St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH

Professional

Both

$226.42

Service Code	HCPCS 64400
Min. Negotiated Rate	$169.82
Max. Negotiated Rate	$169.82
Rate for Payer: Cash Price	$62.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$169.82
Rate for Payer: SOMOS Essential	$169.82

PR INJECTION AA&/STRD VAGUS NERVE

Professional

Both

$193.03

Service Code	HCPCS 64408
Min. Negotiated Rate	$144.77
Max. Negotiated Rate	$144.77
Rate for Payer: Cash Price	$51.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$144.77
Rate for Payer: SOMOS Essential	$144.77

PR INJECTION AIR/CONTRAST PERITONEAL CAVITY SPX

Professional

Both

$372.12

Service Code	HCPCS 49400
Min. Negotiated Rate	$279.09
Max. Negotiated Rate	$279.09
Rate for Payer: Cash Price	$100.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$279.09
Rate for Payer: SOMOS Essential	$279.09

PR INJECTION ANES AGENT SPHENOPALATINE GANGLION

Professional

Both

$468.65

Service Code	HCPCS 64505
Min. Negotiated Rate	$351.49
Max. Negotiated Rate	$351.49
Rate for Payer: Cash Price	$127.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$351.49
Rate for Payer: SOMOS Essential	$351.49

PR INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC

Professional

Both

$348.53

Service Code	HCPCS 64520
Min. Negotiated Rate	$261.40
Max. Negotiated Rate	$261.40
Rate for Payer: Cash Price	$96.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$261.40
Rate for Payer: SOMOS Essential	$261.40

PR INJECTION ANES SUPERIOR HYPOGASTRIC PLEXUS

Professional

Both

$520.17

Service Code	HCPCS 64517
Min. Negotiated Rate	$390.13
Max. Negotiated Rate	$390.13
Rate for Payer: Cash Price	$142.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$390.13
Rate for Payer: SOMOS Essential	$390.13

PR INJECTION ANKLE ARTHROGRAPHY

Professional

Both

$214.90

Service Code	HCPCS 27648
Min. Negotiated Rate	$161.18
Max. Negotiated Rate	$161.18
Rate for Payer: Cash Price	$59.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$161.18
Rate for Payer: SOMOS Essential	$161.18

PR INJECTION CONTRAST MEDIUM DACRYOCYSTOGRAPY

Professional

Both

$214.24

Service Code	HCPCS 68850
Min. Negotiated Rate	$160.68
Max. Negotiated Rate	$160.68
Rate for Payer: Cash Price	$58.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$160.68
Rate for Payer: SOMOS Essential	$160.68

PR INJECTION CORPORA CAVERNOSOGRAPY

Professional

Both

$335.09

Service Code	HCPCS 54230
Min. Negotiated Rate	$251.32
Max. Negotiated Rate	$251.32
Rate for Payer: Cash Price	$91.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$251.32
Rate for Payer: SOMOS Essential	$251.32

PR INJECTION ELBOW ARTHROGRAPHY

Professional

Both

$277.13

Service Code	HCPCS 24220
Min. Negotiated Rate	$207.85
Max. Negotiated Rate	$207.85
Rate for Payer: Cash Price	$74.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$207.85
Rate for Payer: SOMOS Essential	$207.85

PR INJECTION ENZYME PALMAR FASCIAL CORD

Professional

Both

$287.91

Service Code	HCPCS 20527
Min. Negotiated Rate	$215.93
Max. Negotiated Rate	$215.93
Rate for Payer: Cash Price	$77.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$215.93
Rate for Payer: SOMOS Essential	$215.93

PR INJECTION EPIDURAL BLOOD/CLOT PATCH

Professional

Both

$468.93

Service Code	HCPCS 62273
Min. Negotiated Rate	$351.70
Max. Negotiated Rate	$351.70
Rate for Payer: Cash Price	$128.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$351.70
Rate for Payer: SOMOS Essential	$351.70

