St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX

Professional

Both

$1,065.47

Service Code	HCPCS 62268
Min. Negotiated Rate	$799.10
Max. Negotiated Rate	$799.10
Rate for Payer: Cash Price	$416.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$799.10
Rate for Payer: SOMOS Essential	$799.10

PR PERCUTANEOUS ISLET CELLTRANS

Professional

Both

$1,289.65

Service Code	HCPCS G0341
Min. Negotiated Rate	$967.24
Max. Negotiated Rate	$967.24
Rate for Payer: Cash Price	$348.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$967.24
Rate for Payer: SOMOS Essential	$967.24

PR PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS

Professional

Both

$18.38

Service Code	HCPCS 95004
Min. Negotiated Rate	$13.78
Max. Negotiated Rate	$13.78
Rate for Payer: Cash Price	$4.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$13.78
Rate for Payer: SOMOS Essential	$13.78

PR PERCUTANEOUS TRANSCATHETER SEPTAL REDUCTION THER

Professional

Both

$3,242.65

Service Code	HCPCS 93583
Min. Negotiated Rate	$2,431.99
Max. Negotiated Rate	$2,431.99
Rate for Payer: Cash Price	$864.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,431.99
Rate for Payer: SOMOS Essential	$2,431.99

PR PERCUTANEOUS TX MALAR AREA FRACTURE

Professional

Both

$1,426.64

Service Code	HCPCS 21355
Min. Negotiated Rate	$1,069.98
Max. Negotiated Rate	$1,069.98
Rate for Payer: Cash Price	$386.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,069.98
Rate for Payer: SOMOS Essential	$1,069.98

PR PERCUTANEOUS TX MANDIBULAR FX W/EXTERNAL FIXJ

Professional

Both

$1,996.26

Service Code	HCPCS 21452
Min. Negotiated Rate	$1,497.20
Max. Negotiated Rate	$1,497.20
Rate for Payer: Cash Price	$534.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,497.20
Rate for Payer: SOMOS Essential	$1,497.20

PR PERCUTANEOUS TX NASOETHMOID COMPLEX FRACTURE

Professional

Both

$3,249.26

Service Code	HCPCS 21340
Min. Negotiated Rate	$2,436.94
Max. Negotiated Rate	$2,436.94
Rate for Payer: Cash Price	$881.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,436.94
Rate for Payer: SOMOS Essential	$2,436.94

PR PERCUTAN TRANSCATH CLOSURE PAT DUCT ARTERIOSUS

Professional

Both

$2,903.46

Service Code	HCPCS 93582
Min. Negotiated Rate	$2,177.60
Max. Negotiated Rate	$2,177.60
Rate for Payer: Cash Price	$770.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,177.60
Rate for Payer: SOMOS Essential	$2,177.60

PR PEREYRA PX W/ANTERIOR COLPORRHAPHY

Professional

Both

$3,465.77

Service Code	HCPCS 57289
Min. Negotiated Rate	$2,599.33
Max. Negotiated Rate	$2,599.33
Rate for Payer: Cash Price	$935.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,599.33
Rate for Payer: SOMOS Essential	$2,599.33

PR PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED

Professional

Both

$1,026.80

Service Code	HCPCS 33016
Min. Negotiated Rate	$770.10
Max. Negotiated Rate	$770.10
Rate for Payer: Cash Price	$273.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$770.10
Rate for Payer: SOMOS Essential	$770.10

PR PERICARDIOTOMY REMOVAL CLOT/FOREIGN BODY PRIMARY

Professional

Both

$3,668.88

Service Code	HCPCS 33020
Min. Negotiated Rate	$2,751.66
Max. Negotiated Rate	$2,751.66
Rate for Payer: Cash Price	$972.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,751.66
Rate for Payer: SOMOS Essential	$2,751.66

PR PERI-IMPLANT CAPSULECTOMY BREAST COMPLETE

Professional

Both

$3,124.80

Service Code	HCPCS 19371
Min. Negotiated Rate	$2,343.60
Max. Negotiated Rate	$2,343.60
Rate for Payer: Cash Price	$841.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,343.60
Rate for Payer: SOMOS Essential	$2,343.60

