St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS

Professional

Both

$995.93

Service Code	HCPCS 95928
Min. Negotiated Rate	$746.95
Max. Negotiated Rate	$746.95
Rate for Payer: Cash Price	$279.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$746.95
Rate for Payer: SOMOS Essential	$746.95

PR CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS

Professional

Both

$682.54

Service Code	HCPCS 95928 TC
Min. Negotiated Rate	$511.90
Max. Negotiated Rate	$511.90
Rate for Payer: Cash Price	$193.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$511.90
Rate for Payer: SOMOS Essential	$511.90

PR CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LI

Professional

Both

$467.29

Service Code	HCPCS 95939 26
Min. Negotiated Rate	$350.47
Max. Negotiated Rate	$350.47
Rate for Payer: Cash Price	$128.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$350.47
Rate for Payer: SOMOS Essential	$350.47

PR CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LI

Professional

Both

$1,853.81

Service Code	HCPCS 95939 TC
Min. Negotiated Rate	$1,390.36
Max. Negotiated Rate	$1,390.36
Rate for Payer: Cash Price	$522.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,390.36
Rate for Payer: SOMOS Essential	$1,390.36

PR CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LI

Professional

Both

$2,321.10

Service Code	HCPCS 95939
Min. Negotiated Rate	$1,740.82
Max. Negotiated Rate	$1,740.82
Rate for Payer: Cash Price	$651.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,740.82
Rate for Payer: SOMOS Essential	$1,740.82

PR CURETTAGE POSTPARTUM

Professional

Both

$874.79

Service Code	HCPCS 59160
Min. Negotiated Rate	$656.09
Max. Negotiated Rate	$656.09
Rate for Payer: Cash Price	$232.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$656.09
Rate for Payer: SOMOS Essential	$656.09

PR CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX 1ST

Professional

Both

$625.84

Service Code	HCPCS 46940
Min. Negotiated Rate	$469.38
Max. Negotiated Rate	$469.38
Rate for Payer: Cash Price	$168.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$469.38
Rate for Payer: SOMOS Essential	$469.38

PR CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX SBSQ

Professional

Both

$558.57

Service Code	HCPCS 46942
Min. Negotiated Rate	$418.93
Max. Negotiated Rate	$418.93
Rate for Payer: Cash Price	$151.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$418.93
Rate for Payer: SOMOS Essential	$418.93

PR CUTANANEOUS APPENDICO-VESICOSTOMY

Professional

Both

$5,238.42

Service Code	HCPCS 50845
Min. Negotiated Rate	$3,928.82
Max. Negotiated Rate	$3,928.82
Rate for Payer: Cash Price	$1,432.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,928.82
Rate for Payer: SOMOS Essential	$3,928.82

PR CUTANEOUS VESICOSTOMY

Professional

Both

$2,993.76

Service Code	HCPCS 51980
Min. Negotiated Rate	$2,245.32
Max. Negotiated Rate	$2,245.32
Rate for Payer: Cash Price	$818.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,245.32
Rate for Payer: SOMOS Essential	$2,245.32

PR CV STRS TST XERS&/OR RX CONT ECG I&R ONLY

Professional

Both

$54.67

Service Code	HCPCS 93018
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$41.00
Rate for Payer: Cash Price	$15.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41.00
Rate for Payer: SOMOS Essential	$41.00

PR CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY

Professional

Both

$156.42

Service Code	HCPCS 93017
Min. Negotiated Rate	$117.32
Max. Negotiated Rate	$117.32
Rate for Payer: Cash Price	$44.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$117.32
Rate for Payer: SOMOS Essential	$117.32

PR CV STRS TST XERS&/OR RX CONT ECG W/O I&R

Professional

Both

$82.11

Service Code	HCPCS 93016
Min. Negotiated Rate	$61.58
Max. Negotiated Rate	$61.58
Rate for Payer: Cash Price	$22.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$61.58
Rate for Payer: SOMOS Essential	$61.58

