St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR ESOPHAGUS LENGTHENING

Professional

Both

$513.66

Service Code	HCPCS 43338
Min. Negotiated Rate	$385.24
Max. Negotiated Rate	$385.24
Rate for Payer: Cash Price	$134.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$385.24
Rate for Payer: SOMOS Essential	$385.24

PR ESOPHGL BALO DISTENSION DX STD W/PROVOCATION

Professional

Both

$2,263.70

Service Code	HCPCS 91040
Min. Negotiated Rate	$1,697.78
Max. Negotiated Rate	$1,697.78
Rate for Payer: Cash Price	$606.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,697.78
Rate for Payer: SOMOS Essential	$1,697.78

PR ESOPHGL BALO DISTENSION DX STD W/PROVOCATION

Professional

Both

$199.57

Service Code	HCPCS 91040 26
Min. Negotiated Rate	$149.68
Max. Negotiated Rate	$149.68
Rate for Payer: Cash Price	$54.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$149.68
Rate for Payer: SOMOS Essential	$149.68

PR ESOPHGL BALO DISTENSION DX STD W/PROVOCATION

Professional

Both

$2,064.09

Service Code	HCPCS 91040 TC
Min. Negotiated Rate	$1,548.07
Max. Negotiated Rate	$1,548.07
Rate for Payer: Cash Price	$551.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,548.07
Rate for Payer: SOMOS Essential	$1,548.07

PR ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG

Professional

Both

$1,532.09

Service Code	HCPCS 91038 TC
Min. Negotiated Rate	$1,149.07
Max. Negotiated Rate	$1,149.07
Rate for Payer: Cash Price	$411.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,149.07
Rate for Payer: SOMOS Essential	$1,149.07

PR ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG

Professional

Both

$1,749.83

Service Code	HCPCS 91038
Min. Negotiated Rate	$1,312.37
Max. Negotiated Rate	$1,312.37
Rate for Payer: Cash Price	$471.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,312.37
Rate for Payer: SOMOS Essential	$1,312.37

PR ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG

Professional

Both

$217.70

Service Code	HCPCS 91038 26
Min. Negotiated Rate	$163.28
Max. Negotiated Rate	$163.28
Rate for Payer: Cash Price	$60.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$163.28
Rate for Payer: SOMOS Essential	$163.28

PR ESOPHGL REC ATRIAL W/WO VENTR ELECTRGRAMS W/PACG

Professional

Both

$85.19

Service Code	HCPCS 93616 TC
Min. Negotiated Rate	$63.89
Max. Negotiated Rate	$63.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$63.89
Rate for Payer: SOMOS Essential	$63.89

PR ESOPHGL REC ATRIAL W/WO VENTR ELECTRGRAMS W/PACG

Professional

Both

$313.25

Service Code	HCPCS 93616
Min. Negotiated Rate	$234.94
Max. Negotiated Rate	$234.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$234.94
Rate for Payer: SOMOS Essential	$234.94

PR ESOPHGL REC ATRIAL W/WO VENTR ELECTRGRAMS W/PACG

Professional

Both

$228.06

Service Code	HCPCS 93616 26
Min. Negotiated Rate	$171.04
Max. Negotiated Rate	$171.04
Rate for Payer: Cash Price	$62.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$171.04
Rate for Payer: SOMOS Essential	$171.04

PR ESOPHGL REC ATRIAL W/WO VENTRICULAR ELECTROGRAMS

Professional

Both

$65.38

Service Code	HCPCS 93615 TC
Min. Negotiated Rate	$49.04
Max. Negotiated Rate	$49.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$49.04
Rate for Payer: SOMOS Essential	$49.04

PR ESOPHGL REC ATRIAL W/WO VENTRICULAR ELECTROGRAMS

Professional

Both

$144.17

Service Code	HCPCS 93615 26
Min. Negotiated Rate	$108.13
Max. Negotiated Rate	$108.13
Rate for Payer: Cash Price	$38.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$108.13
Rate for Payer: SOMOS Essential	$108.13

PR ESOPHGL REC ATRIAL W/WO VENTRICULAR ELECTROGRAMS

Professional

Both

$209.55

Service Code	HCPCS 93615
Min. Negotiated Rate	$157.16
Max. Negotiated Rate	$157.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$157.16
Rate for Payer: SOMOS Essential	$157.16

