St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR PDT DSTR PRMLG LES SKN ILLUM/ACTIVJ PER DAY

Professional

Both

$606.48

Service Code	HCPCS 96567
Min. Negotiated Rate	$454.86
Max. Negotiated Rate	$454.86
Rate for Payer: Cash Price	$161.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$454.86
Rate for Payer: SOMOS Essential	$454.86

PR PDT NDSC ABL ABNOR TISS VIA ACTIVJ RX 30 MIN

Professional

Both

$237.20

Service Code	HCPCS 96570
Min. Negotiated Rate	$177.90
Max. Negotiated Rate	$177.90
Rate for Payer: Cash Price	$55.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$177.90
Rate for Payer: SOMOS Essential	$177.90

PR PDT NDSC ABL ABNOR TISS VIA ACTIVJ RX A 15 MIN

Professional

Both

$101.40

Service Code	HCPCS 96571
Min. Negotiated Rate	$76.05
Max. Negotiated Rate	$76.05
Rate for Payer: Cash Price	$27.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$76.05
Rate for Payer: SOMOS Essential	$76.05

PR PEDIATRIC APNEA MONITOR ANALYSES COMPUTER

Professional

Both

$1,016.37

Service Code	HCPCS 94776
Min. Negotiated Rate	$762.28
Max. Negotiated Rate	$762.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$762.28
Rate for Payer: SOMOS Essential	$762.28

PR PEDIATRIC APNEA MONITOR ATTACHMENT

Professional

Both

$214.31

Service Code	HCPCS 94775
Min. Negotiated Rate	$160.73
Max. Negotiated Rate	$160.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$160.73
Rate for Payer: SOMOS Essential	$160.73

PR PEDIATRIC APNEA MONITOR ATTACHMENT PHYS I&R

Professional

Both

$1,357.90

Service Code	HCPCS 94774
Min. Negotiated Rate	$1,018.42
Max. Negotiated Rate	$1,018.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,018.42
Rate for Payer: SOMOS Essential	$1,018.42

PR PEDIATRIC APNEA MONITOR PHYS/QHP REVIEW

Professional

Both

$127.44

Service Code	HCPCS 94777
Min. Negotiated Rate	$95.58
Max. Negotiated Rate	$95.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$95.58
Rate for Payer: SOMOS Essential	$95.58

PR PEL EXNTJ GYNECOLOGIC MAL

Professional

Both

$12,743.12

Service Code	HCPCS 58240
Min. Negotiated Rate	$9,557.34
Max. Negotiated Rate	$9,557.34
Rate for Payer: Cash Price	$3,429.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9,557.34
Rate for Payer: SOMOS Essential	$9,557.34

PR PEL LMPHADEC W/XTRNL ILIAC HYPOGSTR&OBTURATOR

Professional

Both

$3,442.74

Service Code	HCPCS 38770
Min. Negotiated Rate	$2,582.06
Max. Negotiated Rate	$2,582.06
Rate for Payer: Cash Price	$937.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,582.06
Rate for Payer: SOMOS Essential	$2,582.06

PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL

Professional

Both

$454.06

Service Code	HCPCS 57410
Min. Negotiated Rate	$340.54
Max. Negotiated Rate	$340.54
Rate for Payer: Cash Price	$124.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$340.54
Rate for Payer: SOMOS Essential	$340.54

PR PELVIC EXENTERATION COLORECTAL MALIGNANCY

Professional

Both

$11,685.03

Service Code	HCPCS 45126
Min. Negotiated Rate	$8,763.77
Max. Negotiated Rate	$8,763.77
Rate for Payer: Cash Price	$3,177.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,763.77
Rate for Payer: SOMOS Essential	$8,763.77

PR PELVIC EXENTERATION COMPLETE MALIGNANCY

Professional

Both

$9,613.70

Service Code	HCPCS 51597
Min. Negotiated Rate	$7,210.28
Max. Negotiated Rate	$7,210.28
Rate for Payer: Cash Price	$2,618.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,210.28
Rate for Payer: SOMOS Essential	$7,210.28

PR PELVIC FIXATION OTHER THAN SACRUM

Professional

Both

$1,645.35

Service Code	HCPCS 22848
Min. Negotiated Rate	$1,234.01
Max. Negotiated Rate	$1,234.01
Rate for Payer: Cash Price	$436.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,234.01
Rate for Payer: SOMOS Essential	$1,234.01

