St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR CONDITIONING PLAY AUDIOMETRY

Professional

Both

$353.50

Service Code	HCPCS 92582
Min. Negotiated Rate	$265.12
Max. Negotiated Rate	$265.12
Rate for Payer: Cash Price	$102.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$265.12
Rate for Payer: SOMOS Essential	$265.12

PR CONDYLECTOMY TEMPOROMANDIBULAR JOINT SPX

Professional

Both

$3,651.59

Service Code	HCPCS 21050
Min. Negotiated Rate	$2,738.69
Max. Negotiated Rate	$2,738.69
Rate for Payer: Cash Price	$992.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,738.69
Rate for Payer: SOMOS Essential	$2,738.69

PR CONIZATION CERVIX W/WO D&C RPR ELTRD EXC

Professional

Both

$1,111.29

Service Code	HCPCS 57522
Min. Negotiated Rate	$833.47
Max. Negotiated Rate	$833.47
Rate for Payer: Cash Price	$302.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$833.47
Rate for Payer: SOMOS Essential	$833.47

PR CONIZATION CERVIX W/WO D&C RPR KNIFE/LASER

Professional

Both

$1,293.22

Service Code	HCPCS 57520
Min. Negotiated Rate	$969.92
Max. Negotiated Rate	$969.92
Rate for Payer: Cash Price	$351.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$969.92
Rate for Payer: SOMOS Essential	$969.92

PR CONJUNCTIVAL FLAP BRIDGE/PARTIAL SPX

Professional

Both

$1,689.91

Service Code	HCPCS 68360
Min. Negotiated Rate	$1,267.43
Max. Negotiated Rate	$1,267.43
Rate for Payer: Cash Price	$466.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,267.43
Rate for Payer: SOMOS Essential	$1,267.43

PR CONJUNCTIVAL FLAP TOTAL

Professional

Both

$2,693.46

Service Code	HCPCS 68362
Min. Negotiated Rate	$2,020.10
Max. Negotiated Rate	$2,020.10
Rate for Payer: Cash Price	$742.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,020.10
Rate for Payer: SOMOS Essential	$2,020.10

PR CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT

Professional

Both

$2,694.65

Service Code	HCPCS 68325
Min. Negotiated Rate	$2,020.99
Max. Negotiated Rate	$2,020.99
Rate for Payer: Cash Price	$743.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,020.99
Rate for Payer: SOMOS Essential	$2,020.99

PR CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT

Professional

Both

$2,227.30

Service Code	HCPCS 68320
Min. Negotiated Rate	$1,670.48
Max. Negotiated Rate	$1,670.48
Rate for Payer: Cash Price	$614.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,670.48
Rate for Payer: SOMOS Essential	$1,670.48

PR CONJUNCTIVORHINOSTOMY INSJ TUBE/STENT

Professional

Both

$3,580.78

Service Code	HCPCS 68750
Min. Negotiated Rate	$2,685.58
Max. Negotiated Rate	$2,685.58
Rate for Payer: Cash Price	$983.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,685.58
Rate for Payer: SOMOS Essential	$2,685.58

PR CONJUNCTIVORHINOSTOMY W/O TUBE

Professional

Both

$3,380.02

Service Code	HCPCS 68745
Min. Negotiated Rate	$2,535.02
Max. Negotiated Rate	$2,535.02
Rate for Payer: Cash Price	$927.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,535.02
Rate for Payer: SOMOS Essential	$2,535.02

PR CONJUNCTPL CUL-DE-SAC W/BUCCAL MUC MEMB GRAFT

Professional

Both

$2,906.23

Service Code	HCPCS 68328
Min. Negotiated Rate	$2,179.67
Max. Negotiated Rate	$2,179.67
Rate for Payer: Cash Price	$796.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,179.67
Rate for Payer: SOMOS Essential	$2,179.67

PR CONSTJ INTERMARGIN ADHES/TARSOR/CANTHOR W/TRPOS

Professional

Both

$1,940.58

Service Code	HCPCS 67882
Min. Negotiated Rate	$1,455.44
Max. Negotiated Rate	$1,455.44
Rate for Payer: Cash Price	$534.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,455.44
Rate for Payer: SOMOS Essential	$1,455.44

PR CONSTJ INTERMARGIN ADHES/TARSORRH/CANTHORRHAPY

Professional

Both

$1,519.74

Service Code	HCPCS 67880
Min. Negotiated Rate	$1,139.80
Max. Negotiated Rate	$1,139.80
Rate for Payer: Cash Price	$419.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,139.80
Rate for Payer: SOMOS Essential	$1,139.80

