St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN

Professional

Both

$409.82

Service Code	HCPCS 62323
Min. Negotiated Rate	$307.36
Max. Negotiated Rate	$307.36
Rate for Payer: Cash Price	$112.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$307.36
Rate for Payer: SOMOS Essential	$307.36

PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN

Professional

Both

$438.03

Service Code	HCPCS 62327
Min. Negotiated Rate	$328.52
Max. Negotiated Rate	$328.52
Rate for Payer: Cash Price	$122.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$328.52
Rate for Payer: SOMOS Essential	$328.52

PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN

Professional

Both

$354.27

Service Code	HCPCS 62326
Min. Negotiated Rate	$265.70
Max. Negotiated Rate	$265.70
Rate for Payer: Cash Price	$95.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$265.70
Rate for Payer: SOMOS Essential	$265.70

PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN

Professional

Both

$336.81

Service Code	HCPCS 62322
Min. Negotiated Rate	$252.61
Max. Negotiated Rate	$252.61
Rate for Payer: Cash Price	$89.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$252.61
Rate for Payer: SOMOS Essential	$252.61

PR NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS

Professional

Both

$665.25

Service Code	HCPCS 36466
Min. Negotiated Rate	$498.94
Max. Negotiated Rate	$498.94
Rate for Payer: Cash Price	$175.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$498.94
Rate for Payer: SOMOS Essential	$498.94

PR NJX NONCMPND SCLEROSANT SINGLE INCMPTNT VEIN

Professional

Both

$513.91

Service Code	HCPCS 36465
Min. Negotiated Rate	$385.43
Max. Negotiated Rate	$385.43
Rate for Payer: Cash Price	$137.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$385.43
Rate for Payer: SOMOS Essential	$385.43

PR NJX PARAVERTBRL FCT JT W/US LUMB/SAC 3RD&> LVL

Professional

Both

$394.10

Service Code	HCPCS 0218T
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 PEYRONIE W/SURG EXPOS PLAQUE

Professional

Both

$2,234.33

Service Code	HCPCS 54205
Min. Negotiated Rate	$1,675.75
Max. Negotiated Rate	$1,675.75
Rate for Payer: Cash Price	$614.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,675.75
Rate for Payer: SOMOS Essential	$1,675.75

PR NJX & PLACEMENT CHAIN CONTRAST&/URETHROCSTOGRAPY

Professional

Both

$161.00

Service Code	HCPCS 51605
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$120.75
Rate for Payer: Cash Price	$44.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$120.75
Rate for Payer: SOMOS Essential	$120.75

PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS

Professional

Both

$271.36

Service Code	HCPCS 50431
Min. Negotiated Rate	$203.52
Max. Negotiated Rate	$203.52
Rate for Payer: Cash Price	$74.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$203.52
Rate for Payer: SOMOS Essential	$203.52

PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS

Professional

Both

$630.74

Service Code	HCPCS 50430
Min. Negotiated Rate	$473.06
Max. Negotiated Rate	$473.06
Rate for Payer: Cash Price	$171.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$473.06
Rate for Payer: SOMOS Essential	$473.06

PR NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE

Professional

Both

$171.26

Service Code	HCPCS 27369
Min. Negotiated Rate	$128.44
Max. Negotiated Rate	$128.44
Rate for Payer: Cash Price	$45.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$128.44
Rate for Payer: SOMOS Essential	$128.44

PR NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH

Professional

Both

$207.20

Service Code	HCPCS 36005
Min. Negotiated Rate	$155.40
Max. Negotiated Rate	$155.40
Rate for Payer: Cash Price	$54.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$155.40
Rate for Payer: SOMOS Essential	$155.40

PR NJX RETROGRADE URETHROCSTOGRAPY

Professional

Both

$267.86

Service Code	HCPCS 51610
Min. Negotiated Rate	$200.90
Max. Negotiated Rate	$200.90
Rate for Payer: Cash Price	$73.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$200.90
Rate for Payer: SOMOS Essential	$200.90

PR NJX SEL HRT ART CONGENITAL HRT CATH W/S&I

Professional

Both

$222.08

Service Code	HCPCS 93563
Min. Negotiated Rate	$166.56
Max. Negotiated Rate	$166.56
Rate for Payer: Cash Price	$58.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$166.56
Rate for Payer: SOMOS Essential	$166.56

PR NJX SEL HRT ART/GRFT CONGENITAL HRT CATH W/S&I

Professional

Both

$242.24

Service Code	HCPCS 93564
Min. Negotiated Rate	$181.68
Max. Negotiated Rate	$181.68
Rate for Payer: Cash Price	$64.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$181.68
Rate for Payer: SOMOS Essential	$181.68

PR NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I

Professional

Both

$119.91

Service Code	HCPCS 93565
Min. Negotiated Rate	$89.93
Max. Negotiated Rate	$89.93
Rate for Payer: Cash Price	$31.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$89.93
Rate for Payer: SOMOS Essential	$89.93

PR NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I

Professional

Both

$115.85

Service Code	HCPCS 93566
Min. Negotiated Rate	$86.89
Max. Negotiated Rate	$86.89
Rate for Payer: Cash Price	$29.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$86.89
Rate for Payer: SOMOS Essential	$86.89

PR NJX SUPRAVALV AORTOG HRT CATH W/S&I

Professional

Both

$168.70

Service Code	HCPCS 93567
Min. Negotiated Rate	$126.52
Max. Negotiated Rate	$126.52
Rate for Payer: Cash Price	$43.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$126.52
Rate for Payer: SOMOS Essential	$126.52

PR NJX VISUALIZATION ILEAL CONDUIT&/URETEROPYELOG

Professional

Both

$290.26

Service Code	HCPCS 50690
Min. Negotiated Rate	$217.70
Max. Negotiated Rate	$217.70
Rate for Payer: Cash Price	$79.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$217.70
Rate for Payer: SOMOS Essential	$217.70

PR NOCTURNAL PENILE TUMESCENCE &/RIGIDITY TEST

Professional

Both

$440.72

Service Code	HCPCS 54250 26
Min. Negotiated Rate	$330.54
Max. Negotiated Rate	$330.54
Rate for Payer: Cash Price	$119.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$330.54
Rate for Payer: SOMOS Essential	$330.54

PR NOCTURNAL PENILE TUMESCENCE &/RIGIDITY TEST

Professional

Both

$63.11

Service Code	HCPCS 54250 TC
Min. Negotiated Rate	$47.33
Max. Negotiated Rate	$47.33
Rate for Payer: Cash Price	$17.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$47.33
Rate for Payer: SOMOS Essential	$47.33

PR NOCTURNAL PENILE TUMESCENCE &/RIGIDITY TEST

Professional

Both

$503.83

Service Code	HCPCS 54250
Min. Negotiated Rate	$377.87
Max. Negotiated Rate	$377.87
Rate for Payer: Cash Price	$137.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$377.87
Rate for Payer: SOMOS Essential	$377.87

PR NONINVASIVE EAR/PULSE OXIMETRY MULTIPLE DETER

Professional

Both

$17.12

Service Code	HCPCS 94761
Min. Negotiated Rate	$12.84
Max. Negotiated Rate	$12.84
Rate for Payer: Cash Price	$4.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$12.84
Rate for Payer: SOMOS Essential	$12.84

PR NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR

Professional

Both

$110.57

Service Code	HCPCS 94762
Min. Negotiated Rate	$82.93
Max. Negotiated Rate	$82.93
Rate for Payer: Cash Price	$30.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$82.93
Rate for Payer: SOMOS Essential	$82.93

Know your out-of-pocket cost for care.

All Charges