St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL EA ADDL

Professional

Both

$212.98

Service Code	HCPCS 64484
Min. Negotiated Rate	$159.74
Max. Negotiated Rate	$159.74
Rate for Payer: Cash Price	$58.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$159.74
Rate for Payer: SOMOS Essential	$159.74

PR NJX ANES STELLATE GANGLION CRV SYMPATHETIC

Professional

Both

$318.01

Service Code	HCPCS 64510
Min. Negotiated Rate	$238.51
Max. Negotiated Rate	$238.51
Rate for Payer: Cash Price	$87.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$238.51
Rate for Payer: SOMOS Essential	$238.51

PR NJX ARTERIAL OCCLUSION ARVEN MALFRMJ SPINAL

Professional

Both

$4,592.74

Service Code	HCPCS 62294
Min. Negotiated Rate	$3,444.56
Max. Negotiated Rate	$3,444.56
Rate for Payer: Cash Price	$1,215.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,444.56
Rate for Payer: SOMOS Essential	$3,444.56

PR NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS

Professional

Both

$286.23

Service Code	HCPCS 47531
Min. Negotiated Rate	$214.67
Max. Negotiated Rate	$214.67
Rate for Payer: Cash Price	$78.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$214.67
Rate for Payer: SOMOS Essential	$214.67

PR NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS

Professional

Both

$861.14

Service Code	HCPCS 47532
Min. Negotiated Rate	$645.86
Max. Negotiated Rate	$645.86
Rate for Payer: Cash Price	$233.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$645.86
Rate for Payer: SOMOS Essential	$645.86

PR NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT

Professional

Both

$314.86

Service Code	HCPCS 54235
Min. Negotiated Rate	$236.14
Max. Negotiated Rate	$236.14
Rate for Payer: Cash Price	$85.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$236.14
Rate for Payer: SOMOS Essential	$236.14

PR NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY

Professional

Both

$182.14

Service Code	HCPCS 51600
Min. Negotiated Rate	$136.60
Max. Negotiated Rate	$136.60
Rate for Payer: Cash Price	$48.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$136.60
Rate for Payer: SOMOS Essential	$136.60

PR NJX DRG C-CATHJ NSLCTV P-ART ANGIOGRAPHY

Professional

Both

$206.78

Service Code	HCPCS 93568
Min. Negotiated Rate	$155.08
Max. Negotiated Rate	$155.08
Rate for Payer: Cash Price	$53.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$155.08
Rate for Payer: SOMOS Essential	$155.08

PR NJX DRG C-CATHJ SLCTV P-ART ANGIOGRAPHY BI

Professional

Both

$254.87

Service Code	HCPCS 93573
Min. Negotiated Rate	$191.15
Max. Negotiated Rate	$191.15
Rate for Payer: Cash Price	$68.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$191.15
Rate for Payer: SOMOS Essential	$191.15

PR NJX DRG C-CATHJ SLCTV P-ART ANGIOGRAPHY UNI

Professional

Both

$152.92

Service Code	HCPCS 93569
Min. Negotiated Rate	$114.69
Max. Negotiated Rate	$114.69
Rate for Payer: Cash Price	$41.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$114.69
Rate for Payer: SOMOS Essential	$114.69

PR NJX DRG C-CATHJ SLCTV PULM ANGRPH MAPCA CHD EA

Professional

Both

$375.10

Service Code	HCPCS 93575
Min. Negotiated Rate	$281.32
Max. Negotiated Rate	$281.32
Rate for Payer: Cash Price	$101.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$281.32
Rate for Payer: SOMOS Essential	$281.32

PR NJX DRG C-CATHJ SLCTV PULM VEN ANGIOGRAPHY

Professional

Both

$279.58

Service Code	HCPCS 93574
Min. Negotiated Rate	$209.68
Max. Negotiated Rate	$209.68
Rate for Payer: Cash Price	$76.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$209.68
Rate for Payer: SOMOS Essential	$209.68

PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL

Professional

Both

$245.70

Service Code	HCPCS 64491
Min. Negotiated Rate	$184.28
Max. Negotiated Rate	$184.28
Rate for Payer: Cash Price	$66.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$184.28
Rate for Payer: SOMOS Essential	$184.28

PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL

Professional

Both

$250.01

Service Code	HCPCS 64492
Min. Negotiated Rate	$187.51
Max. Negotiated Rate	$187.51
Rate for Payer: Cash Price	$68.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$187.51
Rate for Payer: SOMOS Essential	$187.51

PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL

Professional

Both

$377.76

Service Code	HCPCS 64493
Min. Negotiated Rate	$283.32
Max. Negotiated Rate	$283.32
Rate for Payer: Cash Price	$102.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$283.32
Rate for Payer: SOMOS Essential	$283.32

PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL

Professional

Both

$211.54

Service Code	HCPCS 64494
Min. Negotiated Rate	$158.66
Max. Negotiated Rate	$158.66
Rate for Payer: Cash Price	$57.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$158.66
Rate for Payer: SOMOS Essential	$158.66

PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL

Professional

Both

$214.41

Service Code	HCPCS 64495
Min. Negotiated Rate	$160.81
Max. Negotiated Rate	$160.81
Rate for Payer: Cash Price	$58.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$160.81
Rate for Payer: SOMOS Essential	$160.81

PR NJX DX/THER PARAVER FCT JT W/US CER/THOR 1 LVL

Professional

Both

$849.49

Service Code	HCPCS 0213T
Min. Negotiated Rate	$637.12
Max. Negotiated Rate	$637.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$637.12
Rate for Payer: SOMOS Essential	$637.12

PR NJX DX/THER PARAVER FCT JT W/US CER/THOR 2ND LVL

Professional

Both

$423.92

Service Code	HCPCS 0214T
Min. Negotiated Rate	$317.94
Max. Negotiated Rate	$317.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$317.94
Rate for Payer: SOMOS Essential	$317.94

PR NJX DX/THER PARAVER FCT JT W/US LUMB/SAC 1 LVL

Professional

Both

$770.32

Service Code	HCPCS 0216T
Min. Negotiated Rate	$577.74
Max. Negotiated Rate	$577.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$577.74
Rate for Payer: SOMOS Essential	$577.74

PR NJX DX/THER PARAVER FCT JT W/US LUMB/SAC LVL 2

Professional

Both

$394.10

Service Code	HCPCS 0217T
Min. Negotiated Rate	$295.58
Max. Negotiated Rate	$295.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$295.58
Rate for Payer: SOMOS Essential	$295.58

PR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN

Professional

Both

$441.42

Service Code	HCPCS 62321
Min. Negotiated Rate	$331.06
Max. Negotiated Rate	$331.06
Rate for Payer: Cash Price	$121.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$331.06
Rate for Payer: SOMOS Essential	$331.06

PR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN

Professional

Both

$456.79

Service Code	HCPCS 62325
Min. Negotiated Rate	$342.59
Max. Negotiated Rate	$342.59
Rate for Payer: Cash Price	$123.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$342.59
Rate for Payer: SOMOS Essential	$342.59

PR NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN

Professional

Both

$428.82

Service Code	HCPCS 62320
Min. Negotiated Rate	$321.62
Max. Negotiated Rate	$321.62
Rate for Payer: Cash Price	$114.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$321.62
Rate for Payer: SOMOS Essential	$321.62

PR NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN

Professional

Both

$366.59

Service Code	HCPCS 62324
Min. Negotiated Rate	$274.94
Max. Negotiated Rate	$274.94
Rate for Payer: Cash Price	$99.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$274.94
Rate for Payer: SOMOS Essential	$274.94

Know your out-of-pocket cost for care.

All Charges