PR CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH

Professional

Both

$2,325.12

Service Code	HCPCS 31611
Min. Negotiated Rate	$1,743.84
Max. Negotiated Rate	$1,743.84
Rate for Payer: Cash Price	$631.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,743.84
Rate for Payer: SOMOS Essential	$1,743.84

PR CONSTRUCTION APICAL-AORTIC CONDUIT

Professional

Both

$7,697.90

Service Code	HCPCS 33404
Min. Negotiated Rate	$5,773.42
Max. Negotiated Rate	$5,773.42
Rate for Payer: Cash Price	$2,047.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,773.42
Rate for Payer: SOMOS Essential	$5,773.42

PR CONSTRUCTION ARTIFICIAL VAGINA W/GRAFT

Professional

Both

$3,620.02

Service Code	HCPCS 57292
Min. Negotiated Rate	$2,715.02
Max. Negotiated Rate	$2,715.02
Rate for Payer: Cash Price	$974.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,715.02
Rate for Payer: SOMOS Essential	$2,715.02

PR CONSTRUCTION ARTIFICIAL VAGINA W/O GRAFT

Professional

Both

$2,398.13

Service Code	HCPCS 57291
Min. Negotiated Rate	$1,798.60
Max. Negotiated Rate	$1,798.60
Rate for Payer: Cash Price	$649.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,798.60
Rate for Payer: SOMOS Essential	$1,798.60

PR CONT GLUC MNTR PHYSICIAN/QHP PROVIDED EQUIPTMENT

Professional

Both

$629.06

Service Code	HCPCS 95250
Min. Negotiated Rate	$471.80
Max. Negotiated Rate	$471.80
Rate for Payer: Cash Price	$175.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$471.80
Rate for Payer: SOMOS Essential	$471.80

PR CONT GLUC MONITORING PATIENT PROVIDED EQUIPTMENT

Professional

Both

$266.81

Service Code	HCPCS 95249
Min. Negotiated Rate	$200.11
Max. Negotiated Rate	$200.11
Rate for Payer: Cash Price	$77.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$200.11
Rate for Payer: SOMOS Essential	$200.11

PR CONTINENT DVRJ W/INT ANAST ANY SGM SM&/LG INTSTN

Professional

Both

$6,855.24

Service Code	HCPCS 50825
Min. Negotiated Rate	$5,141.43
Max. Negotiated Rate	$5,141.43
Rate for Payer: Cash Price	$1,870.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,141.43
Rate for Payer: SOMOS Essential	$5,141.43

PR CONTINENT ILEOSTOMY KOCK PROCEDURE SPX

Professional

Both

$6,405.81

Service Code	HCPCS 44316
Min. Negotiated Rate	$4,804.36
Max. Negotiated Rate	$4,804.36
Rate for Payer: Cash Price	$1,705.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,804.36
Rate for Payer: SOMOS Essential	$4,804.36

PR CONT INTRAOP NEURO MONITOR

Professional

Both

$129.22

Service Code	HCPCS G0453
Min. Negotiated Rate	$96.92
Max. Negotiated Rate	$96.92
Rate for Payer: Cash Price	$35.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$96.92
Rate for Payer: SOMOS Essential	$96.92

PR CONTINUOUS GLUCOSE MONITORING ANALYSIS I&R

Professional

Both

$138.88

Service Code	HCPCS 95251
Min. Negotiated Rate	$104.16
Max. Negotiated Rate	$104.16
Rate for Payer: Cash Price	$38.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$104.16
Rate for Payer: SOMOS Essential	$104.16

PR CONTINUOUS INHALATION TREATMENT 1ST HR

Professional

Both

$257.18

Service Code	HCPCS 94644
Min. Negotiated Rate	$192.88
Max. Negotiated Rate	$192.88
Rate for Payer: Cash Price	$70.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$192.88
Rate for Payer: SOMOS Essential	$192.88

PR CONTINUOUS INHALATION TREATMENT EA ADDL HR

Professional

Both

$68.85

Service Code	HCPCS 94645
Min. Negotiated Rate	$51.64
Max. Negotiated Rate	$51.64
Rate for Payer: Cash Price	$19.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$51.64
Rate for Payer: SOMOS Essential	$51.64

Know your out-of-pocket cost for care.

All Charges