St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR DILATION CERVICAL CANAL INSTRUMENTAL SPX

Professional

Both

$205.45

Service Code	HCPCS 57800
Min. Negotiated Rate	$154.09
Max. Negotiated Rate	$154.09
Rate for Payer: Cash Price	$56.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$154.09
Rate for Payer: SOMOS Essential	$154.09

PR DILATION & CURETTAGE CERVICAL STUMP

Professional

Both

$560.98

Service Code	HCPCS 57558
Min. Negotiated Rate	$420.74
Max. Negotiated Rate	$420.74
Rate for Payer: Cash Price	$152.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$420.74
Rate for Payer: SOMOS Essential	$420.74

PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC

Professional

Both

$1,017.87

Service Code	HCPCS 58120
Min. Negotiated Rate	$763.40
Max. Negotiated Rate	$763.40
Rate for Payer: Cash Price	$275.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$763.40
Rate for Payer: SOMOS Essential	$763.40

PR DILATION ESOPHAGUS GUIDE WIRE

Professional

Both

$365.16

Service Code	HCPCS 43453
Min. Negotiated Rate	$273.87
Max. Negotiated Rate	$273.87
Rate for Payer: Cash Price	$99.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$273.87
Rate for Payer: SOMOS Essential	$273.87

PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS

Professional

Both

$337.65

Service Code	HCPCS 43450
Min. Negotiated Rate	$253.24
Max. Negotiated Rate	$253.24
Rate for Payer: Cash Price	$91.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$253.24
Rate for Payer: SOMOS Essential	$253.24

PR DILATION LACRIMAL PUNCTUM W/WO IRRGATION

Professional

Both

$324.98

Service Code	HCPCS 68801
Min. Negotiated Rate	$243.74
Max. Negotiated Rate	$243.74
Rate for Payer: Cash Price	$91.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$243.74
Rate for Payer: SOMOS Essential	$243.74

PR DILATION SALIVARY DUCT

Professional

Both

$253.05

Service Code	HCPCS 42650
Min. Negotiated Rate	$189.79
Max. Negotiated Rate	$189.79
Rate for Payer: Cash Price	$69.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$189.79
Rate for Payer: SOMOS Essential	$189.79

PR DILATION VAGINA W/ANESTHESIA OTHER THAN LOCAL

Professional

Both

$560.91

Service Code	HCPCS 57400
Min. Negotiated Rate	$420.68
Max. Negotiated Rate	$420.68
Rate for Payer: Cash Price	$152.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$420.68
Rate for Payer: SOMOS Essential	$420.68

PR DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL

Professional

Both

$840.35

Service Code	HCPCS 45910
Min. Negotiated Rate	$630.26
Max. Negotiated Rate	$630.26
Rate for Payer: Cash Price	$227.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$630.26
Rate for Payer: SOMOS Essential	$630.26

PR DILAT URETHRAL STRIX DILATOR MALE 1ST

Professional

Both

$271.39

Service Code	HCPCS 53600
Min. Negotiated Rate	$203.54
Max. Negotiated Rate	$203.54
Rate for Payer: Cash Price	$72.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$203.54
Rate for Payer: SOMOS Essential	$203.54

PR DILAT URETHRAL STRIX DILATOR MALE SBSQ

Professional

Both

$223.13

Service Code	HCPCS 53601
Min. Negotiated Rate	$167.35
Max. Negotiated Rate	$167.35
Rate for Payer: Cash Price	$60.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$167.35
Rate for Payer: SOMOS Essential	$167.35

PR DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST

Professional

Both

$361.27

Service Code	HCPCS 53620
Min. Negotiated Rate	$270.95
Max. Negotiated Rate	$270.95
Rate for Payer: Cash Price	$98.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$270.95
Rate for Payer: SOMOS Essential	$270.95

PR DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE SBSQ

Professional

Both

$300.41

Service Code	HCPCS 53621
Min. Negotiated Rate	$225.31
Max. Negotiated Rate	$225.31
Rate for Payer: Cash Price	$81.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$225.31
Rate for Payer: SOMOS Essential	$225.31

