St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS

Professional

Both

$384.02

Service Code	HCPCS 90847
Min. Negotiated Rate	$288.02
Max. Negotiated Rate	$288.02
Rate for Payer: Cash Price	$109.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$288.02
Rate for Payer: SOMOS Essential	$288.02

PR FASCIA LATA GRAFT BY STRIPPER

Professional

Both

$1,729.95

Service Code	HCPCS 20920
Min. Negotiated Rate	$1,297.46
Max. Negotiated Rate	$1,297.46
Rate for Payer: Cash Price	$470.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,297.46
Rate for Payer: SOMOS Essential	$1,297.46

PR FASCIA LATA GRAFT INCISION & AREA EXPOSURE

Professional

Both

$2,191.35

Service Code	HCPCS 20922
Min. Negotiated Rate	$1,643.51
Max. Negotiated Rate	$1,643.51
Rate for Payer: Cash Price	$599.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,643.51
Rate for Payer: SOMOS Essential	$1,643.51

PR FASCIECTOMY PLANTAR FASCIA PARTIAL SPX

Professional

Both

$1,512.39

Service Code	HCPCS 28060
Min. Negotiated Rate	$1,134.29
Max. Negotiated Rate	$1,134.29
Rate for Payer: Cash Price	$418.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,134.29
Rate for Payer: SOMOS Essential	$1,134.29

PR FASCIOTOMY FOOT&/TOE

Professional

Both

$1,230.43

Service Code	HCPCS 28008
Min. Negotiated Rate	$922.82
Max. Negotiated Rate	$922.82
Rate for Payer: Cash Price	$339.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$922.82
Rate for Payer: SOMOS Essential	$922.82

PR FASCIOTOMY HIP/THIGH ANY TYPE

Professional

Both

$4,072.95

Service Code	HCPCS 27025
Min. Negotiated Rate	$3,054.71
Max. Negotiated Rate	$3,054.71
Rate for Payer: Cash Price	$1,109.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,054.71
Rate for Payer: SOMOS Essential	$3,054.71

PR FASCIOTOMY ILIOTIBIAL OPEN

Professional

Both

$2,148.72

Service Code	HCPCS 27305
Min. Negotiated Rate	$1,611.54
Max. Negotiated Rate	$1,611.54
Rate for Payer: Cash Price	$582.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,611.54
Rate for Payer: SOMOS Essential	$1,611.54

PR FASCIOTOMY PALMAR OPEN PARTIAL

Professional

Both

$2,100.95

Service Code	HCPCS 26045
Min. Negotiated Rate	$1,575.71
Max. Negotiated Rate	$1,575.71
Rate for Payer: Cash Price	$571.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,575.71
Rate for Payer: SOMOS Essential	$1,575.71

PR FASCIOTOMY PALMAR PERCUTANEOUS

Professional

Both

$1,404.83

Service Code	HCPCS 26040
Min. Negotiated Rate	$1,053.62
Max. Negotiated Rate	$1,053.62
Rate for Payer: Cash Price	$383.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,053.62
Rate for Payer: SOMOS Essential	$1,053.62

PR FASCIOTOMY PLANTAR FASCIA RADICAL SPX

Professional

Both

$1,683.47

Service Code	HCPCS 28062
Min. Negotiated Rate	$1,262.60
Max. Negotiated Rate	$1,262.60
Rate for Payer: Cash Price	$464.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,262.60
Rate for Payer: SOMOS Essential	$1,262.60

PR FASCT PALM W/WO Z-PLASTY TISSUE REARGMT/SKN GRFT

Professional

Both

$2,655.80

Service Code	HCPCS 26121
Min. Negotiated Rate	$1,991.85
Max. Negotiated Rate	$1,991.85
Rate for Payer: Cash Price	$720.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,991.85
Rate for Payer: SOMOS Essential	$1,991.85

PR FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W/WO RPR

Professional

Both

$3,695.16

Service Code	HCPCS 26123
Min. Negotiated Rate	$2,771.37
Max. Negotiated Rate	$2,771.37
Rate for Payer: Cash Price	$1,003.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,771.37
Rate for Payer: SOMOS Essential	$2,771.37

