St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR BFB TRAING W/EMG &/MANOMETRY 1ST 15 MIN CNTCT

Professional

Both

$169.68

Service Code	HCPCS 90912
Min. Negotiated Rate	$127.26
Max. Negotiated Rate	$127.26
Rate for Payer: Cash Price	$46.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$127.26
Rate for Payer: SOMOS Essential	$127.26

PR BFB TRAING W/EMG&/MANOMETRY EA ADDL 15 MIN CNTCT

Professional

Both

$99.44

Service Code	HCPCS 90913
Min. Negotiated Rate	$74.58
Max. Negotiated Rate	$74.58
Rate for Payer: Cash Price	$26.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$74.58
Rate for Payer: SOMOS Essential	$74.58

PR BIA WHOLE BODY COMPOSITION ASSESSMENT W/I&R

Professional

Both

$119.21

Service Code	HCPCS 0358T
Min. Negotiated Rate	$89.41
Max. Negotiated Rate	$89.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$89.41
Rate for Payer: SOMOS Essential	$89.41

PR BICORONAL TRANSZYGMTC&/LEFORT I W/O BONE GRFT

Professional

Both

$11,971.12

Service Code	HCPCS 61586
Min. Negotiated Rate	$8,978.34
Max. Negotiated Rate	$8,978.34
Rate for Payer: Cash Price	$3,162.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,978.34
Rate for Payer: SOMOS Essential	$8,978.34

PR BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH

Professional

Both

$1,151.92

Service Code	HCPCS 47552
Min. Negotiated Rate	$863.94
Max. Negotiated Rate	$863.94
Rate for Payer: Cash Price	$310.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$863.94
Rate for Payer: SOMOS Essential	$863.94

PR BILIARY ENDOSCOPY PRQ VIA T-TUBE W/RMVL CALCULUS

Professional

Both

$1,878.70

Service Code	HCPCS 47554
Min. Negotiated Rate	$1,409.02
Max. Negotiated Rate	$1,409.02
Rate for Payer: Cash Price	$505.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,409.02
Rate for Payer: SOMOS Essential	$1,409.02

PR BILIARY NDSC INTRAOPERATIVE

Professional

Both

$736.26

Service Code	HCPCS 47550
Min. Negotiated Rate	$552.20
Max. Negotiated Rate	$552.20
Rate for Payer: Cash Price	$193.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$552.20
Rate for Payer: SOMOS Essential	$552.20

PR BILIARY NDSC PRQ T-TUBE DILAT STRIX W/STENT

Professional

Both

$1,556.84

Service Code	HCPCS 47556
Min. Negotiated Rate	$1,167.63
Max. Negotiated Rate	$1,167.63
Rate for Payer: Cash Price	$419.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,167.63
Rate for Payer: SOMOS Essential	$1,167.63

PR BILIARY NDSC PRQ T-TUBE W/BX SINGLE/MULTIPLE

Professional

Both

$1,155.70

Service Code	HCPCS 47553
Min. Negotiated Rate	$866.78
Max. Negotiated Rate	$866.78
Rate for Payer: Cash Price	$310.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$866.78
Rate for Payer: SOMOS Essential	$866.78

PR BILIARY NDSC PRQ T-TUBE W/DIL DUCT W/O STENT

Professional

Both

$1,374.31

Service Code	HCPCS 47555
Min. Negotiated Rate	$1,030.73
Max. Negotiated Rate	$1,030.73
Rate for Payer: Cash Price	$370.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,030.73
Rate for Payer: SOMOS Essential	$1,030.73

PR BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE

Professional

Both

$38.22

Service Code	HCPCS 92504
Min. Negotiated Rate	$28.66
Max. Negotiated Rate	$28.66
Rate for Payer: Cash Price	$10.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28.66
Rate for Payer: SOMOS Essential	$28.66

PR BIOFEEDBACK TRAINING ANY MODALITY

Professional

Both

$74.20

Service Code	HCPCS 90901
Min. Negotiated Rate	$55.65
Max. Negotiated Rate	$55.65
Rate for Payer: Cash Price	$21.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$55.65
Rate for Payer: SOMOS Essential	$55.65

