St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM LMBR

Professional

Both

$5,419.33

Service Code	HCPCS 22114
Min. Negotiated Rate	$4,064.50
Max. Negotiated Rate	$4,064.50
Rate for Payer: Cash Price	$1,441.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,064.50
Rate for Payer: SOMOS Essential	$4,064.50

PR PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM THRC

Professional

Both

$5,419.33

Service Code	HCPCS 22112
Min. Negotiated Rate	$4,064.50
Max. Negotiated Rate	$4,064.50
Rate for Payer: Cash Price	$1,441.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,064.50
Rate for Payer: SOMOS Essential	$4,064.50

PR PRTL HYMENECTOMY/REVJ HYMENAL RING

Professional

Both

$888.37

Service Code	HCPCS 56700
Min. Negotiated Rate	$666.28
Max. Negotiated Rate	$666.28
Rate for Payer: Cash Price	$240.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$666.28
Rate for Payer: SOMOS Essential	$666.28

PR PRTL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY

Professional

Both

$3,132.05

Service Code	HCPCS 60210
Min. Negotiated Rate	$2,349.04
Max. Negotiated Rate	$2,349.04
Rate for Payer: Cash Price	$841.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,349.04
Rate for Payer: SOMOS Essential	$2,349.04

PR PRTL THYROID LOBEC UNI W/CONTRATLAT STOT LOBEC

Professional

Both

$4,649.79

Service Code	HCPCS 60212
Min. Negotiated Rate	$3,487.34
Max. Negotiated Rate	$3,487.34
Rate for Payer: Cash Price	$1,238.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,487.34
Rate for Payer: SOMOS Essential	$3,487.34

PR PSYCHIATRIC DIAGNOSTIC EVALUATION

Professional

Both

$581.63

Service Code	HCPCS 90791
Min. Negotiated Rate	$436.22
Max. Negotiated Rate	$436.22
Rate for Payer: Cash Price	$159.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$436.22
Rate for Payer: SOMOS Essential	$436.22

PR PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES

Professional

Both

$676.66

Service Code	HCPCS 90792
Min. Negotiated Rate	$507.50
Max. Negotiated Rate	$507.50
Rate for Payer: Cash Price	$185.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$507.50
Rate for Payer: SOMOS Essential	$507.50

PR PSYCHOANALYSIS

Professional

Both

$324.00

Service Code	HCPCS 90845
Min. Negotiated Rate	$243.00
Max. Negotiated Rate	$243.00
Rate for Payer: Cash Price	$94.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$243.00
Rate for Payer: SOMOS Essential	$243.00

PR PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR

Professional

Both

$293.79

Service Code	HCPCS 96131
Min. Negotiated Rate	$220.34
Max. Negotiated Rate	$220.34
Rate for Payer: Cash Price	$80.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$220.34
Rate for Payer: SOMOS Essential	$220.34

PR PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR

Professional

Both

$427.07

Service Code	HCPCS 96130
Min. Negotiated Rate	$320.30
Max. Negotiated Rate	$320.30
Rate for Payer: Cash Price	$119.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$320.30
Rate for Payer: SOMOS Essential	$320.30

PR PSYCHOTHERAPY COMPLEX INTERACTIVE

Professional

Both

$51.24

Service Code	HCPCS 90785
Min. Negotiated Rate	$38.43
Max. Negotiated Rate	$38.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38.43
Rate for Payer: SOMOS Essential	$38.43

PR PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES

Professional

Both

$248.57

Service Code	HCPCS 90840
Min. Negotiated Rate	$186.43
Max. Negotiated Rate	$186.43
Rate for Payer: Cash Price	$71.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$186.43
Rate for Payer: SOMOS Essential	$186.43

PR PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES

Professional

Both

$485.52

Service Code	HCPCS 90839
Min. Negotiated Rate	$364.14
Max. Negotiated Rate	$364.14
Rate for Payer: Cash Price	$139.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$364.14
Rate for Payer: SOMOS Essential	$364.14

PR PSYCHOTHERAPY W/PATIENT 30 MINUTES

Professional

Both

$255.50

Service Code	HCPCS 90832
Min. Negotiated Rate	$191.62
Max. Negotiated Rate	$191.62
Rate for Payer: Cash Price	$73.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$191.62
Rate for Payer: SOMOS Essential	$191.62

PR PSYCHOTHERAPY W/PATIENT 45 MINUTES

Professional

Both

$340.10

Service Code	HCPCS 90834
Min. Negotiated Rate	$255.08
Max. Negotiated Rate	$255.08
Rate for Payer: Cash Price	$97.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$255.08
Rate for Payer: SOMOS Essential	$255.08

PR PSYCHOTHERAPY W/PATIENT 60 MINUTES

Professional

Both

$498.26

Service Code	HCPCS 90837
Min. Negotiated Rate	$373.70
Max. Negotiated Rate	$373.70
Rate for Payer: Cash Price	$143.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$373.70
Rate for Payer: SOMOS Essential	$373.70

PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN

Professional

Both

$243.11

Service Code	HCPCS 90833
Min. Negotiated Rate	$182.33
Max. Negotiated Rate	$182.33
Rate for Payer: Cash Price	$70.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$182.33
Rate for Payer: SOMOS Essential	$182.33

PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 45 MIN

Professional

Both

$308.74

Service Code	HCPCS 90836
Min. Negotiated Rate	$231.56
Max. Negotiated Rate	$231.56
Rate for Payer: Cash Price	$88.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$231.56
Rate for Payer: SOMOS Essential	$231.56

PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 60 MIN

Professional

Both

$410.80

Service Code	HCPCS 90838
Min. Negotiated Rate	$308.10
Max. Negotiated Rate	$308.10
Rate for Payer: Cash Price	$117.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$308.10
Rate for Payer: SOMOS Essential	$308.10

PR PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT

Professional

Both

$11.38

Service Code	HCPCS 96146
Min. Negotiated Rate	$8.54
Max. Negotiated Rate	$8.54
Rate for Payer: Cash Price	$2.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.54
Rate for Payer: SOMOS Essential	$8.54

PR PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN

Professional

Both

$68.99

Service Code	HCPCS 96137
Min. Negotiated Rate	$51.74
Max. Negotiated Rate	$51.74
Rate for Payer: Cash Price	$19.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$51.74
Rate for Payer: SOMOS Essential	$51.74

PR PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN

Professional

Both

$146.48

Service Code	HCPCS 96138
Min. Negotiated Rate	$109.86
Max. Negotiated Rate	$109.86
Rate for Payer: Cash Price	$40.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$109.86
Rate for Payer: SOMOS Essential	$109.86

PR PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN

Professional

Both

$150.82

Service Code	HCPCS 96139
Min. Negotiated Rate	$113.12
Max. Negotiated Rate	$113.12
Rate for Payer: Cash Price	$41.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$113.12
Rate for Payer: SOMOS Essential	$113.12

PR PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN

Professional

Both

$91.60

Service Code	HCPCS 96136
Min. Negotiated Rate	$68.70
Max. Negotiated Rate	$68.70
Rate for Payer: Cash Price	$25.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$68.70
Rate for Payer: SOMOS Essential	$68.70

PR PT/CAREGIVER TRAING FOR INITIATION HOME INR MNTR

Professional

Both

$307.06

Service Code	HCPCS 93792
Min. Negotiated Rate	$230.30
Max. Negotiated Rate	$230.30
Rate for Payer: Cash Price	$83.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$230.30
Rate for Payer: SOMOS Essential	$230.30

Know your out-of-pocket cost for care.

All Charges