St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR DISCECTOMY ANT DCMPRN CORD THORACIC EA NTRSPC

Professional

Both

$999.11

Service Code	HCPCS 63078
Min. Negotiated Rate	$749.33
Max. Negotiated Rate	$749.33
Rate for Payer: Cash Price	$261.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$749.33
Rate for Payer: SOMOS Essential	$749.33

PR DISCISSION SECONDARY MEMBRANOUS CATARACT

Professional

Both

$1,977.26

Service Code	HCPCS 66820
Min. Negotiated Rate	$1,482.94
Max. Negotiated Rate	$1,482.94
Rate for Payer: Cash Price	$539.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,482.94
Rate for Payer: SOMOS Essential	$1,482.94

PR DISCISSION VITREOUS STRANS PARS PLANA APPROACH

Professional

Both

$2,315.67

Service Code	HCPCS 67030
Min. Negotiated Rate	$1,736.75
Max. Negotiated Rate	$1,736.75
Rate for Payer: Cash Price	$637.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,736.75
Rate for Payer: SOMOS Essential	$1,736.75

PR DISE DYN EVAL SLEEP DISORDERED BREATHING FLX DX

Professional

Both

$410.45

Service Code	HCPCS 42975
Min. Negotiated Rate	$307.84
Max. Negotiated Rate	$307.84
Rate for Payer: Cash Price	$112.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$307.84
Rate for Payer: SOMOS Essential	$307.84

PR DISPLACEMENT THERAPY PROETZ TYPE

Professional

Both

$446.81

Service Code	HCPCS 30210
Min. Negotiated Rate	$335.11
Max. Negotiated Rate	$335.11
Rate for Payer: Cash Price	$121.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$335.11
Rate for Payer: SOMOS Essential	$335.11

PR DISRTCJ SHOULDER SECONDARY CLSR/SCAR REVISION

Professional

Both

$2,093.53

Service Code	HCPCS 23921
Min. Negotiated Rate	$1,570.15
Max. Negotiated Rate	$1,570.15
Rate for Payer: Cash Price	$571.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,570.15
Rate for Payer: SOMOS Essential	$1,570.15

PR DISSECTION DEEP JUGULAR NODE

Professional

Both

$2,281.06

Service Code	HCPCS 38542
Min. Negotiated Rate	$1,710.80
Max. Negotiated Rate	$1,710.80
Rate for Payer: Cash Price	$618.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,710.80
Rate for Payer: SOMOS Essential	$1,710.80

PR DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD

Professional

Both

$18.55

Service Code	HCPCS 92587 TC
Min. Negotiated Rate	$13.91
Max. Negotiated Rate	$13.91
Rate for Payer: Cash Price	$4.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$13.91
Rate for Payer: SOMOS Essential	$13.91

PR DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD

Professional

Both

$89.57

Service Code	HCPCS 92587
Min. Negotiated Rate	$67.18
Max. Negotiated Rate	$67.18
Rate for Payer: Cash Price	$24.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$67.18
Rate for Payer: SOMOS Essential	$67.18

PR DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD

Professional

Both

$71.02

Service Code	HCPCS 92587 26
Min. Negotiated Rate	$53.26
Max. Negotiated Rate	$53.26
Rate for Payer: Cash Price	$19.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$53.26
Rate for Payer: SOMOS Essential	$53.26

PR DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL

Professional

Both

$24.29

Service Code	HCPCS 92588 TC
Min. Negotiated Rate	$18.22
Max. Negotiated Rate	$18.22
Rate for Payer: Cash Price	$6.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18.22
Rate for Payer: SOMOS Essential	$18.22

PR DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL

Professional

Both

$113.30

Service Code	HCPCS 92588 26
Min. Negotiated Rate	$84.98
Max. Negotiated Rate	$84.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$84.98
Rate for Payer: SOMOS Essential	$84.98

PR DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL

Professional

Both

$137.62

Service Code	HCPCS 92588
Min. Negotiated Rate	$103.22
Max. Negotiated Rate	$103.22
Rate for Payer: Cash Price	$36.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$103.22
Rate for Payer: SOMOS Essential	$103.22