PR BIOMPEDANCE-DERIVED PHYSIOLOGIC CV ANALYSIS

Professional

Both

$114.87

Service Code	HCPCS 93701
Min. Negotiated Rate	$86.15
Max. Negotiated Rate	$86.15
Rate for Payer: Cash Price	$32.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$86.15
Rate for Payer: SOMOS Essential	$86.15

PR BIOPSY BONE OPEN DEEP

Professional

Both

$1,493.31

Service Code	HCPCS 20245
Min. Negotiated Rate	$1,119.98
Max. Negotiated Rate	$1,119.98
Rate for Payer: Cash Price	$400.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,119.98
Rate for Payer: SOMOS Essential	$1,119.98

PR BIOPSY BONE OPEN SUPERFICIAL

Professional

Both

$584.50

Service Code	HCPCS 20240
Min. Negotiated Rate	$438.38
Max. Negotiated Rate	$438.38
Rate for Payer: Cash Price	$159.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$438.38
Rate for Payer: SOMOS Essential	$438.38

PR BIOPSY BONE TROCAR/NEEDLE DEEP

Professional

Both

$534.84

Service Code	HCPCS 20225
Min. Negotiated Rate	$401.13
Max. Negotiated Rate	$401.13
Rate for Payer: Cash Price	$144.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$401.13
Rate for Payer: SOMOS Essential	$401.13

PR BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL

Professional

Both

$363.86

Service Code	HCPCS 20220
Min. Negotiated Rate	$272.90
Max. Negotiated Rate	$272.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$272.90
Rate for Payer: SOMOS Essential	$272.90

PR BIOPSY BREAST OPEN INCISIONAL

Professional

Both

$1,004.82

Service Code	HCPCS 19101
Min. Negotiated Rate	$753.62
Max. Negotiated Rate	$753.62
Rate for Payer: Cash Price	$268.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$753.62
Rate for Payer: SOMOS Essential	$753.62

PR BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX

Professional

Both

$323.05

Service Code	HCPCS 57500
Min. Negotiated Rate	$242.29
Max. Negotiated Rate	$242.29
Rate for Payer: Cash Price	$88.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$242.29
Rate for Payer: SOMOS Essential	$242.29

PR BIOPSY CONJUNCTIVA

Professional

Both

$391.79

Service Code	HCPCS 68100
Min. Negotiated Rate	$293.84
Max. Negotiated Rate	$293.84
Rate for Payer: Cash Price	$107.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$293.84
Rate for Payer: SOMOS Essential	$293.84

PR BIOPSY CORNEA

Professional

Both

$416.89

Service Code	HCPCS 65410
Min. Negotiated Rate	$312.67
Max. Negotiated Rate	$312.67
Rate for Payer: Cash Price	$115.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$312.67
Rate for Payer: SOMOS Essential	$312.67

PR BIOPSY EPIDIDYMIS NEEDLE

Professional

Both

$518.07

Service Code	HCPCS 54800
Min. Negotiated Rate	$388.55
Max. Negotiated Rate	$388.55
Rate for Payer: Cash Price	$143.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$388.55
Rate for Payer: SOMOS Essential	$388.55

PR BIOPSY EXTERNAL AUDITORY CANAL

Professional

Both

$272.97

Service Code	HCPCS 69105
Min. Negotiated Rate	$204.73
Max. Negotiated Rate	$204.73
Rate for Payer: Cash Price	$74.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$204.73
Rate for Payer: SOMOS Essential	$204.73

PR BIOPSY EXTERNAL EAR

Professional

Both

$197.82

Service Code	HCPCS 69100
Min. Negotiated Rate	$148.36
Max. Negotiated Rate	$148.36
Rate for Payer: Cash Price	$52.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$148.36
Rate for Payer: SOMOS Essential	$148.36

PR BIOPSY EXTRAOCULAR MUSCLE

Professional

Both

$783.34

Service Code	HCPCS 67346
Min. Negotiated Rate	$587.50
Max. Negotiated Rate	$587.50
Rate for Payer: Cash Price	$216.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$587.50
Rate for Payer: SOMOS Essential	$587.50

Know your out-of-pocket cost for care.

All Charges