St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR BREAST RECONSTRUCTION 1PEDICLED TRAM FLAP ANAST

Professional

Both

$9,471.35

Service Code	HCPCS 19368
Min. Negotiated Rate	$7,103.51
Max. Negotiated Rate	$7,103.51
Rate for Payer: Cash Price	$2,542.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,103.51
Rate for Payer: SOMOS Essential	$7,103.51

PR BREAST RECONSTRUCTION BIPEDICLED TRAM FLAP

Professional

Both

$8,801.14

Service Code	HCPCS 19369
Min. Negotiated Rate	$6,600.86
Max. Negotiated Rate	$6,600.86
Rate for Payer: Cash Price	$2,363.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,600.86
Rate for Payer: SOMOS Essential	$6,600.86

PR BREAST RECONSTRUCTION SINGLE PEDICLED TRAM FLAP

Professional

Both

$7,728.74

Service Code	HCPCS 19367
Min. Negotiated Rate	$5,796.56
Max. Negotiated Rate	$5,796.56
Rate for Payer: Cash Price	$2,078.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,796.56
Rate for Payer: SOMOS Essential	$5,796.56

PR BREAST RECONSTRUCTION W/FREE FLAP

Professional

Both

$11,887.86

Service Code	HCPCS 19364
Min. Negotiated Rate	$8,915.90
Max. Negotiated Rate	$8,915.90
Rate for Payer: Cash Price	$3,190.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,915.90
Rate for Payer: SOMOS Essential	$8,915.90

PR BREAST RECONSTRUCTION W/LATISSIMUS DORSI FLAP

Professional

Both

$6,809.85

Service Code	HCPCS 19361
Min. Negotiated Rate	$5,107.39
Max. Negotiated Rate	$5,107.39
Rate for Payer: Cash Price	$1,832.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,107.39
Rate for Payer: SOMOS Essential	$5,107.39

PR BREAST REDUCTION

Professional

Both

$4,785.83

Service Code	HCPCS 19318
Min. Negotiated Rate	$3,589.37
Max. Negotiated Rate	$3,589.37
Rate for Payer: Cash Price	$1,288.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,589.37
Rate for Payer: SOMOS Essential	$3,589.37

PR BREATH HYDROGEN/METHANE TEST

Professional

Both

$361.13

Service Code	HCPCS 91065
Min. Negotiated Rate	$270.85
Max. Negotiated Rate	$270.85
Rate for Payer: Cash Price	$86.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$270.85
Rate for Payer: SOMOS Essential	$270.85

PR BREATH HYDROGEN/METHANE TEST

Professional

Both

$39.27

Service Code	HCPCS 91065 26
Min. Negotiated Rate	$29.45
Max. Negotiated Rate	$29.45
Rate for Payer: Cash Price	$10.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29.45
Rate for Payer: SOMOS Essential	$29.45

PR BREATH HYDROGEN/METHANE TEST

Professional

Both

$321.86

Service Code	HCPCS 91065 TC
Min. Negotiated Rate	$241.40
Max. Negotiated Rate	$241.40
Rate for Payer: Cash Price	$76.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$241.40
Rate for Payer: SOMOS Essential	$241.40

PR BREATHING RESPONSE TO HYPOXIA

Professional

Both

$78.58

Service Code	HCPCS 94450 26
Min. Negotiated Rate	$58.94
Max. Negotiated Rate	$58.94
Rate for Payer: Cash Price	$20.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$58.94
Rate for Payer: SOMOS Essential	$58.94

PR BREATHING RESPONSE TO HYPOXIA

Professional

Both

$271.43

Service Code	HCPCS 94450 TC
Min. Negotiated Rate	$203.57
Max. Negotiated Rate	$203.57
Rate for Payer: Cash Price	$71.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$203.57
Rate for Payer: SOMOS Essential	$203.57

PR BREATHING RESPONSE TO HYPOXIA

Professional

Both

$349.97

Service Code	HCPCS 94450
Min. Negotiated Rate	$262.48
Max. Negotiated Rate	$262.48
Rate for Payer: Cash Price	$92.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$262.48
Rate for Payer: SOMOS Essential	$262.48

