St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR INJECTION PX DISCOGRAPHY EACH LEVEL LUMBAR

Professional

Both

$647.99

Service Code	HCPCS 62290
Min. Negotiated Rate	$485.99
Max. Negotiated Rate	$485.99
Rate for Payer: Cash Price	$174.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$485.99
Rate for Payer: SOMOS Essential	$485.99

PR INJECTION PX DISCOGRPHY EA LVL CERVICAL/THORACIC

Professional

Both

$598.19

Service Code	HCPCS 62291
Min. Negotiated Rate	$448.64
Max. Negotiated Rate	$448.64
Rate for Payer: Cash Price	$158.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$448.64
Rate for Payer: SOMOS Essential	$448.64

PR INJECTION PX ONLY MAMMARY DUCTOGRAM/GALACTOGRAM

Professional

Both

$318.64

Service Code	HCPCS 19030
Min. Negotiated Rate	$238.98
Max. Negotiated Rate	$238.98
Rate for Payer: Cash Price	$84.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$238.98
Rate for Payer: SOMOS Essential	$238.98

PR INJECTION PX PRQ TX EXTREMITY PSEUDOANEURYSM

Professional

Both

$442.58

Service Code	HCPCS 36002
Min. Negotiated Rate	$331.94
Max. Negotiated Rate	$331.94
Rate for Payer: Cash Price	$118.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$331.94
Rate for Payer: SOMOS Essential	$331.94

PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS

Professional

Both

$330.47

Service Code	HCPCS 36471
Min. Negotiated Rate	$247.85
Max. Negotiated Rate	$247.85
Rate for Payer: Cash Price	$87.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$247.85
Rate for Payer: SOMOS Essential	$247.85

PR INJECTION SCLEROSANT SINGLE INCMPTNT VEIN

Professional

Both

$172.06

Service Code	HCPCS 36470
Min. Negotiated Rate	$129.04
Max. Negotiated Rate	$129.04
Rate for Payer: Cash Price	$44.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$129.04
Rate for Payer: SOMOS Essential	$129.04

PR INJECTION SCLEROSING SOLUTION HEMORRHOIDS

Professional

Both

$799.37

Service Code	HCPCS 46500
Min. Negotiated Rate	$599.53
Max. Negotiated Rate	$599.53
Rate for Payer: Cash Price	$216.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$599.53
Rate for Payer: SOMOS Essential	$599.53

PR INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG

Professional

Both

$207.24

Service Code	HCPCS 23350
Min. Negotiated Rate	$155.43
Max. Negotiated Rate	$155.43
Rate for Payer: Cash Price	$55.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$155.43
Rate for Payer: SOMOS Essential	$155.43

PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES

Professional

Both

$156.31

Service Code	HCPCS 20552
Min. Negotiated Rate	$117.23
Max. Negotiated Rate	$117.23
Rate for Payer: Cash Price	$42.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$117.23
Rate for Payer: SOMOS Essential	$117.23

PR INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES

Professional

Both

$180.25

Service Code	HCPCS 20553
Min. Negotiated Rate	$135.19
Max. Negotiated Rate	$135.19
Rate for Payer: Cash Price	$47.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$135.19
Rate for Payer: SOMOS Essential	$135.19

PR INJECTION SINGLE TENDON ORIGIN/INSERTION

Professional

Both

$165.87

Service Code	HCPCS 20551
Min. Negotiated Rate	$124.40
Max. Negotiated Rate	$124.40
Rate for Payer: Cash Price	$43.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$124.40
Rate for Payer: SOMOS Essential	$124.40

PR INJECTION SINUS TRACT DIAGNOSTIC

Professional

Both

$150.29

Service Code	HCPCS 20501
Min. Negotiated Rate	$112.72
Max. Negotiated Rate	$112.72
Rate for Payer: Cash Price	$40.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$112.72
Rate for Payer: SOMOS Essential	$112.72

