St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG

Professional

Both

$330.51

Service Code	HCPCS 58611
Min. Negotiated Rate	$247.88
Max. Negotiated Rate	$247.88
Rate for Payer: Cash Price	$87.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$247.88
Rate for Payer: SOMOS Essential	$247.88

PR LIG/TRNSXJ FLP TUBE ABDL/VAG APPR UNI/BI

Professional

Both

$1,620.89

Service Code	HCPCS 58600
Min. Negotiated Rate	$1,215.67
Max. Negotiated Rate	$1,215.67
Rate for Payer: Cash Price	$438.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,215.67
Rate for Payer: SOMOS Essential	$1,215.67

PR LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX

Professional

Both

$1,475.67

Service Code	HCPCS 58605
Min. Negotiated Rate	$1,106.75
Max. Negotiated Rate	$1,106.75
Rate for Payer: Cash Price	$398.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,106.75
Rate for Payer: SOMOS Essential	$1,106.75

PR LIMITED PHARYNGECTOMY

Professional

Both

$6,122.34

Service Code	HCPCS 42890
Min. Negotiated Rate	$4,591.76
Max. Negotiated Rate	$4,591.76
Rate for Payer: Cash Price	$1,648.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,591.76
Rate for Payer: SOMOS Essential	$4,591.76

PR LIMITED VISUAL FIELD XM UNI/BI I&R

Professional

Both

$139.37

Service Code	HCPCS 92081
Min. Negotiated Rate	$104.53
Max. Negotiated Rate	$104.53
Rate for Payer: Cash Price	$38.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$104.53
Rate for Payer: SOMOS Essential	$104.53

PR LIMITED VISUAL FIELD XM UNI/BI I&R

Professional

Both

$76.06

Service Code	HCPCS 92081 TC
Min. Negotiated Rate	$57.04
Max. Negotiated Rate	$57.04
Rate for Payer: Cash Price	$21.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$57.04
Rate for Payer: SOMOS Essential	$57.04

PR LIMITED VISUAL FIELD XM UNI/BI I&R

Professional

Both

$63.32

Service Code	HCPCS 92081 26
Min. Negotiated Rate	$47.49
Max. Negotiated Rate	$47.49
Rate for Payer: Cash Price	$17.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$47.49
Rate for Payer: SOMOS Essential	$47.49

PR LITHOLAPAXY COMP/LG > 2.5 CM

Professional

Both

$1,956.75

Service Code	HCPCS 52318
Min. Negotiated Rate	$1,467.56
Max. Negotiated Rate	$1,467.56
Rate for Payer: Cash Price	$533.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,467.56
Rate for Payer: SOMOS Essential	$1,467.56

PR LITHOLAPAXY SMPL/SM <2.5 CM

Professional

Both

$1,431.75

Service Code	HCPCS 52317
Min. Negotiated Rate	$1,073.81
Max. Negotiated Rate	$1,073.81
Rate for Payer: Cash Price	$389.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,073.81
Rate for Payer: SOMOS Essential	$1,073.81

PR LITHOTRIPSY XTRCORP SHOCK WAVE

Professional

Both

$2,393.65

Service Code	HCPCS 50590
Min. Negotiated Rate	$1,795.24
Max. Negotiated Rate	$1,795.24
Rate for Payer: Cash Price	$658.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,795.24
Rate for Payer: SOMOS Essential	$1,795.24

PR LITT LES ICR MLT TRAJECTORIES MLT/CPLX LESIONS

Professional

Both

$4,462.47

Service Code	HCPCS 61737
Min. Negotiated Rate	$3,346.85
Max. Negotiated Rate	$3,346.85
Rate for Payer: Cash Price	$1,846.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,346.85
Rate for Payer: SOMOS Essential	$3,346.85

PR LITT LES ICR SINGLE TRAJECTORY 1 SIMPLE LESION

Professional

Both

$3,713.92

Service Code	HCPCS 61736
Min. Negotiated Rate	$2,785.44
Max. Negotiated Rate	$2,785.44
Rate for Payer: Cash Price	$1,520.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,785.44
Rate for Payer: SOMOS Essential	$2,785.44

PR LIVER ELASTOGRAPHY W/O IMAG W/I&R

Professional

Both

$129.54

Service Code	HCPCS 91200
Min. Negotiated Rate	$97.16
Max. Negotiated Rate	$97.16
Rate for Payer: Cash Price	$35.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$97.16
Rate for Payer: SOMOS Essential	$97.16

