St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST

Professional

Both

$1,854.97

Service Code	HCPCS 37184
Min. Negotiated Rate	$1,391.23
Max. Negotiated Rate	$1,391.23
Rate for Payer: Cash Price	$492.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,391.23
Rate for Payer: SOMOS Essential	$1,391.23

PR PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA SBSQ

Professional

Both

$706.55

Service Code	HCPCS 37185
Min. Negotiated Rate	$529.91
Max. Negotiated Rate	$529.91
Rate for Payer: Cash Price	$186.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$529.91
Rate for Payer: SOMOS Essential	$529.91

PR PRINCIPAL CARE MGMT SVC 1ST 30 PHYS/QHP CAL MO

Professional

Both

$298.10

Service Code	HCPCS 99424
Min. Negotiated Rate	$223.58
Max. Negotiated Rate	$223.58
Rate for Payer: Cash Price	$82.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$223.58
Rate for Payer: SOMOS Essential	$223.58

PR PRINCIPAL CARE MGMT SVC 1ST 30 STAFF CAL MO

Professional

Both

$200.34

Service Code	HCPCS 99426
Min. Negotiated Rate	$150.26
Max. Negotiated Rate	$150.26
Rate for Payer: Cash Price	$55.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$150.26
Rate for Payer: SOMOS Essential	$150.26

PR PRINCIPAL CARE MGMT SVC EA ADDL 30 STAFF CAL MO

Professional

Both

$142.73

Service Code	HCPCS 99427
Min. Negotiated Rate	$107.05
Max. Negotiated Rate	$107.05
Rate for Payer: Cash Price	$38.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$107.05
Rate for Payer: SOMOS Essential	$107.05

PR PRINCIPAL CARE MGMT SVC EA ADL 30 PHY/QHP CAL MO

Professional

Both

$206.22

Service Code	HCPCS 99425
Min. Negotiated Rate	$154.66
Max. Negotiated Rate	$154.66
Rate for Payer: Cash Price	$56.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$154.66
Rate for Payer: SOMOS Essential	$154.66

PR PROBE LACRIMAL CANALICULI W/WO IRRIGATION

Professional

Both

$486.29

Service Code	HCPCS 68840
Min. Negotiated Rate	$364.72
Max. Negotiated Rate	$364.72
Rate for Payer: Cash Price	$134.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$364.72
Rate for Payer: SOMOS Essential	$364.72

PR PROBE NASOLACRIMAL DUCT WITH CATHETER DILATION

Professional

Both

$650.09

Service Code	HCPCS 68816
Min. Negotiated Rate	$487.57
Max. Negotiated Rate	$487.57
Rate for Payer: Cash Price	$178.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$487.57
Rate for Payer: SOMOS Essential	$487.57

PR PROBE NASOLACRIMAL DUCT W/WO IRRG INSJ TUBE/STNT

Professional

Both

$918.75

Service Code	HCPCS 68815
Min. Negotiated Rate	$689.06
Max. Negotiated Rate	$689.06
Rate for Payer: Cash Price	$253.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$689.06
Rate for Payer: SOMOS Essential	$689.06

PR PROBE NASOLACRIMAL DUCT W/WO IRRIGATION

Professional

Both

$529.03

Service Code	HCPCS 68810
Min. Negotiated Rate	$396.77
Max. Negotiated Rate	$396.77
Rate for Payer: Cash Price	$145.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$396.77
Rate for Payer: SOMOS Essential	$396.77

PR PROBE NASOLACRIMAL DUCT W/WO IRRIG REQ GEN ANES

Professional

Both

$556.68

Service Code	HCPCS 68811
Min. Negotiated Rate	$417.51
Max. Negotiated Rate	$417.51
Rate for Payer: Cash Price	$153.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$417.51
Rate for Payer: SOMOS Essential	$417.51

PR PROCTOPEXY ABDOMINAL APPROACH

Professional

Both

$4,548.11

Service Code	HCPCS 45540
Min. Negotiated Rate	$3,411.08
Max. Negotiated Rate	$3,411.08
Rate for Payer: Cash Price	$1,220.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,411.08
Rate for Payer: SOMOS Essential	$3,411.08

