St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR DEVLOPMENT TEST INTERPT&REP

Professional

Both

$47.29

Service Code	HCPCS G0451
Min. Negotiated Rate	$35.47
Max. Negotiated Rate	$35.47
Rate for Payer: Cash Price	$13.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35.47
Rate for Payer: SOMOS Essential	$35.47

PR DIABETES PREVENTION PROG STANDARDIZED CURRICULUM

Professional

Both

$67.17

Service Code	HCPCS 0403T
Min. Negotiated Rate	$50.38
Max. Negotiated Rate	$50.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$50.38
Rate for Payer: SOMOS Essential	$50.38

PR DIAB MANAGE TRN IND/GROUP

Professional

Both

$62.79

Service Code	HCPCS G0109
Min. Negotiated Rate	$47.09
Max. Negotiated Rate	$47.09
Rate for Payer: Cash Price	$17.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$47.09
Rate for Payer: SOMOS Essential	$47.09

PR DIAB MANAGE TRN PER INDIV

Professional

Both

$221.41

Service Code	HCPCS G0108
Min. Negotiated Rate	$166.06
Max. Negotiated Rate	$166.06
Rate for Payer: Cash Price	$61.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$166.06
Rate for Payer: SOMOS Essential	$166.06

PR DIAGNOSTIC ARTHROSCOPY SHOULDER +- SYNOVIAL BX

Professional

Both

$2,074.73

Service Code	HCPCS 29805
Min. Negotiated Rate	$1,556.05
Max. Negotiated Rate	$1,556.05
Rate for Payer: Cash Price	$561.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,556.05
Rate for Payer: SOMOS Essential	$1,556.05

PR DIAGNOSTIC BONE MARROW ASPIRATIONS

Professional

Both

$278.29

Service Code	HCPCS 38220
Min. Negotiated Rate	$208.72
Max. Negotiated Rate	$208.72
Rate for Payer: Cash Price	$75.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$208.72
Rate for Payer: SOMOS Essential	$208.72

PR DIAGNOSTIC BONE MARROW BIOPSIES

Professional

Both

$286.86

Service Code	HCPCS 38221
Min. Negotiated Rate	$215.14
Max. Negotiated Rate	$215.14
Rate for Payer: Cash Price	$78.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$215.14
Rate for Payer: SOMOS Essential	$215.14

PR DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS

Professional

Both

$309.51

Service Code	HCPCS 38222
Min. Negotiated Rate	$232.13
Max. Negotiated Rate	$232.13
Rate for Payer: Cash Price	$83.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$232.13
Rate for Payer: SOMOS Essential	$232.13

PR DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL

Professional

Both

$103.50

Service Code	HCPCS G0279 TC
Min. Negotiated Rate	$77.62
Max. Negotiated Rate	$77.62
Rate for Payer: Cash Price	$22.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$77.62
Rate for Payer: SOMOS Essential	$77.62

PR DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL

Professional

Both

$221.24

Service Code	HCPCS G0279
Min. Negotiated Rate	$165.93
Max. Negotiated Rate	$165.93
Rate for Payer: Cash Price	$53.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$165.93
Rate for Payer: SOMOS Essential	$165.93

PR DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL

Professional

Both

$117.71

Service Code	HCPCS G0279 26
Min. Negotiated Rate	$88.28
Max. Negotiated Rate	$88.28
Rate for Payer: Cash Price	$31.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$88.28
Rate for Payer: SOMOS Essential	$88.28

PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE

Professional

Both

$274.68

Service Code	HCPCS 62270
Min. Negotiated Rate	$206.01
Max. Negotiated Rate	$206.01
Rate for Payer: Cash Price	$75.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$206.01
Rate for Payer: SOMOS Essential	$206.01

PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT

Professional

Both

$359.24

Service Code	HCPCS 62328
Min. Negotiated Rate	$269.43
Max. Negotiated Rate	$269.43
Rate for Payer: Cash Price	$95.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$269.43
Rate for Payer: SOMOS Essential	$269.43

