St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR PARTIAL EXCISION BONE SCAPULA

Professional

Both

$2,984.94

Service Code	HCPCS 23182
Min. Negotiated Rate	$2,238.70
Max. Negotiated Rate	$2,238.70
Rate for Payer: Cash Price	$809.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,238.70
Rate for Payer: SOMOS Essential	$2,238.70

PR PARTIAL EXCISION BONE TALUS/CALCANEUS

Professional

Both

$2,121.39

Service Code	HCPCS 28120
Min. Negotiated Rate	$1,591.04
Max. Negotiated Rate	$1,591.04
Rate for Payer: Cash Price	$579.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,591.04
Rate for Payer: SOMOS Essential	$1,591.04

PR PARTIAL EXCISION BONE TIBIA

Professional

Both

$3,640.60

Service Code	HCPCS 27640
Min. Negotiated Rate	$2,730.45
Max. Negotiated Rate	$2,730.45
Rate for Payer: Cash Price	$986.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,730.45
Rate for Payer: SOMOS Essential	$2,730.45

PR PARTIAL EXCISION BONE ULNA

Professional

Both

$2,513.60

Service Code	HCPCS 25150
Min. Negotiated Rate	$1,885.20
Max. Negotiated Rate	$1,885.20
Rate for Payer: Cash Price	$682.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,885.20
Rate for Payer: SOMOS Essential	$1,885.20

PR PARTIAL EXCISION DEEP PELVIS

Professional

Both

$4,314.77

Service Code	HCPCS 27071
Min. Negotiated Rate	$3,236.08
Max. Negotiated Rate	$3,236.08
Rate for Payer: Cash Price	$1,160.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,236.08
Rate for Payer: SOMOS Essential	$3,236.08

PR PARTIAL EXCISION DISTAL PHALANX FINGER

Professional

Both

$1,954.82

Service Code	HCPCS 26236
Min. Negotiated Rate	$1,466.12
Max. Negotiated Rate	$1,466.12
Rate for Payer: Cash Price	$533.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,466.12
Rate for Payer: SOMOS Essential	$1,466.12

PR PARTIAL EXCISION PROXIMAL/MIDDLE PHALANX FINGER

Professional

Both

$2,178.40

Service Code	HCPCS 26235
Min. Negotiated Rate	$1,633.80
Max. Negotiated Rate	$1,633.80
Rate for Payer: Cash Price	$593.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,633.80
Rate for Payer: SOMOS Essential	$1,633.80

PR PARTIAL EXCISION SUPERFICIAL PELVIS

Professional

Both

$3,904.18

Service Code	HCPCS 27070
Min. Negotiated Rate	$2,928.14
Max. Negotiated Rate	$2,928.14
Rate for Payer: Cash Price	$1,053.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,928.14
Rate for Payer: SOMOS Essential	$2,928.14

PR PARTIAL LARYNGECTOMY HEMILARYGECTOMY HORIZONTAL

Professional

Both

$8,815.00

Service Code	HCPCS 31370
Min. Negotiated Rate	$6,611.25
Max. Negotiated Rate	$6,611.25
Rate for Payer: Cash Price	$2,375.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,611.25
Rate for Payer: SOMOS Essential	$6,611.25

PR PARTIAL LARYNGECTOMY HEMILARYNG ANTEROVERTICAL

Professional

Both

$8,263.64

Service Code	HCPCS 31380
Min. Negotiated Rate	$6,197.73
Max. Negotiated Rate	$6,197.73
Rate for Payer: Cash Price	$2,227.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,197.73
Rate for Payer: SOMOS Essential	$6,197.73

PR PARTIAL LARYNGECTOMY HEMILARYNG LATEROVERTICAL

Professional

Both

$8,379.91

Service Code	HCPCS 31375
Min. Negotiated Rate	$6,284.93
Max. Negotiated Rate	$6,284.93
Rate for Payer: Cash Price	$2,258.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,284.93
Rate for Payer: SOMOS Essential	$6,284.93

PR PARTIAL LARYNG HEMILARYNG ANTERO-LATERO-VERTICAL

Professional

Both

$9,043.41

Service Code	HCPCS 31382
Min. Negotiated Rate	$6,782.56
Max. Negotiated Rate	$6,782.56
Rate for Payer: Cash Price	$2,438.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,782.56
Rate for Payer: SOMOS Essential	$6,782.56