PR DIVERTICULECTOMY HYPOPHARYNX/ESOPH CRV APPR

Professional

Both

$3,462.73

Service Code	HCPCS 43130
Min. Negotiated Rate	$2,597.05
Max. Negotiated Rate	$2,597.05
Rate for Payer: Cash Price	$936.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,597.05
Rate for Payer: SOMOS Essential	$2,597.05

PR DIVERTICULECTOMY HYPOPHARYNX/ESOPH THRC APPR

Professional

Both

$6,561.07

Service Code	HCPCS 43135
Min. Negotiated Rate	$4,920.80
Max. Negotiated Rate	$4,920.80
Rate for Payer: Cash Price	$1,744.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,920.80
Rate for Payer: SOMOS Essential	$4,920.80

PR DIVISION ABERRANT VESSEL VASCULAR RING

Professional

Both

$4,834.27

Service Code	HCPCS 33802
Min. Negotiated Rate	$3,625.70
Max. Negotiated Rate	$3,625.70
Rate for Payer: Cash Price	$1,291.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,625.70
Rate for Payer: SOMOS Essential	$3,625.70

PR DIVISION ABERRANT VESSEL W/REANASTOMOSIS

Professional

Both

$5,128.10

Service Code	HCPCS 33803
Min. Negotiated Rate	$3,846.08
Max. Negotiated Rate	$3,846.08
Rate for Payer: Cash Price	$1,363.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,846.08
Rate for Payer: SOMOS Essential	$3,846.08

PR DIVISION PLANTAR FASCIA & MUSCLE SPX

Professional

Both

$1,761.06

Service Code	HCPCS 28250
Min. Negotiated Rate	$1,320.80
Max. Negotiated Rate	$1,320.80
Rate for Payer: Cash Price	$483.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,320.80
Rate for Payer: SOMOS Essential	$1,320.80

PR DIVISION SCALENUS ANTICUS RESECTION CERVICAL RIB

Professional

Both

$2,394.95

Service Code	HCPCS 21705
Min. Negotiated Rate	$1,796.21
Max. Negotiated Rate	$1,796.21
Rate for Payer: Cash Price	$636.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,796.21
Rate for Payer: SOMOS Essential	$1,796.21

PR DIVISION SCALENUS ANTICUS W/O RESCJ CERVICAL RIB

Professional

Both

$1,601.25

Service Code	HCPCS 21700
Min. Negotiated Rate	$1,200.94
Max. Negotiated Rate	$1,200.94
Rate for Payer: Cash Price	$426.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,200.94
Rate for Payer: SOMOS Essential	$1,200.94

PR DIVISION STERNOCLEIDOMASTOID OPEN W/CAST

Professional

Both

$2,408.46

Service Code	HCPCS 21725
Min. Negotiated Rate	$1,806.34
Max. Negotiated Rate	$1,806.34
Rate for Payer: Cash Price	$652.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,806.34
Rate for Payer: SOMOS Essential	$1,806.34

PR DIVISION STERNOCLEIDOMASTOID OPEN W/O CAST

Professional

Both

$2,516.57

Service Code	HCPCS 21720
Min. Negotiated Rate	$1,887.43
Max. Negotiated Rate	$1,887.43
Rate for Payer: Cash Price	$672.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,887.43
Rate for Payer: SOMOS Essential	$1,887.43

PR DIVISION STRICTURE RECTUM

Professional

Both

$1,915.34

Service Code	HCPCS 45150
Min. Negotiated Rate	$1,436.50
Max. Negotiated Rate	$1,436.50
Rate for Payer: Cash Price	$514.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,436.50
Rate for Payer: SOMOS Essential	$1,436.50

PR DLYD PLACEMENT XTN PROSTH FOR EVASC RPR 1ST VSL

Professional

Both

$3,511.87

Service Code	HCPCS 34710
Min. Negotiated Rate	$2,633.90
Max. Negotiated Rate	$2,633.90
Rate for Payer: Cash Price	$933.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,633.90
Rate for Payer: SOMOS Essential	$2,633.90

PR DLYD PLACEMENT XTN PROSTH FOR EVASC RPR EA ADDL

Professional

Both

$1,301.30

Service Code	HCPCS 34711
Min. Negotiated Rate	$975.98
Max. Negotiated Rate	$975.98
Rate for Payer: Cash Price	$344.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$975.98
Rate for Payer: SOMOS Essential	$975.98

Know your out-of-pocket cost for care.

All Charges