St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR POSITIONAL NYSTAGMUS TEST

Professional

Both

$97.37

Service Code	HCPCS 92542 26
Min. Negotiated Rate	$73.03
Max. Negotiated Rate	$73.03
Rate for Payer: Cash Price	$26.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$73.03
Rate for Payer: SOMOS Essential	$73.03

PR POSITIONAL NYSTAGMUS TEST

Professional

Both

$117.36

Service Code	HCPCS 92542
Min. Negotiated Rate	$88.02
Max. Negotiated Rate	$88.02
Rate for Payer: Cash Price	$32.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$88.02
Rate for Payer: SOMOS Essential	$88.02

PR POST-CATARACT LASER SURGERY

Professional

Both

$1,290.24

Service Code	HCPCS 66821
Min. Negotiated Rate	$967.68
Max. Negotiated Rate	$967.68
Rate for Payer: Cash Price	$355.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$967.68
Rate for Payer: SOMOS Essential	$967.68

PR POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY

Professional

Both

$2,680.65

Service Code	HCPCS 57250
Min. Negotiated Rate	$2,010.49
Max. Negotiated Rate	$2,010.49
Rate for Payer: Cash Price	$723.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,010.49
Rate for Payer: SOMOS Essential	$2,010.49

PR POST-D/C CARE PLAN OVERS 30M

Professional

Both

$308.98

Service Code	HCPCS G2014
Min. Negotiated Rate	$231.74
Max. Negotiated Rate	$231.74
Rate for Payer: Cash Price	$84.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$231.74
Rate for Payer: SOMOS Essential	$231.74

PR POST-D/C CARE PLAN OVERS 60M

Professional

Both

$430.50

Service Code	HCPCS G2015
Min. Negotiated Rate	$322.88
Max. Negotiated Rate	$322.88
Rate for Payer: Cash Price	$117.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$322.88
Rate for Payer: SOMOS Essential	$322.88

PR POST-D/C H VST EXT PT 20 M

Professional

Both

$190.82

Service Code	HCPCS G2006
Min. Negotiated Rate	$143.12
Max. Negotiated Rate	$143.12
Rate for Payer: Cash Price	$53.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$143.12
Rate for Payer: SOMOS Essential	$143.12

PR POST-D/C H VST EXT PT 30 M

Professional

Both

$313.60

Service Code	HCPCS G2007
Min. Negotiated Rate	$235.20
Max. Negotiated Rate	$235.20
Rate for Payer: Cash Price	$86.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$235.20
Rate for Payer: SOMOS Essential	$235.20

PR POST-D/C H VST EXT PT 45 M

Professional

Both

$505.09

Service Code	HCPCS G2008
Min. Negotiated Rate	$378.82
Max. Negotiated Rate	$378.82
Rate for Payer: Cash Price	$138.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$378.82
Rate for Payer: SOMOS Essential	$378.82

PR POST-D/C H VST EXT PT 60 M

Professional

Both

$716.42

Service Code	HCPCS G2009
Min. Negotiated Rate	$537.32
Max. Negotiated Rate	$537.32
Rate for Payer: Cash Price	$195.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$537.32
Rate for Payer: SOMOS Essential	$537.32

PR POST-D/C H VST EXT PT 75 M

Professional

Both

$846.62

Service Code	HCPCS G2013
Min. Negotiated Rate	$634.96
Max. Negotiated Rate	$634.96
Rate for Payer: Cash Price	$232.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$634.96
Rate for Payer: SOMOS Essential	$634.96

PR POST D/C H VST NEW PT 20 M

Professional

Both

$194.95

Service Code	HCPCS G2001
Min. Negotiated Rate	$146.21
Max. Negotiated Rate	$146.21
Rate for Payer: Cash Price	$54.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$146.21
Rate for Payer: SOMOS Essential	$146.21

PR POST-D/C H VST NEW PT 30 M

Professional

Both

$294.21

Service Code	HCPCS G2002
Min. Negotiated Rate	$220.66
Max. Negotiated Rate	$220.66
Rate for Payer: Cash Price	$81.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$220.66
Rate for Payer: SOMOS Essential	$220.66