PR PARTIAL REPAIR OR REMOVAL OF SHOULDER BONE

Professional

Both

$2,748.38

Service Code	HCPCS 23130
Min. Negotiated Rate	$2,061.28
Max. Negotiated Rate	$2,061.28
Rate for Payer: Cash Price	$744.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,061.28
Rate for Payer: SOMOS Essential	$2,061.28

PR PARTICAL EXCISION BONE PHALANX TOE

Professional

Both

$1,392.06

Service Code	HCPCS 28124
Min. Negotiated Rate	$1,044.04
Max. Negotiated Rate	$1,044.04
Rate for Payer: Cash Price	$386.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,044.04
Rate for Payer: SOMOS Essential	$1,044.04

PR PATCH/APPLICATION TEST SPECIFY NUMBER TESTS

Professional

Both

$22.86

Service Code	HCPCS 95044
Min. Negotiated Rate	$17.14
Max. Negotiated Rate	$17.14
Rate for Payer: Cash Price	$6.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17.14
Rate for Payer: SOMOS Essential	$17.14

PR PATELLECTOMY/HEMIPATELLECTOMY

Professional

Both

$2,906.51

Service Code	HCPCS 27350
Min. Negotiated Rate	$2,179.88
Max. Negotiated Rate	$2,179.88
Rate for Payer: Cash Price	$786.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,179.88
Rate for Payer: SOMOS Essential	$2,179.88

PR PATIENT-INITIATED SPIROMETRIC PHYS/QHP R&I ONLY

Professional

Both

$96.46

Service Code	HCPCS 94016
Min. Negotiated Rate	$72.34
Max. Negotiated Rate	$72.34
Rate for Payer: Cash Price	$26.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$72.34
Rate for Payer: SOMOS Essential	$72.34

PR PATIENT-INITIATED SPIROMETRIC RECORDING

Professional

Both

$133.56

Service Code	HCPCS 94015
Min. Negotiated Rate	$100.17
Max. Negotiated Rate	$100.17
Rate for Payer: Cash Price	$37.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$100.17
Rate for Payer: SOMOS Essential	$100.17

PR PATTERN ELECTRORETINOGRAPHY W/I&R

Professional

Both

$318.64

Service Code	HCPCS 0509T
Min. Negotiated Rate	$238.98
Max. Negotiated Rate	$238.98
Rate for Payer: Cash Price	$88.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$238.98
Rate for Payer: SOMOS Essential	$238.98

PR PATTERN ELECTRORETINOGRAPHY W/I&R

Professional

Both

$235.62

Service Code	HCPCS 0509T TC
Min. Negotiated Rate	$176.72
Max. Negotiated Rate	$176.72
Rate for Payer: Cash Price	$65.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$176.72
Rate for Payer: SOMOS Essential	$176.72

PR PATTERN ELECTRORETINOGRAPHY W/I&R

Professional

Both

$83.02

Service Code	HCPCS 0509T 26
Min. Negotiated Rate	$62.26
Max. Negotiated Rate	$62.26
Rate for Payer: Cash Price	$22.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$62.26
Rate for Payer: SOMOS Essential	$62.26

PR PCV13 VACCINE FOR INTRAMUSCULAR USE

Professional

Both

$940.94

Service Code	HCPCS 90670
Min. Negotiated Rate	$705.70
Max. Negotiated Rate	$705.70
Rate for Payer: Cash Price	$257.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$705.70
Rate for Payer: SOMOS Essential	$705.70

PR PCV15 VACCINE FOR INTRAMUSCULAR USE

Professional

Both

$718.62

Service Code	HCPCS 90671
Min. Negotiated Rate	$538.96
Max. Negotiated Rate	$538.96
Rate for Payer: Cash Price	$253.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$538.96
Rate for Payer: SOMOS Essential	$538.96

PR PCV20 VACCINE FOR INTRAMUSCULAR USE

Professional

Both

$886.24

Service Code	HCPCS 90677
Min. Negotiated Rate	$664.68
Max. Negotiated Rate	$664.68
Rate for Payer: Cash Price	$298.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$664.68
Rate for Payer: SOMOS Essential	$664.68

PR PDT DSTR PRMLG LES SKN ILLUM/ACTIVJ BY PHYS/QHP

Professional

Both

$985.60

Service Code	HCPCS 96573
Min. Negotiated Rate	$739.20
Max. Negotiated Rate	$739.20
Rate for Payer: Cash Price	$265.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$739.20
Rate for Payer: SOMOS Essential	$739.20

Know your out-of-pocket cost for care.

All Charges