St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG RADIOLOGIC EXAM COLON DOUBLE CONTRAST STUDY

Professional

Both

$955.82

Service Code	HCPCS 74280
Min. Negotiated Rate	$716.86
Max. Negotiated Rate	$716.86
Rate for Payer: Cash Price	$255.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$716.86
Rate for Payer: SOMOS Essential	$716.86

CHG RADIOLOGIC EXAM COLON DOUBLE CONTRAST STUDY

Professional

Both

$241.64

Service Code	HCPCS 74280 26
Min. Negotiated Rate	$181.23
Max. Negotiated Rate	$181.23
Rate for Payer: Cash Price	$65.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$181.23
Rate for Payer: SOMOS Essential	$181.23

CHG RADIOLOGIC EXAM COLON SINGLE CONTRAST STUDY

Professional

Both

$658.56

Service Code	HCPCS 74270
Min. Negotiated Rate	$493.92
Max. Negotiated Rate	$493.92
Rate for Payer: Cash Price	$177.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$493.92
Rate for Payer: SOMOS Essential	$493.92

CHG RADIOLOGIC EXAM COLON SINGLE CONTRAST STUDY

Professional

Both

$462.74

Service Code	HCPCS 74270 TC
Min. Negotiated Rate	$347.06
Max. Negotiated Rate	$347.06
Rate for Payer: Cash Price	$124.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$347.06
Rate for Payer: SOMOS Essential	$347.06

CHG RADIOLOGIC EXAM COLON SINGLE CONTRAST STUDY

Professional

Both

$195.83

Service Code	HCPCS 74270 26
Min. Negotiated Rate	$146.87
Max. Negotiated Rate	$146.87
Rate for Payer: Cash Price	$53.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$146.87
Rate for Payer: SOMOS Essential	$146.87

CHG RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES

Professional

Both

$150.82

Service Code	HCPCS 74022 TC
Min. Negotiated Rate	$113.12
Max. Negotiated Rate	$113.12
Rate for Payer: Cash Price	$41.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$113.12
Rate for Payer: SOMOS Essential	$113.12

CHG RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES

Professional

Both

$62.79

Service Code	HCPCS 74022 26
Min. Negotiated Rate	$47.09
Max. Negotiated Rate	$47.09
Rate for Payer: Cash Price	$16.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$47.09
Rate for Payer: SOMOS Essential	$47.09

CHG RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES

Professional

Both

$213.61

Service Code	HCPCS 74022
Min. Negotiated Rate	$160.21
Max. Negotiated Rate	$160.21
Rate for Payer: Cash Price	$58.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$160.21
Rate for Payer: SOMOS Essential	$160.21

CHG RADIOLOGIC EXAM ESOPHAGUS DOUBLE CONTRAST STUDY

Professional

Both

$134.54

Service Code	HCPCS 74221 26
Min. Negotiated Rate	$100.90
Max. Negotiated Rate	$100.90
Rate for Payer: Cash Price	$36.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$100.90
Rate for Payer: SOMOS Essential	$100.90

CHG RADIOLOGIC EXAM ESOPHAGUS DOUBLE CONTRAST STUDY

Professional

Both

$341.99

Service Code	HCPCS 74221 TC
Min. Negotiated Rate	$256.49
Max. Negotiated Rate	$256.49
Rate for Payer: Cash Price	$91.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$256.49
Rate for Payer: SOMOS Essential	$256.49

CHG RADIOLOGIC EXAM ESOPHAGUS DOUBLE CONTRAST STUDY

Professional

Both

$476.53

Service Code	HCPCS 74221
Min. Negotiated Rate	$357.40
Max. Negotiated Rate	$357.40
Rate for Payer: Cash Price	$127.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$357.40
Rate for Payer: SOMOS Essential	$357.40

CHG RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY

Professional

Both

$425.22

Service Code	HCPCS 74220
Min. Negotiated Rate	$318.92
Max. Negotiated Rate	$318.92
Rate for Payer: Cash Price	$113.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$318.92
Rate for Payer: SOMOS Essential	$318.92

CHG RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY

Professional

Both

$307.48

Service Code	HCPCS 74220 TC
Min. Negotiated Rate	$230.61
Max. Negotiated Rate	$230.61
Rate for Payer: Cash Price	$81.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$230.61
Rate for Payer: SOMOS Essential	$230.61

CHG RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY

Professional

Both

$117.71

Service Code	HCPCS 74220 26
Min. Negotiated Rate	$88.28
Max. Negotiated Rate	$88.28
Rate for Payer: Cash Price	$31.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$88.28
Rate for Payer: SOMOS Essential	$88.28

CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS

Professional

Both

$140.53

Service Code	HCPCS 73600
Min. Negotiated Rate	$105.40
Max. Negotiated Rate	$105.40
Rate for Payer: Cash Price	$37.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$105.40
Rate for Payer: SOMOS Essential	$105.40

CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS

Professional

Both

$107.66

Service Code	HCPCS 73600 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 RADIOLOGIC EXAMINATION ANKLE 2 VIEWS

Professional

Both

$32.83

Service Code	HCPCS 73600 26
Min. Negotiated Rate	$24.62
Max. Negotiated Rate	$24.62
Rate for Payer: Cash Price	$8.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24.62
Rate for Payer: SOMOS Essential	$24.62

CHG RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY

Professional

Both

$35.35

Service Code	HCPCS 70030 26
Min. Negotiated Rate	$26.51
Max. Negotiated Rate	$26.51
Rate for Payer: Cash Price	$9.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26.51
Rate for Payer: SOMOS Essential	$26.51

CHG RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY

Professional

Both

$104.79

Service Code	HCPCS 70030 TC
Min. Negotiated Rate	$78.59
Max. Negotiated Rate	$78.59
Rate for Payer: Cash Price	$28.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$78.59
Rate for Payer: SOMOS Essential	$78.59

CHG RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY

Professional

Both

$140.14

Service Code	HCPCS 70030
Min. Negotiated Rate	$105.10
Max. Negotiated Rate	$105.10
Rate for Payer: Cash Price	$38.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$105.10
Rate for Payer: SOMOS Essential	$105.10

CHG RADIOLOGIC EXAMINATION FEMUR 1 VIEW

Professional

Both

$126.14

Service Code	HCPCS 73551
Min. Negotiated Rate	$94.60
Max. Negotiated Rate	$94.60
Rate for Payer: Cash Price	$34.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$94.60
Rate for Payer: SOMOS Essential	$94.60

CHG RADIOLOGIC EXAMINATION FEMUR 1 VIEW

Professional

Both

$32.83

Service Code	HCPCS 73551 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 RADIOLOGIC EXAMINATION FEMUR 1 VIEW

Professional

Both

$93.31

Service Code	HCPCS 73551 TC
Min. Negotiated Rate	$69.98
Max. Negotiated Rate	$69.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$69.98
Rate for Payer: SOMOS Essential	$69.98

CHG RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS

Professional

Both

$35.35

Service Code	HCPCS 73552 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 RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS

Professional

Both

$117.74

Service Code	HCPCS 73552 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

Know your out-of-pocket cost for care.

All Charges