St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR MASTECTOMY GYNECOMASTIA

Professional

Both

$1,937.29

Service Code	HCPCS 19300
Min. Negotiated Rate	$1,452.97
Max. Negotiated Rate	$1,452.97
Rate for Payer: Cash Price	$518.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,452.97
Rate for Payer: SOMOS Essential	$1,452.97

PR MASTECTOMY PARTIAL

Professional

Both

$2,979.45

Service Code	HCPCS 19301
Min. Negotiated Rate	$2,234.59
Max. Negotiated Rate	$2,234.59
Rate for Payer: Cash Price	$797.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,234.59
Rate for Payer: SOMOS Essential	$2,234.59

PR MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY

Professional

Both

$4,093.60

Service Code	HCPCS 19302
Min. Negotiated Rate	$3,070.20
Max. Negotiated Rate	$3,070.20
Rate for Payer: Cash Price	$1,095.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,070.20
Rate for Payer: SOMOS Essential	$3,070.20

PR MASTECTOMY SIMPLE COMPLETE

Professional

Both

$4,321.84

Service Code	HCPCS 19303
Min. Negotiated Rate	$3,241.38
Max. Negotiated Rate	$3,241.38
Rate for Payer: Cash Price	$1,156.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,241.38
Rate for Payer: SOMOS Essential	$3,241.38

PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN

Professional

Both

$5,324.03

Service Code	HCPCS 19307
Min. Negotiated Rate	$3,993.02
Max. Negotiated Rate	$3,993.02
Rate for Payer: Cash Price	$1,423.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,993.02
Rate for Payer: SOMOS Essential	$3,993.02

PR MASTOIDECTOMY COMPLETE

Professional

Both

$4,097.07

Service Code	HCPCS 69502
Min. Negotiated Rate	$3,072.80
Max. Negotiated Rate	$3,072.80
Rate for Payer: Cash Price	$1,106.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,072.80
Rate for Payer: SOMOS Essential	$3,072.80

PR MASTOIDECTOMY MODIFIED RADICAL

Professional

Both

$5,346.53

Service Code	HCPCS 69505
Min. Negotiated Rate	$4,009.90
Max. Negotiated Rate	$4,009.90
Rate for Payer: Cash Price	$1,439.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,009.90
Rate for Payer: SOMOS Essential	$4,009.90

PR MASTOIDECTOMY RADICAL

Professional

Both

$5,466.69

Service Code	HCPCS 69511
Min. Negotiated Rate	$4,100.02
Max. Negotiated Rate	$4,100.02
Rate for Payer: Cash Price	$1,473.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,100.02
Rate for Payer: SOMOS Essential	$4,100.02

PR MASTOID OBLITERATION SEPARATE PROCEDURE

Professional

Both

$4,101.02

Service Code	HCPCS 69670
Min. Negotiated Rate	$3,075.76
Max. Negotiated Rate	$3,075.76
Rate for Payer: Cash Price	$1,107.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,075.76
Rate for Payer: SOMOS Essential	$3,075.76

PR MASTOPEXY

Professional

Both

$3,483.90

Service Code	HCPCS 19316
Min. Negotiated Rate	$2,612.92
Max. Negotiated Rate	$2,612.92
Rate for Payer: Cash Price	$939.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,612.92
Rate for Payer: SOMOS Essential	$2,612.92

PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP

Professional

Both

$1,398.85

Service Code	HCPCS 19020
Min. Negotiated Rate	$1,049.14
Max. Negotiated Rate	$1,049.14
Rate for Payer: Cash Price	$378.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,049.14
Rate for Payer: SOMOS Essential	$1,049.14

PR MAST RAD W/PECTORAL MUSC AX INT MAM LYMPH NODES

Professional

Both

$5,512.54

Service Code	HCPCS 19306
Min. Negotiated Rate	$4,134.40
Max. Negotiated Rate	$4,134.40
Rate for Payer: Cash Price	$1,474.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,134.40
Rate for Payer: SOMOS Essential	$4,134.40

