St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR FULL FIELD ELECTRORETINOGRAPHY W/I&R

Professional

Both

$142.35

Service Code	HCPCS 92273 26
Min. Negotiated Rate	$106.76
Max. Negotiated Rate	$106.76
Rate for Payer: Cash Price	$38.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$106.76
Rate for Payer: SOMOS Essential	$106.76

PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND ADDL HR

Professional

Both

$693.53

Service Code	HCPCS 95962 26
Min. Negotiated Rate	$520.15
Max. Negotiated Rate	$520.15
Rate for Payer: Cash Price	$190.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$520.15
Rate for Payer: SOMOS Essential	$520.15

PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND ADDL HR

Professional

Both

$439.60

Service Code	HCPCS 95962 TC
Min. Negotiated Rate	$329.70
Max. Negotiated Rate	$329.70
Rate for Payer: Cash Price	$129.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$329.70
Rate for Payer: SOMOS Essential	$329.70

PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND ADDL HR

Professional

Both

$1,133.13

Service Code	HCPCS 95962
Min. Negotiated Rate	$849.85
Max. Negotiated Rate	$849.85
Rate for Payer: Cash Price	$319.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$849.85
Rate for Payer: SOMOS Essential	$849.85

PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR

Professional

Both

$1,325.07

Service Code	HCPCS 95961
Min. Negotiated Rate	$993.80
Max. Negotiated Rate	$993.80
Rate for Payer: Cash Price	$381.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$993.80
Rate for Payer: SOMOS Essential	$993.80

PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR

Professional

Both

$666.72

Service Code	HCPCS 95961 TC
Min. Negotiated Rate	$500.04
Max. Negotiated Rate	$500.04
Rate for Payer: Cash Price	$200.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$500.04
Rate for Payer: SOMOS Essential	$500.04

PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR

Professional

Both

$658.35

Service Code	HCPCS 95961 26
Min. Negotiated Rate	$493.76
Max. Negotiated Rate	$493.76
Rate for Payer: Cash Price	$181.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$493.76
Rate for Payer: SOMOS Essential	$493.76

PR FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT

Professional

Both

$71.75

Service Code	HCPCS 92250 TC
Min. Negotiated Rate	$53.81
Max. Negotiated Rate	$53.81
Rate for Payer: Cash Price	$19.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$53.81
Rate for Payer: SOMOS Essential	$53.81

PR FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT

Professional

Both

$154.77

Service Code	HCPCS 92250
Min. Negotiated Rate	$116.08
Max. Negotiated Rate	$116.08
Rate for Payer: Cash Price	$42.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$116.08
Rate for Payer: SOMOS Essential	$116.08

PR FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT

Professional

Both

$83.02

Service Code	HCPCS 92250 26
Min. Negotiated Rate	$62.26
Max. Negotiated Rate	$62.26
Rate for Payer: Cash Price	$22.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$62.26
Rate for Payer: SOMOS Essential	$62.26

PR F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY

Professional

Both

$518.67

Service Code	HCPCS 93304 TC
Min. Negotiated Rate	$389.00
Max. Negotiated Rate	$389.00
Rate for Payer: Cash Price	$142.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$389.00
Rate for Payer: SOMOS Essential	$389.00

PR F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY

Professional

Both

$662.34

Service Code	HCPCS 93304
Min. Negotiated Rate	$496.76
Max. Negotiated Rate	$496.76
Rate for Payer: Cash Price	$180.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$496.76
Rate for Payer: SOMOS Essential	$496.76

PR F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY

Professional

Both

$143.71

Service Code	HCPCS 93304 26
Min. Negotiated Rate	$107.78
Max. Negotiated Rate	$107.78
Rate for Payer: Cash Price	$38.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$107.78
Rate for Payer: SOMOS Essential	$107.78

PR FUSION OPPOSITION THUMB W/AUTOGENOUS GRAFT

Professional

Both

$3,691.38

Service Code	HCPCS 26820
Min. Negotiated Rate	$2,768.54
Max. Negotiated Rate	$2,768.54
Rate for Payer: Cash Price	$994.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,768.54
Rate for Payer: SOMOS Essential	$2,768.54

PR GAMETE ZYGOTE/EMBRYO FALLOPIAN TRANSFER ANY METH

Professional

Both

$923.69

Service Code	HCPCS 58976
Min. Negotiated Rate	$692.77
Max. Negotiated Rate	$692.77
Rate for Payer: Cash Price	$246.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$692.77
Rate for Payer: SOMOS Essential	$692.77

PR GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V

Professional

Both

$137.87

Service Code	HCPCS 94727 TC
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$103.40
Rate for Payer: Cash Price	$39.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$103.40
Rate for Payer: SOMOS Essential	$103.40

PR GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V

Professional

Both

$46.80

Service Code	HCPCS 94727 26
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Cash Price	$12.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35.10
Rate for Payer: SOMOS Essential	$35.10

PR GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V

Professional

Both

$184.66

Service Code	HCPCS 94727
Min. Negotiated Rate	$138.50
Max. Negotiated Rate	$138.50
Rate for Payer: Cash Price	$51.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$138.50
Rate for Payer: SOMOS Essential	$138.50

PR GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIMEN

Professional

Both

$165.66

Service Code	HCPCS 43754
Min. Negotiated Rate	$124.24
Max. Negotiated Rate	$124.24
Rate for Payer: Cash Price	$45.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$124.24
Rate for Payer: SOMOS Essential	$124.24

PR GASTRIC INTUBATION DX & ASPIRATJ MULTIPLE SPEC

Professional

Both

$249.90

Service Code	HCPCS 43755
Min. Negotiated Rate	$187.42
Max. Negotiated Rate	$187.42
Rate for Payer: Cash Price	$68.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$187.42
Rate for Payer: SOMOS Essential	$187.42

PR GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE

Professional

Both

$94.08

Service Code	HCPCS 43753
Min. Negotiated Rate	$70.56
Max. Negotiated Rate	$70.56
Rate for Payer: Cash Price	$25.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70.56
Rate for Payer: SOMOS Essential	$70.56

PR GASTRIC MOTILITY MANOMETRIC STUDIES

Professional

Both

$283.29

Service Code	HCPCS 91020 26
Min. Negotiated Rate	$212.47
Max. Negotiated Rate	$212.47
Rate for Payer: Cash Price	$78.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$212.47
Rate for Payer: SOMOS Essential	$212.47

PR GASTRIC MOTILITY MANOMETRIC STUDIES

Professional

Both

$880.92

Service Code	HCPCS 91020 TC
Min. Negotiated Rate	$660.69
Max. Negotiated Rate	$660.69
Rate for Payer: Cash Price	$242.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$660.69
Rate for Payer: SOMOS Essential	$660.69

PR GASTRIC MOTILITY MANOMETRIC STUDIES

Professional

Both

$1,164.21

Service Code	HCPCS 91020
Min. Negotiated Rate	$873.16
Max. Negotiated Rate	$873.16
Rate for Payer: Cash Price	$321.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$873.16
Rate for Payer: SOMOS Essential	$873.16

PR GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/<

Professional

Both

$7,480.41

Service Code	HCPCS 43846
Min. Negotiated Rate	$5,610.31
Max. Negotiated Rate	$5,610.31
Rate for Payer: Cash Price	$1,991.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,610.31
Rate for Payer: SOMOS Essential	$5,610.31

Know your out-of-pocket cost for care.

All Charges