St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR PTERYGOMAXILLARY FOSSA SURGERY ANY APPROACH

Professional

Both

$3,502.94

Service Code	HCPCS 31040
Min. Negotiated Rate	$2,627.20
Max. Negotiated Rate	$2,627.20
Rate for Payer: Cash Price	$947.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,627.20
Rate for Payer: SOMOS Essential	$2,627.20

PR PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM

Professional

Both

$11.52

Service Code	HCPCS 96160
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$8.64
Rate for Payer: Cash Price	$3.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.64
Rate for Payer: SOMOS Essential	$8.64

PR PT-INITIATE SPIROMETRIC RECORDING PHYS/QHP R&I

Professional

Both

$230.02

Service Code	HCPCS 94014
Min. Negotiated Rate	$172.52
Max. Negotiated Rate	$172.52
Rate for Payer: Cash Price	$64.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$172.52
Rate for Payer: SOMOS Essential	$172.52

PR PULMONARY ARTERY EMBOLECTOMY W/CARD BYPASS

Professional

Both

$11,690.00

Service Code	HCPCS 33910
Min. Negotiated Rate	$8,767.50
Max. Negotiated Rate	$8,767.50
Rate for Payer: Cash Price	$3,054.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,767.50
Rate for Payer: SOMOS Essential	$8,767.50

PR PULMONARY ARTERY EMBOLECTOMY W/O CARD BYPASS

Professional

Both

$6,061.51

Service Code	HCPCS 33915
Min. Negotiated Rate	$4,546.13
Max. Negotiated Rate	$4,546.13
Rate for Payer: Cash Price	$1,608.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,546.13
Rate for Payer: SOMOS Essential	$4,546.13

PR PULMONARY ENDARTERCOMY W/WO EMBOLECTOMY W/BYPASS

Professional

Both

$18,481.12

Service Code	HCPCS 33916
Min. Negotiated Rate	$13,860.84
Max. Negotiated Rate	$13,860.84
Rate for Payer: Cash Price	$4,883.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$13,860.84
Rate for Payer: SOMOS Essential	$13,860.84

PR PULMONARY STRESS TESTING

Professional

Both

$87.15

Service Code	HCPCS 94618 26
Min. Negotiated Rate	$65.36
Max. Negotiated Rate	$65.36
Rate for Payer: Cash Price	$23.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$65.36
Rate for Payer: SOMOS Essential	$65.36

PR PULMONARY STRESS TESTING

Professional

Both

$138.78

Service Code	HCPCS 94618
Min. Negotiated Rate	$104.08
Max. Negotiated Rate	$104.08
Rate for Payer: Cash Price	$38.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$104.08
Rate for Payer: SOMOS Essential	$104.08

PR PULMONARY STRESS TESTING

Professional

Both

$51.63

Service Code	HCPCS 94618 TC
Min. Negotiated Rate	$38.72
Max. Negotiated Rate	$38.72
Rate for Payer: Cash Price	$14.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38.72
Rate for Payer: SOMOS Essential	$38.72

PR PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION

Professional

Both

$108.71

Service Code	HCPCS 11105
Min. Negotiated Rate	$81.53
Max. Negotiated Rate	$81.53
Rate for Payer: Cash Price	$29.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$81.53
Rate for Payer: SOMOS Essential	$81.53

PR PUNCH BIOPSY SKIN SINGLE LESION

Professional

Both

$197.44

Service Code	HCPCS 11104
Min. Negotiated Rate	$148.08
Max. Negotiated Rate	$148.08
Rate for Payer: Cash Price	$53.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$148.08
Rate for Payer: SOMOS Essential	$148.08

PR PUNCH GRAFT HAIR TRANSPLANT 1-15 PUNCH GRAFTS

Professional

Both

$1,111.50

Service Code	HCPCS 15775
Min. Negotiated Rate	$833.62
Max. Negotiated Rate	$833.62
Rate for Payer: Cash Price	$298.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$833.62
Rate for Payer: SOMOS Essential	$833.62

