St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR ESOPG/GSTR TAMPONADE W/BALO SENGSTAKEN TYPE

Professional

Both

$882.60

Service Code	HCPCS 43460
Min. Negotiated Rate	$661.95
Max. Negotiated Rate	$661.95
Rate for Payer: Cash Price	$239.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$661.95
Rate for Payer: SOMOS Essential	$661.95

PR ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION

Professional

Both

$108.64

Service Code	HCPCS 91013
Min. Negotiated Rate	$81.48
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$29.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$81.48
Rate for Payer: SOMOS Essential	$81.48

PR ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION

Professional

Both

$71.89

Service Code	HCPCS 91013 TC
Min. Negotiated Rate	$53.92
Max. Negotiated Rate	$53.92
Rate for Payer: Cash Price	$19.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$53.92
Rate for Payer: SOMOS Essential	$53.92

PR ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION

Professional

Both

$36.79

Service Code	HCPCS 91013 26
Min. Negotiated Rate	$27.59
Max. Negotiated Rate	$27.59
Rate for Payer: Cash Price	$10.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27.59
Rate for Payer: SOMOS Essential	$27.59

PR ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT

Professional

Both

$683.97

Service Code	HCPCS 91010 TC
Min. Negotiated Rate	$512.98
Max. Negotiated Rate	$512.98
Rate for Payer: Cash Price	$186.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$512.98
Rate for Payer: SOMOS Essential	$512.98

PR ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT

Professional

Both

$255.78

Service Code	HCPCS 91010 26
Min. Negotiated Rate	$191.84
Max. Negotiated Rate	$191.84
Rate for Payer: Cash Price	$70.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$191.84
Rate for Payer: SOMOS Essential	$191.84

PR ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT

Professional

Both

$939.75

Service Code	HCPCS 91010
Min. Negotiated Rate	$704.81
Max. Negotiated Rate	$704.81
Rate for Payer: Cash Price	$256.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$704.81
Rate for Payer: SOMOS Essential	$704.81

PR ESOPHAGECTOMY DISTAL 2/3 W/LAPAROSCOPIC MOBLJ

Professional

Both

$15,840.30

Service Code	HCPCS 43287
Min. Negotiated Rate	$11,880.22
Max. Negotiated Rate	$11,880.22
Rate for Payer: Cash Price	$4,215.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$11,880.22
Rate for Payer: SOMOS Essential	$11,880.22

PR ESOPHAGECTOMY TOTAL NEAR TOTAL W/LAPS MOBLJ

Professional

Both

$14,230.62

Service Code	HCPCS 43286
Min. Negotiated Rate	$10,672.96
Max. Negotiated Rate	$10,672.96
Rate for Payer: Cash Price	$3,772.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10,672.96
Rate for Payer: SOMOS Essential	$10,672.96

PR ESOPHAGECTOMY TOTAL NEAR TOTAL W/THRSC MOBLJ

Professional

Both

$16,724.58

Service Code	HCPCS 43288
Min. Negotiated Rate	$12,543.44
Max. Negotiated Rate	$12,543.44
Rate for Payer: Cash Price	$4,443.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$12,543.44
Rate for Payer: SOMOS Essential	$12,543.44

PR ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION

Professional

Both

$571.59

Service Code	HCPCS 43236
Min. Negotiated Rate	$428.69
Max. Negotiated Rate	$428.69
Rate for Payer: Cash Price	$157.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$428.69
Rate for Payer: SOMOS Essential	$428.69

PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC

Professional

Both

$512.61

Service Code	HCPCS 43235
Min. Negotiated Rate	$384.46
Max. Negotiated Rate	$384.46
Rate for Payer: Cash Price	$139.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$384.46
Rate for Payer: SOMOS Essential	$384.46

PR ESOPHAGOGASTRODUODENOSCOPY US SCOPE W/ADJ STRXRS

Professional

Both

$812.88

Service Code	HCPCS 43237
Min. Negotiated Rate	$609.66
Max. Negotiated Rate	$609.66
Rate for Payer: Cash Price	$220.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$609.66
Rate for Payer: SOMOS Essential	$609.66

