St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR FETAL UMBILICAL CORD OCCLUSION W/ULTRSND GUIDNCE

Professional

Both

$2,416.89

Service Code	HCPCS 59072
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

PR FILLETED FINGER/TOE FLAP W/PREPJ RECIPIENT SITE

Professional

Both

$2,829.09

Service Code	HCPCS 14350
Min. Negotiated Rate	$2,121.82
Max. Negotiated Rate	$2,121.82
Rate for Payer: Cash Price	$774.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,121.82
Rate for Payer: SOMOS Essential	$2,121.82

PR FILTERED SPEECH TEST

Professional

Both

$130.69

Service Code	HCPCS 92571
Min. Negotiated Rate	$98.02
Max. Negotiated Rate	$98.02
Rate for Payer: Cash Price	$36.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$98.02
Rate for Payer: SOMOS Essential	$98.02

PR FIMBRIOPLASTY

Professional

Both

$3,585.96

Service Code	HCPCS 58760
Min. Negotiated Rate	$2,689.47
Max. Negotiated Rate	$2,689.47
Rate for Payer: Cash Price	$965.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,689.47
Rate for Payer: SOMOS Essential	$2,689.47

PR FINE NEEDLE ASPIRATION BX W/CT GDN 1ST LESION

Professional

Both

$449.65

Service Code	HCPCS 10009
Min. Negotiated Rate	$337.24
Max. Negotiated Rate	$337.24
Rate for Payer: Cash Price	$120.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$337.24
Rate for Payer: SOMOS Essential	$337.24

PR FINE NEEDLE ASPIRATION BX W/CT GDN EA ADDL

Professional

Both

$298.90

Service Code	HCPCS 10010
Min. Negotiated Rate	$224.18
Max. Negotiated Rate	$224.18
Rate for Payer: Cash Price	$81.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$224.18
Rate for Payer: SOMOS Essential	$224.18

PR FINE NEEDLE ASPIRATION BX W/FLUOR GDN 1ST LESION

Professional

Both

$367.82

Service Code	HCPCS 10007
Min. Negotiated Rate	$275.86
Max. Negotiated Rate	$275.86
Rate for Payer: Cash Price	$101.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$275.86
Rate for Payer: SOMOS Essential	$275.86

PR FINE NEEDLE ASPIRATION BX W/FLUOR GDN EA ADDL

Professional

Both

$223.06

Service Code	HCPCS 10008
Min. Negotiated Rate	$167.30
Max. Negotiated Rate	$167.30
Rate for Payer: Cash Price	$58.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$167.30
Rate for Payer: SOMOS Essential	$167.30

PR FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION

Professional

Both

$233.45

Service Code	HCPCS 10021
Min. Negotiated Rate	$175.09
Max. Negotiated Rate	$175.09
Rate for Payer: Cash Price	$62.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$175.09
Rate for Payer: SOMOS Essential	$175.09

PR FINE NEEDLE ASPIRATION BX W/O IMG GDN EA ADDL

Professional

Both

$180.60

Service Code	HCPCS 10004
Min. Negotiated Rate	$135.45
Max. Negotiated Rate	$135.45
Rate for Payer: Cash Price	$50.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$135.45
Rate for Payer: SOMOS Essential	$135.45

PR FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION

Professional

Both

$308.46

Service Code	HCPCS 10005
Min. Negotiated Rate	$231.34
Max. Negotiated Rate	$231.34
Rate for Payer: Cash Price	$82.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$231.34
Rate for Payer: SOMOS Essential	$231.34

PR FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL

Professional

Both

$207.24

Service Code	HCPCS 10006
Min. Negotiated Rate	$155.43
Max. Negotiated Rate	$155.43
Rate for Payer: Cash Price	$56.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$155.43
Rate for Payer: SOMOS Essential	$155.43

PR FINE NEEDLE ASPIRATION ORBITAL CONTENTS

Professional

Both

$418.32

Service Code	HCPCS 67415
Min. Negotiated Rate	$313.74
Max. Negotiated Rate	$313.74
Rate for Payer: Cash Price	$114.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$313.74
Rate for Payer: SOMOS Essential	$313.74

