St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR PROSTHETICS TRAINING INITIAL ENCTR EA 15 MINS

Professional

Both

$171.75

Service Code	HCPCS 97761
Min. Negotiated Rate	$128.81
Max. Negotiated Rate	$128.81
Rate for Payer: Cash Price	$47.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$128.81
Rate for Payer: SOMOS Essential	$128.81

PR PROTEIN ANALYSIS W/PROBE

Professional

Both

$69.20

Service Code	HCPCS 88372 26
Min. Negotiated Rate	$51.90
Max. Negotiated Rate	$51.90
Rate for Payer: Cash Price	$19.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$51.90
Rate for Payer: SOMOS Essential	$51.90

PR PROTEIN, WESTERN BLOT TISSUE

Professional

Both

$74.97

Service Code	HCPCS 88371 26
Min. Negotiated Rate	$56.23
Max. Negotiated Rate	$56.23
Rate for Payer: Cash Price	$20.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$56.23
Rate for Payer: SOMOS Essential	$56.23

PR PROVIDE TEST MATERIAL,EQUIPM

Professional

Both

$290.22

Service Code	HCPCS G0249
Min. Negotiated Rate	$217.66
Max. Negotiated Rate	$217.66
Rate for Payer: Cash Price	$77.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$217.66
Rate for Payer: SOMOS Essential	$217.66

PR PRQ ASPIR PULPOSUS/INTERVERTEBRAL DISC/PVRT TISS

Professional

Both

$636.23

Service Code	HCPCS 62267
Min. Negotiated Rate	$477.17
Max. Negotiated Rate	$477.17
Rate for Payer: Cash Price	$172.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$477.17
Rate for Payer: SOMOS Essential	$477.17

PR PRQ BALLOON VALVULOPLASTY AORTIC VALVE

Professional

Both

$5,787.25

Service Code	HCPCS 92986
Min. Negotiated Rate	$4,340.44
Max. Negotiated Rate	$4,340.44
Rate for Payer: Cash Price	$1,551.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,340.44
Rate for Payer: SOMOS Essential	$4,340.44

PR PRQ BALLOON VALVULOPLASTY MITRAL VALVE

Professional

Both

$5,990.01

Service Code	HCPCS 92987
Min. Negotiated Rate	$4,492.51
Max. Negotiated Rate	$4,492.51
Rate for Payer: Cash Price	$1,598.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,492.51
Rate for Payer: SOMOS Essential	$4,492.51

PR PRQ BALLOON VALVULOPLASTY PULMONARY VALVE

Professional

Both

$4,788.25

Service Code	HCPCS 92990
Min. Negotiated Rate	$3,591.19
Max. Negotiated Rate	$3,591.19
Rate for Payer: Cash Price	$1,281.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,591.19
Rate for Payer: SOMOS Essential	$3,591.19

PR PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W/IMAGING

Professional

Both

$1,283.73

Service Code	HCPCS 64561
Min. Negotiated Rate	$962.80
Max. Negotiated Rate	$962.80
Rate for Payer: Cash Price	$349.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$962.80
Rate for Payer: SOMOS Essential	$962.80

PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD CRANIAL NERVE

Professional

Both

$1,669.47

Service Code	HCPCS 64553
Min. Negotiated Rate	$1,252.10
Max. Negotiated Rate	$1,252.10
Rate for Payer: Cash Price	$572.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,252.10
Rate for Payer: SOMOS Essential	$1,252.10

PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV

Professional

Both

$1,363.74

Service Code	HCPCS 64555
Min. Negotiated Rate	$1,022.80
Max. Negotiated Rate	$1,022.80
Rate for Payer: Cash Price	$369.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,022.80
Rate for Payer: SOMOS Essential	$1,022.80

PR PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL

Professional

Both

$1,734.11

Service Code	HCPCS 63650
Min. Negotiated Rate	$1,300.58
Max. Negotiated Rate	$1,300.58
Rate for Payer: Cash Price	$475.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,300.58
Rate for Payer: SOMOS Essential	$1,300.58

PR PRQ LYSIS EPIDURAL ADHESIONS MULT SESS 2/> DAYS

Professional

Both

$1,321.22

Service Code	HCPCS 62263
Min. Negotiated Rate	$990.92
Max. Negotiated Rate	$990.92
Rate for Payer: Cash Price	$371.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$990.92
Rate for Payer: SOMOS Essential	$990.92