PR CV STRS TST XERS&/OR RX CONT ECG W/SI&R

Professional

Both

$293.20

Service Code	HCPCS 93015
Min. Negotiated Rate	$219.90
Max. Negotiated Rate	$219.90
Rate for Payer: Cash Price	$82.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$219.90
Rate for Payer: SOMOS Essential	$219.90

PR CYSTECTOMY COMPLETE SEPARATE PROCEDURE

Professional

Both

$6,159.16

Service Code	HCPCS 51570
Min. Negotiated Rate	$4,619.37
Max. Negotiated Rate	$4,619.37
Rate for Payer: Cash Price	$1,677.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,619.37
Rate for Payer: SOMOS Essential	$4,619.37

PR CYSTECTOMY PARTIAL COMPLICATED

Professional

Both

$5,273.80

Service Code	HCPCS 51555
Min. Negotiated Rate	$3,955.35
Max. Negotiated Rate	$3,955.35
Rate for Payer: Cash Price	$1,441.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,955.35
Rate for Payer: SOMOS Essential	$3,955.35

PR CYSTECTOMY PARTIAL SIMPLE

Professional

Both

$4,066.30

Service Code	HCPCS 51550
Min. Negotiated Rate	$3,049.72
Max. Negotiated Rate	$3,049.72
Rate for Payer: Cash Price	$1,109.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,049.72
Rate for Payer: SOMOS Essential	$3,049.72

PR CYSTECTOMY W/BI PELVIC LYMPHADENECTOMY

Professional

Both

$7,581.63

Service Code	HCPCS 51575
Min. Negotiated Rate	$5,686.22
Max. Negotiated Rate	$5,686.22
Rate for Payer: Cash Price	$2,060.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,686.22
Rate for Payer: SOMOS Essential	$5,686.22

PR CYSTECTOMY W/URETEROSIGMOID BI PELV LYMPH NODES

Professional

Both

$8,769.32

Service Code	HCPCS 51585
Min. Negotiated Rate	$6,576.99
Max. Negotiated Rate	$6,576.99
Rate for Payer: Cash Price	$2,392.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,576.99
Rate for Payer: SOMOS Essential	$6,576.99

PR CYSTECTOMY W/URETEROSIGMOIDOSTOMY W/NODES

Professional

Both

$7,886.38

Service Code	HCPCS 51580
Min. Negotiated Rate	$5,914.78
Max. Negotiated Rate	$5,914.78
Rate for Payer: Cash Price	$2,153.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,914.78
Rate for Payer: SOMOS Essential	$5,914.78

PR CYSTO BLADDER W/URETERAL CATHETERIZATION

Professional

Both

$547.54

Service Code	HCPCS 52005
Min. Negotiated Rate	$410.66
Max. Negotiated Rate	$410.66
Rate for Payer: Cash Price	$151.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$410.66
Rate for Payer: SOMOS Essential	$410.66

PR CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS

Professional

Both

$632.98

Service Code	HCPCS 52281
Min. Negotiated Rate	$474.74
Max. Negotiated Rate	$474.74
Rate for Payer: Cash Price	$172.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$474.74
Rate for Payer: SOMOS Essential	$474.74

PR CYSTO FRAGMENTATION URETERAL STONE

Professional

Both

$1,323.63

Service Code	HCPCS 52325
Min. Negotiated Rate	$992.72
Max. Negotiated Rate	$992.72
Rate for Payer: Cash Price	$360.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$992.72
Rate for Payer: SOMOS Essential	$992.72

PR CYSTO INC FULG/RESCJ URTL VALVES/FOLDS

Professional

Both

$1,991.22

Service Code	HCPCS 52400
Min. Negotiated Rate	$1,493.42
Max. Negotiated Rate	$1,493.42
Rate for Payer: Cash Price	$545.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,493.42
Rate for Payer: SOMOS Essential	$1,493.42

PR CYSTO INC/RESCJ ORIFICE BLDR DIVERTICULUM 1/MLT

Professional

Both

$1,156.47

Service Code	HCPCS 52305
Min. Negotiated Rate	$867.35
Max. Negotiated Rate	$867.35
Rate for Payer: Cash Price	$313.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$867.35
Rate for Payer: SOMOS Essential	$867.35

Know your out-of-pocket cost for care.

All Charges