St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR GASTRIC RSTCV W/BYP W/SM INT RCNSTJ LIMIT ABSRPJ

Professional

Both

$8,186.50

Service Code	HCPCS 43847
Min. Negotiated Rate	$6,139.88
Max. Negotiated Rate	$6,139.88
Rate for Payer: Cash Price	$2,179.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,139.88
Rate for Payer: SOMOS Essential	$6,139.88

PR GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM

Professional

Both

$8,848.25

Service Code	HCPCS 43845
Min. Negotiated Rate	$6,636.19
Max. Negotiated Rate	$6,636.19
Rate for Payer: Cash Price	$2,358.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,636.19
Rate for Payer: SOMOS Essential	$6,636.19

PR GASTROCNEMIUS RECESSION

Professional

Both

$1,958.88

Service Code	HCPCS 27687
Min. Negotiated Rate	$1,469.16
Max. Negotiated Rate	$1,469.16
Rate for Payer: Cash Price	$536.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,469.16
Rate for Payer: SOMOS Essential	$1,469.16

PR GASTRODUODENOSTOMY

Professional

Both

$4,604.29

Service Code	HCPCS 43810
Min. Negotiated Rate	$3,453.22
Max. Negotiated Rate	$3,453.22
Rate for Payer: Cash Price	$1,227.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,453.22
Rate for Payer: SOMOS Essential	$3,453.22

PR GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT

Professional

Both

$821.87

Service Code	HCPCS 91034
Min. Negotiated Rate	$616.40
Max. Negotiated Rate	$616.40
Rate for Payer: Cash Price	$223.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$616.40
Rate for Payer: SOMOS Essential	$616.40

PR GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT

Professional

Both

$199.71

Service Code	HCPCS 91034 26
Min. Negotiated Rate	$149.78
Max. Negotiated Rate	$149.78
Rate for Payer: Cash Price	$54.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$149.78
Rate for Payer: SOMOS Essential	$149.78

PR GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT

Professional

Both

$622.16

Service Code	HCPCS 91034 TC
Min. Negotiated Rate	$466.62
Max. Negotiated Rate	$466.62
Rate for Payer: Cash Price	$168.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$466.62
Rate for Payer: SOMOS Essential	$466.62

PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD

Professional

Both

$522.97

Service Code	HCPCS 91037 TC
Min. Negotiated Rate	$392.23
Max. Negotiated Rate	$392.23
Rate for Payer: Cash Price	$143.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$392.23
Rate for Payer: SOMOS Essential	$392.23

PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD

Professional

Both

$715.79

Service Code	HCPCS 91037
Min. Negotiated Rate	$536.84
Max. Negotiated Rate	$536.84
Rate for Payer: Cash Price	$195.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$536.84
Rate for Payer: SOMOS Essential	$536.84

PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD

Professional

Both

$192.82

Service Code	HCPCS 91037 26
Min. Negotiated Rate	$144.62
Max. Negotiated Rate	$144.62
Rate for Payer: Cash Price	$52.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$144.62
Rate for Payer: SOMOS Essential	$144.62

PR GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD

Professional

Both

$1,650.11

Service Code	HCPCS 91035 TC
Min. Negotiated Rate	$1,237.58
Max. Negotiated Rate	$1,237.58
Rate for Payer: Cash Price	$442.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,237.58
Rate for Payer: SOMOS Essential	$1,237.58

PR GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD

Professional

Both

$329.74

Service Code	HCPCS 91035 26
Min. Negotiated Rate	$247.30
Max. Negotiated Rate	$247.30
Rate for Payer: Cash Price	$89.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$247.30
Rate for Payer: SOMOS Essential	$247.30

PR GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD

Professional

Both

$1,979.85

Service Code	HCPCS 91035
Min. Negotiated Rate	$1,484.89
Max. Negotiated Rate	$1,484.89
Rate for Payer: Cash Price	$532.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,484.89
Rate for Payer: SOMOS Essential	$1,484.89

