St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR PYELOPLASTY COMPLICATED

Professional

Both

$5,816.58

Service Code	HCPCS 50405
Min. Negotiated Rate	$4,362.44
Max. Negotiated Rate	$4,362.44
Rate for Payer: Cash Price	$1,587.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,362.44
Rate for Payer: SOMOS Essential	$4,362.44

PR PYELOPLASTY SIMPLE

Professional

Both

$4,815.48

Service Code	HCPCS 50400
Min. Negotiated Rate	$3,611.61
Max. Negotiated Rate	$3,611.61
Rate for Payer: Cash Price	$1,316.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,611.61
Rate for Payer: SOMOS Essential	$3,611.61

PR PYELOTOMY COMPLICATED

Professional

Both

$4,678.07

Service Code	HCPCS 50135
Min. Negotiated Rate	$3,508.55
Max. Negotiated Rate	$3,508.55
Rate for Payer: Cash Price	$1,276.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,508.55
Rate for Payer: SOMOS Essential	$3,508.55

PR PYELOTOMY W/DRAINAGE PYELOSTOMY

Professional

Both

$4,097.38

Service Code	HCPCS 50125
Min. Negotiated Rate	$3,073.04
Max. Negotiated Rate	$3,073.04
Rate for Payer: Cash Price	$1,121.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,073.04
Rate for Payer: SOMOS Essential	$3,073.04

PR PYELOTOMY W/EXPLORATION

Professional

Both

$3,962.88

Service Code	HCPCS 50120
Min. Negotiated Rate	$2,972.16
Max. Negotiated Rate	$2,972.16
Rate for Payer: Cash Price	$1,084.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,972.16
Rate for Payer: SOMOS Essential	$2,972.16

PR PYELOTOMY W/REMOVAL CALCULUS

Professional

Both

$4,312.56

Service Code	HCPCS 50130
Min. Negotiated Rate	$3,234.42
Max. Negotiated Rate	$3,234.42
Rate for Payer: Cash Price	$1,177.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,234.42
Rate for Payer: SOMOS Essential	$3,234.42

PR PYLOROMYOTOMY CUTTING PYLORIC MUSC

Professional

Both

$3,081.19

Service Code	HCPCS 43520
Min. Negotiated Rate	$2,310.89
Max. Negotiated Rate	$2,310.89
Rate for Payer: Cash Price	$828.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,310.89
Rate for Payer: SOMOS Essential	$2,310.89

PR PYLOROPLASTY

Professional

Both

$4,196.05

Service Code	HCPCS 43800
Min. Negotiated Rate	$3,147.04
Max. Negotiated Rate	$3,147.04
Rate for Payer: Cash Price	$1,120.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,147.04
Rate for Payer: SOMOS Essential	$3,147.04

PR QNHP OL DIGITAL ASSMT&MGMT EST PT <7 D 11-20 MIN

Professional

Both

$77.98

Service Code	HCPCS 98971
Min. Negotiated Rate	$58.48
Max. Negotiated Rate	$58.48
Rate for Payer: Cash Price	$22.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$58.48
Rate for Payer: SOMOS Essential	$58.48

PR QNHP OL DIGITAL ASSMT&MGMT EST PT <7 D 21+ MIN

Professional

Both

$120.65

Service Code	HCPCS 98972
Min. Negotiated Rate	$90.49
Max. Negotiated Rate	$90.49
Rate for Payer: Cash Price	$33.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$90.49
Rate for Payer: SOMOS Essential	$90.49

PR QNHP OL DIGITAL ASSMT&MGMT EST PT <7 D 5-10 MIN

Professional

Both

$45.54

Service Code	HCPCS 98970
Min. Negotiated Rate	$34.16
Max. Negotiated Rate	$34.16
Rate for Payer: Cash Price	$12.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34.16
Rate for Payer: SOMOS Essential	$34.16

PR QUADRICEPSPLASTY

Professional

Both

$3,292.77

Service Code	HCPCS 27430
Min. Negotiated Rate	$2,469.58
Max. Negotiated Rate	$2,469.58
Rate for Payer: Cash Price	$891.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,469.58
Rate for Payer: SOMOS Essential	$2,469.58

