St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

CHG RADIOLOGIC EXAMINATION FOOT 2 VIEWS

Professional

Both

$121.84

Service Code	HCPCS 73620
Min. Negotiated Rate	$91.38
Max. Negotiated Rate	$91.38
Rate for Payer: Cash Price	$33.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$91.38
Rate for Payer: SOMOS Essential	$91.38

CHG RADIOLOGIC EXAMINATION FOOT 2 VIEWS

Professional

Both

$91.88

Service Code	HCPCS 73620 TC
Min. Negotiated Rate	$68.91
Max. Negotiated Rate	$68.91
Rate for Payer: Cash Price	$25.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$68.91
Rate for Payer: SOMOS Essential	$68.91

CHG RADIOLOGIC EXAMINATION FOOT 2 VIEWS

Professional

Both

$29.96

Service Code	HCPCS 73620 26
Min. Negotiated Rate	$22.47
Max. Negotiated Rate	$22.47
Rate for Payer: Cash Price	$8.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22.47
Rate for Payer: SOMOS Essential	$22.47

CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS

Professional

Both

$114.87

Service Code	HCPCS 73560 TC
Min. Negotiated Rate	$86.15
Max. Negotiated Rate	$86.15
Rate for Payer: Cash Price	$31.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$86.15
Rate for Payer: SOMOS Essential	$86.15

CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS

Professional

Both

$32.83

Service Code	HCPCS 73560 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 KNEE 1/2 VIEWS

Professional

Both

$147.70

Service Code	HCPCS 73560
Min. Negotiated Rate	$110.78
Max. Negotiated Rate	$110.78
Rate for Payer: Cash Price	$40.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$110.78
Rate for Payer: SOMOS Essential	$110.78

CHG RADIOLOGIC EXAMINATION KNEE 3 VIEWS

Professional

Both

$36.79

Service Code	HCPCS 73562 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 RADIOLOGIC EXAMINATION KNEE 3 VIEWS

Professional

Both

$137.87

Service Code	HCPCS 73562 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 RADIOLOGIC EXAMINATION KNEE 3 VIEWS

Professional

Both

$174.65

Service Code	HCPCS 73562
Min. Negotiated Rate	$130.99
Max. Negotiated Rate	$130.99
Rate for Payer: Cash Price	$48.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$130.99
Rate for Payer: SOMOS Essential	$130.99

CHG RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS

Professional

Both

$130.69

Service Code	HCPCS 70100 TC
Min. Negotiated Rate	$98.02
Max. Negotiated Rate	$98.02
Rate for Payer: Cash Price	$35.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$98.02
Rate for Payer: SOMOS Essential	$98.02

CHG RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS

Professional

Both

$35.35

Service Code	HCPCS 70100 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 MANDIPLE PRTL <4 VIEWS

Professional

Both

$166.01

Service Code	HCPCS 70100
Min. Negotiated Rate	$124.51
Max. Negotiated Rate	$124.51
Rate for Payer: Cash Price	$45.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$124.51
Rate for Payer: SOMOS Essential	$124.51

CHG RADIOLOGIC EXAMINATION NECK SOFT TISSUE

Professional

Both

$135.84

Service Code	HCPCS 70360
Min. Negotiated Rate	$101.88
Max. Negotiated Rate	$101.88
Rate for Payer: Cash Price	$36.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$101.88
Rate for Payer: SOMOS Essential	$101.88

CHG RADIOLOGIC EXAMINATION NECK SOFT TISSUE

Professional

Both

$100.49

Service Code	HCPCS 70360 TC
Min. Negotiated Rate	$75.37
Max. Negotiated Rate	$75.37
Rate for Payer: Cash Price	$26.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$75.37
Rate for Payer: SOMOS Essential	$75.37

CHG RADIOLOGIC EXAMINATION NECK SOFT TISSUE

Professional

Both

$35.35

Service Code	HCPCS 70360 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 OSSEOUS SURVEY COMPL

Professional

Both

$320.29

Service Code	HCPCS 77075 TC
Min. Negotiated Rate	$240.22
Max. Negotiated Rate	$240.22
Rate for Payer: Cash Price	$87.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$240.22
Rate for Payer: SOMOS Essential	$240.22

CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL

Professional

Both

$108.57

Service Code	HCPCS 77075 26
Min. Negotiated Rate	$81.43
Max. Negotiated Rate	$81.43
Rate for Payer: Cash Price	$28.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$81.43
Rate for Payer: SOMOS Essential	$81.43

CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL

Professional

Both

$428.86

Service Code	HCPCS 77075
Min. Negotiated Rate	$321.64
Max. Negotiated Rate	$321.64
Rate for Payer: Cash Price	$116.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$321.64
Rate for Payer: SOMOS Essential	$321.64

CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT

Professional

Both

$136.01

Service Code	HCPCS 77076 26
Min. Negotiated Rate	$102.01
Max. Negotiated Rate	$102.01
Rate for Payer: Cash Price	$36.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$102.01
Rate for Payer: SOMOS Essential	$102.01

CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT

Professional

Both

$459.17

Service Code	HCPCS 77076
Min. Negotiated Rate	$344.38
Max. Negotiated Rate	$344.38
Rate for Payer: Cash Price	$124.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$344.38
Rate for Payer: SOMOS Essential	$344.38

CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT

Professional

Both

$323.16

Service Code	HCPCS 77076 TC
Min. Negotiated Rate	$242.37
Max. Negotiated Rate	$242.37
Rate for Payer: Cash Price	$88.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$242.37
Rate for Payer: SOMOS Essential	$242.37

CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED

Professional

Both

$83.58

Service Code	HCPCS 77074 26
Min. Negotiated Rate	$62.68
Max. Negotiated Rate	$62.68
Rate for Payer: Cash Price	$22.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$62.68
Rate for Payer: SOMOS Essential	$62.68

CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED

Professional

Both

$276.08

Service Code	HCPCS 77074
Min. Negotiated Rate	$207.06
Max. Negotiated Rate	$207.06
Rate for Payer: Cash Price	$75.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$207.06
Rate for Payer: SOMOS Essential	$207.06

CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED

Professional

Both

$192.50

Service Code	HCPCS 77074 TC
Min. Negotiated Rate	$144.38
Max. Negotiated Rate	$144.38
Rate for Payer: Cash Price	$52.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$144.38
Rate for Payer: SOMOS Essential	$144.38

Know your out-of-pocket cost for care.

All Charges