St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL

Professional

Both

$1,726.17

Service Code	HCPCS 22511
Min. Negotiated Rate	$1,294.63
Max. Negotiated Rate	$1,294.63
Rate for Payer: Cash Price	$467.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,294.63
Rate for Payer: SOMOS Essential	$1,294.63

PR PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC

Professional

Both

$1,840.86

Service Code	HCPCS 22510
Min. Negotiated Rate	$1,380.64
Max. Negotiated Rate	$1,380.64
Rate for Payer: Cash Price	$495.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,380.64
Rate for Payer: SOMOS Essential	$1,380.64

PR PETROUS APICECTOMY RADICAL MASTOIDECTOMY

Professional

Both

$7,270.55

Service Code	HCPCS 69530
Min. Negotiated Rate	$5,452.91
Max. Negotiated Rate	$5,452.91
Rate for Payer: Cash Price	$1,958.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,452.91
Rate for Payer: SOMOS Essential	$5,452.91

PR PHALANGECTOMY TOE EACH TOE

Professional

Both

$1,166.80

Service Code	HCPCS 28150
Min. Negotiated Rate	$875.10
Max. Negotiated Rate	$875.10
Rate for Payer: Cash Price	$323.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$875.10
Rate for Payer: SOMOS Essential	$875.10

PR PHARYNGOESOPHAGEAL REPAIR

Professional

Both

$4,144.07

Service Code	HCPCS 42953
Min. Negotiated Rate	$3,108.05
Max. Negotiated Rate	$3,108.05
Rate for Payer: Cash Price	$1,120.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,108.05
Rate for Payer: SOMOS Essential	$3,108.05

PR PHARYNGOLARYNGECTOMY W/RAD NECK DSJ W/O RCNSTJ

Professional

Both

$12,059.92

Service Code	HCPCS 31390
Min. Negotiated Rate	$9,044.94
Max. Negotiated Rate	$9,044.94
Rate for Payer: Cash Price	$3,250.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9,044.94
Rate for Payer: SOMOS Essential	$9,044.94

PR PHARYNGOLARYNGECTOMY W/RAD NECK DSJ W/RCNSTJ

Professional

Both

$12,661.74

Service Code	HCPCS 31395
Min. Negotiated Rate	$9,496.30
Max. Negotiated Rate	$9,496.30
Rate for Payer: Cash Price	$3,410.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9,496.30
Rate for Payer: SOMOS Essential	$9,496.30

PR PHARYNGOPLASTY PLSTC/RCNSTV OPRATION PHARYNX

Professional

Both

$3,461.43

Service Code	HCPCS 42950
Min. Negotiated Rate	$2,596.07
Max. Negotiated Rate	$2,596.07
Rate for Payer: Cash Price	$933.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,596.07
Rate for Payer: SOMOS Essential	$2,596.07

PR PHARYNGOSTOMY FSTLJ PHARYNX XTRNL FEEDING

Professional

Both

$3,286.12

Service Code	HCPCS 42955
Min. Negotiated Rate	$2,464.59
Max. Negotiated Rate	$2,464.59
Rate for Payer: Cash Price	$888.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,464.59
Rate for Payer: SOMOS Essential	$2,464.59

PR PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE

Professional

Both

$424.66

Service Code	HCPCS 99195
Min. Negotiated Rate	$318.50
Max. Negotiated Rate	$318.50
Rate for Payer: Cash Price	$114.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$318.50
Rate for Payer: SOMOS Essential	$318.50

PR PHOTOCHEMOTHERAPY DERMATOSES 4-8 HRS SUPERVISION

Professional

Both

$658.11

Service Code	HCPCS 96913
Min. Negotiated Rate	$493.58
Max. Negotiated Rate	$493.58
Rate for Payer: Cash Price	$181.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$493.58
Rate for Payer: SOMOS Essential	$493.58

PR PHOTOCHEMOTX PSORALENS&ULTRAVIOLET PUVA

Professional

Both

$434.00

Service Code	HCPCS 96912
Min. Negotiated Rate	$325.50
Max. Negotiated Rate	$325.50
Rate for Payer: Cash Price	$119.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$325.50
Rate for Payer: SOMOS Essential	$325.50