PR DILAT URETHRAL STRIX/VESICAL NCK DILAT MALE ANES

Professional

Both

$270.10

Service Code	HCPCS 53605
Min. Negotiated Rate	$202.58
Max. Negotiated Rate	$202.58
Rate for Payer: Cash Price	$72.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$202.58
Rate for Payer: SOMOS Essential	$202.58

PR DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM

Professional

Both

$68.67

Service Code	HCPCS 90700
Min. Negotiated Rate	$51.50
Max. Negotiated Rate	$51.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$51.50
Rate for Payer: SOMOS Essential	$51.50

PR DIRECT NASAL MUCOUS MEMBRANE TEST

Professional

Both

$120.61

Service Code	HCPCS 95065
Min. Negotiated Rate	$90.46
Max. Negotiated Rate	$90.46
Rate for Payer: Cash Price	$34.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$90.46
Rate for Payer: SOMOS Essential	$90.46

PR DIR/PTCH CLS SINUS VENOSUS W/WO ANOM PUL VEN DRG

Professional

Both

$7,702.59

Service Code	HCPCS 33645
Min. Negotiated Rate	$5,776.94
Max. Negotiated Rate	$5,776.94
Rate for Payer: Cash Price	$2,045.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,776.94
Rate for Payer: SOMOS Essential	$5,776.94

PR DIR RPR ANEURYSM ABDOM AORTA W/ILIAC VESSELS

Professional

Both

$8,339.45

Service Code	HCPCS 35102
Min. Negotiated Rate	$6,254.59
Max. Negotiated Rate	$6,254.59
Rate for Payer: Cash Price	$2,214.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,254.59
Rate for Payer: SOMOS Essential	$6,254.59

PR DIR RPR ANEURYSM ABDOM AORTA W/VISCERAL VESSELS

Professional

Both

$7,915.78

Service Code	HCPCS 35091
Min. Negotiated Rate	$5,936.84
Max. Negotiated Rate	$5,936.84
Rate for Payer: Cash Price	$2,092.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,936.84
Rate for Payer: SOMOS Essential	$5,936.84

PR DIR RPR ANEURYSM ABDOMINAL AORTA

Professional

Both

$7,688.21

Service Code	HCPCS 35081
Min. Negotiated Rate	$5,766.16
Max. Negotiated Rate	$5,766.16
Rate for Payer: Cash Price	$2,036.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,766.16
Rate for Payer: SOMOS Essential	$5,766.16

PR DIR RPR ANEURYSM AXIL-BRACHIAL ARM INCISION

Professional

Both

$4,496.52

Service Code	HCPCS 35011
Min. Negotiated Rate	$3,372.39
Max. Negotiated Rate	$3,372.39
Rate for Payer: Cash Price	$1,192.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,372.39
Rate for Payer: SOMOS Essential	$3,372.39

PR DIR RPR ANEURYSM CAROTID-SUBCLAVIAN ARTERY

Professional

Both

$4,998.88

Service Code	HCPCS 35001
Min. Negotiated Rate	$3,749.16
Max. Negotiated Rate	$3,749.16
Rate for Payer: Cash Price	$1,323.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,749.16
Rate for Payer: SOMOS Essential	$3,749.16

PR DIR RPR ANEURYSM & GRAFT COMMON FEMORAL ARTERY

Professional

Both

$4,857.58

Service Code	HCPCS 35141
Min. Negotiated Rate	$3,643.18
Max. Negotiated Rate	$3,643.18
Rate for Payer: Cash Price	$1,285.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,643.18
Rate for Payer: SOMOS Essential	$3,643.18

PR DIR RPR ANEURYSM & GRAFT ILIAC ARTERY

Professional

Both

$6,124.48

Service Code	HCPCS 35131
Min. Negotiated Rate	$4,593.36
Max. Negotiated Rate	$4,593.36
Rate for Payer: Cash Price	$1,626.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,593.36
Rate for Payer: SOMOS Essential	$4,593.36

PR DIR RPR ANEURYSM & GRAFT POPLITEAL ARTERY

Professional

Both

$5,507.32

Service Code	HCPCS 35151
Min. Negotiated Rate	$4,130.49
Max. Negotiated Rate	$4,130.49
Rate for Payer: Cash Price	$1,462.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,130.49
Rate for Payer: SOMOS Essential	$4,130.49

Know your out-of-pocket cost for care.

All Charges