PR GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R

Professional

Both

$3,682.77

Service Code	HCPCS 91111
Min. Negotiated Rate	$2,762.08
Max. Negotiated Rate	$2,762.08
Rate for Payer: Cash Price	$1,028.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,762.08
Rate for Payer: SOMOS Essential	$2,762.08

PR GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R

Professional

Both

$3,503.05

Service Code	HCPCS 91111 TC
Min. Negotiated Rate	$2,627.29
Max. Negotiated Rate	$2,627.29
Rate for Payer: Cash Price	$979.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,627.29
Rate for Payer: SOMOS Essential	$2,627.29

PR GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R

Professional

Both

$179.73

Service Code	HCPCS 91111 26
Min. Negotiated Rate	$134.80
Max. Negotiated Rate	$134.80
Rate for Payer: Cash Price	$48.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$134.80
Rate for Payer: SOMOS Essential	$134.80

PR GASTROJEJUNOSTOMY W/O VAGOTOMY

Professional

Both

$6,057.03

Service Code	HCPCS 43820
Min. Negotiated Rate	$4,542.77
Max. Negotiated Rate	$4,542.77
Rate for Payer: Cash Price	$1,617.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,542.77
Rate for Payer: SOMOS Essential	$4,542.77

PR GASTROJEJUNOSTOMY W/VAGOTOMY ANY TYPE

Professional

Both

$5,940.03

Service Code	HCPCS 43825
Min. Negotiated Rate	$4,455.02
Max. Negotiated Rate	$4,455.02
Rate for Payer: Cash Price	$1,582.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,455.02
Rate for Payer: SOMOS Essential	$4,455.02

PR GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ

Professional

Both

$6,130.71

Service Code	HCPCS 43840
Min. Negotiated Rate	$4,598.03
Max. Negotiated Rate	$4,598.03
Rate for Payer: Cash Price	$1,634.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,598.03
Rate for Payer: SOMOS Essential	$4,598.03

PR GASTROSTOMY OPN NEONATAL FEEDING

Professional

Both

$2,754.47

Service Code	HCPCS 43831
Min. Negotiated Rate	$2,065.85
Max. Negotiated Rate	$2,065.85
Rate for Payer: Cash Price	$738.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,065.85
Rate for Payer: SOMOS Essential	$2,065.85

PR GASTROSTOMY OPN W/CONSTJ GSTR TUBE

Professional

Both

$4,702.71

Service Code	HCPCS 43832
Min. Negotiated Rate	$3,527.03
Max. Negotiated Rate	$3,527.03
Rate for Payer: Cash Price	$1,261.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,527.03
Rate for Payer: SOMOS Essential	$3,527.03

PR GASTROSTOMY OPN W/O CONSTJ GSTR TUBE SPX

Professional

Both

$3,169.74

Service Code	HCPCS 43830
Min. Negotiated Rate	$2,377.30
Max. Negotiated Rate	$2,377.30
Rate for Payer: Cash Price	$846.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,377.30
Rate for Payer: SOMOS Essential	$2,377.30

PR GASTROTOMY W/EXPLORATION/FOREIGN BODY REMOVAL

Professional

Both

$3,519.74

Service Code	HCPCS 43500
Min. Negotiated Rate	$2,639.80
Max. Negotiated Rate	$2,639.80
Rate for Payer: Cash Price	$948.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,639.80
Rate for Payer: SOMOS Essential	$2,639.80

PR GASTROTOMY W/SUTR RPR PRE-ESOPG/GASTRIC LAC

Professional

Both

$6,911.59

Service Code	HCPCS 43502
Min. Negotiated Rate	$5,183.69
Max. Negotiated Rate	$5,183.69
Rate for Payer: Cash Price	$1,839.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,183.69
Rate for Payer: SOMOS Essential	$5,183.69

PR GASTROTOMY W/SUTURE REPAIR BLEEDING ULCER

Professional

Both

$6,080.06

Service Code	HCPCS 43501
Min. Negotiated Rate	$4,560.04
Max. Negotiated Rate	$4,560.04
Rate for Payer: Cash Price	$1,626.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,560.04
Rate for Payer: SOMOS Essential	$4,560.04

Know your out-of-pocket cost for care.

All Charges