St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR HOME SLEEP TEST/TYPE 3 PORTA

Professional

Both

$179.80

Service Code	HCPCS G0399 26
Min. Negotiated Rate	$134.85
Max. Negotiated Rate	$134.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$134.85
Rate for Payer: SOMOS Essential	$134.85

PR HOME SLEEP TEST/TYPE 3 PORTA

Professional

Both

$390.78

Service Code	HCPCS G0399
Min. Negotiated Rate	$293.08
Max. Negotiated Rate	$293.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$293.08
Rate for Payer: SOMOS Essential	$293.08

PR HOME SLEEP TEST/TYPE 3 PORTA

Professional

Both

$210.98

Service Code	HCPCS G0399 TC
Min. Negotiated Rate	$158.24
Max. Negotiated Rate	$158.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$158.24
Rate for Payer: SOMOS Essential	$158.24

PR HOME SLEEP TEST/TYPE 4 PORTA

Professional

Both

$197.37

Service Code	HCPCS G0400 26
Min. Negotiated Rate	$148.03
Max. Negotiated Rate	$148.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$148.03
Rate for Payer: SOMOS Essential	$148.03

PR HOME SLEEP TEST/TYPE 4 PORTA

Professional

Both

$174.09

Service Code	HCPCS G0400 TC
Min. Negotiated Rate	$130.57
Max. Negotiated Rate	$130.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$130.57
Rate for Payer: SOMOS Essential	$130.57

PR HOME SLEEP TEST/TYPE 4 PORTA

Professional

Both

$371.49

Service Code	HCPCS G0400
Min. Negotiated Rate	$278.62
Max. Negotiated Rate	$278.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$278.62
Rate for Payer: SOMOS Essential	$278.62

PR HOSPICE CARE SUPERVISION

Professional

Both

$427.91

Service Code	HCPCS G0182
Min. Negotiated Rate	$320.93
Max. Negotiated Rate	$320.93
Rate for Payer: Cash Price	$117.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$320.93
Rate for Payer: SOMOS Essential	$320.93

PR HOSPITAL IP/OBS CARE SAME DATE HIGH MDM 85 MIN

Professional

Both

$846.34

Service Code	HCPCS 99236
Min. Negotiated Rate	$634.76
Max. Negotiated Rate	$634.76
Rate for Payer: Cash Price	$231.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$634.76
Rate for Payer: SOMOS Essential	$634.76

PR HOSPITAL IP/OBS CARE SAME DATE MOD MDM 70 MIN

Professional

Both

$646.98

Service Code	HCPCS 99235
Min. Negotiated Rate	$485.24
Max. Negotiated Rate	$485.24
Rate for Payer: Cash Price	$177.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$485.24
Rate for Payer: SOMOS Essential	$485.24

PR HOSPITAL IP/OBS CARE SAME DATE SF/LOW MDM 45 MIN

Professional

Both

$406.11

Service Code	HCPCS 99234
Min. Negotiated Rate	$304.58
Max. Negotiated Rate	$304.58
Rate for Payer: Cash Price	$109.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$304.58
Rate for Payer: SOMOS Essential	$304.58

PR HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN

Professional

Both

$469.60

Service Code	HCPCS 99239
Min. Negotiated Rate	$352.20
Max. Negotiated Rate	$352.20
Rate for Payer: Cash Price	$127.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$352.20
Rate for Payer: SOMOS Essential	$352.20

PR HOSPITAL IP/OBS DISCHARGE DAY MGMT 30 MIN/<

Professional

Both

$330.09

Service Code	HCPCS 99238
Min. Negotiated Rate	$247.57
Max. Negotiated Rate	$247.57
Rate for Payer: Cash Price	$90.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$247.57
Rate for Payer: SOMOS Essential	$247.57

PR HRHC 1 COL/GRP W/FSTULECTMY INCL FSSRECTOMY

Professional

Both

$2,170.70

Service Code	HCPCS 46258
Min. Negotiated Rate	$1,628.02
Max. Negotiated Rate	$1,628.02
Rate for Payer: Cash Price	$584.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,628.02
Rate for Payer: SOMOS Essential	$1,628.02