PR PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY

Professional

Both

$1,013.25

Service Code	HCPCS 62264
Min. Negotiated Rate	$759.94
Max. Negotiated Rate	$759.94
Rate for Payer: Cash Price	$277.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$759.94
Rate for Payer: SOMOS Essential	$759.94

PR PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL

Professional

Both

$1,078.77

Service Code	HCPCS 47533
Min. Negotiated Rate	$809.08
Max. Negotiated Rate	$809.08
Rate for Payer: Cash Price	$289.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$809.08
Rate for Payer: SOMOS Essential	$809.08

PR PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT

Professional

Both

$1,503.53

Service Code	HCPCS 47534
Min. Negotiated Rate	$1,127.65
Max. Negotiated Rate	$1,127.65
Rate for Payer: Cash Price	$404.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,127.65
Rate for Payer: SOMOS Essential	$1,127.65

PR PRQ PORTAL VEIN CATHETERIZATION ANY METHOD

Professional

Both

$1,338.93

Service Code	HCPCS 36481
Min. Negotiated Rate	$1,004.20
Max. Negotiated Rate	$1,004.20
Rate for Payer: Cash Price	$359.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,004.20
Rate for Payer: SOMOS Essential	$1,004.20

PR PRQ SKELETAL FIXATION TALUS FRACTURE W/MANJ

Professional

Both

$2,204.37

Service Code	HCPCS 28436
Min. Negotiated Rate	$1,653.28
Max. Negotiated Rate	$1,653.28
Rate for Payer: Cash Price	$601.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,653.28
Rate for Payer: SOMOS Essential	$1,653.28

PR PRQ SKELETAL FIXATION TIBIAL SHAFT FRACTURE

Professional

Both

$2,560.36

Service Code	HCPCS 27756
Min. Negotiated Rate	$1,920.27
Max. Negotiated Rate	$1,920.27
Rate for Payer: Cash Price	$694.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,920.27
Rate for Payer: SOMOS Essential	$1,920.27

PR PRQ SKELETAL FIXATION ULNAR STYLOID FRACTURE

Professional

Both

$2,176.90

Service Code	HCPCS 25651
Min. Negotiated Rate	$1,632.68
Max. Negotiated Rate	$1,632.68
Rate for Payer: Cash Price	$594.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,632.68
Rate for Payer: SOMOS Essential	$1,632.68

PR PRQ SKELETAL FIX CARPO/METACARPAL FX DISLC THUMB

Professional

Both

$2,138.54

Service Code	HCPCS 26650
Min. Negotiated Rate	$1,603.90
Max. Negotiated Rate	$1,603.90
Rate for Payer: Cash Price	$583.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,603.90
Rate for Payer: SOMOS Essential	$1,603.90

PR PRQ SKELETAL FIXJ CALCANEAL FRACTURE W/MANJ

Professional

Both

$2,485.53

Service Code	HCPCS 28406
Min. Negotiated Rate	$1,864.15
Max. Negotiated Rate	$1,864.15
Rate for Payer: Cash Price	$712.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,864.15
Rate for Payer: SOMOS Essential	$1,864.15

PR PRQ SKELETAL FIXJ DISTAL RADIOULNAR DISLOCATION

Professional

Both

$2,361.49

Service Code	HCPCS 25671
Min. Negotiated Rate	$1,771.12
Max. Negotiated Rate	$1,771.12
Rate for Payer: Cash Price	$649.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,771.12
Rate for Payer: SOMOS Essential	$1,771.12

PR PRQ SKELETAL FIXJ FEMORAL FX DISTAL END

Professional

Both

$2,999.75

Service Code	HCPCS 27509
Min. Negotiated Rate	$2,249.81
Max. Negotiated Rate	$2,249.81
Rate for Payer: Cash Price	$810.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,249.81
Rate for Payer: SOMOS Essential	$2,249.81

PR PRQ SKELETAL FIXJ METACARPAL FX EACH BONE

Professional

Both

$2,143.79

Service Code	HCPCS 26608
Min. Negotiated Rate	$1,607.84
Max. Negotiated Rate	$1,607.84
Rate for Payer: Cash Price	$583.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,607.84
Rate for Payer: SOMOS Essential	$1,607.84

Know your out-of-pocket cost for care.

All Charges