St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL MUCOSAL RESEXN

Professional

Both

$976.36

Service Code	HCPCS 43211
Min. Negotiated Rate	$732.27
Max. Negotiated Rate	$732.27
Rate for Payer: Cash Price	$264.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$732.27
Rate for Payer: SOMOS Essential	$732.27

PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL ULTRASOUND EXAM

Professional

Both

$652.72

Service Code	HCPCS 43231
Min. Negotiated Rate	$489.54
Max. Negotiated Rate	$489.54
Rate for Payer: Cash Price	$177.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$489.54
Rate for Payer: SOMOS Essential	$489.54

PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY

Professional

Both

$433.62

Service Code	HCPCS 43202
Min. Negotiated Rate	$325.22
Max. Negotiated Rate	$325.22
Rate for Payer: Cash Price	$117.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$325.22
Rate for Payer: SOMOS Essential	$325.22

PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ

Professional

Both

$439.08

Service Code	HCPCS 43201
Min. Negotiated Rate	$329.31
Max. Negotiated Rate	$329.31
Rate for Payer: Cash Price	$119.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$329.31
Rate for Payer: SOMOS Essential	$329.31

PR ESOPHAGOSCOPY FLEXIBLE W/BLEEDING CONTROL

Professional

Both

$689.05

Service Code	HCPCS 43227
Min. Negotiated Rate	$516.79
Max. Negotiated Rate	$516.79
Rate for Payer: Cash Price	$187.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$516.79
Rate for Payer: SOMOS Essential	$516.79

PR ESOPHAGOSCOPY FLEX TRANSORAL INJECTION VARICES

Professional

Both

$562.63

Service Code	HCPCS 43204
Min. Negotiated Rate	$421.97
Max. Negotiated Rate	$421.97
Rate for Payer: Cash Price	$152.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$421.97
Rate for Payer: SOMOS Essential	$421.97

PR ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION

Professional

Both

$820.72

Service Code	HCPCS 43229
Min. Negotiated Rate	$615.54
Max. Negotiated Rate	$615.54
Rate for Payer: Cash Price	$223.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$615.54
Rate for Payer: SOMOS Essential	$615.54

PR ESOPHAGOSCOPY INTRA/TRANSMURAL NEEDLE ASPIRAT/BX

Professional

Both

$815.26

Service Code	HCPCS 43232
Min. Negotiated Rate	$611.44
Max. Negotiated Rate	$611.44
Rate for Payer: Cash Price	$224.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$611.44
Rate for Payer: SOMOS Essential	$611.44

PR ESOPHAGOSCOPY RETROGRADE DILATE BALLOON/OTHER

Professional

Both

$1,110.27

Service Code	HCPCS 43213
Min. Negotiated Rate	$832.70
Max. Negotiated Rate	$832.70
Rate for Payer: Cash Price	$298.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$832.70
Rate for Payer: SOMOS Essential	$832.70

PR ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION

Professional

Both

$792.40

Service Code	HCPCS 43195
Min. Negotiated Rate	$594.30
Max. Negotiated Rate	$594.30
Rate for Payer: Cash Price	$214.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$594.30
Rate for Payer: SOMOS Essential	$594.30

PR ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH

Professional

Both

$667.56

Service Code	HCPCS 43191
Min. Negotiated Rate	$500.67
Max. Negotiated Rate	$500.67
Rate for Payer: Cash Price	$180.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$500.67
Rate for Payer: SOMOS Essential	$500.67

PR ESOPHAGOSCOPY RIGID TRANSORAL INJ SUBMUCOSAL

Professional

Both

$729.02

Service Code	HCPCS 43192
Min. Negotiated Rate	$546.76
Max. Negotiated Rate	$546.76
Rate for Payer: Cash Price	$197.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$546.76
Rate for Payer: SOMOS Essential	$546.76

PR ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY

Professional

Both

$724.82

Service Code	HCPCS 43193
Min. Negotiated Rate	$543.62
Max. Negotiated Rate	$543.62
Rate for Payer: Cash Price	$196.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$543.62
Rate for Payer: SOMOS Essential	$543.62

