St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR REMOTE THER MNTR TX MGMT PHYS/QHP EA ADDL 20 MIN

Professional

Both

$121.84

Service Code	HCPCS 98981
Min. Negotiated Rate	$91.38
Max. Negotiated Rate	$91.38
Rate for Payer: Cash Price	$33.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$91.38
Rate for Payer: SOMOS Essential	$91.38

PR REMOT IMAGE SUBMIT BY PT

Professional

Both

$36.79

Service Code	HCPCS G2010
Min. Negotiated Rate	$27.59
Max. Negotiated Rate	$27.59
Rate for Payer: Cash Price	$10.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27.59
Rate for Payer: SOMOS Essential	$27.59

PR REMOT IMG SUB BY PT, NON E/M

Professional

Both

$36.79

Service Code	HCPCS G2250
Min. Negotiated Rate	$27.59
Max. Negotiated Rate	$27.59
Rate for Payer: Cash Price	$10.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27.59
Rate for Payer: SOMOS Essential	$27.59

PR REMOVAL ANAL SETON OTHER MARKER

Professional

Both

$377.41

Service Code	HCPCS 46030
Min. Negotiated Rate	$283.06
Max. Negotiated Rate	$283.06
Rate for Payer: Cash Price	$100.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$283.06
Rate for Payer: SOMOS Essential	$283.06

PR REMOVAL ANKLE IMPLANT

Professional

Both

$2,486.19

Service Code	HCPCS 27704
Min. Negotiated Rate	$1,864.64
Max. Negotiated Rate	$1,864.64
Rate for Payer: Cash Price	$673.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,864.64
Rate for Payer: SOMOS Essential	$1,864.64

PR REMOVAL ANTERIOR INSTRUMENTATION

Professional

Both

$5,128.03

Service Code	HCPCS 22855
Min. Negotiated Rate	$3,846.02
Max. Negotiated Rate	$3,846.02
Rate for Payer: Cash Price	$1,366.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,846.02
Rate for Payer: SOMOS Essential	$3,846.02

PR REMOVAL BILIARY DRG CATHETER REQ FLUOR GID RS&I

Professional

Both

$395.99

Service Code	HCPCS 47537
Min. Negotiated Rate	$296.99
Max. Negotiated Rate	$296.99
Rate for Payer: Cash Price	$106.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$296.99
Rate for Payer: SOMOS Essential	$296.99

PR REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I

Professional

Both

$637.53

Service Code	HCPCS 47544
Min. Negotiated Rate	$478.15
Max. Negotiated Rate	$478.15
Rate for Payer: Cash Price	$171.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$478.15
Rate for Payer: SOMOS Essential	$478.15

PR REMOVAL/BIVALVING FULL ARM/FULL LEG CAST

Professional

Both

$192.71

Service Code	HCPCS 29705
Min. Negotiated Rate	$144.53
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$51.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$144.53
Rate for Payer: SOMOS Essential	$144.53

PR REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST

Professional

Both

$143.33

Service Code	HCPCS 29700
Min. Negotiated Rate	$107.50
Max. Negotiated Rate	$107.50
Rate for Payer: Cash Price	$38.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$107.50
Rate for Payer: SOMOS Essential	$107.50

PR REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA

Professional

Both

$617.12

Service Code	HCPCS 59871
Min. Negotiated Rate	$462.84
Max. Negotiated Rate	$462.84
Rate for Payer: Cash Price	$163.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$462.84
Rate for Payer: SOMOS Essential	$462.84

PR REMOVAL CONTOURING BENIGN TUMOR FACIAL BONE

Professional

Both

$2,683.87

Service Code	HCPCS 21029
Min. Negotiated Rate	$2,012.90
Max. Negotiated Rate	$2,012.90
Rate for Payer: Cash Price	$736.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,012.90
Rate for Payer: SOMOS Essential	$2,012.90

PR REMOVAL CRNL NRV NSTIM ELTRDS & PULSE GENERATO

Professional

Both

$3,520.79

Service Code	HCPCS 64570
Min. Negotiated Rate	$2,640.59
Max. Negotiated Rate	$2,640.59
Rate for Payer: Cash Price	$935.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,640.59
Rate for Payer: SOMOS Essential	$2,640.59

