St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR ANORECTAL MANOMETRY

Professional

Both

$813.33

Service Code	HCPCS 91122 TC
Min. Negotiated Rate	$610.00
Max. Negotiated Rate	$610.00
Rate for Payer: Cash Price	$224.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$610.00
Rate for Payer: SOMOS Essential	$610.00

PR ANORECTAL MANOMETRY

Professional

Both

$1,164.45

Service Code	HCPCS 91122
Min. Negotiated Rate	$873.34
Max. Negotiated Rate	$873.34
Rate for Payer: Cash Price	$320.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$873.34
Rate for Payer: SOMOS Essential	$873.34

PR ANORECTAL MYOMECTOMY

Professional

Both

$1,687.25

Service Code	HCPCS 45108
Min. Negotiated Rate	$1,265.44
Max. Negotiated Rate	$1,265.44
Rate for Payer: Cash Price	$454.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,265.44
Rate for Payer: SOMOS Essential	$1,265.44

PR ANOSCOPY ABLATION LESION

Professional

Both

$380.73

Service Code	HCPCS 46615
Min. Negotiated Rate	$285.55
Max. Negotiated Rate	$285.55
Rate for Payer: Cash Price	$104.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$285.55
Rate for Payer: SOMOS Essential	$285.55

PR ANOSCOPY CONTROL BLEEDING

Professional

Both

$279.58

Service Code	HCPCS 46614
Min. Negotiated Rate	$209.68
Max. Negotiated Rate	$209.68
Rate for Payer: Cash Price	$75.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$209.68
Rate for Payer: SOMOS Essential	$209.68

PR ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD

Professional

Both

$179.62

Service Code	HCPCS 46600
Min. Negotiated Rate	$134.72
Max. Negotiated Rate	$134.72
Rate for Payer: Cash Price	$48.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$134.72
Rate for Payer: SOMOS Essential	$134.72

PR ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT

Professional

Both

$395.71

Service Code	HCPCS 46601
Min. Negotiated Rate	$296.78
Max. Negotiated Rate	$296.78
Rate for Payer: Cash Price	$108.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$296.78
Rate for Payer: SOMOS Essential	$296.78

PR ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX

Professional

Both

$527.24

Service Code	HCPCS 46607
Min. Negotiated Rate	$395.43
Max. Negotiated Rate	$395.43
Rate for Payer: Cash Price	$143.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$395.43
Rate for Payer: SOMOS Essential	$395.43

PR ANOSCOPY W/BX SINGLE/MULTIPLE

Professional

Both

$324.35

Service Code	HCPCS 46606
Min. Negotiated Rate	$243.26
Max. Negotiated Rate	$243.26
Rate for Payer: Cash Price	$88.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$243.26
Rate for Payer: SOMOS Essential	$243.26

PR ANOSCOPY W/DILATION

Professional

Both

$286.06

Service Code	HCPCS 46604
Min. Negotiated Rate	$214.54
Max. Negotiated Rate	$214.54
Rate for Payer: Cash Price	$77.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$214.54
Rate for Payer: SOMOS Essential	$214.54

PR ANOSCOPY W/RMVL FOREIGN BODY

Professional

Both

$382.34

Service Code	HCPCS 46608
Min. Negotiated Rate	$286.76
Max. Negotiated Rate	$286.76
Rate for Payer: Cash Price	$101.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$286.76
Rate for Payer: SOMOS Essential	$286.76

PR ANOSCOPY W/RMVL LESION CAUTERY

Professional

Both

$352.35

Service Code	HCPCS 46610
Min. Negotiated Rate	$264.26
Max. Negotiated Rate	$264.26
Rate for Payer: Cash Price	$94.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$264.26
Rate for Payer: SOMOS Essential	$264.26

PR ANOSC RMVL 1 TUM POLYP/OTH LES SNARE TQ

Professional

Both

$342.76

Service Code	HCPCS 46611
Min. Negotiated Rate	$257.07
Max. Negotiated Rate	$257.07
Rate for Payer: Cash Price	$93.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$257.07
Rate for Payer: SOMOS Essential	$257.07