PR POST-D/C H VST NEW PT 45 M

Professional

Both

$486.26

Service Code	HCPCS G2003
Min. Negotiated Rate	$364.70
Max. Negotiated Rate	$364.70
Rate for Payer: Cash Price	$133.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$364.70
Rate for Payer: SOMOS Essential	$364.70

PR POST-D/C H VST NEW PT 60 M

Professional

Both

$645.09

Service Code	HCPCS G2004
Min. Negotiated Rate	$483.82
Max. Negotiated Rate	$483.82
Rate for Payer: Cash Price	$175.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$483.82
Rate for Payer: SOMOS Essential	$483.82

PR POST-D/C H VST NEW PT 75 M

Professional

Both

$846.62

Service Code	HCPCS G2005
Min. Negotiated Rate	$634.96
Max. Negotiated Rate	$634.96
Rate for Payer: Cash Price	$232.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$634.96
Rate for Payer: SOMOS Essential	$634.96

PR POSTERIOR NON-SEGMENTAL INSTRUMENTATION

Professional

Both

$3,500.81

Service Code	HCPCS 22840
Min. Negotiated Rate	$2,625.61
Max. Negotiated Rate	$2,625.61
Rate for Payer: Cash Price	$922.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,625.61
Rate for Payer: SOMOS Essential	$2,625.61

PR POSTERIOR SEGMENTAL INSTRUMENTATION 13/> VRT SE

Professional

Both

$4,504.15

Service Code	HCPCS 22844
Min. Negotiated Rate	$3,378.11
Max. Negotiated Rate	$3,378.11
Rate for Payer: Cash Price	$1,189.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,378.11
Rate for Payer: SOMOS Essential	$3,378.11

PR POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG

Professional

Both

$3,540.11

Service Code	HCPCS 22842
Min. Negotiated Rate	$2,655.08
Max. Negotiated Rate	$2,655.08
Rate for Payer: Cash Price	$934.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,655.08
Rate for Payer: SOMOS Essential	$2,655.08

PR POSTERIOR SEGMENTAL INSTRUMENTATION 7-12 VRT SEG

Professional

Both

$3,790.19

Service Code	HCPCS 22843
Min. Negotiated Rate	$2,842.64
Max. Negotiated Rate	$2,842.64
Rate for Payer: Cash Price	$1,000.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,842.64
Rate for Payer: SOMOS Essential	$2,842.64

PR POSTPARTUM CARE ONLY SEPARATE PROCEDURE

Professional

Both

$829.40

Service Code	HCPCS 59430
Min. Negotiated Rate	$622.05
Max. Negotiated Rate	$622.05
Rate for Payer: Cash Price	$218.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$622.05
Rate for Payer: SOMOS Essential	$622.05

PR POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE

Professional

Both

$127.23

Service Code	HCPCS 64566
Min. Negotiated Rate	$95.42
Max. Negotiated Rate	$95.42
Rate for Payer: Cash Price	$34.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$95.42
Rate for Payer: SOMOS Essential	$95.42

PR PPPS, INITIAL VISIT

Professional

Both

$681.07

Service Code	HCPCS G0438
Min. Negotiated Rate	$510.80
Max. Negotiated Rate	$510.80
Rate for Payer: Cash Price	$187.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$510.80
Rate for Payer: SOMOS Essential	$510.80

PR PPPS, SUBSEQ VISIT

Professional

Both

$532.07

Service Code	HCPCS G0439
Min. Negotiated Rate	$399.05
Max. Negotiated Rate	$399.05
Rate for Payer: Cash Price	$148.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$399.05
Rate for Payer: SOMOS Essential	$399.05

PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE

Professional

Both

$397.49

Service Code	HCPCS 90732
Min. Negotiated Rate	$298.12
Max. Negotiated Rate	$298.12
Rate for Payer: Cash Price	$133.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$298.12
Rate for Payer: SOMOS Essential	$298.12

Know your out-of-pocket cost for care.

All Charges