St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS

Professional

Both

$391.23

Service Code	HCPCS 95863 26
Min. Negotiated Rate	$293.42
Max. Negotiated Rate	$293.42
Rate for Payer: Cash Price	$107.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$293.42
Rate for Payer: SOMOS Essential	$293.42

PR NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS

Professional

Both

$479.99

Service Code	HCPCS 95863 TC
Min. Negotiated Rate	$359.99
Max. Negotiated Rate	$359.99
Rate for Payer: Cash Price	$130.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$359.99
Rate for Payer: SOMOS Essential	$359.99

PR NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS

Professional

Both

$871.22

Service Code	HCPCS 95863
Min. Negotiated Rate	$653.42
Max. Negotiated Rate	$653.42
Rate for Payer: Cash Price	$237.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$653.42
Rate for Payer: SOMOS Essential	$653.42

PR NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS

Professional

Both

$560.49

Service Code	HCPCS 95864 TC
Min. Negotiated Rate	$420.37
Max. Negotiated Rate	$420.37
Rate for Payer: Cash Price	$151.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$420.37
Rate for Payer: SOMOS Essential	$420.37

PR NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS

Professional

Both

$979.41

Service Code	HCPCS 95864
Min. Negotiated Rate	$734.56
Max. Negotiated Rate	$734.56
Rate for Payer: Cash Price	$266.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$734.56
Rate for Payer: SOMOS Essential	$734.56

PR NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS

Professional

Both

$418.92

Service Code	HCPCS 95864 26
Min. Negotiated Rate	$314.19
Max. Negotiated Rate	$314.19
Rate for Payer: Cash Price	$114.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$314.19
Rate for Payer: SOMOS Essential	$314.19

PR NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ

Professional

Both

$430.64

Service Code	HCPCS 51785 26
Min. Negotiated Rate	$322.98
Max. Negotiated Rate	$322.98
Rate for Payer: Cash Price	$112.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$322.98
Rate for Payer: SOMOS Essential	$322.98

PR NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ

Professional

Both

$1,495.87

Service Code	HCPCS 51785 TC
Min. Negotiated Rate	$1,121.90
Max. Negotiated Rate	$1,121.90
Rate for Payer: Cash Price	$408.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,121.90
Rate for Payer: SOMOS Essential	$1,121.90

PR NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ

Professional

Both

$1,926.51

Service Code	HCPCS 51785
Min. Negotiated Rate	$1,444.88
Max. Negotiated Rate	$1,444.88
Rate for Payer: Cash Price	$520.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,444.88
Rate for Payer: SOMOS Essential	$1,444.88

PR NDL OCULOELECTROMYOGRAPHY 1+EO MUSC 1/BOTH EYE

Professional

Both

$358.47

Service Code	HCPCS 92265
Min. Negotiated Rate	$268.85
Max. Negotiated Rate	$268.85
Rate for Payer: Cash Price	$99.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$268.85
Rate for Payer: SOMOS Essential	$268.85

PR NDL OCULOELECTROMYOGRAPHY 1+EO MUSC 1/BOTH EYE

Professional

Both

$179.55

Service Code	HCPCS 92265 TC
Min. Negotiated Rate	$134.66
Max. Negotiated Rate	$134.66
Rate for Payer: Cash Price	$50.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$134.66
Rate for Payer: SOMOS Essential	$134.66

PR NDL OCULOELECTROMYOGRAPHY 1+EO MUSC 1/BOTH EYE

Professional

Both

$178.92

Service Code	HCPCS 92265 26
Min. Negotiated Rate	$134.19
Max. Negotiated Rate	$134.19
Rate for Payer: Cash Price	$49.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$134.19
Rate for Payer: SOMOS Essential	$134.19

PR NDSC ABLATION & RCNSTJ ATRIA EXTEN W/O BYPASS

Professional

Both

$8,162.25

Service Code	HCPCS 33266
Min. Negotiated Rate	$6,121.69
Max. Negotiated Rate	$6,121.69
Rate for Payer: Cash Price	$2,168.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,121.69
Rate for Payer: SOMOS Essential	$6,121.69

