St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS/U

Professional

Both

$2,749.39

Service Code	HCPCS 25450
Min. Negotiated Rate	$2,062.04
Max. Negotiated Rate	$2,062.04
Rate for Payer: Cash Price	$745.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,062.04
Rate for Payer: SOMOS Essential	$2,062.04

PR EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS&ULNA

Professional

Both

$3,247.44

Service Code	HCPCS 25455
Min. Negotiated Rate	$2,435.58
Max. Negotiated Rate	$2,435.58
Rate for Payer: Cash Price	$878.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,435.58
Rate for Payer: SOMOS Essential	$2,435.58

PR EPIPHYSL ARRST EPIPHYSIOD/STAPLING TRCHNTR FEMUR

Professional

Both

$3,191.20

Service Code	HCPCS 27185
Min. Negotiated Rate	$2,393.40
Max. Negotiated Rate	$2,393.40
Rate for Payer: Cash Price	$863.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,393.40
Rate for Payer: SOMOS Essential	$2,393.40

PR EPISIOTOMY/VAG RPR OTH/THN ATTENDING

Professional

Both

$682.85

Service Code	HCPCS 59300
Min. Negotiated Rate	$512.14
Max. Negotiated Rate	$512.14
Rate for Payer: Cash Price	$181.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$512.14
Rate for Payer: SOMOS Essential	$512.14

PREP KITS

Facility

$4.97

Hospital Charge Code	42905260
Hospital Revenue Code	801
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$3.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.48
Rate for Payer: Aetna Government	$2.48
Rate for Payer: Brighton Health Commercial	$3.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.38
Rate for Payer: Group Health Inc Commercial	$2.48
Rate for Payer: Group Health Inc Medicare	$1.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.48
Rate for Payer: Hamaspik Choice Inc Medicare	$2.48

PREPZYME

Facility

$30.75

Hospital Charge Code	64903244
Hospital Revenue Code	270
Min. Negotiated Rate	$10.76
Max. Negotiated Rate	$24.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.38
Rate for Payer: Aetna Government	$15.38
Rate for Payer: Brighton Health Commercial	$23.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.91
Rate for Payer: Group Health Inc Commercial	$15.38
Rate for Payer: Group Health Inc Medicare	$10.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.38
Rate for Payer: Hamaspik Choice Inc Medicare	$15.38

PR ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA

Professional

Both

$1,566.25

Service Code	HCPCS 43277
Min. Negotiated Rate	$1,174.69
Max. Negotiated Rate	$1,174.69
Rate for Payer: Cash Price	$425.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,174.69
Rate for Payer: SOMOS Essential	$1,174.69

PR ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE

Professional

Both

$1,994.34

Service Code	HCPCS 43276
Min. Negotiated Rate	$1,495.76
Max. Negotiated Rate	$1,495.76
Rate for Payer: Cash Price	$542.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,495.76
Rate for Payer: SOMOS Essential	$1,495.76

PR ERCP DESTRUCTION/LITHOTRIPSY CALCULI ANY METHOD

Professional

Both

$1,791.34

Service Code	HCPCS 43265
Min. Negotiated Rate	$1,343.50
Max. Negotiated Rate	$1,343.50
Rate for Payer: Cash Price	$487.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,343.50
Rate for Payer: SOMOS Essential	$1,343.50

PR ERCP DX COLLECTION SPECIMEN BRUSHING/WASHING

Professional

Both

$1,334.34

Service Code	HCPCS 43260
Min. Negotiated Rate	$1,000.76
Max. Negotiated Rate	$1,000.76
Rate for Payer: Cash Price	$363.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,000.76
Rate for Payer: SOMOS Essential	$1,000.76

PR ERCP REMOVE CALCULI/DEBRIS BILIARY/PANCREAS DUCT

Professional

Both

$1,508.26

Service Code	HCPCS 43264
Min. Negotiated Rate	$1,131.20
Max. Negotiated Rate	$1,131.20
Rate for Payer: Cash Price	$409.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,131.20
Rate for Payer: SOMOS Essential	$1,131.20

PR ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT

Professional

Both

$1,556.91

Service Code	HCPCS 43275
Min. Negotiated Rate	$1,167.68
Max. Negotiated Rate	$1,167.68
Rate for Payer: Cash Price	$423.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,167.68
Rate for Payer: SOMOS Essential	$1,167.68