PR ANOSC RMVL MULT TUMORS CAUTERY/SNARE

Professional

Both

$425.67

Service Code	HCPCS 46612
Min. Negotiated Rate	$319.25
Max. Negotiated Rate	$319.25
Rate for Payer: Cash Price	$114.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$319.25
Rate for Payer: SOMOS Essential	$319.25

PR ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX

Professional

Both

$452.73

Service Code	HCPCS 45990
Min. Negotiated Rate	$339.55
Max. Negotiated Rate	$339.55
Rate for Payer: Cash Price	$123.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$339.55
Rate for Payer: SOMOS Essential	$339.55

PR ANTEPARTUM CARE ONLY 4-6 VISITS

Professional

Both

$1,994.27

Service Code	HCPCS 59425
Min. Negotiated Rate	$1,495.70
Max. Negotiated Rate	$1,495.70
Rate for Payer: Cash Price	$527.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,495.70
Rate for Payer: SOMOS Essential	$1,495.70

PR ANTEPARTUM CARE ONLY 7/> VISITS

Professional

Both

$3,665.03

Service Code	HCPCS 59426
Min. Negotiated Rate	$2,748.77
Max. Negotiated Rate	$2,748.77
Rate for Payer: Cash Price	$968.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,748.77
Rate for Payer: SOMOS Essential	$2,748.77

PR ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYSTO

Professional

Both

$2,659.93

Service Code	HCPCS 57240
Min. Negotiated Rate	$1,994.95
Max. Negotiated Rate	$1,994.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,994.95
Rate for Payer: SOMOS Essential	$1,994.95

PR ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS

Professional

Both

$3,380.76

Service Code	HCPCS 22845
Min. Negotiated Rate	$2,535.57
Max. Negotiated Rate	$2,535.57
Rate for Payer: Cash Price	$891.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,535.57
Rate for Payer: SOMOS Essential	$2,535.57

PR ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS

Professional

Both

$3,522.12

Service Code	HCPCS 22846
Min. Negotiated Rate	$2,641.59
Max. Negotiated Rate	$2,641.59
Rate for Payer: Cash Price	$928.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,641.59
Rate for Payer: SOMOS Essential	$2,641.59

PR ANTERIOR INSTRUMENTATION 8/> VERTEBRAL SEGMENTS

Professional

Both

$3,511.66

Service Code	HCPCS 22847
Min. Negotiated Rate	$2,633.74
Max. Negotiated Rate	$2,633.74
Rate for Payer: Cash Price	$937.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,633.74
Rate for Payer: SOMOS Essential	$2,633.74

PR ANTERIOR TIBIAL TUBERCLEPLASTY

Professional

Both

$3,667.02

Service Code	HCPCS 27418
Min. Negotiated Rate	$2,750.26
Max. Negotiated Rate	$2,750.26
Rate for Payer: Cash Price	$979.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,750.26
Rate for Payer: SOMOS Essential	$2,750.26

PR ANTICOAGULANT MGMT FOR PT TAKING WARFARIN

Professional

Both

$46.83

Service Code	HCPCS 93793
Min. Negotiated Rate	$35.12
Max. Negotiated Rate	$35.12
Rate for Payer: Cash Price	$12.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35.12
Rate for Payer: SOMOS Essential	$35.12

PR ANT SGM IMAGING I&R SPECLR MICROSCOPY&NDTHL ALYS

Professional

Both

$77.49

Service Code	HCPCS 92286 TC
Min. Negotiated Rate	$58.12
Max. Negotiated Rate	$58.12
Rate for Payer: Cash Price	$21.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$58.12
Rate for Payer: SOMOS Essential	$58.12

PR ANT SGM IMAGING I&R SPECLR MICROSCOPY&NDTHL ALYS

Professional

Both

$161.95

Service Code	HCPCS 92286
Min. Negotiated Rate	$121.46
Max. Negotiated Rate	$121.46
Rate for Payer: Cash Price	$44.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$121.46
Rate for Payer: SOMOS Essential	$121.46

Know your out-of-pocket cost for care.

All Charges