PR ESOPHAGOJEJUNOSTOMY W/O TOT GSTRCT ABDL APPR

Professional

Both

$6,245.19

Service Code	HCPCS 43340
Min. Negotiated Rate	$4,683.89
Max. Negotiated Rate	$4,683.89
Rate for Payer: Cash Price	$1,663.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,683.89
Rate for Payer: SOMOS Essential	$4,683.89

PR ESOPHAGOJEJUNOSTOMY W/O TOT GSTRCT THRC APPR

Professional

Both

$6,247.29

Service Code	HCPCS 43341
Min. Negotiated Rate	$4,685.47
Max. Negotiated Rate	$4,685.47
Rate for Payer: Cash Price	$1,666.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,685.47
Rate for Payer: SOMOS Essential	$4,685.47

PR ESOPHAGOMYOTOMY HELLER TYPE ABDOMINAL APPROACH

Professional

Both

$6,048.56

Service Code	HCPCS 43330
Min. Negotiated Rate	$4,536.42
Max. Negotiated Rate	$4,536.42
Rate for Payer: Cash Price	$1,610.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,536.42
Rate for Payer: SOMOS Essential	$4,536.42

PR ESOPHAGOMYOTOMY HELLER TYPE THORACIC APPROACH

Professional

Both

$5,983.60

Service Code	HCPCS 43331
Min. Negotiated Rate	$4,487.70
Max. Negotiated Rate	$4,487.70
Rate for Payer: Cash Price	$1,593.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,487.70
Rate for Payer: SOMOS Essential	$4,487.70

PR ESOPHAGOSCOPY DILATE ESOPHAGUS BALLOON 30 MM

Professional

Both

$825.72

Service Code	HCPCS 43214
Min. Negotiated Rate	$619.29
Max. Negotiated Rate	$619.29
Rate for Payer: Cash Price	$223.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$619.29
Rate for Payer: SOMOS Essential	$619.29

PR ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM

Professional

Both

$496.86

Service Code	HCPCS 43220
Min. Negotiated Rate	$372.64
Max. Negotiated Rate	$372.64
Rate for Payer: Cash Price	$134.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$372.64
Rate for Payer: SOMOS Essential	$372.64

PR ESOPHAGOSCOPY FLEXIBLE GUIDE WIRE DILATION

Professional

Both

$556.01

Service Code	HCPCS 43226
Min. Negotiated Rate	$417.01
Max. Negotiated Rate	$417.01
Rate for Payer: Cash Price	$150.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$417.01
Rate for Payer: SOMOS Essential	$417.01

PR ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY

Professional

Both

$599.48

Service Code	HCPCS 43215
Min. Negotiated Rate	$449.61
Max. Negotiated Rate	$449.61
Rate for Payer: Cash Price	$162.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$449.61
Rate for Payer: SOMOS Essential	$449.61

PR ESOPHAGOSCOPY FLEXIB LESION REMOVAL TUMOR SNARE

Professional

Both

$661.19

Service Code	HCPCS 43217
Min. Negotiated Rate	$495.89
Max. Negotiated Rate	$495.89
Rate for Payer: Cash Price	$181.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$495.89
Rate for Payer: SOMOS Essential	$495.89

PR ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC

Professional

Both

$351.05

Service Code	HCPCS 43197
Min. Negotiated Rate	$263.29
Max. Negotiated Rate	$263.29
Rate for Payer: Cash Price	$94.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$263.29
Rate for Payer: SOMOS Essential	$263.29

PR ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY

Professional

Both

$418.53

Service Code	HCPCS 43198
Min. Negotiated Rate	$313.90
Max. Negotiated Rate	$313.90
Rate for Payer: Cash Price	$112.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$313.90
Rate for Payer: SOMOS Essential	$313.90

PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC

Professional

Both

$374.61

Service Code	HCPCS 43200
Min. Negotiated Rate	$280.96
Max. Negotiated Rate	$280.96
Rate for Payer: Cash Price	$101.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$280.96
Rate for Payer: SOMOS Essential	$280.96

Know your out-of-pocket cost for care.

All Charges