PR BRIEF ALCOHOL MISUSE COUNSEL

Professional

Both

$94.61

Service Code	HCPCS G0443
Min. Negotiated Rate	$70.96
Max. Negotiated Rate	$70.96
Rate for Payer: Cash Price	$25.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70.96
Rate for Payer: SOMOS Essential	$70.96

PR BRIEF CHECK IN BY MD/QHP

Professional

Both

$51.17

Service Code	HCPCS G2012
Min. Negotiated Rate	$38.38
Max. Negotiated Rate	$38.38
Rate for Payer: Cash Price	$14.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38.38
Rate for Payer: SOMOS Essential	$38.38

PR BRIEF CHKIN, 5-10, NON-E/M

Professional

Both

$51.17

Service Code	HCPCS G2251
Min. Negotiated Rate	$38.38
Max. Negotiated Rate	$38.38
Rate for Payer: Cash Price	$14.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38.38
Rate for Payer: SOMOS Essential	$38.38

PR BRIEF CHKIN BY MD/QHP, 11-20

Professional

Both

$103.74

Service Code	HCPCS G2252
Min. Negotiated Rate	$77.80
Max. Negotiated Rate	$77.80
Rate for Payer: Cash Price	$27.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$77.80
Rate for Payer: SOMOS Essential	$77.80

PR BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN

Professional

Both

$123.48

Service Code	HCPCS 94060 TC
Min. Negotiated Rate	$92.61
Max. Negotiated Rate	$92.61
Rate for Payer: Cash Price	$34.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$92.61
Rate for Payer: SOMOS Essential	$92.61

PR BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN

Professional

Both

$163.84

Service Code	HCPCS 94060
Min. Negotiated Rate	$122.88
Max. Negotiated Rate	$122.88
Rate for Payer: Cash Price	$45.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$122.88
Rate for Payer: SOMOS Essential	$122.88

PR BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN

Professional

Both

$40.36

Service Code	HCPCS 94060 26
Min. Negotiated Rate	$30.27
Max. Negotiated Rate	$30.27
Rate for Payer: Cash Price	$11.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30.27
Rate for Payer: SOMOS Essential	$30.27

PR BRNCHSC BRUSHING/PROTECTED BRUSHINGS

Professional

Both

$531.90

Service Code	HCPCS 31623
Min. Negotiated Rate	$398.92
Max. Negotiated Rate	$398.92
Rate for Payer: Cash Price	$145.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$398.92
Rate for Payer: SOMOS Essential	$398.92

PR BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX

Professional

Both

$896.35

Service Code	HCPCS 31652
Min. Negotiated Rate	$672.26
Max. Negotiated Rate	$672.26
Rate for Payer: Cash Price	$243.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$672.26
Rate for Payer: SOMOS Essential	$672.26

PR BRNCHSC EBUS GUIDED SAMPL 3/> NODE STATION/STRUX

Professional

Both

$994.21

Service Code	HCPCS 31653
Min. Negotiated Rate	$745.66
Max. Negotiated Rate	$745.66
Rate for Payer: Cash Price	$270.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$745.66
Rate for Payer: SOMOS Essential	$745.66

PR BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX

Professional

Both

$544.29

Service Code	HCPCS 31622
Min. Negotiated Rate	$408.22
Max. Negotiated Rate	$408.22
Rate for Payer: Cash Price	$149.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$408.22
Rate for Payer: SOMOS Essential	$408.22

PR BRNCHSC OCCLUSION&INSERT BRONCH VALVE ADDL LOBE

Professional

Both

$314.86

Service Code	HCPCS 31651
Min. Negotiated Rate	$236.14
Max. Negotiated Rate	$236.14
Rate for Payer: Cash Price	$83.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$236.14
Rate for Payer: SOMOS Essential	$236.14

PR BRNCHSC OCCLUSION&INSERT BRONCH VALVE INIT LOBE

Professional

Both

$830.90

Service Code	HCPCS 31647
Min. Negotiated Rate	$623.18
Max. Negotiated Rate	$623.18
Rate for Payer: Cash Price	$226.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$623.18
Rate for Payer: SOMOS Essential	$623.18

Know your out-of-pocket cost for care.

All Charges