PR REMOVAL DEEP DRUG DELIVERY DEVICE

Professional

Both

$283.68

Service Code	HCPCS 20701
Min. Negotiated Rate	$212.76
Max. Negotiated Rate	$212.76
Rate for Payer: Cash Price	$75.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$212.76
Rate for Payer: SOMOS Essential	$212.76

PR REMOVAL EMBEDDED FOREIGN BODY EYELID

Professional

Both

$489.13

Service Code	HCPCS 67938
Min. Negotiated Rate	$366.85
Max. Negotiated Rate	$366.85
Rate for Payer: Cash Price	$133.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$366.85
Rate for Payer: SOMOS Essential	$366.85

PR REMOVAL ENTIRE OI IMPLT SKL MAG TC ATTCH ESP<100

Professional

Both

$2,298.24

Service Code	HCPCS 69727
Min. Negotiated Rate	$1,723.68
Max. Negotiated Rate	$1,723.68
Rate for Payer: Cash Price	$623.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,723.68
Rate for Payer: SOMOS Essential	$1,723.68

PR REMOVAL ENTIRE OI IMPLT SKL PERQ ATTACHMENT ESP

Professional

Both

$2,060.45

Service Code	HCPCS 69726
Min. Negotiated Rate	$1,545.34
Max. Negotiated Rate	$1,545.34
Rate for Payer: Cash Price	$558.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,545.34
Rate for Payer: SOMOS Essential	$1,545.34

PR REMOVAL ESOPHAGEAL SPHINCTER AGMNTJ DEVICE

Professional

Both

$3,038.53

Service Code	HCPCS 43285
Min. Negotiated Rate	$2,278.90
Max. Negotiated Rate	$2,278.90
Rate for Payer: Cash Price	$811.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,278.90
Rate for Payer: SOMOS Essential	$2,278.90

PR REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES

Professional

Both

$1,497.13

Service Code	HCPCS 20694
Min. Negotiated Rate	$1,122.85
Max. Negotiated Rate	$1,122.85
Rate for Payer: Cash Price	$408.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,122.85
Rate for Payer: SOMOS Essential	$1,122.85

PR REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL

Professional

Both

$119.77

Service Code	HCPCS 65205
Min. Negotiated Rate	$89.83
Max. Negotiated Rate	$89.83
Rate for Payer: Cash Price	$32.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$89.83
Rate for Payer: SOMOS Essential	$89.83

PR REMOVAL FOREIGN BODY DEEP PENILE TISSUE

Professional

Both

$1,793.47

Service Code	HCPCS 54115
Min. Negotiated Rate	$1,345.10
Max. Negotiated Rate	$1,345.10
Rate for Payer: Cash Price	$493.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,345.10
Rate for Payer: SOMOS Essential	$1,345.10

PR REMOVAL FOREIGN BODY DEEP THIGH/KNEE

Professional

Both

$1,779.19

Service Code	HCPCS 27372
Min. Negotiated Rate	$1,334.39
Max. Negotiated Rate	$1,334.39
Rate for Payer: Cash Price	$481.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,334.39
Rate for Payer: SOMOS Essential	$1,334.39

PR REMOVAL FOREIGN BODY FOOT COMPLICATED

Professional

Both

$1,522.50

Service Code	HCPCS 28193
Min. Negotiated Rate	$1,141.88
Max. Negotiated Rate	$1,141.88
Rate for Payer: Cash Price	$419.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,141.88
Rate for Payer: SOMOS Essential	$1,141.88

PR REMOVAL FOREIGN BODY FOOT DEEP

Professional

Both

$1,295.53

Service Code	HCPCS 28192
Min. Negotiated Rate	$971.65
Max. Negotiated Rate	$971.65
Rate for Payer: Cash Price	$357.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$971.65
Rate for Payer: SOMOS Essential	$971.65

PR REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS

Professional

Both

$552.41

Service Code	HCPCS 28190
Min. Negotiated Rate	$414.31
Max. Negotiated Rate	$414.31
Rate for Payer: Cash Price	$152.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$414.31
Rate for Payer: SOMOS Essential	$414.31

Know your out-of-pocket cost for care.

All Charges