St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL

Professional

Both

$321.13

Service Code	HCPCS 50688
Min. Negotiated Rate	$240.85
Max. Negotiated Rate	$240.85
Rate for Payer: Cash Price	$88.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$240.85
Rate for Payer: SOMOS Essential	$240.85

PR CHOLECSTC EXPL DUX SPHNCTROTOMY/SPHNCTROP

Professional

Both

$6,227.62

Service Code	HCPCS 47620
Min. Negotiated Rate	$4,670.72
Max. Negotiated Rate	$4,670.72
Rate for Payer: Cash Price	$1,656.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,670.72
Rate for Payer: SOMOS Essential	$4,670.72

PR CHOLECSTONTRSTM ROUX-EN-Y W/GASTRONTRSTM

Professional

Both

$6,678.46

Service Code	HCPCS 47741
Min. Negotiated Rate	$5,008.84
Max. Negotiated Rate	$5,008.84
Rate for Payer: Cash Price	$1,777.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,008.84
Rate for Payer: SOMOS Essential	$5,008.84

PR CHOLECSTOT/CHOLECSTOST W/EXPL DRG/RMVL ST1 SPX

Professional

Both

$3,940.23

Service Code	HCPCS 47480
Min. Negotiated Rate	$2,955.17
Max. Negotiated Rate	$2,955.17
Rate for Payer: Cash Price	$1,050.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,955.17
Rate for Payer: SOMOS Essential	$2,955.17

PR CHOLECYSTECTOMY

Professional

Both

$4,821.74

Service Code	HCPCS 47600
Min. Negotiated Rate	$3,616.30
Max. Negotiated Rate	$3,616.30
Rate for Payer: Cash Price	$1,287.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,616.30
Rate for Payer: SOMOS Essential	$3,616.30

PR CHOLECYSTECTOMY EXPL DUCT CHOLEDOCHOENTEROSTOMY

Professional

Both

$5,765.41

Service Code	HCPCS 47612
Min. Negotiated Rate	$4,324.06
Max. Negotiated Rate	$4,324.06
Rate for Payer: Cash Price	$1,534.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,324.06
Rate for Payer: SOMOS Essential	$4,324.06

PR CHOLECYSTECTOMY W/CHOLANGIOGRAPHY

Professional

Both

$5,096.39

Service Code	HCPCS 47605
Min. Negotiated Rate	$3,822.29
Max. Negotiated Rate	$3,822.29
Rate for Payer: Cash Price	$1,357.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,822.29
Rate for Payer: SOMOS Essential	$3,822.29

PR CHOLECYSTECTOMY W/EXPLORATION COMMON DUCT

Professional

Both

$5,661.01

Service Code	HCPCS 47610
Min. Negotiated Rate	$4,245.76
Max. Negotiated Rate	$4,245.76
Rate for Payer: Cash Price	$1,502.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,245.76
Rate for Payer: SOMOS Essential	$4,245.76

PR CHOLECYSTOENTEROSTOMY DIRECT

Professional

Both

$5,231.80

Service Code	HCPCS 47720
Min. Negotiated Rate	$3,923.85
Max. Negotiated Rate	$3,923.85
Rate for Payer: Cash Price	$1,393.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,923.85
Rate for Payer: SOMOS Essential	$3,923.85

PR CHOLECYSTOENTEROSTOMY ROUX-EN-Y

Professional

Both

$5,941.85

Service Code	HCPCS 47740
Min. Negotiated Rate	$4,456.39
Max. Negotiated Rate	$4,456.39
Rate for Payer: Cash Price	$1,583.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,456.39
Rate for Payer: SOMOS Essential	$4,456.39

PR CHOLECYSTOENTEROSTOMY W/GASTROENTEROSTOMY

Professional

Both

$6,134.77

Service Code	HCPCS 47721
Min. Negotiated Rate	$4,601.08
Max. Negotiated Rate	$4,601.08
Rate for Payer: Cash Price	$1,633.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,601.08
Rate for Payer: SOMOS Essential	$4,601.08

PR CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT

Professional

Both

$1,384.74

Service Code	HCPCS 47490
Min. Negotiated Rate	$1,038.56
Max. Negotiated Rate	$1,038.56
Rate for Payer: Cash Price	$374.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,038.56
Rate for Payer: SOMOS Essential	$1,038.56