PR ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT

Professional

Both

$1,915.31

Service Code	HCPCS 43274
Min. Negotiated Rate	$1,436.48
Max. Negotiated Rate	$1,436.48
Rate for Payer: Cash Price	$521.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,436.48
Rate for Payer: SOMOS Essential	$1,436.48

PR ERCP TUMOR/POLYP/LESION ABLATION W/DILATION&WIRE

Professional

Both

$1,790.08

Service Code	HCPCS 43278
Min. Negotiated Rate	$1,342.56
Max. Negotiated Rate	$1,342.56
Rate for Payer: Cash Price	$487.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,342.56
Rate for Payer: SOMOS Essential	$1,342.56

PR ERCP W/BIOPSY SINGLE/MULTIPLE

Professional

Both

$1,404.27

Service Code	HCPCS 43261
Min. Negotiated Rate	$1,053.20
Max. Negotiated Rate	$1,053.20
Rate for Payer: Cash Price	$381.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,053.20
Rate for Payer: SOMOS Essential	$1,053.20

PR ERCP W/PRESSURE MEASUREMENT SPHINCTER OF ODDI

Professional

Both

$1,480.75

Service Code	HCPCS 43263
Min. Negotiated Rate	$1,110.56
Max. Negotiated Rate	$1,110.56
Rate for Payer: Cash Price	$402.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,110.56
Rate for Payer: SOMOS Essential	$1,110.56

PR ERCP W/SPHINCTEROTOMY/PAPILLOTOMY

Professional

Both

$1,479.31

Service Code	HCPCS 43262
Min. Negotiated Rate	$1,109.48
Max. Negotiated Rate	$1,109.48
Rate for Payer: Cash Price	$401.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,109.48
Rate for Payer: SOMOS Essential	$1,109.48

PR ERGONOVINE PROVOCATION TST

Professional

Both

$214.97

Service Code	HCPCS 93024 26
Min. Negotiated Rate	$161.23
Max. Negotiated Rate	$161.23
Rate for Payer: Cash Price	$59.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$161.23
Rate for Payer: SOMOS Essential	$161.23

PR ERGONOVINE PROVOCATION TST

Professional

Both

$243.81

Service Code	HCPCS 93024 TC
Min. Negotiated Rate	$182.86
Max. Negotiated Rate	$182.86
Rate for Payer: Cash Price	$69.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$182.86
Rate for Payer: SOMOS Essential	$182.86

PR ERGONOVINE PROVOCATION TST

Professional

Both

$458.82

Service Code	HCPCS 93024
Min. Negotiated Rate	$344.12
Max. Negotiated Rate	$344.12
Rate for Payer: Cash Price	$128.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$344.12
Rate for Payer: SOMOS Essential	$344.12

PR ESCHAROTOMY EACH ADDITIONAL INCISION

Professional

Both

$364.70

Service Code	HCPCS 16036
Min. Negotiated Rate	$273.52
Max. Negotiated Rate	$273.52
Rate for Payer: Cash Price	$97.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$273.52
Rate for Payer: SOMOS Essential	$273.52

PR ESCHAROTOMY FIRST INCISION

Professional

Both

$828.94

Service Code	HCPCS 16035
Min. Negotiated Rate	$621.70
Max. Negotiated Rate	$621.70
Rate for Payer: Cash Price	$226.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$621.70
Rate for Payer: SOMOS Essential	$621.70

PR ESOPG/GSTR FUNDOPLASTY W/FUNDIC PATCH

Professional

Both

$6,152.86

Service Code	HCPCS 43325
Min. Negotiated Rate	$4,614.64
Max. Negotiated Rate	$4,614.64
Rate for Payer: Cash Price	$1,636.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,614.64
Rate for Payer: SOMOS Essential	$4,614.64

PR ESOPG/GSTR FUNDOPLASTY W/LAPAROTOMY

Professional

Both

$3,700.83

Service Code	HCPCS 43327
Min. Negotiated Rate	$2,775.62
Max. Negotiated Rate	$2,775.62
Rate for Payer: Cash Price	$980.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,775.62
Rate for Payer: SOMOS Essential	$2,775.62

PR ESOPG/GSTR FUNDOPLASTY W/THORACOTOMY

Professional

Both

$5,013.26

Service Code	HCPCS 43328
Min. Negotiated Rate	$3,759.94
Max. Negotiated Rate	$3,759.94
Rate for Payer: Cash Price	$1,332.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,759.94
Rate for Payer: SOMOS Essential	$3,759.94

Know your out-of-pocket cost for care.

All Charges