St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID

Professional

Both

$634.10

Service Code	HCPCS 19083
Min. Negotiated Rate	$475.58
Max. Negotiated Rate	$475.58
Rate for Payer: Cash Price	$171.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$475.58
Rate for Payer: SOMOS Essential	$475.58

PR BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID

Professional

Both

$369.36

Service Code	HCPCS 19086
Min. Negotiated Rate	$277.02
Max. Negotiated Rate	$277.02
Rate for Payer: Cash Price	$98.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$277.02
Rate for Payer: SOMOS Essential	$277.02

PR BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID

Professional

Both

$342.16

Service Code	HCPCS 19082
Min. Negotiated Rate	$256.62
Max. Negotiated Rate	$256.62
Rate for Payer: Cash Price	$90.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$256.62
Rate for Payer: SOMOS Essential	$256.62

PR BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID

Professional

Both

$322.60

Service Code	HCPCS 19084
Min. Negotiated Rate	$241.95
Max. Negotiated Rate	$241.95
Rate for Payer: Cash Price	$85.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$241.95
Rate for Payer: SOMOS Essential	$241.95

PR BX/EXC LYMPH NODE NEEDLE SUPERFICIAL

Professional

Both

$357.77

Service Code	HCPCS 38505
Min. Negotiated Rate	$268.33
Max. Negotiated Rate	$268.33
Rate for Payer: Cash Price	$96.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$268.33
Rate for Payer: SOMOS Essential	$268.33

PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE

Professional

Both

$1,985.31

Service Code	HCPCS 38525
Min. Negotiated Rate	$1,488.98
Max. Negotiated Rate	$1,488.98
Rate for Payer: Cash Price	$533.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,488.98
Rate for Payer: SOMOS Essential	$1,488.98

PR BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE

Professional

Both

$1,844.15

Service Code	HCPCS 38510
Min. Negotiated Rate	$1,383.11
Max. Negotiated Rate	$1,383.11
Rate for Payer: Cash Price	$494.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,383.11
Rate for Payer: SOMOS Essential	$1,383.11

PR BX/EXC LYMPH NODE OPEN INT MAMMARY NODE

Professional

Both

$2,493.12

Service Code	HCPCS 38530
Min. Negotiated Rate	$1,869.84
Max. Negotiated Rate	$1,869.84
Rate for Payer: Cash Price	$674.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,869.84
Rate for Payer: SOMOS Essential	$1,869.84

PR BX/EXC LYMPH NODE OPEN SUPERFICIAL

Professional

Both

$1,145.13

Service Code	HCPCS 38500
Min. Negotiated Rate	$858.85
Max. Negotiated Rate	$858.85
Rate for Payer: Cash Price	$306.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$858.85
Rate for Payer: SOMOS Essential	$858.85

PR BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD

Professional

Both

$2,075.05

Service Code	HCPCS 38520
Min. Negotiated Rate	$1,556.29
Max. Negotiated Rate	$1,556.29
Rate for Payer: Cash Price	$557.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,556.29
Rate for Payer: SOMOS Essential	$1,556.29

PR BX INTESTINE CAPSULE TUBE PRORAL 1/> SPECIMENS

Professional

Both

$442.61

Service Code	HCPCS 44100
Min. Negotiated Rate	$331.96
Max. Negotiated Rate	$331.96
Rate for Payer: Cash Price	$120.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$331.96
Rate for Payer: SOMOS Essential	$331.96

PR BX LVR NDL DONE PURPOSE TM OTH MAJOR PX

Professional

Both

$465.89

Service Code	HCPCS 47001
Min. Negotiated Rate	$349.42
Max. Negotiated Rate	$349.42
Rate for Payer: Cash Price	$123.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$349.42
Rate for Payer: SOMOS Essential	$349.42

PR BX NASOPHARYNX SURVEY UNKNOWN PRIMARY LESION

Professional

Both

$610.65

Service Code	HCPCS 42806
Min. Negotiated Rate	$457.99
Max. Negotiated Rate	$457.99
Rate for Payer: Cash Price	$167.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$457.99
Rate for Payer: SOMOS Essential	$457.99

