St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR COLONOSCOPY STOMA DX INCLUDING COLLJ SPEC SPX

Professional

Both

$664.16

Service Code	HCPCS 44388
Min. Negotiated Rate	$498.12
Max. Negotiated Rate	$498.12
Rate for Payer: Cash Price	$179.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$498.12
Rate for Payer: SOMOS Essential	$498.12

PR COLONOSCOPY STOMA RMVL LES BY HOT BIOPSY FORCEPS

Professional

Both

$851.24

Service Code	HCPCS 44392
Min. Negotiated Rate	$638.43
Max. Negotiated Rate	$638.43
Rate for Payer: Cash Price	$230.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$638.43
Rate for Payer: SOMOS Essential	$638.43

PR COLONOSCOPY STOMA W/BALLOON DILATION

Professional

Both

$760.24

Service Code	HCPCS 44405
Min. Negotiated Rate	$570.18
Max. Negotiated Rate	$570.18
Rate for Payer: Cash Price	$207.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$570.18
Rate for Payer: SOMOS Essential	$570.18

PR COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE

Professional

Both

$723.31

Service Code	HCPCS 44389
Min. Negotiated Rate	$542.48
Max. Negotiated Rate	$542.48
Rate for Payer: Cash Price	$195.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$542.48
Rate for Payer: SOMOS Essential	$542.48

PR COLONOSCOPY STOMA W/ENDOSCOPIC MUCOSAL RESCJ

Professional

Both

$1,264.90

Service Code	HCPCS 44403
Min. Negotiated Rate	$948.68
Max. Negotiated Rate	$948.68
Rate for Payer: Cash Price	$343.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$948.68
Rate for Payer: SOMOS Essential	$948.68

PR COLONOSCOPY STOMA W/ENDOSCOPIC STENT PLCMT

Professional

Both

$1,087.03

Service Code	HCPCS 44402
Min. Negotiated Rate	$815.27
Max. Negotiated Rate	$815.27
Rate for Payer: Cash Price	$294.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$815.27
Rate for Payer: SOMOS Essential	$815.27

PR COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND EXAM

Professional

Both

$951.16

Service Code	HCPCS 44406
Min. Negotiated Rate	$713.37
Max. Negotiated Rate	$713.37
Rate for Payer: Cash Price	$258.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$713.37
Rate for Payer: SOMOS Essential	$713.37

PR COLONOSCOPY STOMA W/RMVL FOREIGN BODY

Professional

Both

$874.90

Service Code	HCPCS 44390
Min. Negotiated Rate	$656.18
Max. Negotiated Rate	$656.18
Rate for Payer: Cash Price	$237.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$656.18
Rate for Payer: SOMOS Essential	$656.18

PR COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE

Professional

Both

$947.21

Service Code	HCPCS 44394
Min. Negotiated Rate	$710.41
Max. Negotiated Rate	$710.41
Rate for Payer: Cash Price	$256.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$710.41
Rate for Payer: SOMOS Essential	$710.41

PR COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION

Professional

Both

$724.75

Service Code	HCPCS 44404
Min. Negotiated Rate	$543.56
Max. Negotiated Rate	$543.56
Rate for Payer: Cash Price	$195.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$543.56
Rate for Payer: SOMOS Essential	$543.56

PR COLONOSCOPY STOMA W/US GID NDL ASPIR/BX

Professional

Both

$1,143.63

Service Code	HCPCS 44407
Min. Negotiated Rate	$857.72
Max. Negotiated Rate	$857.72
Rate for Payer: Cash Price	$309.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$857.72
Rate for Payer: SOMOS Essential	$857.72

PR COLONOSCOPY THROUGH STOMA WITH DECOMPRESSION

Professional

Both

$959.07

Service Code	HCPCS 44408
Min. Negotiated Rate	$719.30
Max. Negotiated Rate	$719.30
Rate for Payer: Cash Price	$260.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$719.30
Rate for Payer: SOMOS Essential	$719.30

PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE

Professional

Both

$837.97

Service Code	HCPCS 45380
Min. Negotiated Rate	$628.48
Max. Negotiated Rate	$628.48
Rate for Payer: Cash Price	$227.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$628.48
Rate for Payer: SOMOS Essential	$628.48

