St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR EGD ESOPHAGUS BALLOON DILATION 30 MM OR LARGER

Professional

Both

$965.90

Service Code	HCPCS 43233
Min. Negotiated Rate	$724.42
Max. Negotiated Rate	$724.42
Rate for Payer: Cash Price	$262.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$724.42
Rate for Payer: SOMOS Essential	$724.42

PR EGD FLEXIBLE FOREIGN BODY REMOVAL

Professional

Both

$740.46

Service Code	HCPCS 43247
Min. Negotiated Rate	$555.34
Max. Negotiated Rate	$555.34
Rate for Payer: Cash Price	$200.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$555.34
Rate for Payer: SOMOS Essential	$555.34

PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS

Professional

Both

$719.64

Service Code	HCPCS 43250
Min. Negotiated Rate	$539.73
Max. Negotiated Rate	$539.73
Rate for Payer: Cash Price	$194.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$539.73
Rate for Payer: SOMOS Essential	$539.73

PR EGD FLEX TRANSORAL W/OPTICAL ENDOMICROSCOPY

Professional

Both

$699.37

Service Code	HCPCS 43252
Min. Negotiated Rate	$524.53
Max. Negotiated Rate	$524.53
Rate for Payer: Cash Price	$190.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$524.53
Rate for Payer: SOMOS Essential	$524.53

PR EGD FLX TRNSORL W/DPLMNT NTRGSTR BARIATRIC BALO

Professional

Both

$798.53

Service Code	HCPCS 43290
Min. Negotiated Rate	$598.90
Max. Negotiated Rate	$598.90
Rate for Payer: Cash Price	$213.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$598.90
Rate for Payer: SOMOS Essential	$598.90

PR EGD FLX TRNSORL W/RMVL NTRGSTR BARIATRIC BALO

Professional

Both

$672.00

Service Code	HCPCS 43291
Min. Negotiated Rate	$504.00
Max. Negotiated Rate	$504.00
Rate for Payer: Cash Price	$182.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$504.00
Rate for Payer: SOMOS Essential	$504.00

PR EGD INJECTION SCLEROSIS ESOPHGL/GASTRIC VARICES

Professional

Both

$991.62

Service Code	HCPCS 43243
Min. Negotiated Rate	$743.72
Max. Negotiated Rate	$743.72
Rate for Payer: Cash Price	$269.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$743.72
Rate for Payer: SOMOS Essential	$743.72

PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS

Professional

Both

$691.67

Service Code	HCPCS 43248
Min. Negotiated Rate	$518.75
Max. Negotiated Rate	$518.75
Rate for Payer: Cash Price	$188.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$518.75
Rate for Payer: SOMOS Essential	$518.75

PR EGD INTRALUMINAL TUBE/CATHETER INSERTION

Professional

Both

$590.91

Service Code	HCPCS 43241
Min. Negotiated Rate	$443.18
Max. Negotiated Rate	$443.18
Rate for Payer: Cash Price	$162.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$443.18
Rate for Payer: SOMOS Essential	$443.18

PR EGD INTRMURAL NEEDLE ASPIR/BIOP ALTERED ANATOMY

Professional

Both

$1,092.21

Service Code	HCPCS 43242
Min. Negotiated Rate	$819.16
Max. Negotiated Rate	$819.16
Rate for Payer: Cash Price	$296.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$819.16
Rate for Payer: SOMOS Essential	$819.16

PR EGD INTRMURAL US NEEDLE ASPIRATE/BIOPSY ESOPHAGS

Professional

Both

$961.56

Service Code	HCPCS 43238
Min. Negotiated Rate	$721.17
Max. Negotiated Rate	$721.17
Rate for Payer: Cash Price	$261.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$721.17
Rate for Payer: SOMOS Essential	$721.17

PR EGD PARTIAL/COMPL ESOPHAGOGASTRIC FUNDOPLASTY

Professional

Both

$1,847.90

Service Code	HCPCS 43210
Min. Negotiated Rate	$1,385.92
Max. Negotiated Rate	$1,385.92
Rate for Payer: Cash Price	$496.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,385.92
Rate for Payer: SOMOS Essential	$1,385.92

PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE

Professional

Both

$850.96

Service Code	HCPCS 43246
Min. Negotiated Rate	$638.22
Max. Negotiated Rate	$638.22
Rate for Payer: Cash Price	$229.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$638.22
Rate for Payer: SOMOS Essential	$638.22

PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH

Professional

Both

$816.90

Service Code	HCPCS 43251
Min. Negotiated Rate	$612.68
Max. Negotiated Rate	$612.68
Rate for Payer: Cash Price	$221.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$612.68
Rate for Payer: SOMOS Essential	$612.68

PREG DRNG ADJV TRTMT

Facility

$0.01

Service Code	HCPCS G2205
Hospital Charge Code	30300333
Hospital Revenue Code	929
Max. Negotiated Rate	$94.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$94.00

PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE

Professional

Both

$577.08

Service Code	HCPCS 43239
Min. Negotiated Rate	$432.81
Max. Negotiated Rate	$432.81
Rate for Payer: Cash Price	$157.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$432.81
Rate for Payer: SOMOS Essential	$432.81

PR EGD TRANSORAL CONTROL BLEEDING ANY METHOD

Professional

Both

$831.18

Service Code	HCPCS 43255
Min. Negotiated Rate	$623.38
Max. Negotiated Rate	$623.38
Rate for Payer: Cash Price	$225.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$623.38
Rate for Payer: SOMOS Essential	$623.38

PR EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION

Professional

Both

$1,119.69

Service Code	HCPCS 43254
Min. Negotiated Rate	$839.77
Max. Negotiated Rate	$839.77
Rate for Payer: Cash Price	$304.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$839.77
Rate for Payer: SOMOS Essential	$839.77

PR EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST

Professional

Both

$1,621.59

Service Code	HCPCS 43240
Min. Negotiated Rate	$1,216.19
Max. Negotiated Rate	$1,216.19
Rate for Payer: Cash Price	$441.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,216.19
Rate for Payer: SOMOS Essential	$1,216.19

PR EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER

Professional

Both

$1,090.78

Service Code	HCPCS 43253
Min. Negotiated Rate	$818.08
Max. Negotiated Rate	$818.08
Rate for Payer: Cash Price	$295.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$818.08
Rate for Payer: SOMOS Essential	$818.08

PREGNANCY - URINE

Facility

$21.53

Service Code	HCPCS 81025
Hospital Charge Code	40626000
Hospital Revenue Code	300
Rate for Payer: Cash Price	$8.61

PREGNANCY - URINE

Facility

$21.53

Service Code	HCPCS 81025
Hospital Charge Code	40626000
Hospital Revenue Code	300
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$322.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.61
Rate for Payer: Aetna Government	$8.61
Rate for Payer: Affinity Essential Plan 1&2	$7.24
Rate for Payer: Affinity Essential Plan 3&4	$7.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.22
Rate for Payer: Amida Care Medicaid	$3.22
Rate for Payer: Brighton Health Commercial	$16.15
Rate for Payer: Cash Price	$8.61
Rate for Payer: Cash Price	$8.61
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.51
Rate for Payer: Elderplan Medicare Advantage	$8.61
Rate for Payer: EmblemHealth Commercial	$8.61
Rate for Payer: Fidelis CHP/HARP/Medicaid	$322.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3.22
Rate for Payer: Fidelis Essential Plan QHP	$3.22
Rate for Payer: Fidelis Medicare Advantage	$8.61
Rate for Payer: Fidelis Qualified Health Plan	$3.38
Rate for Payer: Group Health Inc Commercial	$8.61
Rate for Payer: Group Health Inc Medicare	$8.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.22
Rate for Payer: Hamaspik Choice Inc Medicare	$8.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.22
Rate for Payer: Healthfirst Essential Plan	$7.24
Rate for Payer: Healthfirst Medicare Advantage	$8.61
Rate for Payer: Healthfirst QHP	$3.22
Rate for Payer: Humana Medicare	$8.78
Rate for Payer: Senior Whole Health Medicare Advantage	$8.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.22
Rate for Payer: SOMOS Essential	$3.22
Rate for Payer: United Healthcare Commercial	$8.01
Rate for Payer: United Healthcare Essential Plan 1&2	$7.24
Rate for Payer: United Healthcare Essential Plan 3&4	$3.54
Rate for Payer: United Healthcare Medicaid	$3.22
Rate for Payer: United Healthcare Medicare Advantage	$8.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.89
Rate for Payer: Wellcare Medicare	$7.75

PR EGST W/WO VAGOTOMY&PYLOROPLASTY TABDL/TTHRC AP

Professional

Both

$6,327.13

Service Code	HCPCS 43320
Min. Negotiated Rate	$4,745.35
Max. Negotiated Rate	$4,745.35
Rate for Payer: Cash Price	$1,684.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,745.35
Rate for Payer: SOMOS Essential	$4,745.35

PR EKG FOR INITIAL PREVENT EXAM

Professional

Both

$61.25

Service Code	HCPCS G0403
Min. Negotiated Rate	$45.94
Max. Negotiated Rate	$45.94
Rate for Payer: Cash Price	$16.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$45.94
Rate for Payer: SOMOS Essential	$45.94

PR EKG INTERPRET & REPORT PREVE

Professional

Both

$32.66

Service Code	HCPCS G0405
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$24.50
Rate for Payer: Cash Price	$8.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24.50
Rate for Payer: SOMOS Essential	$24.50

Know your out-of-pocket cost for care.

All Charges