PR BX PROSTATE STRTCTC SATURATION SAMPLING IMG GID

Professional

Both

$1,577.10

Service Code	HCPCS 55706
Min. Negotiated Rate	$1,182.82
Max. Negotiated Rate	$1,182.82
Rate for Payer: Cash Price	$432.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,182.82
Rate for Payer: SOMOS Essential	$1,182.82

PR BYPASS COMPOSITE GRAFT PROSTHETIC & VEIN

Professional

Both

$353.26

Service Code	HCPCS 35681
Min. Negotiated Rate	$264.94
Max. Negotiated Rate	$264.94
Rate for Payer: Cash Price	$93.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$264.94
Rate for Payer: SOMOS Essential	$264.94

PR BYPASS GRAFT W/OTHER THAN VEIN ILIO-CELIAC

Professional

Both

$8,033.45

Service Code	HCPCS 35632
Min. Negotiated Rate	$6,025.09
Max. Negotiated Rate	$6,025.09
Rate for Payer: Cash Price	$2,127.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,025.09
Rate for Payer: SOMOS Essential	$6,025.09

PR BYPASS GRAFT W/OTHER THAN VEIN ILIO-MESENTERIC

Professional

Both

$8,820.04

Service Code	HCPCS 35633
Min. Negotiated Rate	$6,615.03
Max. Negotiated Rate	$6,615.03
Rate for Payer: Cash Price	$2,333.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,615.03
Rate for Payer: SOMOS Essential	$6,615.03

PR BYPASS GRAFT W/OTHER THAN VEIN ILIORENAL

Professional

Both

$7,864.01

Service Code	HCPCS 35634
Min. Negotiated Rate	$5,898.01
Max. Negotiated Rate	$5,898.01
Rate for Payer: Cash Price	$2,082.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,898.01
Rate for Payer: SOMOS Essential	$5,898.01

PR BYPASS NOT VEIN AORTOSUBCLA/CAROTID/INNOMINATE

Professional

Both

$7,044.59

Service Code	HCPCS 35626
Min. Negotiated Rate	$5,283.44
Max. Negotiated Rate	$5,283.44
Rate for Payer: Cash Price	$1,864.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,283.44
Rate for Payer: SOMOS Essential	$5,283.44

PR BYPASS W/VEIN AORTOBIFEMORAL

Professional

Both

$10,868.34

Service Code	HCPCS 35540
Min. Negotiated Rate	$8,151.26
Max. Negotiated Rate	$8,151.26
Rate for Payer: Cash Price	$2,875.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,151.26
Rate for Payer: SOMOS Essential	$8,151.26

PR BYPASS W/VEIN AORTOBI-ILIAC

Professional

Both

$10,389.65

Service Code	HCPCS 35538
Min. Negotiated Rate	$7,792.24
Max. Negotiated Rate	$7,792.24
Rate for Payer: Cash Price	$2,749.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,792.24
Rate for Payer: SOMOS Essential	$7,792.24

PR BYPASS W/VEIN AORTOCELIAC/AORTOMESENTERIC

Professional

Both

$8,678.01

Service Code	HCPCS 35531
Min. Negotiated Rate	$6,508.51
Max. Negotiated Rate	$6,508.51
Rate for Payer: Cash Price	$2,297.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,508.51
Rate for Payer: SOMOS Essential	$6,508.51

PR BYPASS W/VEIN AORTOFEMORAL

Professional

Both

$9,747.75

Service Code	HCPCS 35539
Min. Negotiated Rate	$7,310.81
Max. Negotiated Rate	$7,310.81
Rate for Payer: Cash Price	$2,580.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,310.81
Rate for Payer: SOMOS Essential	$7,310.81

PR BYPASS W/VEIN AORTOILIAC

Professional

Both

$9,268.91

Service Code	HCPCS 35537
Min. Negotiated Rate	$6,951.68
Max. Negotiated Rate	$6,951.68
Rate for Payer: Cash Price	$2,455.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,951.68
Rate for Payer: SOMOS Essential	$6,951.68

PR BYPASS W/VEIN AORTORENAL

Professional

Both

$7,581.98

Service Code	HCPCS 35560
Min. Negotiated Rate	$5,686.48
Max. Negotiated Rate	$5,686.48
Rate for Payer: Cash Price	$2,008.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,686.48
Rate for Payer: SOMOS Essential	$5,686.48

Know your out-of-pocket cost for care.

All Charges