St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP UXTR

Professional

Both

$5,325.04

Service Code	HCPCS 15736
Min. Negotiated Rate	$3,993.78
Max. Negotiated Rate	$3,993.78
Rate for Payer: Cash Price	$1,439.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,993.78
Rate for Payer: SOMOS Essential	$3,993.78

PR MUSC MYOQ/FSCQ FLAP HEAD&NECK W/NAMED VASC PEDCL

Professional

Both

$4,450.81

Service Code	HCPCS 15733
Min. Negotiated Rate	$3,338.11
Max. Negotiated Rate	$3,338.11
Rate for Payer: Cash Price	$1,202.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,338.11
Rate for Payer: SOMOS Essential	$3,338.11

PR MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS

Professional

Both

$504.04

Service Code	HCPCS 62305
Min. Negotiated Rate	$378.03
Max. Negotiated Rate	$378.03
Rate for Payer: Cash Price	$136.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$378.03
Rate for Payer: SOMOS Essential	$378.03

PR MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL

Professional

Both

$492.21

Service Code	HCPCS 62302
Min. Negotiated Rate	$369.16
Max. Negotiated Rate	$369.16
Rate for Payer: Cash Price	$132.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$369.16
Rate for Payer: SOMOS Essential	$369.16

PR MYELOGRAPHY VIA LUMBAR INJECTION RS&I THORACIC

Professional

Both

$492.21

Service Code	HCPCS 62303
Min. Negotiated Rate	$369.16
Max. Negotiated Rate	$369.16
Rate for Payer: Cash Price	$132.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$369.16
Rate for Payer: SOMOS Essential	$369.16

PR MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL

Professional

Both

$485.77

Service Code	HCPCS 62304
Min. Negotiated Rate	$364.33
Max. Negotiated Rate	$364.33
Rate for Payer: Cash Price	$131.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$364.33
Rate for Payer: SOMOS Essential	$364.33

PR MYOCARDIAL PERFUSION ECHO ISCHM/VIABILITY ASSMT

Professional

Both

$96.22

Service Code	HCPCS 0439T
Min. Negotiated Rate	$72.16
Max. Negotiated Rate	$72.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$72.16
Rate for Payer: SOMOS Essential	$72.16

PR MYOCARDIAL RESECTION

Professional

Both

$11,612.06

Service Code	HCPCS 33542
Min. Negotiated Rate	$8,709.04
Max. Negotiated Rate	$8,709.04
Rate for Payer: Cash Price	$3,083.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,709.04
Rate for Payer: SOMOS Essential	$8,709.04

PR MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD MECH

Professional

Both

$47.04

Service Code	HCPCS 93356
Min. Negotiated Rate	$35.28
Max. Negotiated Rate	$35.28
Rate for Payer: Cash Price	$12.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35.28
Rate for Payer: SOMOS Essential	$35.28

PR MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR

Professional

Both

$2,482.59

Service Code	HCPCS 58145
Min. Negotiated Rate	$1,861.94
Max. Negotiated Rate	$1,861.94
Rate for Payer: Cash Price	$672.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,861.94
Rate for Payer: SOMOS Essential	$1,861.94

PR MYOMECTOMY 1-4 MYOMAS W/250 GM/< ABDOMINAL APPR

Professional

Both

$4,093.15

Service Code	HCPCS 58140
Min. Negotiated Rate	$3,069.86
Max. Negotiated Rate	$3,069.86
Rate for Payer: Cash Price	$1,084.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,069.86
Rate for Payer: SOMOS Essential	$3,069.86

PR MYOMECTOMY 5/> MYOMAS &/>250 GM ABDOMINA

Professional

Both

$5,039.51

Service Code	HCPCS 58146
Min. Negotiated Rate	$3,779.63
Max. Negotiated Rate	$3,779.63
Rate for Payer: Cash Price	$1,355.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,779.63
Rate for Payer: SOMOS Essential	$3,779.63

PR MYRINGOPLASTY

Professional

Both

$2,144.87

Service Code	HCPCS 69620
Min. Negotiated Rate	$1,608.65
Max. Negotiated Rate	$1,608.65
Rate for Payer: Cash Price	$582.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,608.65
Rate for Payer: SOMOS Essential	$1,608.65

