St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS

Professional

Both

$31.40

Service Code	HCPCS 73092 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 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

CHG RADEX WRIST 2 VIEWS

Professional

Both

$146.27

Service Code	HCPCS 73100
Min. Negotiated Rate	$109.70
Max. Negotiated Rate	$109.70
Rate for Payer: Cash Price	$39.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$109.70
Rate for Payer: SOMOS Essential	$109.70

CHG RADEX WRIST 2 VIEWS

Professional

Both

$113.44

Service Code	HCPCS 73100 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 WRIST 2 VIEWS

Professional

Both

$32.83

Service Code	HCPCS 73100 26
Min. Negotiated Rate	$24.62
Max. Negotiated Rate	$24.62
Rate for Payer: Cash Price	$8.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24.62
Rate for Payer: SOMOS Essential	$24.62

CHG RADEX WRIST ARTHROGRAPHY RS&I

Professional

Both

$471.35

Service Code	HCPCS 73115 TC
Min. Negotiated Rate	$353.51
Max. Negotiated Rate	$353.51
Rate for Payer: Cash Price	$127.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$353.51
Rate for Payer: SOMOS Essential	$353.51

CHG RADEX WRIST ARTHROGRAPHY RS&I

Professional

Both

$583.00

Service Code	HCPCS 73115
Min. Negotiated Rate	$437.25
Max. Negotiated Rate	$437.25
Rate for Payer: Cash Price	$157.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$437.25
Rate for Payer: SOMOS Essential	$437.25

CHG RADEX WRIST ARTHROGRAPHY RS&I

Professional

Both

$111.65

Service Code	HCPCS 73115 26
Min. Negotiated Rate	$83.74
Max. Negotiated Rate	$83.74
Rate for Payer: Cash Price	$29.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$83.74
Rate for Payer: SOMOS Essential	$83.74

CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS

Professional

Both

$142.17

Service Code	HCPCS 73110 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 WRIST COMPLETE MINIMUM 3 VIEWS

Professional

Both

$176.26

Service Code	HCPCS 73110
Min. Negotiated Rate	$132.20
Max. Negotiated Rate	$132.20
Rate for Payer: Cash Price	$48.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$132.20
Rate for Payer: SOMOS Essential	$132.20

CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS

Professional

Both

$34.09

Service Code	HCPCS 73110 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 RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT

Professional

Both

$4,834.10

Service Code	HCPCS 77371
Min. Negotiated Rate	$3,625.58
Max. Negotiated Rate	$3,625.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,625.58
Rate for Payer: SOMOS Essential	$3,625.58

CHG RADIATION DELIVERY STEREOTACTIC CRANIAL LINEAR

Professional

Both

$4,184.78

Service Code	HCPCS 77372
Min. Negotiated Rate	$3,138.58
Max. Negotiated Rate	$3,138.58
Rate for Payer: Cash Price	$1,128.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,138.58
Rate for Payer: SOMOS Essential	$3,138.58

CHG RADIATION THERAPY MGMT 1/2 FRACTIONS ONLY

Professional

Both

$443.24

Service Code	HCPCS 77431
Min. Negotiated Rate	$332.43
Max. Negotiated Rate	$332.43
Rate for Payer: Cash Price	$122.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$332.43
Rate for Payer: SOMOS Essential	$332.43

CHG RADIATION TREATMENT MANAGEMENT 5 TREATMENTS

Professional

Both

$789.36

Service Code	HCPCS 77427
Min. Negotiated Rate	$592.02
Max. Negotiated Rate	$592.02
Rate for Payer: Cash Price	$215.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$592.02
Rate for Payer: SOMOS Essential	$592.02

CHG RADIATION TX DELIVERY SUPERFICIAL&/ORTHO VOLTA

Professional

Both

$178.12

Service Code	HCPCS 77401
Min. Negotiated Rate	$133.59
Max. Negotiated Rate	$133.59
Rate for Payer: Cash Price	$49.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$133.59
Rate for Payer: SOMOS Essential	$133.59

CHG RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS

Professional

Both

$184.84

Service Code	HCPCS 70110
Min. Negotiated Rate	$138.63
Max. Negotiated Rate	$138.63
Rate for Payer: Cash Price	$50.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$138.63
Rate for Payer: SOMOS Essential	$138.63

CHG RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS

Professional

Both

$46.97

Service Code	HCPCS 70110 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 RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS

Professional

Both

$137.87

Service Code	HCPCS 70110 TC
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$103.40
Rate for Payer: Cash Price	$37.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$103.40
Rate for Payer: SOMOS Essential	$103.40

CHG RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN

Professional

Both

$61.57

Service Code	HCPCS 76098 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 RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN

Professional

Both

$179.27

Service Code	HCPCS 76098
Min. Negotiated Rate	$134.45
Max. Negotiated Rate	$134.45
Rate for Payer: Cash Price	$49.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$134.45
Rate for Payer: SOMOS Essential	$134.45

CHG RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN

Professional

Both

$117.74

Service Code	HCPCS 76098 TC
Min. Negotiated Rate	$88.30
Max. Negotiated Rate	$88.30
Rate for Payer: Cash Price	$32.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$88.30
Rate for Payer: SOMOS Essential	$88.30

CHG RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I

Professional

Both

$224.11

Service Code	HCPCS 75989 26
Min. Negotiated Rate	$168.08
Max. Negotiated Rate	$168.08
Rate for Payer: Cash Price	$60.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$168.08
Rate for Payer: SOMOS Essential	$168.08

CHG RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I

Professional

Both

$475.55

Service Code	HCPCS 75989
Min. Negotiated Rate	$356.66
Max. Negotiated Rate	$356.66
Rate for Payer: Cash Price	$128.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$356.66
Rate for Payer: SOMOS Essential	$356.66

CHG RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I

Professional

Both

$251.44

Service Code	HCPCS 75989 TC
Min. Negotiated Rate	$188.58
Max. Negotiated Rate	$188.58
Rate for Payer: Cash Price	$67.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$188.58
Rate for Payer: SOMOS Essential	$188.58

Know your out-of-pocket cost for care.

All Charges