PR NDSC ABLATION & RCNSTJ ATRIA LIMITED W/O BYPAS

Professional

Both

$6,034.81

Service Code	HCPCS 33265
Min. Negotiated Rate	$4,526.11
Max. Negotiated Rate	$4,526.11
Rate for Payer: Cash Price	$1,606.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,526.11
Rate for Payer: SOMOS Essential	$4,526.11

PR NDSC DCMPRN SPINAL CORD 1 W/LAMOT NTRSPC LUMBAR

Professional

Both

$7,182.32

Service Code	HCPCS 62380
Min. Negotiated Rate	$5,386.74
Max. Negotiated Rate	$5,386.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,386.74
Rate for Payer: SOMOS Essential	$5,386.74

PR NDSC EVAL INTSTINAL POUCH DX W/COLLJ SPEC SPX

Professional

Both

$311.68

Service Code	HCPCS 44385
Min. Negotiated Rate	$233.76
Max. Negotiated Rate	$233.76
Rate for Payer: Cash Price	$83.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$233.76
Rate for Payer: SOMOS Essential	$233.76

PR NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE

Professional

Both

$374.99

Service Code	HCPCS 44386
Min. Negotiated Rate	$281.24
Max. Negotiated Rate	$281.24
Rate for Payer: Cash Price	$101.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$281.24
Rate for Payer: SOMOS Essential	$281.24

PR NDSC NJX IMPLT MATRL URT&/BLDR NCK

Professional

Both

$842.49

Service Code	HCPCS 51715
Min. Negotiated Rate	$631.87
Max. Negotiated Rate	$631.87
Rate for Payer: Cash Price	$228.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$631.87
Rate for Payer: SOMOS Essential	$631.87

PR NDSC SURG W/VIDEO-ASSISTED HARVEST VEIN CABG

Professional

Both

$70.91

Service Code	HCPCS 33508
Min. Negotiated Rate	$53.18
Max. Negotiated Rate	$53.18
Rate for Payer: Cash Price	$18.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$53.18
Rate for Payer: SOMOS Essential	$53.18

PR NDSC URETEROTOMY RMVL FB/CALCULUS

Professional

Both

$1,473.50

Service Code	HCPCS 50980
Min. Negotiated Rate	$1,105.12
Max. Negotiated Rate	$1,105.12
Rate for Payer: Cash Price	$400.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,105.12
Rate for Payer: SOMOS Essential	$1,105.12

PR NDSC URETEROTOMY URTRL CATHJ W/WO DILAT URETER

Professional

Both

$1,481.38

Service Code	HCPCS 50972
Min. Negotiated Rate	$1,111.04
Max. Negotiated Rate	$1,111.04
Rate for Payer: Cash Price	$402.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,111.04
Rate for Payer: SOMOS Essential	$1,111.04

PR NDSC WRST SURG W/RLS TRANSVRS CARPL LIGM

Professional

Both

$2,261.56

Service Code	HCPCS 29848
Min. Negotiated Rate	$1,696.17
Max. Negotiated Rate	$1,696.17
Rate for Payer: Cash Price	$616.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,696.17
Rate for Payer: SOMOS Essential	$1,696.17

PR NEAR INFRARED DUAL IMG MEIBOMIAN GLND UNI/BI I&R

Professional

Both

$118.55

Service Code	HCPCS 0507T TC
Min. Negotiated Rate	$88.91
Max. Negotiated Rate	$88.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$88.91
Rate for Payer: SOMOS Essential	$88.91

PR NEAR INFRARED DUAL IMG MEIBOMIAN GLND UNI/BI I&R

Professional

Both

$118.55

Service Code	HCPCS 0507T
Min. Negotiated Rate	$88.91
Max. Negotiated Rate	$88.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$88.91
Rate for Payer: SOMOS Essential	$88.91

PR NEAR INFRARED DUAL IMG MEIBOMIAN GLND UNI/BI I&R

Professional

Both

$118.55

Service Code	HCPCS 0507T 26
Min. Negotiated Rate	$88.91
Max. Negotiated Rate	$88.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$88.91
Rate for Payer: SOMOS Essential	$88.91

Know your out-of-pocket cost for care.

All Charges