PR CHOLEDOCHOT/OST W/O SPHNCTROTOMY/SPHNCTROP

Professional

Both

$5,999.07

Service Code	HCPCS 47420
Min. Negotiated Rate	$4,499.30
Max. Negotiated Rate	$4,499.30
Rate for Payer: Cash Price	$1,608.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,499.30
Rate for Payer: SOMOS Essential	$4,499.30

PR CHOLEDOCHOT/OST W/SPHNCTROTOMY/SPHNCTROP

Professional

Both

$6,189.54

Service Code	HCPCS 47425
Min. Negotiated Rate	$4,642.16
Max. Negotiated Rate	$4,642.16
Rate for Payer: Cash Price	$1,646.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,642.16
Rate for Payer: SOMOS Essential	$4,642.16

PR CHOLINESTERASE INHIBITOR CHALLENGE TEST

Professional

Both

$116.13

Service Code	HCPCS 95857
Min. Negotiated Rate	$87.10
Max. Negotiated Rate	$87.10
Rate for Payer: Cash Price	$31.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$87.10
Rate for Payer: SOMOS Essential	$87.10

PR CHORIONIC VILLUS SAMPLING

Professional

Both

$607.08

Service Code	HCPCS 59015
Min. Negotiated Rate	$455.31
Max. Negotiated Rate	$455.31
Rate for Payer: Cash Price	$161.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$455.31
Rate for Payer: SOMOS Essential	$455.31

PR CHROMOTUBATION OVIDUCT W/MATERIALS

Professional

Both

$417.76

Service Code	HCPCS 58350
Min. Negotiated Rate	$313.32
Max. Negotiated Rate	$313.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$313.32
Rate for Payer: SOMOS Essential	$313.32

PR CHRONIC CARE MGMT SVC PHYS 1ST 30 MIN CAL MONTH

Professional

Both

$305.80

Service Code	HCPCS 99491
Min. Negotiated Rate	$229.35
Max. Negotiated Rate	$229.35
Rate for Payer: Cash Price	$83.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$229.35
Rate for Payer: SOMOS Essential	$229.35

PR CHRONIC CARE MGMT SVC PHYS EA ADDL 30 MIN CAL MO

Professional

Both

$204.79

Service Code	HCPCS 99437
Min. Negotiated Rate	$153.59
Max. Negotiated Rate	$153.59
Rate for Payer: Cash Price	$56.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$153.59
Rate for Payer: SOMOS Essential	$153.59

PR CHRONIC CARE MGMT SVCS STAFF 1ST 20 MIN CAL MO

Professional

Both

$204.79

Service Code	HCPCS 99490
Min. Negotiated Rate	$153.59
Max. Negotiated Rate	$153.59
Rate for Payer: Cash Price	$55.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$153.59
Rate for Payer: SOMOS Essential	$153.59

PR CHRONIC CARE MGMT SVC STAF EA ADDL 20 MIN CAL MO

Professional

Both

$140.32

Service Code	HCPCS 99439
Min. Negotiated Rate	$105.24
Max. Negotiated Rate	$105.24
Rate for Payer: Cash Price	$38.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$105.24
Rate for Payer: SOMOS Essential	$105.24

PR CHRONIC PAIN MGMT 30 MINS

Professional

Both

$298.10

Service Code	HCPCS G3002
Min. Negotiated Rate	$223.58
Max. Negotiated Rate	$223.58
Rate for Payer: Cash Price	$82.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$223.58
Rate for Payer: SOMOS Essential	$223.58

PR CHRONIC PAIN MGMT ADDL 15M

Professional

Both

$103.74

Service Code	HCPCS G3003
Min. Negotiated Rate	$77.80
Max. Negotiated Rate	$77.80
Rate for Payer: Cash Price	$28.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$77.80
Rate for Payer: SOMOS Essential	$77.80

PR CILIARY BODY DESTRUCTION CRYOTHERAPY

Professional

Both

$1,696.80

Service Code	HCPCS 66720
Min. Negotiated Rate	$1,272.60
Max. Negotiated Rate	$1,272.60
Rate for Payer: Cash Price	$469.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,272.60
Rate for Payer: SOMOS Essential	$1,272.60

PR CILIARY BODY DESTRUCTION CYCLODIALYSIS

Professional

Both

$1,607.38

Service Code	HCPCS 66740
Min. Negotiated Rate	$1,205.54
Max. Negotiated Rate	$1,205.54
Rate for Payer: Cash Price	$444.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,205.54
Rate for Payer: SOMOS Essential	$1,205.54

Know your out-of-pocket cost for care.

All Charges