PR PUNCH GRAFT HAIR TRANSPLANT >15 PUNCH GRAFTS

Professional

Both

$1,515.64

Service Code	HCPCS 15776
Min. Negotiated Rate	$1,136.73
Max. Negotiated Rate	$1,136.73
Rate for Payer: Cash Price	$409.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,136.73
Rate for Payer: SOMOS Essential	$1,136.73

PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST

Professional

Both

$412.97

Service Code	HCPCS 10160
Min. Negotiated Rate	$309.73
Max. Negotiated Rate	$309.73
Rate for Payer: Cash Price	$112.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$309.73
Rate for Payer: SOMOS Essential	$309.73

PR PUNCTURE ASPIRATION CYST BREAST EACH ADDL CYST

Professional

Both

$85.12

Service Code	HCPCS 19001
Min. Negotiated Rate	$63.84
Max. Negotiated Rate	$63.84
Rate for Payer: Cash Price	$23.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$63.84
Rate for Payer: SOMOS Essential	$63.84

PR PUNCTURE ASPIRATION CYST OF BREAST

Professional

Both

$179.87

Service Code	HCPCS 19000
Min. Negotiated Rate	$134.90
Max. Negotiated Rate	$134.90
Rate for Payer: Cash Price	$47.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$134.90
Rate for Payer: SOMOS Essential	$134.90

PR PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX

Professional

Both

$247.10

Service Code	HCPCS 61070
Min. Negotiated Rate	$185.32
Max. Negotiated Rate	$185.32
Rate for Payer: Cash Price	$65.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$185.32
Rate for Payer: SOMOS Essential	$185.32

PR PURE TONE AUDIOMETRY AIR & BONE

Professional

Both

$188.16

Service Code	HCPCS 92553
Min. Negotiated Rate	$141.12
Max. Negotiated Rate	$141.12
Rate for Payer: Cash Price	$54.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$141.12
Rate for Payer: SOMOS Essential	$141.12

PR PURE TONE AUDIOMETRY AIR ONLY

Professional

Both

$153.69

Service Code	HCPCS 92552
Min. Negotiated Rate	$115.27
Max. Negotiated Rate	$115.27
Rate for Payer: Cash Price	$45.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$115.27
Rate for Payer: SOMOS Essential	$115.27

PR PURE TONE AUDIOMETRY AUTOMATED AIR & BONE

Professional

Both

$173.22

Service Code	HCPCS 0209T
Min. Negotiated Rate	$129.92
Max. Negotiated Rate	$129.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$129.92
Rate for Payer: SOMOS Essential	$129.92

PR PURE TONE AUDIOMETRY AUTOMATED AIR ONLY

Professional

Both

$143.05

Service Code	HCPCS 0208T
Min. Negotiated Rate	$107.29
Max. Negotiated Rate	$107.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$107.29
Rate for Payer: SOMOS Essential	$107.29

PR PUSH TRANSFUSION BLOOD 2 YR OR YOUNGER

Professional

Both

$202.79

Service Code	HCPCS 36440
Min. Negotiated Rate	$152.09
Max. Negotiated Rate	$152.09
Rate for Payer: Cash Price	$55.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$152.09
Rate for Payer: SOMOS Essential	$152.09

PR PVB THORACIC CONT CATHETER INFUSION W/IMG GID

Professional

Both

$334.81

Service Code	HCPCS 64463
Min. Negotiated Rate	$251.11
Max. Negotiated Rate	$251.11
Rate for Payer: Cash Price	$90.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$251.11
Rate for Payer: SOMOS Essential	$251.11

PR PVB THORACIC SECOND & ADDL INJ SITE W/IMG GID

Professional

Both

$199.64

Service Code	HCPCS 64462
Min. Negotiated Rate	$149.73
Max. Negotiated Rate	$149.73
Rate for Payer: Cash Price	$53.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$149.73
Rate for Payer: SOMOS Essential	$149.73

PR PVB THORACIC SINGLE INJECTION SITE W/IMG GID

Professional

Both

$321.76

Service Code	HCPCS 64461
Min. Negotiated Rate	$241.32
Max. Negotiated Rate	$241.32
Rate for Payer: Cash Price	$86.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$241.32
Rate for Payer: SOMOS Essential	$241.32

Know your out-of-pocket cost for care.

All Charges