St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR FLEXIBLE NDSC EVAL SWLNG&LARYN SENS C/V REC

Professional

Both

$399.39

Service Code	HCPCS 92616
Min. Negotiated Rate	$299.54
Max. Negotiated Rate	$299.54
Rate for Payer: Cash Price	$109.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$299.54
Rate for Payer: SOMOS Essential	$299.54

PR FLEXOR ORIGIN SLIDE F/ARM&/WRST TENDON TRANSFE

Professional

Both

$4,063.47

Service Code	HCPCS 25316
Min. Negotiated Rate	$3,047.60
Max. Negotiated Rate	$3,047.60
Rate for Payer: Cash Price	$1,097.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,047.60
Rate for Payer: SOMOS Essential	$3,047.60

PR FLEXOR ORIGIN SLIDE FOREARM &/WRIST

Professional

Both

$3,418.03

Service Code	HCPCS 25315
Min. Negotiated Rate	$2,563.52
Max. Negotiated Rate	$2,563.52
Rate for Payer: Cash Price	$924.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,563.52
Rate for Payer: SOMOS Essential	$2,563.52

PR FLEXOR-PLASTY ELBOW

Professional

Both

$3,191.20

Service Code	HCPCS 24330
Min. Negotiated Rate	$2,393.40
Max. Negotiated Rate	$2,393.40
Rate for Payer: Cash Price	$863.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,393.40
Rate for Payer: SOMOS Essential	$2,393.40

PR FLEXOR-PLASTY ELBOW W/EXTENSOR ADVANCEMENT

Professional

Both

$3,484.22

Service Code	HCPCS 24331
Min. Negotiated Rate	$2,613.16
Max. Negotiated Rate	$2,613.16
Rate for Payer: Cash Price	$941.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,613.16
Rate for Payer: SOMOS Essential	$2,613.16

PR FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT

Professional

Both

$140.74

Service Code	HCPCS 92230
Min. Negotiated Rate	$105.56
Max. Negotiated Rate	$105.56
Rate for Payer: Cash Price	$38.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$105.56
Rate for Payer: SOMOS Essential	$105.56

PR FLUORESCEIN ANGRPH W/MULTIFRAME IMG I&R UNI/BI

Professional

Both

$165.66

Service Code	HCPCS 92235 26
Min. Negotiated Rate	$124.24
Max. Negotiated Rate	$124.24
Rate for Payer: Cash Price	$45.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$124.24
Rate for Payer: SOMOS Essential	$124.24

PR FLUORESCEIN ANGRPH W/MULTIFRAME IMG I&R UNI/BI

Professional

Both

$410.97

Service Code	HCPCS 92235 TC
Min. Negotiated Rate	$308.23
Max. Negotiated Rate	$308.23
Rate for Payer: Cash Price	$142.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$308.23
Rate for Payer: SOMOS Essential	$308.23

PR FLUORESCEIN ANGRPH W/MULTIFRAME IMG I&R UNI/BI

Professional

Both

$576.66

Service Code	HCPCS 92235
Min. Negotiated Rate	$432.50
Max. Negotiated Rate	$432.50
Rate for Payer: Cash Price	$188.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$432.50
Rate for Payer: SOMOS Essential	$432.50

PR FLUORESCEIN&ICG ANGRPH MULTIFRAME IMG I&R UNI/BI

Professional

Both

$881.06

Service Code	HCPCS 92242 TC
Min. Negotiated Rate	$660.80
Max. Negotiated Rate	$660.80
Rate for Payer: Cash Price	$269.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$660.80
Rate for Payer: SOMOS Essential	$660.80

PR FLUORESCEIN&ICG ANGRPH MULTIFRAME IMG I&R UNI/BI

Professional

Both

$217.63

Service Code	HCPCS 92242 26
Min. Negotiated Rate	$163.22
Max. Negotiated Rate	$163.22
Rate for Payer: Cash Price	$58.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$163.22
Rate for Payer: SOMOS Essential	$163.22

PR FLUORESCEIN&ICG ANGRPH MULTIFRAME IMG I&R UNI/BI

Professional

Both

$1,098.65

Service Code	HCPCS 92242
Min. Negotiated Rate	$823.99
Max. Negotiated Rate	$823.99
Rate for Payer: Cash Price	$327.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$823.99
Rate for Payer: SOMOS Essential	$823.99

