St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG

Professional

Both

$1,792.70

Service Code	HCPCS 95805
Min. Negotiated Rate	$1,344.52
Max. Negotiated Rate	$1,344.52
Rate for Payer: Cash Price	$507.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,344.52
Rate for Payer: SOMOS Essential	$1,344.52

PR MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG

Professional

Both

$1,569.65

Service Code	HCPCS 95805 TC
Min. Negotiated Rate	$1,177.24
Max. Negotiated Rate	$1,177.24
Rate for Payer: Cash Price	$446.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,177.24
Rate for Payer: SOMOS Essential	$1,177.24

PR MNTR INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME

Professional

Both

$380.45

Service Code	HCPCS 20950
Min. Negotiated Rate	$285.34
Max. Negotiated Rate	$285.34
Rate for Payer: Cash Price	$104.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$285.34
Rate for Payer: SOMOS Essential	$285.34

PR MNT SUBS TX FOR CHANGE DX

Professional

Both

$109.41

Service Code	HCPCS G0270
Min. Negotiated Rate	$82.06
Max. Negotiated Rate	$82.06
Rate for Payer: Cash Price	$30.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$82.06
Rate for Payer: SOMOS Essential	$82.06

PR MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT

Professional

Both

$534.14

Service Code	HCPCS 44139
Min. Negotiated Rate	$400.60
Max. Negotiated Rate	$400.60
Rate for Payer: Cash Price	$141.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$400.60
Rate for Payer: SOMOS Essential	$400.60

PR MODIFICAJ CONTACT LENS SPX SUPVJ ADAPTATION

Professional

Both

$195.37

Service Code	HCPCS 92325
Min. Negotiated Rate	$146.53
Max. Negotiated Rate	$146.53
Rate for Payer: Cash Price	$48.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$146.53
Rate for Payer: SOMOS Essential	$146.53

PR MODIFICAJ OC IMPLT W/PLMT/RPLCMT PEGS SPX

Professional

Both

$1,216.85

Service Code	HCPCS 65125
Min. Negotiated Rate	$912.64
Max. Negotiated Rate	$912.64
Rate for Payer: Cash Price	$336.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$912.64
Rate for Payer: SOMOS Essential	$912.64

PR MOD SEDAT ENDO SERVICE >5YRS

Professional

Both

$23.73

Service Code	HCPCS G0500
Min. Negotiated Rate	$17.80
Max. Negotiated Rate	$17.80
Rate for Payer: Cash Price	$6.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17.80
Rate for Payer: SOMOS Essential	$17.80

PR MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS

Professional

Both

$254.21

Service Code	HCPCS 99157
Min. Negotiated Rate	$190.66
Max. Negotiated Rate	$190.66
Rate for Payer: Cash Price	$66.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$190.66
Rate for Payer: SOMOS Essential	$190.66

PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS

Professional

Both

$341.57

Service Code	HCPCS 99155
Min. Negotiated Rate	$256.18
Max. Negotiated Rate	$256.18
Rate for Payer: Cash Price	$92.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$256.18
Rate for Payer: SOMOS Essential	$256.18

PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS

Professional

Both

$314.86

Service Code	HCPCS 99156
Min. Negotiated Rate	$236.14
Max. Negotiated Rate	$236.14
Rate for Payer: Cash Price	$83.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$236.14
Rate for Payer: SOMOS Essential	$236.14

PR MOD SED SAME PHYS/QHP EACH ADDL 15 MINS

Professional

Both

$50.05

Service Code	HCPCS 99153
Min. Negotiated Rate	$37.54
Max. Negotiated Rate	$37.54
Rate for Payer: Cash Price	$14.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37.54
Rate for Payer: SOMOS Essential	$37.54

PR MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS

Professional

Both

$99.44

Service Code	HCPCS 99151
Min. Negotiated Rate	$74.58
Max. Negotiated Rate	$74.58
Rate for Payer: Cash Price	$26.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$74.58
Rate for Payer: SOMOS Essential	$74.58

PR MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS

Professional

Both

$53.76

Service Code	HCPCS 99152
Min. Negotiated Rate	$40.32
Max. Negotiated Rate	$40.32
Rate for Payer: Cash Price	$13.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$40.32
Rate for Payer: SOMOS Essential	$40.32

PR MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS

Professional

Both

$1,480.50

Service Code	HCPCS 17311
Min. Negotiated Rate	$1,110.38
Max. Negotiated Rate	$1,110.38
Rate for Payer: Cash Price	$400.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,110.38
Rate for Payer: SOMOS Essential	$1,110.38

PR MOHS MICROGRAPHIC H/N/H/F/G EACH ADDL STAGE

Professional

Both

$789.39

Service Code	HCPCS 17312
Min. Negotiated Rate	$592.04
Max. Negotiated Rate	$592.04
Rate for Payer: Cash Price	$213.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$592.04
Rate for Payer: SOMOS Essential	$592.04

PR MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS

Professional

Both

$1,326.57

Service Code	HCPCS 17313
Min. Negotiated Rate	$994.93
Max. Negotiated Rate	$994.93
Rate for Payer: Cash Price	$359.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$994.93
Rate for Payer: SOMOS Essential	$994.93

PR MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE

Professional

Both

$211.09

Service Code	HCPCS 17315
Min. Negotiated Rate	$158.32
Max. Negotiated Rate	$158.32
Rate for Payer: Cash Price	$56.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$158.32
Rate for Payer: SOMOS Essential	$158.32

PR MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE

Professional

Both

$725.52

Service Code	HCPCS 17314
Min. Negotiated Rate	$544.14
Max. Negotiated Rate	$544.14
Rate for Payer: Cash Price	$197.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$544.14
Rate for Payer: SOMOS Essential	$544.14

PR MOLECULAR PATHOLOGY INTERPR

Professional

Both

$14.25

Service Code	HCPCS G0452 TC
Min. Negotiated Rate	$10.69
Max. Negotiated Rate	$10.69
Rate for Payer: Cash Price	$4.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10.69
Rate for Payer: SOMOS Essential	$10.69

PR MOLECULAR PATHOLOGY INTERPR

Professional

Both

$183.75

Service Code	HCPCS G0452 26
Min. Negotiated Rate	$137.81
Max. Negotiated Rate	$137.81
Rate for Payer: Cash Price	$50.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$137.81
Rate for Payer: SOMOS Essential	$137.81

PR MOLECULAR PATHOLOGY INTERPR

Professional

Both

$198.00

Service Code	HCPCS G0452
Min. Negotiated Rate	$148.50
Max. Negotiated Rate	$148.50
Rate for Payer: Cash Price	$54.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$148.50
Rate for Payer: SOMOS Essential	$148.50

PR MOTION FLUOR EVAL SWLNG FUNCJ C/V REC

Professional

Both

$378.04

Service Code	HCPCS 92611
Min. Negotiated Rate	$283.53
Max. Negotiated Rate	$283.53
Rate for Payer: Cash Price	$104.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$283.53
Rate for Payer: SOMOS Essential	$283.53

PR MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB

Professional

Both

$137.87

Service Code	HCPCS 95905 TC
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$103.40
Rate for Payer: Cash Price	$36.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$103.40
Rate for Payer: SOMOS Essential	$103.40

PR MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB

Professional

Both

$149.73

Service Code	HCPCS 95905
Min. Negotiated Rate	$112.30
Max. Negotiated Rate	$112.30
Rate for Payer: Cash Price	$39.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$112.30
Rate for Payer: SOMOS Essential	$112.30

Know your out-of-pocket cost for care.

All Charges