payer: Cash Price	$10.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28.38
Rate for Payer: SOMOS Essential	$28.38

CHG RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT

Professional

Both

$45.75

Service Code	HCPCS 70330 26
Min. Negotiated Rate	$34.31
Max. Negotiated Rate	$34.31
Rate for Payer: Cash Price	$12.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34.31
Rate for Payer: SOMOS Essential	$34.31

CHG RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT

Professional

Both

$180.99

Service Code	HCPCS 70330 TC
Min. Negotiated Rate	$135.74
Max. Negotiated Rate	$135.74
Rate for Payer: Cash Price	$49.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$135.74
Rate for Payer: SOMOS Essential	$135.74

CHG RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT

Professional

Both

$226.73

Service Code	HCPCS 70330
Min. Negotiated Rate	$170.05
Max. Negotiated Rate	$170.05
Rate for Payer: Cash Price	$61.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$170.05
Rate for Payer: SOMOS Essential	$170.05

CHG RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT

Professional

Both

$113.44

Service Code	HCPCS 70328 TC
Min. Negotiated Rate	$85.08
Max. Negotiated Rate	$85.08
Rate for Payer: Cash Price	$30.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$85.08
Rate for Payer: SOMOS Essential	$85.08

CHG RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT

Professional

Both

$35.35

Service Code	HCPCS 70328 26
Min. Negotiated Rate	$26.51
Max. Negotiated Rate	$26.51
Rate for Payer: Cash Price	$9.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26.51
Rate for Payer: SOMOS Essential	$26.51

CHG RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT

Professional

Both

$148.75

Service Code	HCPCS 70328
Min. Negotiated Rate	$111.56
Max. Negotiated Rate	$111.56
Rate for Payer: Cash Price	$40.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$111.56
Rate for Payer: SOMOS Essential	$111.56

CHG RADEX TOE MINIMUM 2 VIEWS

Professional

Both

$26.22

Service Code	HCPCS 73660 26
Min. Negotiated Rate	$19.66
Max. Negotiated Rate	$19.66
Rate for Payer: Cash Price	$7.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19.66
Rate for Payer: SOMOS Essential	$19.66

CHG RADEX TOE MINIMUM 2 VIEWS

Professional

Both

$126.70

Service Code	HCPCS 73660
Min. Negotiated Rate	$95.02
Max. Negotiated Rate	$95.02
Rate for Payer: Cash Price	$34.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$95.02
Rate for Payer: SOMOS Essential	$95.02

CHG RADEX TOE MINIMUM 2 VIEWS

Professional

Both

$100.49

Service Code	HCPCS 73660 TC
Min. Negotiated Rate	$75.37
Max. Negotiated Rate	$75.37
Rate for Payer: Cash Price	$27.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$75.37
Rate for Payer: SOMOS Essential	$75.37

CHG RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS

Professional

Both

$104.79

Service Code	HCPCS 73092 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

Know your out-of-pocket cost for care.

All Charges