PR ESOPHAGOSCOPY RIG TRANSORAL GUIDE WIRE DILATION

Professional

Both

$831.08

Service Code	HCPCS 43196
Min. Negotiated Rate	$623.31
Max. Negotiated Rate	$623.31
Rate for Payer: Cash Price	$226.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$623.31
Rate for Payer: SOMOS Essential	$623.31

PR ESOPHAGOSCOPY RIG TRANSORAL REMOVAL FOREIGN BODY

Professional

Both

$832.62

Service Code	HCPCS 43194
Min. Negotiated Rate	$624.46
Max. Negotiated Rate	$624.46
Rate for Payer: Cash Price	$220.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$624.46
Rate for Payer: SOMOS Essential	$624.46

PR ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT

Professional

Both

$814.56

Service Code	HCPCS 43212
Min. Negotiated Rate	$610.92
Max. Negotiated Rate	$610.92
Rate for Payer: Cash Price	$217.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$610.92
Rate for Payer: SOMOS Essential	$610.92

PR ESOPHAGOSCOPY TRANSORAL W/OPTICAL ENDOMICROSCOPY

Professional

Both

$552.02

Service Code	HCPCS 43206
Min. Negotiated Rate	$414.02
Max. Negotiated Rate	$414.02
Rate for Payer: Cash Price	$149.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$414.02
Rate for Payer: SOMOS Essential	$414.02

PR ESOPHAGOSCP RIG TRANSORAL HYPOPHARYNX CRV ESOPH

Professional

Both

$2,357.53

Service Code	HCPCS 43180
Min. Negotiated Rate	$1,768.15
Max. Negotiated Rate	$1,768.15
Rate for Payer: Cash Price	$637.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,768.15
Rate for Payer: SOMOS Essential	$1,768.15

PR ESOPHAGOSTOMY FSTLJ ESOPH XTRNL CRV APPR

Professional

Both

$4,769.98

Service Code	HCPCS 43352
Min. Negotiated Rate	$3,577.48
Max. Negotiated Rate	$3,577.48
Rate for Payer: Cash Price	$1,272.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,577.48
Rate for Payer: SOMOS Essential	$3,577.48

PR ESOPHAGOSTOMY FSTLJ ESOPH XTRNL THRC APPR

Professional

Both

$5,883.85

Service Code	HCPCS 43351
Min. Negotiated Rate	$4,412.89
Max. Negotiated Rate	$4,412.89
Rate for Payer: Cash Price	$1,572.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,412.89
Rate for Payer: SOMOS Essential	$4,412.89

PR ESOPHAGOTOMY CERVICAL APPR W/RMVL FB

Professional

Both

$2,555.98

Service Code	HCPCS 43020
Min. Negotiated Rate	$1,916.98
Max. Negotiated Rate	$1,916.98
Rate for Payer: Cash Price	$685.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,916.98
Rate for Payer: SOMOS Essential	$1,916.98

PR ESOPHAGOTOMY THORACIC APPR W/RMVL FB

Professional

Both

$5,821.13

Service Code	HCPCS 43045
Min. Negotiated Rate	$4,365.85
Max. Negotiated Rate	$4,365.85
Rate for Payer: Cash Price	$1,553.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,365.85
Rate for Payer: SOMOS Essential	$4,365.85

PR ESOPHAGUS ACID PERFUSION TEST ESOPHAGITIS

Professional

Both

$182.42

Service Code	HCPCS 91030 26
Min. Negotiated Rate	$136.82
Max. Negotiated Rate	$136.82
Rate for Payer: Cash Price	$49.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$136.82
Rate for Payer: SOMOS Essential	$136.82

PR ESOPHAGUS ACID PERFUSION TEST ESOPHAGITIS

Professional

Both

$611.94

Service Code	HCPCS 91030
Min. Negotiated Rate	$458.96
Max. Negotiated Rate	$458.96
Rate for Payer: Cash Price	$168.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$458.96
Rate for Payer: SOMOS Essential	$458.96

PR ESOPHAGUS ACID PERFUSION TEST ESOPHAGITIS

Professional

Both

$429.52

Service Code	HCPCS 91030 TC
Min. Negotiated Rate	$322.14
Max. Negotiated Rate	$322.14
Rate for Payer: Cash Price	$118.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$322.14
Rate for Payer: SOMOS Essential	$322.14

Know your out-of-pocket cost for care.

All Charges