PR INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC

Professional

Both

$380.77

Service Code	HCPCS 20500
Min. Negotiated Rate	$285.58
Max. Negotiated Rate	$285.58
Rate for Payer: Cash Price	$103.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$285.58
Rate for Payer: SOMOS Essential	$285.58

PR INJECTION TEMPOROMANDIBULAR JOINT ARTHROGRAPHY

Professional

Both

$186.59

Service Code	HCPCS 21116
Min. Negotiated Rate	$139.94
Max. Negotiated Rate	$139.94
Rate for Payer: Cash Price	$50.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$139.94
Rate for Payer: SOMOS Essential	$139.94

PR INJECTION THERAPEUTIC CARPAL TUNNEL

Professional

Both

$250.36

Service Code	HCPCS 20526
Min. Negotiated Rate	$187.77
Max. Negotiated Rate	$187.77
Rate for Payer: Cash Price	$66.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$187.77
Rate for Payer: SOMOS Essential	$187.77

PR INJECTION TURBINATE THERAPEUTIC

Professional

Both

$255.75

Service Code	HCPCS 30200
Min. Negotiated Rate	$191.81
Max. Negotiated Rate	$191.81
Rate for Payer: Cash Price	$69.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$191.81
Rate for Payer: SOMOS Essential	$191.81

PR INJECTION WRIST ARTHROGRAPHY

Professional

Both

$300.41

Service Code	HCPCS 25246
Min. Negotiated Rate	$225.31
Max. Negotiated Rate	$225.31
Rate for Payer: Cash Price	$81.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$225.31
Rate for Payer: SOMOS Essential	$225.31

PR INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA

Professional

Both

$343.00

Service Code	HCPCS 27096
Min. Negotiated Rate	$257.25
Max. Negotiated Rate	$257.25
Rate for Payer: Cash Price	$93.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$257.25
Rate for Payer: SOMOS Essential	$257.25

PR INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH

Professional

Both

$214.55

Service Code	HCPCS 50684
Min. Negotiated Rate	$160.91
Max. Negotiated Rate	$160.91
Rate for Payer: Cash Price	$58.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$160.91
Rate for Payer: SOMOS Essential	$160.91

PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE

Professional

Both

$136.36

Service Code	HCPCS 38792
Min. Negotiated Rate	$102.27
Max. Negotiated Rate	$102.27
Rate for Payer: Cash Price	$36.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$102.27
Rate for Payer: SOMOS Essential	$102.27

PR INJ SUBSTITUTE PARS PLANA/LIMBL W/WO ASPIR SPX

Professional

Both

$2,602.50

Service Code	HCPCS 67025
Min. Negotiated Rate	$1,951.88
Max. Negotiated Rate	$1,951.88
Rate for Payer: Cash Price	$715.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,951.88
Rate for Payer: SOMOS Essential	$1,951.88

PR INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG

Professional

Both

$395.36

Service Code	HCPCS 64530
Min. Negotiated Rate	$296.52
Max. Negotiated Rate	$296.52
Rate for Payer: Cash Price	$107.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$296.52
Rate for Payer: SOMOS Essential	$296.52

PR INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX

Professional

Both

$540.12

Service Code	HCPCS 66020
Min. Negotiated Rate	$405.09
Max. Negotiated Rate	$405.09
Rate for Payer: Cash Price	$149.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$405.09
Rate for Payer: SOMOS Essential	$405.09

PR INJX ANTERIOR CHAMBER EYE MEDICATION SPX

Professional

Both

$460.43

Service Code	HCPCS 66030
Min. Negotiated Rate	$345.32
Max. Negotiated Rate	$345.32
Rate for Payer: Cash Price	$127.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$345.32
Rate for Payer: SOMOS Essential	$345.32

PR INJX/INFUSION NEUROLYTIC SUBSTANCE SUBARACHNOID

Professional

Both

$662.03

Service Code	HCPCS 62280
Min. Negotiated Rate	$496.52
Max. Negotiated Rate	$496.52
Rate for Payer: Cash Price	$182.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$496.52
Rate for Payer: SOMOS Essential	$496.52

Know your out-of-pocket cost for care.

All Charges