PR DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I

Professional

Both

$850.57

Service Code	HCPCS 36909
Min. Negotiated Rate	$637.93
Max. Negotiated Rate	$637.93
Rate for Payer: Cash Price	$227.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$637.93
Rate for Payer: SOMOS Essential	$637.93

PR DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL

Professional

Both

$346.36

Service Code	HCPCS 90945
Min. Negotiated Rate	$259.77
Max. Negotiated Rate	$259.77
Rate for Payer: Cash Price	$95.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$259.77
Rate for Payer: SOMOS Essential	$259.77

PR DIALYSIS OTH/THN HEMODIALY REPEAT PHYS/QHP EVALS

Professional

Both

$495.67

Service Code	HCPCS 90947
Min. Negotiated Rate	$371.75
Max. Negotiated Rate	$371.75
Rate for Payer: Cash Price	$135.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$371.75
Rate for Payer: SOMOS Essential	$371.75

PR DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS

Professional

Both

$210.81

Service Code	HCPCS 57170
Min. Negotiated Rate	$158.11
Max. Negotiated Rate	$158.11
Rate for Payer: Cash Price	$54.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$158.11
Rate for Payer: SOMOS Essential	$158.11

PR DIGITAL ANALYSIS ELECTROENCEPHALOGRAM

Professional

Both

$400.68

Service Code	HCPCS 95957 26
Min. Negotiated Rate	$300.51
Max. Negotiated Rate	$300.51
Rate for Payer: Cash Price	$110.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$300.51
Rate for Payer: SOMOS Essential	$300.51

PR DIGITAL ANALYSIS ELECTROENCEPHALOGRAM

Professional

Both

$759.89

Service Code	HCPCS 95957 TC
Min. Negotiated Rate	$569.92
Max. Negotiated Rate	$569.92
Rate for Payer: Cash Price	$229.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$569.92
Rate for Payer: SOMOS Essential	$569.92

PR DIGITAL ANALYSIS ELECTROENCEPHALOGRAM

Professional

Both

$1,160.57

Service Code	HCPCS 95957
Min. Negotiated Rate	$870.43
Max. Negotiated Rate	$870.43
Rate for Payer: Cash Price	$339.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$870.43
Rate for Payer: SOMOS Essential	$870.43

PR DILAT ANAL SPHNCTR SPX UNDER ANES OTH/THN LOCAL

Professional

Both

$744.21

Service Code	HCPCS 45905
Min. Negotiated Rate	$558.16
Max. Negotiated Rate	$558.16
Rate for Payer: Cash Price	$201.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$558.16
Rate for Payer: SOMOS Essential	$558.16

PR DILAT&CATHJ SALIVARY DUCT W/WO INJECTION

Professional

Both

$400.30

Service Code	HCPCS 42660
Min. Negotiated Rate	$300.22
Max. Negotiated Rate	$300.22
Rate for Payer: Cash Price	$103.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$300.22
Rate for Payer: SOMOS Essential	$300.22

PR DILAT FEMALE URETHRA GENERAL/CNDJ SPINAL ANES

Professional

Both

$159.92

Service Code	HCPCS 53665
Min. Negotiated Rate	$119.94
Max. Negotiated Rate	$119.94
Rate for Payer: Cash Price	$42.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$119.94
Rate for Payer: SOMOS Essential	$119.94

PR DILAT FEMALE URETHRA W/SUPPOSITORY&/INSTLJ INI

Professional

Both

$176.65

Service Code	HCPCS 53660
Min. Negotiated Rate	$132.49
Max. Negotiated Rate	$132.49
Rate for Payer: Cash Price	$47.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$132.49
Rate for Payer: SOMOS Essential	$132.49

PR DILAT FEMALE URT W/SUPPOSITORY&/INSTLJ SBSQ

Professional

Both

$172.17

Service Code	HCPCS 53661
Min. Negotiated Rate	$129.13
Max. Negotiated Rate	$129.13
Rate for Payer: Cash Price	$46.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$129.13
Rate for Payer: SOMOS Essential	$129.13

Know your out-of-pocket cost for care.

All Charges