PR FISSURECTOMY INCL SPHINCTEROTOMY WHEN PERFORMED

Professional

Both

$1,470.56

Service Code	HCPCS 46200
Min. Negotiated Rate	$1,102.92
Max. Negotiated Rate	$1,102.92
Rate for Payer: Cash Price	$401.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,102.92
Rate for Payer: SOMOS Essential	$1,102.92

PR FIT CONTACT LENS TX OCULAR SURFACE DISEASE

Professional

Both

$127.89

Service Code	HCPCS 92071
Min. Negotiated Rate	$95.92
Max. Negotiated Rate	$95.92
Rate for Payer: Cash Price	$35.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$95.92
Rate for Payer: SOMOS Essential	$95.92

PR FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI

Professional

Both

$198.66

Service Code	HCPCS 57160
Min. Negotiated Rate	$149.00
Max. Negotiated Rate	$149.00
Rate for Payer: Cash Price	$53.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$149.00
Rate for Payer: SOMOS Essential	$149.00

PR FITTING CONTACT LENS FOR MGMT OF KERATOCONUS 1ST

Professional

Both

$365.79

Service Code	HCPCS 92072
Min. Negotiated Rate	$274.34
Max. Negotiated Rate	$274.34
Rate for Payer: Cash Price	$99.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$274.34
Rate for Payer: SOMOS Essential	$274.34

PR FIXATION CONTRALATERAL TESTIS SEPARATE PROCEDURE

Professional

Both

$1,256.05

Service Code	HCPCS 54620
Min. Negotiated Rate	$942.04
Max. Negotiated Rate	$942.04
Rate for Payer: Cash Price	$342.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$942.04
Rate for Payer: SOMOS Essential	$942.04

PR FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY

Professional

Both

$3,612.74

Service Code	HCPCS 15740
Min. Negotiated Rate	$2,709.56
Max. Negotiated Rate	$2,709.56
Rate for Payer: Cash Price	$984.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,709.56
Rate for Payer: SOMOS Essential	$2,709.56

PR FLAP NEUROVASCULAR PEDICLE

Professional

Both

$4,043.69

Service Code	HCPCS 15750
Min. Negotiated Rate	$3,032.77
Max. Negotiated Rate	$3,032.77
Rate for Payer: Cash Price	$1,106.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,032.77
Rate for Payer: SOMOS Essential	$3,032.77

PR FLEXIBLE ENDOSCOPIC EVAL LARYN SENS C/V REC I&R

Professional

Both

$132.97

Service Code	HCPCS 92615
Min. Negotiated Rate	$99.73
Max. Negotiated Rate	$99.73
Rate for Payer: Cash Price	$36.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$99.73
Rate for Payer: SOMOS Essential	$99.73

PR FLEXIBLE ENDOSCOPIC EVAL LARYN SENSORY C/V REC

Professional

Both

$265.90

Service Code	HCPCS 92614
Min. Negotiated Rate	$199.42
Max. Negotiated Rate	$199.42
Rate for Payer: Cash Price	$72.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$199.42
Rate for Payer: SOMOS Essential	$199.42

PR FLEXIBLE ENDOSCOPIC EVAL SWALLOW C/V REC

Professional

Both

$267.47

Service Code	HCPCS 92612
Min. Negotiated Rate	$200.60
Max. Negotiated Rate	$200.60
Rate for Payer: Cash Price	$73.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$200.60
Rate for Payer: SOMOS Essential	$200.60

PR FLEXIBLE ENDOSCOPIC EVAL SWALLOW C/V REC I&R

Professional

Both

$148.75

Service Code	HCPCS 92613
Min. Negotiated Rate	$111.56
Max. Negotiated Rate	$111.56
Rate for Payer: Cash Price	$40.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$111.56
Rate for Payer: SOMOS Essential	$111.56

PR FLEXIBLE NDSC EVAL SWLNG&LARYN SENS C/V I&R

Professional

Both

$163.07

Service Code	HCPCS 92617
Min. Negotiated Rate	$122.30
Max. Negotiated Rate	$122.30
Rate for Payer: Cash Price	$45.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$122.30
Rate for Payer: SOMOS Essential	$122.30

Know your out-of-pocket cost for care.

All Charges