PR ESPHAGOSCOPY FLEX LESION REMOVAL HOT BX FORCEPS

Professional

Both

$554.58

Service Code	HCPCS 43216
Min. Negotiated Rate	$415.94
Max. Negotiated Rate	$415.94
Rate for Payer: Cash Price	$151.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$415.94
Rate for Payer: SOMOS Essential	$415.94

PR ESPHGOSCOPY FLEX W/BAND LIGATION ESOPHGL VARICES

Professional

Both

$583.59

Service Code	HCPCS 43205
Min. Negotiated Rate	$437.69
Max. Negotiated Rate	$437.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$437.69
Rate for Payer: SOMOS Essential	$437.69

PR ESPHGP CGEN DFCT THRC APPR W/O RPR FSTL

Professional

Both

$13,104.21

Service Code	HCPCS 43313
Min. Negotiated Rate	$9,828.16
Max. Negotiated Rate	$9,828.16
Rate for Payer: Cash Price	$3,492.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9,828.16
Rate for Payer: SOMOS Essential	$9,828.16

PR ESPHGP CGEN DFCT THRC APPR W/RPR FSTL

Professional

Both

$14,062.93

Service Code	HCPCS 43314
Min. Negotiated Rate	$10,547.20
Max. Negotiated Rate	$10,547.20
Rate for Payer: Cash Price	$3,738.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10,547.20
Rate for Payer: SOMOS Essential	$10,547.20

PR ESPHGP CRV APPR W/O RPR TRACHEOESOPHGL FSTL

Professional

Both

$2,704.17

Service Code	HCPCS 43300
Min. Negotiated Rate	$2,028.13
Max. Negotiated Rate	$2,028.13
Rate for Payer: Cash Price	$735.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,028.13
Rate for Payer: SOMOS Essential	$2,028.13

PR ESPHGP CRV APPR W/RPR TRACHEOESOPHGL FSTL

Professional

Both

$4,714.01

Service Code	HCPCS 43305
Min. Negotiated Rate	$3,535.51
Max. Negotiated Rate	$3,535.51
Rate for Payer: Cash Price	$1,275.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,535.51
Rate for Payer: SOMOS Essential	$3,535.51

PR ESPHGP THRC APPR W/O RPR TRACHEOESOPHGL FSTL

Professional

Both

$6,618.08

Service Code	HCPCS 43310
Min. Negotiated Rate	$4,963.56
Max. Negotiated Rate	$4,963.56
Rate for Payer: Cash Price	$1,759.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,963.56
Rate for Payer: SOMOS Essential	$4,963.56

PR ESPHGP THRC APPR W/RPR TRACHEOESOPHGL FSTL

Professional

Both

$7,083.34

Service Code	HCPCS 43312
Min. Negotiated Rate	$5,312.50
Max. Negotiated Rate	$5,312.50
Rate for Payer: Cash Price	$1,880.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,312.50
Rate for Payer: SOMOS Essential	$5,312.50

PR ESRD RELATED SVC <FULL MONTH 12-19 YR OLD

Professional

Both

$68.36

Service Code	HCPCS 90969
Min. Negotiated Rate	$51.27
Max. Negotiated Rate	$51.27
Rate for Payer: Cash Price	$18.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$51.27
Rate for Payer: SOMOS Essential	$51.27

PR ESRD RELATED SVC <FULL MONTH 20/>YR OLD

Professional

Both

$38.22

Service Code	HCPCS 90970
Min. Negotiated Rate	$28.66
Max. Negotiated Rate	$28.66
Rate for Payer: Cash Price	$10.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28.66
Rate for Payer: SOMOS Essential	$28.66

PR ESRD RELATED SVC <FULL MONTH 2-11 YR OLD

Professional

Both

$69.62

Service Code	HCPCS 90968
Min. Negotiated Rate	$52.22
Max. Negotiated Rate	$52.22
Rate for Payer: Cash Price	$19.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$52.22
Rate for Payer: SOMOS Essential	$52.22

PR ESRD RELATED SVC <FULL MONTH <2 YR OLD

Professional

Both

$70.88

Service Code	HCPCS 90967
Min. Negotiated Rate	$53.16
Max. Negotiated Rate	$53.16
Rate for Payer: Cash Price	$19.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$53.16
Rate for Payer: SOMOS Essential	$53.16

Know your out-of-pocket cost for care.

All Charges