PR HRHC 2/> COL/GRP W/FSTULECTMY INCL FSSRECTMY

Professional

Both

$2,649.26

Service Code	HCPCS 46262
Min. Negotiated Rate	$1,986.94
Max. Negotiated Rate	$1,986.94
Rate for Payer: Cash Price	$708.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,986.94
Rate for Payer: SOMOS Essential	$1,986.94

PR HRHC NTRNL & XTRNL 2/> COLUMN/GROUP W/FISSU

Professional

Both

$2,319.84

Service Code	HCPCS 46261
Min. Negotiated Rate	$1,739.88
Max. Negotiated Rate	$1,739.88
Rate for Payer: Cash Price	$632.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,739.88
Rate for Payer: SOMOS Essential	$1,739.88

PR HYMENOTOMY SIMPLE INCISION

Professional

Both

$207.13

Service Code	HCPCS 56442
Min. Negotiated Rate	$155.35
Max. Negotiated Rate	$155.35
Rate for Payer: Cash Price	$55.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$155.35
Rate for Payer: SOMOS Essential	$155.35

PR HYOID MYOTOMY & SUSPENSION

Professional

Both

$4,235.91

Service Code	HCPCS 21685
Min. Negotiated Rate	$3,176.93
Max. Negotiated Rate	$3,176.93
Rate for Payer: Cash Price	$1,147.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,176.93
Rate for Payer: SOMOS Essential	$3,176.93

PR HYPNOTHERAPY

Professional

Both

$338.14

Service Code	HCPCS 90880
Min. Negotiated Rate	$253.60
Max. Negotiated Rate	$253.60
Rate for Payer: Cash Price	$92.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$253.60
Rate for Payer: SOMOS Essential	$253.60

PR HYPOPHYSEC/EXC PITUITARY TUM TRANSNASAL/SEPTAL

Professional

Both

$7,375.69

Service Code	HCPCS 61548
Min. Negotiated Rate	$5,531.77
Max. Negotiated Rate	$5,531.77
Rate for Payer: Cash Price	$1,959.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,531.77
Rate for Payer: SOMOS Essential	$5,531.77

PR HYSTEROPLASTY RPR UTERINE ANOMALY

Professional

Both

$3,999.10

Service Code	HCPCS 58540
Min. Negotiated Rate	$2,999.32
Max. Negotiated Rate	$2,999.32
Rate for Payer: Cash Price	$1,078.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,999.32
Rate for Payer: SOMOS Essential	$2,999.32

PR HYSTERORRHAPHY REPAIR RUPT UTERUS NONOBSTETRICAL

Professional

Both

$3,497.24

Service Code	HCPCS 58520
Min. Negotiated Rate	$2,622.93
Max. Negotiated Rate	$2,622.93
Rate for Payer: Cash Price	$939.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,622.93
Rate for Payer: SOMOS Essential	$2,622.93

PR HYSTERORRHAPHY RUPTURED UTERUS

Professional

Both

$1,300.99

Service Code	HCPCS 59350
Min. Negotiated Rate	$975.74
Max. Negotiated Rate	$975.74
Rate for Payer: Cash Price	$342.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$975.74
Rate for Payer: SOMOS Essential	$975.74

PR HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS

Professional

Both

$2,002.39

Service Code	HCPCS 58565
Min. Negotiated Rate	$1,501.79
Max. Negotiated Rate	$1,501.79
Rate for Payer: Cash Price	$540.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,501.79
Rate for Payer: SOMOS Essential	$1,501.79

PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C

Professional

Both

$1,002.89

Service Code	HCPCS 58558
Min. Negotiated Rate	$752.17
Max. Negotiated Rate	$752.17
Rate for Payer: Cash Price	$270.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$752.17
Rate for Payer: SOMOS Essential	$752.17

PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE

Professional

Both

$656.43

Service Code	HCPCS 58555
Min. Negotiated Rate	$492.32
Max. Negotiated Rate	$492.32
Rate for Payer: Cash Price	$176.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$492.32
Rate for Payer: SOMOS Essential	$492.32

Know your out-of-pocket cost for care.

All Charges