St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS

Professional

Both

$199.78

Service Code	HCPCS 73564
Min. Negotiated Rate	$149.84
Max. Negotiated Rate	$149.84
Rate for Payer: Cash Price	$55.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$149.84
Rate for Payer: SOMOS Essential	$149.84

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

CHG RADIOLOGIC EXAM MASTOIDS < 3 VIEWS PER SIDE

Professional

Both

$166.01

Service Code	HCPCS 70120
Min. Negotiated Rate	$124.51
Max. Negotiated Rate	$124.51
Rate for Payer: Cash Price	$44.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$124.51
Rate for Payer: SOMOS Essential	$124.51

CHG RADIOLOGIC EXAM MASTOIDS < 3 VIEWS PER SIDE

Professional

Both

$130.69

Service Code	HCPCS 70120 TC
Min. Negotiated Rate	$98.02
Max. Negotiated Rate	$98.02
Rate for Payer: Cash Price	$35.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$98.02
Rate for Payer: SOMOS Essential	$98.02

CHG RADIOLOGIC EXAM MASTOIDS < 3 VIEWS PER SIDE

Professional

Both

$35.35

Service Code	HCPCS 70120 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 EXAM PELVIS COMPL MINIMUM 3 VIEWS

Professional

Both

$48.44

Service Code	HCPCS 72190 26
Min. Negotiated Rate	$36.33
Max. Negotiated Rate	$36.33
Rate for Payer: Cash Price	$13.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36.33
Rate for Payer: SOMOS Essential	$36.33

CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS

Professional

Both

$180.53

Service Code	HCPCS 72190
Min. Negotiated Rate	$135.40
Max. Negotiated Rate	$135.40
Rate for Payer: Cash Price	$49.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$135.40
Rate for Payer: SOMOS Essential	$135.40

CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS

Professional

Both

$132.13

Service Code	HCPCS 72190 TC
Min. Negotiated Rate	$99.10
Max. Negotiated Rate	$99.10
Rate for Payer: Cash Price	$35.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$99.10
Rate for Payer: SOMOS Essential	$99.10

CHG RADIOLOGIC EXAM PHRNX&/CRV ESOPH CONTRAST STUDY

Professional

Both

$300.30

Service Code	HCPCS 74210 TC
Min. Negotiated Rate	$225.22
Max. Negotiated Rate	$225.22
Rate for Payer: Cash Price	$79.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$225.22
Rate for Payer: SOMOS Essential	$225.22

CHG RADIOLOGIC EXAM PHRNX&/CRV ESOPH CONTRAST STUDY

Professional

Both

$415.31

Service Code	HCPCS 74210
Min. Negotiated Rate	$311.48
Max. Negotiated Rate	$311.48
Rate for Payer: Cash Price	$109.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$311.48
Rate for Payer: SOMOS Essential	$311.48

CHG RADIOLOGIC EXAM PHRNX&/CRV ESOPH CONTRAST STUDY

Professional

Both

$115.05

Service Code	HCPCS 74210 26
Min. Negotiated Rate	$86.29
Max. Negotiated Rate	$86.29
Rate for Payer: Cash Price	$30.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$86.29
Rate for Payer: SOMOS Essential	$86.29

CHG RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS

Professional

Both

$167.97

Service Code	HCPCS 72202
Min. Negotiated Rate	$125.98
Max. Negotiated Rate	$125.98
Rate for Payer: Cash Price	$45.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$125.98
Rate for Payer: SOMOS Essential	$125.98

CHG RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS

Professional

Both

$43.05

Service Code	HCPCS 72202 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 RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS

Professional

Both

$124.92

Service Code	HCPCS 72202 TC
Min. Negotiated Rate	$93.69
Max. Negotiated Rate	$93.69
Rate for Payer: Cash Price	$34.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$93.69
Rate for Payer: SOMOS Essential	$93.69

CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS

Professional

Both

$136.43

Service Code	HCPCS 70260 TC
Min. Negotiated Rate	$102.32
Max. Negotiated Rate	$102.32
Rate for Payer: Cash Price	$37.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$102.32
Rate for Payer: SOMOS Essential	$102.32

CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS

Professional

Both

$190.05

Service Code	HCPCS 70260
Min. Negotiated Rate	$142.54
Max. Negotiated Rate	$142.54
Rate for Payer: Cash Price	$51.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$142.54
Rate for Payer: SOMOS Essential	$142.54

CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS

Professional

Both

$53.62

Service Code	HCPCS 70260 26
Min. Negotiated Rate	$40.22
Max. Negotiated Rate	$40.22
Rate for Payer: Cash Price	$14.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$40.22
Rate for Payer: SOMOS Essential	$40.22

CHG RADIOLOGIC EXAM SMALL INT DOUBLE CONTRAST STUDY

Professional

Both

$992.25

Service Code	HCPCS 74251
Min. Negotiated Rate	$744.19
Max. Negotiated Rate	$744.19
Rate for Payer: Cash Price	$423.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$744.19
Rate for Payer: SOMOS Essential	$744.19

CHG RADIOLOGIC EXAM SMALL INT DOUBLE CONTRAST STUDY

Professional

Both

$767.48

Service Code	HCPCS 74251 TC
Min. Negotiated Rate	$575.61
Max. Negotiated Rate	$575.61
Rate for Payer: Cash Price	$362.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$575.61
Rate for Payer: SOMOS Essential	$575.61

CHG RADIOLOGIC EXAM SMALL INT DOUBLE CONTRAST STUDY

Professional

Both

$224.77

Service Code	HCPCS 74251 26
Min. Negotiated Rate	$168.58
Max. Negotiated Rate	$168.58
Rate for Payer: Cash Price	$60.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$168.58
Rate for Payer: SOMOS Essential	$168.58

CHG RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST STUDY

Professional

Both

$154.07

Service Code	HCPCS 74250 26
Min. Negotiated Rate	$115.55
Max. Negotiated Rate	$115.55
Rate for Payer: Cash Price	$41.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$115.55
Rate for Payer: SOMOS Essential	$115.55

CHG RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST STUDY

Professional

Both

$372.16

Service Code	HCPCS 74250 TC
Min. Negotiated Rate	$279.12
Max. Negotiated Rate	$279.12
Rate for Payer: Cash Price	$99.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$279.12
Rate for Payer: SOMOS Essential	$279.12

CHG RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST STUDY

Professional

Both

$526.26

Service Code	HCPCS 74250
Min. Negotiated Rate	$394.70
Max. Negotiated Rate	$394.70
Rate for Payer: Cash Price	$141.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$394.70
Rate for Payer: SOMOS Essential	$394.70

CHG RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY

Professional

Both

$441.18

Service Code	HCPCS 74230 TC
Min. Negotiated Rate	$330.88
Max. Negotiated Rate	$330.88
Rate for Payer: Cash Price	$117.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$330.88
Rate for Payer: SOMOS Essential	$330.88

CHG RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY

Professional

Both

$104.65

Service Code	HCPCS 74230 26
Min. Negotiated Rate	$78.49
Max. Negotiated Rate	$78.49
Rate for Payer: Cash Price	$27.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$78.49
Rate for Payer: SOMOS Essential	$78.49

Know your out-of-pocket cost for care.

All Charges