PR MAST RAD W/PECTORAL MUSCLES AXILLARY LYMPH NODES

Professional

Both

$5,194.77

Service Code	HCPCS 19305
Min. Negotiated Rate	$3,896.08
Max. Negotiated Rate	$3,896.08
Rate for Payer: Cash Price	$1,385.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,896.08
Rate for Payer: SOMOS Essential	$3,896.08

PR MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ

Professional

Both

$11.87

Service Code	HCPCS 94200 26
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$8.90
Rate for Payer: Cash Price	$3.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.90
Rate for Payer: SOMOS Essential	$8.90

PR MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ

Professional

Both

$53.06

Service Code	HCPCS 94200 TC
Min. Negotiated Rate	$39.80
Max. Negotiated Rate	$39.80
Rate for Payer: Cash Price	$14.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39.80
Rate for Payer: SOMOS Essential	$39.80

PR MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ

Professional

Both

$64.93

Service Code	HCPCS 94200
Min. Negotiated Rate	$48.70
Max. Negotiated Rate	$48.70
Rate for Payer: Cash Price	$17.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$48.70
Rate for Payer: SOMOS Essential	$48.70

PR MAXILLARY IMPRESJ PALATAL PROSTHESIS

Professional

Both

$462.74

Service Code	HCPCS 42280
Min. Negotiated Rate	$347.06
Max. Negotiated Rate	$347.06
Rate for Payer: Cash Price	$124.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$347.06
Rate for Payer: SOMOS Essential	$347.06

PR MAXILLECTOMY W/O ORBITAL EXENTERATION

Professional

Both

$7,772.45

Service Code	HCPCS 31225
Min. Negotiated Rate	$5,829.34
Max. Negotiated Rate	$5,829.34
Rate for Payer: Cash Price	$2,096.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,829.34
Rate for Payer: SOMOS Essential	$5,829.34

PR MAXILLECTOMY W/ORBITAL EXENTERATION

Professional

Both

$8,668.28

Service Code	HCPCS 31230
Min. Negotiated Rate	$6,501.21
Max. Negotiated Rate	$6,501.21
Rate for Payer: Cash Price	$2,338.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,501.21
Rate for Payer: SOMOS Essential	$6,501.21

PR MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN

Professional

Both

$185.99

Service Code	HCPCS 36596
Min. Negotiated Rate	$139.49
Max. Negotiated Rate	$139.49
Rate for Payer: Cash Price	$51.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$139.49
Rate for Payer: SOMOS Essential	$139.49

PR MCHNL RMVL PRICATH OBSTR CV DEV VIA VEN ACCESS

Professional

Both

$748.55

Service Code	HCPCS 36595
Min. Negotiated Rate	$561.41
Max. Negotiated Rate	$561.41
Rate for Payer: Cash Price	$201.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$561.41
Rate for Payer: SOMOS Essential	$561.41

PR MD CERTIFICATION HHA PATIENT

Professional

Both

$215.60

Service Code	HCPCS G0180
Min. Negotiated Rate	$161.70
Max. Negotiated Rate	$161.70
Rate for Payer: Cash Price	$61.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$161.70
Rate for Payer: SOMOS Essential	$161.70

PR MD DOCUMENT VISIT BY NPP

Professional

Both

$35.35

Service Code	HCPCS G0454
Min. Negotiated Rate	$26.51
Max. Negotiated Rate	$26.51
Rate for Payer: Cash Price	$9.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26.51
Rate for Payer: SOMOS Essential	$26.51

PR MD RECERTIFICATION HHA PT

Professional

Both

$173.67

Service Code	HCPCS G0179
Min. Negotiated Rate	$130.25
Max. Negotiated Rate	$130.25
Rate for Payer: Cash Price	$48.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$130.25
Rate for Payer: SOMOS Essential	$130.25

PR MD REVIEW INTERPRET OF TEST

Professional

Both

$35.35

Service Code	HCPCS G0250
Min. Negotiated Rate	$26.51
Max. Negotiated Rate	$26.51
Rate for Payer: Cash Price	$9.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26.51
Rate for Payer: SOMOS Essential	$26.51

Know your out-of-pocket cost for care.

All Charges