St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

Professional

Both

$137.87

Service Code	HCPCS 93286 TC
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$103.40
Rate for Payer: Cash Price	$36.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$103.40
Rate for Payer: SOMOS Essential	$103.40

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

Professional

Both

$57.58

Service Code	HCPCS 93286 26
Min. Negotiated Rate	$43.18
Max. Negotiated Rate	$43.18
Rate for Payer: Cash Price	$15.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$43.18
Rate for Payer: SOMOS Essential	$43.18

PR PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB

Professional

Both

$86.42

Service Code	HCPCS 93287 26
Min. Negotiated Rate	$64.82
Max. Negotiated Rate	$64.82
Rate for Payer: Cash Price	$23.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$64.82
Rate for Payer: SOMOS Essential	$64.82

PR PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB

Professional

Both

$137.87

Service Code	HCPCS 93287 TC
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$103.40
Rate for Payer: Cash Price	$36.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$103.40
Rate for Payer: SOMOS Essential	$103.40

PR PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB

Professional

Both

$224.28

Service Code	HCPCS 93287
Min. Negotiated Rate	$168.21
Max. Negotiated Rate	$168.21
Rate for Payer: Cash Price	$59.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$168.21
Rate for Payer: SOMOS Essential	$168.21

PR PERIRECTAL INJ SCLEROSING SOLUTION PROLAPSE

Professional

Both

$171.43

Service Code	HCPCS 45520
Min. Negotiated Rate	$128.57
Max. Negotiated Rate	$128.57
Rate for Payer: Cash Price	$47.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$128.57
Rate for Payer: SOMOS Essential	$128.57

PR PERITONEAL LAVAGE W/WO IMAGING GUIDANCE

Professional

Both

$477.26

Service Code	HCPCS 49084
Min. Negotiated Rate	$357.94
Max. Negotiated Rate	$357.94
Rate for Payer: Cash Price	$126.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$357.94
Rate for Payer: SOMOS Essential	$357.94

PR PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT

Professional

Both

$546.42

Service Code	HCPCS 34713
Min. Negotiated Rate	$409.82
Max. Negotiated Rate	$409.82
Rate for Payer: Cash Price	$143.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$409.82
Rate for Payer: SOMOS Essential	$409.82

PR PERQ ART TRLUML M-THROMBEC &/NFS INTRACRANIAL

Professional

Both

$3,837.12

Service Code	HCPCS 61645
Min. Negotiated Rate	$2,877.84
Max. Negotiated Rate	$2,877.84
Rate for Payer: Cash Price	$1,020.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,877.84
Rate for Payer: SOMOS Essential	$2,877.84

PR PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES

Professional

Both

$1,959.86

Service Code	HCPCS 36837
Min. Negotiated Rate	$1,469.90
Max. Negotiated Rate	$1,469.90
Rate for Payer: Cash Price	$519.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,469.90
Rate for Payer: SOMOS Essential	$1,469.90

PR PERQ AV FISTULA CREATION UXTR SINGLE ACCESS

Professional

Both

$1,482.01

Service Code	HCPCS 36836
Min. Negotiated Rate	$1,111.51
Max. Negotiated Rate	$1,111.51
Rate for Payer: Cash Price	$400.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,111.51
Rate for Payer: SOMOS Essential	$1,111.51

PR PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID

Professional

Both

$513.28

Service Code	HCPCS 19287
Min. Negotiated Rate	$384.96
Max. Negotiated Rate	$384.96
Rate for Payer: Cash Price	$139.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$384.96
Rate for Payer: SOMOS Essential	$384.96

PR PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG

Professional

Both

$351.30

Service Code	HCPCS 19285
Min. Negotiated Rate	$263.48
Max. Negotiated Rate	$263.48
Rate for Payer: Cash Price	$93.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$263.48
Rate for Payer: SOMOS Essential	$263.48

PR PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE

Professional

Both

$410.17

Service Code	HCPCS 19283
Min. Negotiated Rate	$307.63
Max. Negotiated Rate	$307.63
Rate for Payer: Cash Price	$110.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$307.63
Rate for Payer: SOMOS Essential	$307.63

PR PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID

Professional

Both

$257.99

Service Code	HCPCS 19288
Min. Negotiated Rate	$193.49
Max. Negotiated Rate	$193.49
Rate for Payer: Cash Price	$69.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$193.49
Rate for Payer: SOMOS Essential	$193.49

PR PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE

Professional

Both

$178.40

Service Code	HCPCS 19286
Min. Negotiated Rate	$133.80
Max. Negotiated Rate	$133.80
Rate for Payer: Cash Price	$47.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$133.80
Rate for Payer: SOMOS Essential	$133.80

PR PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC

Professional

Both

$207.10

Service Code	HCPCS 19284
Min. Negotiated Rate	$155.32
Max. Negotiated Rate	$155.32
Rate for Payer: Cash Price	$55.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$155.32
Rate for Payer: SOMOS Essential	$155.32

PR PERQ CLSR TCAT L ATR APNDGE W/ENDOCARDIAL IMPLNT

Professional

Both

$3,445.37

Service Code	HCPCS 33340
Min. Negotiated Rate	$2,584.03
Max. Negotiated Rate	$2,584.03
Rate for Payer: Cash Price	$909.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,584.03
Rate for Payer: SOMOS Essential	$2,584.03

PR PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE

Professional

Both

$404.67

Service Code	HCPCS 19281
Min. Negotiated Rate	$303.50
Max. Negotiated Rate	$303.50
Rate for Payer: Cash Price	$108.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$303.50
Rate for Payer: SOMOS Essential	$303.50

PR PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE

Professional

Both

$205.80

Service Code	HCPCS 19282
Min. Negotiated Rate	$154.35
Max. Negotiated Rate	$154.35
Rate for Payer: Cash Price	$54.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$154.35
Rate for Payer: SOMOS Essential	$154.35

PR PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG

Professional

Both

$612.99

Service Code	HCPCS 50436
Min. Negotiated Rate	$459.74
Max. Negotiated Rate	$459.74
Rate for Payer: Cash Price	$166.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$459.74
Rate for Payer: SOMOS Essential	$459.74

PR PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS

Professional

Both

$1,016.37

Service Code	HCPCS 50437
Min. Negotiated Rate	$762.28
Max. Negotiated Rate	$762.28
Rate for Payer: Cash Price	$274.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$762.28
Rate for Payer: SOMOS Essential	$762.28

PR PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING

Professional

Both

$610.86

Service Code	HCPCS 32557
Min. Negotiated Rate	$458.14
Max. Negotiated Rate	$458.14
Rate for Payer: Cash Price	$165.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$458.14
Rate for Payer: SOMOS Essential	$458.14

PR PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING

Professional

Both

$523.88

Service Code	HCPCS 32556
Min. Negotiated Rate	$392.91
Max. Negotiated Rate	$392.91
Rate for Payer: Cash Price	$141.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$392.91
Rate for Payer: SOMOS Essential	$392.91

PR PERQ NL/PL LITHOTRP COMPLEX >2 CM MLT LOCATIONS

Professional

Both

$4,694.76

Service Code	HCPCS 50081
Min. Negotiated Rate	$3,521.07
Max. Negotiated Rate	$3,521.07
Rate for Payer: Cash Price	$1,280.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,521.07
Rate for Payer: SOMOS Essential	$3,521.07

Know your out-of-pocket cost for care.

All Charges