PR QUANTITATIVE PUPILLOMETRY PHYS/QHP I&R UNI/BI

Professional

Both

$25.73

Service Code	HCPCS 95919 TC
Min. Negotiated Rate	$19.30
Max. Negotiated Rate	$19.30
Rate for Payer: Cash Price	$7.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19.30
Rate for Payer: SOMOS Essential	$19.30

PR QUANTITATIVE PUPILLOMETRY PHYS/QHP I&R UNI/BI

Professional

Both

$39.66

Service Code	HCPCS 95919 26
Min. Negotiated Rate	$29.74
Max. Negotiated Rate	$29.74
Rate for Payer: Cash Price	$10.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29.74
Rate for Payer: SOMOS Essential	$29.74

PR QUANTITATIVE PUPILLOMETRY PHYS/QHP I&R UNI/BI

Professional

Both

$65.38

Service Code	HCPCS 95919
Min. Negotiated Rate	$49.04
Max. Negotiated Rate	$49.04
Rate for Payer: Cash Price	$18.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$49.04
Rate for Payer: SOMOS Essential	$49.04

PR QUANT SENAORY TEST&INTERPJ/XTR W/HT-PN STIMULI

Professional

Both

$58.80

Service Code	HCPCS 0109T
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$44.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44.10
Rate for Payer: SOMOS Essential	$44.10

PR QUANT SENSORY TEST&INTERPJ/XTR OTHER STIMULI

Professional

Both

$58.80

Service Code	HCPCS 0110T
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$44.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44.10
Rate for Payer: SOMOS Essential	$44.10

PR QUANT SENSORY TEST&INTERPJ/XTR W/COOL STIMULI

Professional

Both

$58.80

Service Code	HCPCS 0108T
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$44.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44.10
Rate for Payer: SOMOS Essential	$44.10

PR QUANT SENSORY TEST&INTERPJ/XTR W/TOUCH STIMULI

Professional

Both

$58.80

Service Code	HCPCS 0106T
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$44.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44.10
Rate for Payer: SOMOS Essential	$44.10

PR QUANT SENSORY TEST&INTERPJ/XTR W/VIBRJ STIMULI

Professional

Both

$58.80

Service Code	HCPCS 0107T
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$44.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44.10
Rate for Payer: SOMOS Essential	$44.10

PR RAD ABDL HYSTERECTOMY W/BI PELVIC LMPHADENECTOMY

Professional

Both

$7,913.15

Service Code	HCPCS 58210
Min. Negotiated Rate	$5,934.86
Max. Negotiated Rate	$5,934.86
Rate for Payer: Cash Price	$2,140.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,934.86
Rate for Payer: SOMOS Essential	$5,934.86

PR RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS FLXRS

Professional

Both

$3,338.13

Service Code	HCPCS 25115
Min. Negotiated Rate	$2,503.60
Max. Negotiated Rate	$2,503.60
Rate for Payer: Cash Price	$905.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,503.60
Rate for Payer: SOMOS Essential	$2,503.60

PR RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS XTNSRS

Professional

Both

$2,667.07

Service Code	HCPCS 25116
Min. Negotiated Rate	$2,000.30
Max. Negotiated Rate	$2,000.30
Rate for Payer: Cash Price	$727.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,000.30
Rate for Payer: SOMOS Essential	$2,000.30

PR RAD EXC XTRNL AUDITORY CANAL LES NCK DSJ

Professional

Both

$7,034.37

Service Code	HCPCS 69155
Min. Negotiated Rate	$5,275.78
Max. Negotiated Rate	$5,275.78
Rate for Payer: Cash Price	$1,901.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,275.78
Rate for Payer: SOMOS Essential	$5,275.78

PR RAD EXC XTRNL AUDITORY CANAL LES W/O NCK DSJ

Professional

Both

$4,380.64

Service Code	HCPCS 69150
Min. Negotiated Rate	$3,285.48
Max. Negotiated Rate	$3,285.48
Rate for Payer: Cash Price	$1,179.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,285.48
Rate for Payer: SOMOS Essential	$3,285.48

Know your out-of-pocket cost for care.

All Charges