PR PERINEOPLASTY RPR PERINEUM NONOBSTETRICAL SPX

Professional

Both

$1,184.68

Service Code	HCPCS 56810
Min. Negotiated Rate	$888.51
Max. Negotiated Rate	$888.51
Rate for Payer: Cash Price	$322.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$888.51
Rate for Payer: SOMOS Essential	$888.51

PR PERIODIC PREVENTIVE MED ESTABLISHED PATIENT <1Y

Professional

Both

$225.00

Service Code	HCPCS 99391
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$168.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$168.75
Rate for Payer: SOMOS Essential	$168.75

PR PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS

Professional

Both

$258.75

Service Code	HCPCS 99394
Min. Negotiated Rate	$194.06
Max. Negotiated Rate	$194.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$194.06
Rate for Payer: SOMOS Essential	$194.06

PR PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS

Professional

Both

$237.75

Service Code	HCPCS 99392
Min. Negotiated Rate	$178.31
Max. Negotiated Rate	$178.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$178.31
Rate for Payer: SOMOS Essential	$178.31

PR PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS

Professional

Both

$263.25

Service Code	HCPCS 99395
Min. Negotiated Rate	$197.44
Max. Negotiated Rate	$197.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$197.44
Rate for Payer: SOMOS Essential	$197.44

PR PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS

Professional

Both

$287.25

Service Code	HCPCS 99396
Min. Negotiated Rate	$215.44
Max. Negotiated Rate	$215.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$215.44
Rate for Payer: SOMOS Essential	$215.44

PR PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS

Professional

Both

$237.00

Service Code	HCPCS 99393
Min. Negotiated Rate	$177.75
Max. Negotiated Rate	$177.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$177.75
Rate for Payer: SOMOS Essential	$177.75

PR PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER

Professional

Both

$309.00

Service Code	HCPCS 99397
Min. Negotiated Rate	$231.75
Max. Negotiated Rate	$231.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$231.75
Rate for Payer: SOMOS Essential	$231.75

PR PERIORBITAL OSTEOTOMIES BONE GRAFTS EXTRACRANIAL

Professional

Both

$5,980.73

Service Code	HCPCS 21260
Min. Negotiated Rate	$4,485.55
Max. Negotiated Rate	$4,485.55
Rate for Payer: Cash Price	$1,608.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,485.55
Rate for Payer: SOMOS Essential	$4,485.55

PR PERIORBITAL OSTEOTOMIES W/BONE GRAFTS ICRA & XTR

Professional

Both

$10,594.64

Service Code	HCPCS 21261
Min. Negotiated Rate	$7,945.98
Max. Negotiated Rate	$7,945.98
Rate for Payer: Cash Price	$2,846.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,945.98
Rate for Payer: SOMOS Essential	$7,945.98

PR PERIORBITAL OSTEOTOMIES W/BONE GRAFTS W/FOREHEAD

Professional

Both

$9,797.97

Service Code	HCPCS 21263
Min. Negotiated Rate	$7,348.48
Max. Negotiated Rate	$7,348.48
Rate for Payer: Cash Price	$2,633.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,348.48
Rate for Payer: SOMOS Essential	$7,348.48

PR PERIPHERAL ARTERIAL DISEASE REHAB PER SESSION

Professional

Both

$63.11

Service Code	HCPCS 93668
Min. Negotiated Rate	$47.33
Max. Negotiated Rate	$47.33
Rate for Payer: Cash Price	$17.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$47.33
Rate for Payer: SOMOS Essential	$47.33

PR PERI-PX DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON

Professional

Both

$195.41

Service Code	HCPCS 93286
Min. Negotiated Rate	$146.56
Max. Negotiated Rate	$146.56
Rate for Payer: Cash Price	$52.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$146.56
Rate for Payer: SOMOS Essential	$146.56

Know your out-of-pocket cost for care.

All Charges