PR PROCTOPEXY PERINEAL APPROACH

Professional

Both

$4,108.69

Service Code	HCPCS 45541
Min. Negotiated Rate	$3,081.52
Max. Negotiated Rate	$3,081.52
Rate for Payer: Cash Price	$1,104.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,081.52
Rate for Payer: SOMOS Essential	$3,081.52

PR PROCTOPEXY W/SIGMOID RESCJ ABDL APPR

Professional

Both

$6,337.07

Service Code	HCPCS 45550
Min. Negotiated Rate	$4,752.80
Max. Negotiated Rate	$4,752.80
Rate for Payer: Cash Price	$1,692.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,752.80
Rate for Payer: SOMOS Essential	$4,752.80

PR PROCTOPLASTY PROLAPSE MUCOUS MEMBRANE

Professional

Both

$2,629.76

Service Code	HCPCS 45505
Min. Negotiated Rate	$1,972.32
Max. Negotiated Rate	$1,972.32
Rate for Payer: Cash Price	$710.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,972.32
Rate for Payer: SOMOS Essential	$1,972.32

PR PROCTOPLASTY STENOSIS

Professional

Both

$2,569.91

Service Code	HCPCS 45500
Min. Negotiated Rate	$1,927.43
Max. Negotiated Rate	$1,927.43
Rate for Payer: Cash Price	$689.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,927.43
Rate for Payer: SOMOS Essential	$1,927.43

PR PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX

Professional

Both

$206.36

Service Code	HCPCS 45300
Min. Negotiated Rate	$154.77
Max. Negotiated Rate	$154.77
Rate for Payer: Cash Price	$56.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$154.77
Rate for Payer: SOMOS Essential	$154.77

PR PROCTOSGMDSC RIGID ABLATION LESION

Professional

Both

$470.54

Service Code	HCPCS 45320
Min. Negotiated Rate	$352.90
Max. Negotiated Rate	$352.90
Rate for Payer: Cash Price	$125.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$352.90
Rate for Payer: SOMOS Essential	$352.90

PR PROCTOSGMDSC RIGID CONTROL BLEEDING

Professional

Both

$468.55

Service Code	HCPCS 45317
Min. Negotiated Rate	$351.41
Max. Negotiated Rate	$351.41
Rate for Payer: Cash Price	$128.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$351.41
Rate for Payer: SOMOS Essential	$351.41

PR PROCTOSGMDSC RIGID DCMPRN VOLVULUS

Professional

Both

$465.33

Service Code	HCPCS 45321
Min. Negotiated Rate	$349.00
Max. Negotiated Rate	$349.00
Rate for Payer: Cash Price	$124.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$349.00
Rate for Payer: SOMOS Essential	$349.00

PR PROCTOSGMDSC RIGID RMVL 1 LESION CAUTERY

Professional

Both

$382.34

Service Code	HCPCS 45308
Min. Negotiated Rate	$286.76
Max. Negotiated Rate	$286.76
Rate for Payer: Cash Price	$101.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$286.76
Rate for Payer: SOMOS Essential	$286.76

PR PROCTOSGMDSC RIGID RMVL 1 LESION SNARE TQ

Professional

Both

$403.38

Service Code	HCPCS 45309
Min. Negotiated Rate	$302.54
Max. Negotiated Rate	$302.54
Rate for Payer: Cash Price	$107.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$302.54
Rate for Payer: SOMOS Essential	$302.54

PR PROCTOSGMDSC RIGID RMVL MULT TUMOR CAUTERY/SNARE

Professional

Both

$477.19

Service Code	HCPCS 45315
Min. Negotiated Rate	$357.89
Max. Negotiated Rate	$357.89
Rate for Payer: Cash Price	$127.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$357.89
Rate for Payer: SOMOS Essential	$357.89

PR PROCTOSGMDSC RIGID TNDSC STENT PLMT

Professional

Both

$524.69

Service Code	HCPCS 45327
Min. Negotiated Rate	$393.52
Max. Negotiated Rate	$393.52
Rate for Payer: Cash Price	$140.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$393.52
Rate for Payer: SOMOS Essential	$393.52

PR PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE

Professional

Both

$313.88

Service Code	HCPCS 45305
Min. Negotiated Rate	$235.41
Max. Negotiated Rate	$235.41
Rate for Payer: Cash Price	$85.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$235.41
Rate for Payer: SOMOS Essential	$235.41

Know your out-of-pocket cost for care.

All Charges