St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS

Professional

Both

$34.09

Service Code	HCPCS 72170 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 RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS

Professional

Both

$86.10

Service Code	HCPCS 72170 TC
Min. Negotiated Rate	$64.58
Max. Negotiated Rate	$64.58
Rate for Payer: Cash Price	$23.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$64.58
Rate for Payer: SOMOS Essential	$64.58

CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS

Professional

Both

$120.19

Service Code	HCPCS 72170
Min. Negotiated Rate	$90.14
Max. Negotiated Rate	$90.14
Rate for Payer: Cash Price	$32.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$90.14
Rate for Payer: SOMOS Essential	$90.14

CHG RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS

Professional

Both

$32.66

Service Code	HCPCS 72200 26
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$24.50
Rate for Payer: Cash Price	$8.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24.50
Rate for Payer: SOMOS Essential	$24.50

CHG RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS

Professional

Both

$109.10

Service Code	HCPCS 72200 TC
Min. Negotiated Rate	$81.82
Max. Negotiated Rate	$81.82
Rate for Payer: Cash Price	$30.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$81.82
Rate for Payer: SOMOS Essential	$81.82

CHG RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS

Professional

Both

$141.75

Service Code	HCPCS 72200
Min. Negotiated Rate	$106.31
Max. Negotiated Rate	$106.31
Rate for Payer: Cash Price	$39.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$106.31
Rate for Payer: SOMOS Essential	$106.31

CHG RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS

Professional

Both

$129.22

Service Code	HCPCS 70380 TC
Min. Negotiated Rate	$96.92
Max. Negotiated Rate	$96.92
Rate for Payer: Cash Price	$35.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$96.92
Rate for Payer: SOMOS Essential	$96.92

CHG RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS

Professional

Both

$161.88

Service Code	HCPCS 70380
Min. Negotiated Rate	$121.41
Max. Negotiated Rate	$121.41
Rate for Payer: Cash Price	$44.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$121.41
Rate for Payer: SOMOS Essential	$121.41

CHG RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS

Professional

Both

$32.66

Service Code	HCPCS 70380 26
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$24.50
Rate for Payer: Cash Price	$8.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24.50
Rate for Payer: SOMOS Essential	$24.50

CHG RADIOLOGIC EXAMINATION SELLA TURCICA

Professional

Both

$104.79

Service Code	HCPCS 70240 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 RADIOLOGIC EXAMINATION SELLA TURCICA

Professional

Both

$141.40

Service Code	HCPCS 70240
Min. Negotiated Rate	$106.05
Max. Negotiated Rate	$106.05
Rate for Payer: Cash Price	$38.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$106.05
Rate for Payer: SOMOS Essential	$106.05

CHG RADIOLOGIC EXAMINATION SELLA TURCICA

Professional

Both

$36.61

Service Code	HCPCS 70240 26
Min. Negotiated Rate	$27.46
Max. Negotiated Rate	$27.46
Rate for Payer: Cash Price	$10.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27.46
Rate for Payer: SOMOS Essential	$27.46

CHG RADIOLOGIC EXAMINATION SKULL 4< VIEWS

Professional

Both

$154.53

Service Code	HCPCS 70250
Min. Negotiated Rate	$115.90
Max. Negotiated Rate	$115.90
Rate for Payer: Cash Price	$42.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$115.90
Rate for Payer: SOMOS Essential	$115.90

CHG RADIOLOGIC EXAMINATION SKULL 4< VIEWS

Professional

Both

$35.35

Service Code	HCPCS 70250 26
Min. Negotiated Rate	$26.51
Max. Negotiated Rate	$26.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26.51
Rate for Payer: SOMOS Essential	$26.51

CHG RADIOLOGIC EXAMINATION SKULL 4< VIEWS

Professional

Both

$119.18

Service Code	HCPCS 70250 TC
Min. Negotiated Rate	$89.38
Max. Negotiated Rate	$89.38
Rate for Payer: Cash Price	$32.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$89.38
Rate for Payer: SOMOS Essential	$89.38

CHG RADIOLOGIC EXAMINATION TEETH 1 VIEW

Professional

Both

$35.81

Service Code	HCPCS 70300 TC
Min. Negotiated Rate	$26.86
Max. Negotiated Rate	$26.86
Rate for Payer: Cash Price	$9.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26.86
Rate for Payer: SOMOS Essential	$26.86

CHG RADIOLOGIC EXAMINATION TEETH 1 VIEW

Professional

Both

$21.00

Service Code	HCPCS 70300 26
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Cash Price	$5.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15.75
Rate for Payer: SOMOS Essential	$15.75

CHG RADIOLOGIC EXAMINATION TEETH 1 VIEW

Professional

Both

$56.81

Service Code	HCPCS 70300
Min. Negotiated Rate	$42.61
Max. Negotiated Rate	$42.61
Rate for Payer: Cash Price	$15.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$42.61
Rate for Payer: SOMOS Essential	$42.61

CHG RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS

Professional

Both

$31.40

Service Code	HCPCS 73590 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 RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS

Professional

Both

$136.19

Service Code	HCPCS 73590
Min. Negotiated Rate	$102.14
Max. Negotiated Rate	$102.14
Rate for Payer: Cash Price	$37.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$102.14
Rate for Payer: SOMOS Essential	$102.14

CHG RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS

Professional

Both

$104.79

Service Code	HCPCS 73590 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 RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I

Professional

Both

$423.92

Service Code	HCPCS 73580 TC
Min. Negotiated Rate	$317.94
Max. Negotiated Rate	$317.94
Rate for Payer: Cash Price	$94.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$317.94
Rate for Payer: SOMOS Essential	$317.94

CHG RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I

Professional

Both

$126.25

Service Code	HCPCS 73580 26
Min. Negotiated Rate	$94.69
Max. Negotiated Rate	$94.69
Rate for Payer: Cash Price	$34.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$94.69
Rate for Payer: SOMOS Essential	$94.69

CHG RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I

Professional

Both

$550.17

Service Code	HCPCS 73580
Min. Negotiated Rate	$412.63
Max. Negotiated Rate	$412.63
Rate for Payer: Cash Price	$129.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$412.63
Rate for Payer: SOMOS Essential	$412.63

CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS

Professional

Both

$44.66

Service Code	HCPCS 73564 26
Min. Negotiated Rate	$33.50
Max. Negotiated Rate	$33.50
Rate for Payer: Cash Price	$12.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33.50
Rate for Payer: SOMOS Essential	$33.50

Know your out-of-pocket cost for care.

All Charges