PR PHOTOCHEMOTX TAR&UVB/PETROLATUM/UVB

Professional

Both

$510.02

Service Code	HCPCS 96910
Min. Negotiated Rate	$382.52
Max. Negotiated Rate	$382.52
Rate for Payer: Cash Price	$140.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$382.52
Rate for Payer: SOMOS Essential	$382.52

PR PHOTO PATCH TEST SPECIFY NUMBER TSTS

Professional

Both

$28.60

Service Code	HCPCS 95052
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$21.45
Rate for Payer: Cash Price	$7.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21.45
Rate for Payer: SOMOS Essential	$21.45

PR PHOTOPHERESIS EXTRACORPOREAL

Professional

Both

$390.01

Service Code	HCPCS 36522
Min. Negotiated Rate	$292.51
Max. Negotiated Rate	$292.51
Rate for Payer: Cash Price	$105.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$292.51
Rate for Payer: SOMOS Essential	$292.51

PR PHOTO TESTS

Professional

Both

$221.10

Service Code	HCPCS 95056
Min. Negotiated Rate	$165.82
Max. Negotiated Rate	$165.82
Rate for Payer: Cash Price	$62.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$165.82
Rate for Payer: SOMOS Essential	$165.82

PR PHYS BLD BANK SERV,DEV STD

Professional

Both

$196.25

Service Code	HCPCS 86079
Min. Negotiated Rate	$147.19
Max. Negotiated Rate	$147.19
Rate for Payer: Cash Price	$53.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$147.19
Rate for Payer: SOMOS Essential	$147.19

PR PHYS BLD BANK SERV,DIFF XMTCH

Professional

Both

$194.81

Service Code	HCPCS 86077
Min. Negotiated Rate	$146.11
Max. Negotiated Rate	$146.11
Rate for Payer: Cash Price	$53.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$146.11
Rate for Payer: SOMOS Essential	$146.11

PR PHYS BLD BANK SERV,XFUSN RX

Professional

Both

$194.81

Service Code	HCPCS 86078
Min. Negotiated Rate	$146.11
Max. Negotiated Rate	$146.11
Rate for Payer: Cash Price	$53.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$146.11
Rate for Payer: SOMOS Essential	$146.11

PR PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN

Professional

Both

$138.15

Service Code	HCPCS 97750
Min. Negotiated Rate	$103.61
Max. Negotiated Rate	$103.61
Rate for Payer: Cash Price	$38.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$103.61
Rate for Payer: SOMOS Essential	$103.61

PR PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS

Professional

Both

$407.96

Service Code	HCPCS 97163
Min. Negotiated Rate	$305.97
Max. Negotiated Rate	$305.97
Rate for Payer: Cash Price	$112.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$305.97
Rate for Payer: SOMOS Essential	$305.97

PR PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS

Professional

Both

$407.96

Service Code	HCPCS 97161
Min. Negotiated Rate	$305.97
Max. Negotiated Rate	$305.97
Rate for Payer: Cash Price	$112.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$305.97
Rate for Payer: SOMOS Essential	$305.97

PR PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS

Professional

Both

$407.96

Service Code	HCPCS 97162
Min. Negotiated Rate	$305.97
Max. Negotiated Rate	$305.97
Rate for Payer: Cash Price	$112.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$305.97
Rate for Payer: SOMOS Essential	$305.97

PR PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS

Professional

Both

$286.44

Service Code	HCPCS 97164
Min. Negotiated Rate	$214.83
Max. Negotiated Rate	$214.83
Rate for Payer: Cash Price	$78.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$214.83
Rate for Payer: SOMOS Essential	$214.83

PR PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU

Professional

Both

$570.54

Service Code	HCPCS 93464 TC
Min. Negotiated Rate	$427.90
Max. Negotiated Rate	$427.90
Rate for Payer: Cash Price	$155.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$427.90
Rate for Payer: SOMOS Essential	$427.90

Know your out-of-pocket cost for care.

All Charges