PR PELVIC RING FRACTURE UNI/BIL

Professional

Both

$4,700.78

Service Code	HCPCS G0413
Min. Negotiated Rate	$3,525.58
Max. Negotiated Rate	$3,525.58
Rate for Payer: Cash Price	$1,267.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,525.58
Rate for Payer: SOMOS Essential	$3,525.58

PR PELVIC RING FX TREAT INT FIX

Professional

Both

$4,432.02

Service Code	HCPCS G0414
Min. Negotiated Rate	$3,324.02
Max. Negotiated Rate	$3,324.02
Rate for Payer: Cash Price	$1,196.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,324.02
Rate for Payer: SOMOS Essential	$3,324.02

PR PENICILLIN G BENZATHINE INJ

Professional

Both

$602.49

Service Code	HCPCS J0561
Min. Negotiated Rate	$451.87
Max. Negotiated Rate	$451.87
Rate for Payer: Cash Price	$22.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$451.87
Rate for Payer: SOMOS Essential	$451.87

PR PENILE PLETHYSMOGRAPHY

Professional

Both

$276.71

Service Code	HCPCS 54240 26
Min. Negotiated Rate	$207.53
Max. Negotiated Rate	$207.53
Rate for Payer: Cash Price	$71.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$207.53
Rate for Payer: SOMOS Essential	$207.53

PR PENILE PLETHYSMOGRAPHY

Professional

Both

$458.99

Service Code	HCPCS 54240
Min. Negotiated Rate	$344.24
Max. Negotiated Rate	$344.24
Rate for Payer: Cash Price	$124.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$344.24
Rate for Payer: SOMOS Essential	$344.24

PR PENILE PLETHYSMOGRAPHY

Professional

Both

$182.28

Service Code	HCPCS 54240 TC
Min. Negotiated Rate	$136.71
Max. Negotiated Rate	$136.71
Rate for Payer: Cash Price	$52.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$136.71
Rate for Payer: SOMOS Essential	$136.71

PR PENILE REVASCULARIZATION ARTERY W/WO VEIN GRAFT

Professional

Both

$5,262.64

Service Code	HCPCS 37788
Min. Negotiated Rate	$3,946.98
Max. Negotiated Rate	$3,946.98
Rate for Payer: Cash Price	$1,436.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,946.98
Rate for Payer: SOMOS Essential	$3,946.98

PR PENILE VENOUS OCCLUSIVE PROCEDURE

Professional

Both

$2,033.82

Service Code	HCPCS 37790
Min. Negotiated Rate	$1,525.36
Max. Negotiated Rate	$1,525.36
Rate for Payer: Cash Price	$558.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,525.36
Rate for Payer: SOMOS Essential	$1,525.36

PR PENIS CORRJ CHORDEE/1ST STAGE HYPOSPADIAS RPR

Professional

Both

$3,129.32

Service Code	HCPCS 54304
Min. Negotiated Rate	$2,346.99
Max. Negotiated Rate	$2,346.99
Rate for Payer: Cash Price	$856.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,346.99
Rate for Payer: SOMOS Essential	$2,346.99

PR PENIS STRAIGHTENING CHORDEE

Professional

Both

$2,706.66

Service Code	HCPCS 54300
Min. Negotiated Rate	$2,030.00
Max. Negotiated Rate	$2,030.00
Rate for Payer: Cash Price	$741.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,030.00
Rate for Payer: SOMOS Essential	$2,030.00

PR PENTAMIDINE AERSL INHALATION PNEUMOCYSTIS/PROPH

Professional

Both

$274.02

Service Code	HCPCS 94642
Min. Negotiated Rate	$205.52
Max. Negotiated Rate	$205.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$205.52
Rate for Payer: SOMOS Essential	$205.52

PR PERC LAMINO-/LAMINECTOMY IMAGE GUIDE CERV/THORAC

Professional

Both

$2,645.09

Service Code	HCPCS 0274T
Min. Negotiated Rate	$1,983.82
Max. Negotiated Rate	$1,983.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,983.82
Rate for Payer: SOMOS Essential	$1,983.82

Know your out-of-pocket cost for care.

All Charges