PR LIVER ELASTOGRAPHY W/O IMAG W/I&R

Professional

Both

$87.54

Service Code	HCPCS 91200 TC
Min. Negotiated Rate	$65.66
Max. Negotiated Rate	$65.66
Rate for Payer: Cash Price	$24.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$65.66
Rate for Payer: SOMOS Essential	$65.66

PR LIVER ELASTOGRAPHY W/O IMAG W/I&R

Professional

Both

$41.97

Service Code	HCPCS 91200 26
Min. Negotiated Rate	$31.48
Max. Negotiated Rate	$31.48
Rate for Payer: Cash Price	$11.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31.48
Rate for Payer: SOMOS Essential	$31.48

PR LMTD LMPHADEC STAGING SPX PEL&PARA-AORTIC

Professional

Both

$3,070.80

Service Code	HCPCS 38562
Min. Negotiated Rate	$2,303.10
Max. Negotiated Rate	$2,303.10
Rate for Payer: Cash Price	$833.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,303.10
Rate for Payer: SOMOS Essential	$2,303.10

PR LMTD LMPHADEC STAGING SPX RPR AORTIC&/SPLENIC

Professional

Both

$3,119.31

Service Code	HCPCS 38564
Min. Negotiated Rate	$2,339.48
Max. Negotiated Rate	$2,339.48
Rate for Payer: Cash Price	$834.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,339.48
Rate for Payer: SOMOS Essential	$2,339.48

PR LMTD OPH XM&EVAL GENERAL ANES W/WO MNPJ GLOBE

Professional

Both

$284.27

Service Code	HCPCS 92019
Min. Negotiated Rate	$213.20
Max. Negotiated Rate	$213.20
Rate for Payer: Cash Price	$80.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$213.20
Rate for Payer: SOMOS Essential	$213.20

PR LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRIST 1 EA TDN

Professional

Both

$2,499.74

Service Code	HCPCS 25280
Min. Negotiated Rate	$1,874.80
Max. Negotiated Rate	$1,874.80
Rate for Payer: Cash Price	$680.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,874.80
Rate for Payer: SOMOS Essential	$1,874.80

PR LNGTH/SHRT TDN LEG/ANKLE MLT TDN SAME INC EA

Professional

Both

$2,278.78

Service Code	HCPCS 27686
Min. Negotiated Rate	$1,709.08
Max. Negotiated Rate	$1,709.08
Rate for Payer: Cash Price	$628.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,709.08
Rate for Payer: SOMOS Essential	$1,709.08

PR LNGTH/SHRT TENDON LEG/ANKLE 1 TENDON SPX

Professional

Both

$2,002.74

Service Code	HCPCS 27685
Min. Negotiated Rate	$1,502.06
Max. Negotiated Rate	$1,502.06
Rate for Payer: Cash Price	$548.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,502.06
Rate for Payer: SOMOS Essential	$1,502.06

PR LOUDNESS BALANCE BINAURAL/MONAURAL

Professional

Both

$206.85

Service Code	HCPCS 92562
Min. Negotiated Rate	$155.14
Max. Negotiated Rate	$155.14
Rate for Payer: Cash Price	$57.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$155.14
Rate for Payer: SOMOS Essential	$155.14

PR LOW FREQUENCY NON-THERMAL ULTRASOUND PER DAY

Professional

Both

$70.07

Service Code	HCPCS 97610
Min. Negotiated Rate	$52.55
Max. Negotiated Rate	$52.55
Rate for Payer: Cash Price	$19.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$52.55
Rate for Payer: SOMOS Essential	$52.55

PR LOW INTENSITY US STIMJ BONE HEALING NONINVASIVE

Professional

Both

$139.51

Service Code	HCPCS 20979
Min. Negotiated Rate	$104.63
Max. Negotiated Rate	$104.63
Rate for Payer: Cash Price	$36.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$104.63
Rate for Payer: SOMOS Essential	$104.63

PR LOW-LVL LASER THER DYN PHOTONIC & THERMOKIN NRG

Professional

Both

$28.88

Service Code	HCPCS 0552T
Min. Negotiated Rate	$21.66
Max. Negotiated Rate	$21.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21.66
Rate for Payer: SOMOS Essential	$21.66

Know your out-of-pocket cost for care.

All Charges