PR INJECTION HIP ARTHROGRAPHY W/ANESTHESIA

Professional

Both

$350.14

Service Code	HCPCS 27095
Min. Negotiated Rate	$262.60
Max. Negotiated Rate	$262.60
Rate for Payer: Cash Price	$93.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$262.60
Rate for Payer: SOMOS Essential	$262.60

PR INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA

Professional

Both

$289.84

Service Code	HCPCS 27093
Min. Negotiated Rate	$217.38
Max. Negotiated Rate	$217.38
Rate for Payer: Cash Price	$76.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$217.38
Rate for Payer: SOMOS Essential	$217.38

PR INJECTION INTRALESIONAL >7 LESIONS

Professional

Both

$189.67

Service Code	HCPCS 11901
Min. Negotiated Rate	$142.25
Max. Negotiated Rate	$142.25
Rate for Payer: Cash Price	$51.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$142.25
Rate for Payer: SOMOS Essential	$142.25

PR INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS

Professional

Both

$126.11

Service Code	HCPCS 11900
Min. Negotiated Rate	$94.58
Max. Negotiated Rate	$94.58
Rate for Payer: Cash Price	$34.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$94.58
Rate for Payer: SOMOS Essential	$94.58

PR INJECTION INTRAOPERATIVE PANCREATOGRAPHY

Professional

Both

$483.25

Service Code	HCPCS 48400
Min. Negotiated Rate	$362.44
Max. Negotiated Rate	$362.44
Rate for Payer: Cash Price	$126.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$362.44
Rate for Payer: SOMOS Essential	$362.44

PR INJECTION MEDICATION/OTHER SUBST TENON CAPSULE

Professional

Both

$193.73

Service Code	HCPCS 67515
Min. Negotiated Rate	$145.30
Max. Negotiated Rate	$145.30
Rate for Payer: Cash Price	$52.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$145.30
Rate for Payer: SOMOS Essential	$145.30

PR INJECTION PEYRONIE DISEASE

Professional

Both

$367.08

Service Code	HCPCS 54200
Min. Negotiated Rate	$275.31
Max. Negotiated Rate	$275.31
Rate for Payer: Cash Price	$102.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$275.31
Rate for Payer: SOMOS Essential	$275.31

PR INJECTION POSTERIOR CHAMBER EYE MEDICATION

Professional

Both

$381.40

Service Code	HCPCS 0699T
Min. Negotiated Rate	$286.05
Max. Negotiated Rate	$286.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$286.05
Rate for Payer: SOMOS Essential	$286.05

PR INJECTION PROCEDURE LYMPHANGIOGRAPHY

Professional

Both

$351.44

Service Code	HCPCS 38790
Min. Negotiated Rate	$263.58
Max. Negotiated Rate	$263.58
Rate for Payer: Cash Price	$94.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$263.58
Rate for Payer: SOMOS Essential	$263.58

PR INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR

Professional

Both

$352.84

Service Code	HCPCS 62284
Min. Negotiated Rate	$264.63
Max. Negotiated Rate	$264.63
Rate for Payer: Cash Price	$93.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$264.63
Rate for Payer: SOMOS Essential	$264.63

PR INJECTION PROCEDURE SIALOGRAPHY

Professional

Both

$252.77

Service Code	HCPCS 42550
Min. Negotiated Rate	$189.58
Max. Negotiated Rate	$189.58
Rate for Payer: Cash Price	$67.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$189.58
Rate for Payer: SOMOS Essential	$189.58

PR INJECTION PROCEDURE SPLENOPORTOGRAPY

Professional

Both

$531.58

Service Code	HCPCS 38200
Min. Negotiated Rate	$398.68
Max. Negotiated Rate	$398.68
Rate for Payer: Cash Price	$144.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$398.68
Rate for Payer: SOMOS Essential	$398.68

PR INJECTION PX CHEMONUCLEOLYSIS 1/MLT LUMBAR

Professional

Both

$2,414.86

Service Code	HCPCS 62292
Min. Negotiated Rate	$1,811.14
Max. Negotiated Rate	$1,811.14
Rate for Payer: Cash Price	$668.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,811.14
Rate for Payer: SOMOS Essential	$1,811.14

Know your out-of-pocket cost for care.

All Charges