PR COLORECTAL SCRN; HI RISK IND

Professional

Both

$773.36

Service Code	HCPCS G0105
Min. Negotiated Rate	$580.02
Max. Negotiated Rate	$580.02
Rate for Payer: Cash Price	$209.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$580.02
Rate for Payer: SOMOS Essential	$580.02

PR COLOR VISION XM EXTENDED ANOMALOSCOPE/EQUIV

Professional

Both

$230.90

Service Code	HCPCS 92283
Min. Negotiated Rate	$173.18
Max. Negotiated Rate	$173.18
Rate for Payer: Cash Price	$63.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$173.18
Rate for Payer: SOMOS Essential	$173.18

PR COLOR VISION XM EXTENDED ANOMALOSCOPE/EQUIV

Professional

Both

$35.53

Service Code	HCPCS 92283 26
Min. Negotiated Rate	$26.65
Max. Negotiated Rate	$26.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26.65
Rate for Payer: SOMOS Essential	$26.65

PR COLOR VISION XM EXTENDED ANOMALOSCOPE/EQUIV

Professional

Both

$195.37

Service Code	HCPCS 92283 TC
Min. Negotiated Rate	$146.53
Max. Negotiated Rate	$146.53
Rate for Payer: Cash Price	$54.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$146.53
Rate for Payer: SOMOS Essential	$146.53

PR COLOSTOMY/SKIN LEVEL CECOSTOMY

Professional

Both

$5,333.90

Service Code	HCPCS 44320
Min. Negotiated Rate	$4,000.42
Max. Negotiated Rate	$4,000.42
Rate for Payer: Cash Price	$1,428.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,000.42
Rate for Payer: SOMOS Essential	$4,000.42

PR COLOSTOMY/SKN LVL CECOSTOMY W/MULT BXS SPX

Professional

Both

$4,514.34

Service Code	HCPCS 44322
Min. Negotiated Rate	$3,385.76
Max. Negotiated Rate	$3,385.76
Rate for Payer: Cash Price	$1,208.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,385.76
Rate for Payer: SOMOS Essential	$3,385.76

PR COLOTOMY EXPLORATION/BIOPSY/FOREIGN BODY REMOVAL

Professional

Both

$4,381.90

Service Code	HCPCS 44025
Min. Negotiated Rate	$3,286.42
Max. Negotiated Rate	$3,286.42
Rate for Payer: Cash Price	$1,175.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,286.42
Rate for Payer: SOMOS Essential	$3,286.42

PR COLPOCENTESIS SEPARATE PROCEDURE

Professional

Both

$345.42

Service Code	HCPCS 57020
Min. Negotiated Rate	$259.06
Max. Negotiated Rate	$259.06
Rate for Payer: Cash Price	$92.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$259.06
Rate for Payer: SOMOS Essential	$259.06

PR COLPOCLEISIS LE FORT TYPE

Professional

Both

$2,309.86

Service Code	HCPCS 57120
Min. Negotiated Rate	$1,732.40
Max. Negotiated Rate	$1,732.40
Rate for Payer: Cash Price	$625.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,732.40
Rate for Payer: SOMOS Essential	$1,732.40

PR COLPOPERINEORRHAPHY SUTURE INJ VAGINA&/PERINEU

Professional

Both

$1,713.08

Service Code	HCPCS 57210
Min. Negotiated Rate	$1,284.81
Max. Negotiated Rate	$1,284.81
Rate for Payer: Cash Price	$465.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,284.81
Rate for Payer: SOMOS Essential	$1,284.81

PR COLPOPEXY ABDOMINAL APPROACH

Professional

Both

$4,177.46

Service Code	HCPCS 57280
Min. Negotiated Rate	$3,133.10
Max. Negotiated Rate	$3,133.10
Rate for Payer: Cash Price	$1,128.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,133.10
Rate for Payer: SOMOS Essential	$3,133.10

PR COLPOPEXY VAGINAL EXTRAPERITONEAL APPROACH

Professional

Both

$3,010.14

Service Code	HCPCS 57282
Min. Negotiated Rate	$2,257.60
Max. Negotiated Rate	$2,257.60
Rate for Payer: Cash Price	$813.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,257.60
Rate for Payer: SOMOS Essential	$2,257.60

Know your out-of-pocket cost for care.

All Charges