PR MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ

Professional

Both

$519.51

Service Code	HCPCS 69420
Min. Negotiated Rate	$389.63
Max. Negotiated Rate	$389.63
Rate for Payer: Cash Price	$142.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$389.63
Rate for Payer: SOMOS Essential	$389.63

PR MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ ANES

Professional

Both

$657.90

Service Code	HCPCS 69421
Min. Negotiated Rate	$493.42
Max. Negotiated Rate	$493.42
Rate for Payer: Cash Price	$178.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$493.42
Rate for Payer: SOMOS Essential	$493.42

PR NARCOSYNTHESIS PSYC DX&THER PURPOSES

Professional

Both

$484.86

Service Code	HCPCS 90865
Min. Negotiated Rate	$363.64
Max. Negotiated Rate	$363.64
Rate for Payer: Cash Price	$133.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$363.64
Rate for Payer: SOMOS Essential	$363.64

PR NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX

Professional

Both

$279.16

Service Code	HCPCS 31231
Min. Negotiated Rate	$209.37
Max. Negotiated Rate	$209.37
Rate for Payer: Cash Price	$74.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$209.37
Rate for Payer: SOMOS Essential	$209.37

PR NASAL FUNCTION STUDIES

Professional

Both

$111.44

Service Code	HCPCS 92512
Min. Negotiated Rate	$83.58
Max. Negotiated Rate	$83.58
Rate for Payer: Cash Price	$30.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$83.58
Rate for Payer: SOMOS Essential	$83.58

PR NASAL/SINUS ENDOSCOPY DX MAXILLARY SINUSOSCOPY

Professional

Both

$576.49

Service Code	HCPCS 31233
Min. Negotiated Rate	$432.37
Max. Negotiated Rate	$432.37
Rate for Payer: Cash Price	$157.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$432.37
Rate for Payer: SOMOS Essential	$432.37

PR NASAL/SINUS ENDOSCOPY DX SPHENOID SINUSOSCOPY

Professional

Both

$675.26

Service Code	HCPCS 31235
Min. Negotiated Rate	$506.44
Max. Negotiated Rate	$506.44
Rate for Payer: Cash Price	$184.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$506.44
Rate for Payer: SOMOS Essential	$506.44

PR NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY

Professional

Both

$770.11

Service Code	HCPCS 31256
Min. Negotiated Rate	$577.58
Max. Negotiated Rate	$577.58
Rate for Payer: Cash Price	$207.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$577.58
Rate for Payer: SOMOS Essential	$577.58

PR NASAL/SINUS ENDOSCOPY W/SPHENOIDOTOMY

Professional

Both

$862.68

Service Code	HCPCS 31287
Min. Negotiated Rate	$647.01
Max. Negotiated Rate	$647.01
Rate for Payer: Cash Price	$231.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$647.01
Rate for Payer: SOMOS Essential	$647.01

PR NASAL/SINUS NDSC RPR CEREBRSP FLUID LEAK ETHMOID

Professional

Both

$4,940.29

Service Code	HCPCS 31290
Min. Negotiated Rate	$3,705.22
Max. Negotiated Rate	$3,705.22
Rate for Payer: Cash Price	$1,329.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,705.22
Rate for Payer: SOMOS Essential	$3,705.22

PR NASAL/SINUS NDSC RPR CEREBSP FLUID LEAK SPHENOID

Professional

Both

$5,307.65

Service Code	HCPCS 31291
Min. Negotiated Rate	$3,980.74
Max. Negotiated Rate	$3,980.74
Rate for Payer: Cash Price	$1,441.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,980.74
Rate for Payer: SOMOS Essential	$3,980.74

PR NASAL/SINUS NDSC SURG MEDIAL&INF ORB WALL DCMPRN

Professional

Both

$4,629.03

Service Code	HCPCS 31293
Min. Negotiated Rate	$3,471.77
Max. Negotiated Rate	$3,471.77
Rate for Payer: Cash Price	$1,248.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,471.77
Rate for Payer: SOMOS Essential	$3,471.77

Know your out-of-pocket cost for care.

All Charges