PR FOLLICLE PUNCTURE OOCYTE RETRIEVAL ANY METHOD

Professional

Both

$849.70

Service Code	HCPCS 58970
Min. Negotiated Rate	$637.28
Max. Negotiated Rate	$637.28
Rate for Payer: Cash Price	$228.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$637.28
Rate for Payer: SOMOS Essential	$637.28

PR FOLLOWUP EVAL OF FOOT PT LOP

Professional

Both

$79.10

Service Code	HCPCS G0246
Min. Negotiated Rate	$59.32
Max. Negotiated Rate	$59.32
Rate for Payer: Cash Price	$21.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$59.32
Rate for Payer: SOMOS Essential	$59.32

PR FOREHEAD FLAP W/PRESERVATION VASCULAR PEDICLE

Professional

Both

$4,289.99

Service Code	HCPCS 15731
Min. Negotiated Rate	$3,217.49
Max. Negotiated Rate	$3,217.49
Rate for Payer: Cash Price	$1,162.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,217.49
Rate for Payer: SOMOS Essential	$3,217.49

PR FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING

Professional

Both

$238.95

Service Code	HCPCS 54450
Min. Negotiated Rate	$179.21
Max. Negotiated Rate	$179.21
Rate for Payer: Cash Price	$64.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$179.21
Rate for Payer: SOMOS Essential	$179.21

PR FRACTIONAL ABL LSR FENESTRATION EA ADDL 100 SQCM

Professional

Both

$313.74

Service Code	HCPCS 0480T
Min. Negotiated Rate	$235.30
Max. Negotiated Rate	$235.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$235.30
Rate for Payer: SOMOS Essential	$235.30

PR FRACTIONAL ABL LSR FENESTRATION FIRST 100 SQCM

Professional

Both

$756.14

Service Code	HCPCS 0479T
Min. Negotiated Rate	$567.10
Max. Negotiated Rate	$567.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$567.10
Rate for Payer: SOMOS Essential	$567.10

PR FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC

Professional

Both

$510.76

Service Code	HCPCS 30930
Min. Negotiated Rate	$383.07
Max. Negotiated Rate	$383.07
Rate for Payer: Cash Price	$139.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$383.07
Rate for Payer: SOMOS Essential	$383.07

PR FREE FASCIAL FLAP W/MICROVASCULAR ANASTOMOSIS

Professional

Both

$9,754.26

Service Code	HCPCS 15758
Min. Negotiated Rate	$7,315.70
Max. Negotiated Rate	$7,315.70
Rate for Payer: Cash Price	$2,624.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,315.70
Rate for Payer: SOMOS Essential	$7,315.70

PR FREE JEJUNUM TRSF W/MICROVASC ANASTOMOSIS

Professional

Both

$4,299.40

Service Code	HCPCS 43496
Min. Negotiated Rate	$3,224.55
Max. Negotiated Rate	$3,224.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,224.55
Rate for Payer: SOMOS Essential	$3,224.55

PR FREE MUSCLE/MYOCUTANEOUS FLAP W/MVASC ANAST

Professional

Both

$9,889.95

Service Code	HCPCS 15756
Min. Negotiated Rate	$7,417.46
Max. Negotiated Rate	$7,417.46
Rate for Payer: Cash Price	$2,659.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,417.46
Rate for Payer: SOMOS Essential	$7,417.46

PR FREE OSTQ FLAP W/MVASC ANAST METAR/GREAT TOE

Professional

Both

$11,654.13

Service Code	HCPCS 20969
Min. Negotiated Rate	$8,740.60
Max. Negotiated Rate	$8,740.60
Rate for Payer: Cash Price	$3,146.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,740.60
Rate for Payer: SOMOS Essential	$8,740.60

PR FREE OSTQ FLAP W/MVASC ANASTOMOSIS ILIAC CREST

Professional

Both

$12,527.20

Service Code	HCPCS 20970
Min. Negotiated Rate	$9,395.40
Max. Negotiated Rate	$9,395.40
Rate for Payer: Cash Price	$3,367.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9,395.40
Rate for Payer: SOMOS Essential	$9,395.40

PR FREE OSTQ FLAP W/MVASC ANASTOMOSIS METATARSAL

Professional

Both

$12,492.69

Service Code	HCPCS 20972
Min. Negotiated Rate	$9,369.52
Max. Negotiated Rate	$9,369.52
Rate for Payer: Cash Price	$3,357.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9,369.52
Rate for Payer: SOMOS Essential	$9,369.52

Know your out-of-pocket cost for care.

All Charges