PR FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W/WO RPR

Professional

Both

$1,171.10

Service Code	HCPCS 26125
Min. Negotiated Rate	$878.32
Max. Negotiated Rate	$878.32
Rate for Payer: Cash Price	$314.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$878.32
Rate for Payer: SOMOS Essential	$878.32

PR FECAL MICROBIOTA PREP INSTIL

Professional

Both

$300.58

Service Code	HCPCS G0455
Min. Negotiated Rate	$225.44
Max. Negotiated Rate	$225.44
Rate for Payer: Cash Price	$79.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$225.44
Rate for Payer: SOMOS Essential	$225.44

PR FETAL CONTRACTION STRESS TEST

Professional

Both

$169.30

Service Code	HCPCS 59020 26
Min. Negotiated Rate	$126.98
Max. Negotiated Rate	$126.98
Rate for Payer: Cash Price	$44.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$126.98
Rate for Payer: SOMOS Essential	$126.98

PR FETAL CONTRACTION STRESS TEST

Professional

Both

$315.77

Service Code	HCPCS 59020
Min. Negotiated Rate	$236.83
Max. Negotiated Rate	$236.83
Rate for Payer: Cash Price	$85.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$236.83
Rate for Payer: SOMOS Essential	$236.83

PR FETAL CONTRACTION STRESS TEST

Professional

Both

$146.48

Service Code	HCPCS 59020 TC
Min. Negotiated Rate	$109.86
Max. Negotiated Rate	$109.86
Rate for Payer: Cash Price	$41.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$109.86
Rate for Payer: SOMOS Essential	$109.86

PR FETAL FLUID DRAINAGE W/ULTRASOUND GUIDANCE

Professional

Both

$1,429.58

Service Code	HCPCS 59074
Min. Negotiated Rate	$1,072.18
Max. Negotiated Rate	$1,072.18
Rate for Payer: Cash Price	$377.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,072.18
Rate for Payer: SOMOS Essential	$1,072.18

PR FETAL MONITORING LABOR PHYS WRITTEN REPORT

Professional

Both

$232.93

Service Code	HCPCS 59050
Min. Negotiated Rate	$174.70
Max. Negotiated Rate	$174.70
Rate for Payer: Cash Price	$60.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$174.70
Rate for Payer: SOMOS Essential	$174.70

PR FETAL MONITR LABOR PHYS WRTTN REPRT INTERPJ ONLY

Professional

Both

$194.57

Service Code	HCPCS 59051
Min. Negotiated Rate	$145.93
Max. Negotiated Rate	$145.93
Rate for Payer: Cash Price	$51.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$145.93
Rate for Payer: SOMOS Essential	$145.93

PR FETAL NONSTRESS TEST

Professional

Both

$216.97

Service Code	HCPCS 59025
Min. Negotiated Rate	$162.73
Max. Negotiated Rate	$162.73
Rate for Payer: Cash Price	$59.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$162.73
Rate for Payer: SOMOS Essential	$162.73

PR FETAL NONSTRESS TEST

Professional

Both

$129.40

Service Code	HCPCS 59025 26
Min. Negotiated Rate	$97.05
Max. Negotiated Rate	$97.05
Rate for Payer: Cash Price	$34.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$97.05
Rate for Payer: SOMOS Essential	$97.05

PR FETAL NONSTRESS TEST

Professional

Both

$87.54

Service Code	HCPCS 59025 TC
Min. Negotiated Rate	$65.66
Max. Negotiated Rate	$65.66
Rate for Payer: Cash Price	$24.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$65.66
Rate for Payer: SOMOS Essential	$65.66

PR FETAL SCALP BLOOD SAMPLING

Professional

Both

$521.36

Service Code	HCPCS 59030
Min. Negotiated Rate	$391.02
Max. Negotiated Rate	$391.02
Rate for Payer: Cash Price	$137.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$391.02
Rate for Payer: SOMOS Essential	$391.02

PR FETAL SHUNT PLACEMENT W/ULTRASOUND GUIDANCE

Professional

Both

$2,416.89

Service Code	HCPCS 59076
Min. Negotiated Rate	$1,812.67
Max. Negotiated Rate	$1,812.67
Rate for Payer: Cash Price	$637.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,812.67
Rate for Payer: SOMOS Essential	$1,812.67

Know your out-of-pocket cost for care.

All Charges