St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR RX SP-GENRATJ AUGMNT&COMUNICAJ DEV EA 30 MIN

Professional

Both

$198.10

Service Code	HCPCS 92608
Min. Negotiated Rate	$148.58
Max. Negotiated Rate	$148.58
Rate for Payer: Cash Price	$54.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$148.58
Rate for Payer: SOMOS Essential	$148.58

PR SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX

Professional

Both

$3,521.21

Service Code	HCPCS 58700
Min. Negotiated Rate	$2,640.91
Max. Negotiated Rate	$2,640.91
Rate for Payer: Cash Price	$948.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,640.91
Rate for Payer: SOMOS Essential	$2,640.91

PR SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX

Professional

Both

$3,315.45

Service Code	HCPCS 58720
Min. Negotiated Rate	$2,486.59
Max. Negotiated Rate	$2,486.59
Rate for Payer: Cash Price	$898.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,486.59
Rate for Payer: SOMOS Essential	$2,486.59

PR SALPINGOSTOMY

Professional

Both

$3,768.17

Service Code	HCPCS 58770
Min. Negotiated Rate	$2,826.13
Max. Negotiated Rate	$2,826.13
Rate for Payer: Cash Price	$1,013.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,826.13
Rate for Payer: SOMOS Essential	$2,826.13

PR SAPHENOPOPLITEAL VEIN ANASTOMOSIS

Professional

Both

$4,189.19

Service Code	HCPCS 34530
Min. Negotiated Rate	$3,141.89
Max. Negotiated Rate	$3,141.89
Rate for Payer: Cash Price	$1,111.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,141.89
Rate for Payer: SOMOS Essential	$3,141.89

PR SAT BIOPSY 10-20

Professional

Both

$682.92

Service Code	HCPCS G0416 26
Min. Negotiated Rate	$512.19
Max. Negotiated Rate	$512.19
Rate for Payer: Cash Price	$187.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$512.19
Rate for Payer: SOMOS Essential	$512.19

PR SAT BIOPSY 10-20

Professional

Both

$1,487.36

Service Code	HCPCS G0416
Min. Negotiated Rate	$1,115.52
Max. Negotiated Rate	$1,115.52
Rate for Payer: Cash Price	$414.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,115.52
Rate for Payer: SOMOS Essential	$1,115.52

PR SAT BIOPSY 10-20

Professional

Both

$804.44

Service Code	HCPCS G0416 TC
Min. Negotiated Rate	$603.33
Max. Negotiated Rate	$603.33
Rate for Payer: Cash Price	$227.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$603.33
Rate for Payer: SOMOS Essential	$603.33

PR SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES

Professional

Both

$484.96

Service Code	HCPCS 99233
Min. Negotiated Rate	$363.72
Max. Negotiated Rate	$363.72
Rate for Payer: Cash Price	$131.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$363.72
Rate for Payer: SOMOS Essential	$363.72

PR SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES

Professional

Both

$322.53

Service Code	HCPCS 99232
Min. Negotiated Rate	$241.90
Max. Negotiated Rate	$241.90
Rate for Payer: Cash Price	$87.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$241.90
Rate for Payer: SOMOS Essential	$241.90

PR SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES

Professional

Both

$205.80

Service Code	HCPCS 99231
Min. Negotiated Rate	$154.35
Max. Negotiated Rate	$154.35
Rate for Payer: Cash Price	$55.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$154.35
Rate for Payer: SOMOS Essential	$154.35

PR SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES

Professional

Both

$624.05

Service Code	HCPCS 99310
Min. Negotiated Rate	$468.04
Max. Negotiated Rate	$468.04
Rate for Payer: Cash Price	$172.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$468.04
Rate for Payer: SOMOS Essential	$468.04

PR SBSQ NURSING FACILITY CARE LOW MDM 20 MINUTES

Professional

Both

$305.20

Service Code	HCPCS 99308
Min. Negotiated Rate	$228.90
Max. Negotiated Rate	$228.90
Rate for Payer: Cash Price	$83.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$228.90
Rate for Payer: SOMOS Essential	$228.90

PR SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES

Professional

Both

$432.88

Service Code	HCPCS 99309
Min. Negotiated Rate	$324.66
Max. Negotiated Rate	$324.66
Rate for Payer: Cash Price	$120.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$324.66
Rate for Payer: SOMOS Essential	$324.66

PR SBSQ NURSING FACILITY CARE SF MDM 10 MINUTES

Professional

Both

$160.44

Service Code	HCPCS 99307
Min. Negotiated Rate	$120.33
Max. Negotiated Rate	$120.33
Rate for Payer: Cash Price	$45.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$120.33
Rate for Payer: SOMOS Essential	$120.33

PR SBSQ PSYCHIATRIC COLLAB CARE MGMT 1ST 60 MINS

Professional

Both

$407.47

Service Code	HCPCS 99493
Min. Negotiated Rate	$305.60
Max. Negotiated Rate	$305.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$305.60
Rate for Payer: SOMOS Essential	$305.60

PR SCAPULOPEXY

Professional

Both

$4,310.25

Service Code	HCPCS 23400
Min. Negotiated Rate	$3,232.69
Max. Negotiated Rate	$3,232.69
Rate for Payer: Cash Price	$1,161.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,232.69
Rate for Payer: SOMOS Essential	$3,232.69

PR SCLERAL REINFORCEMENT SPX W/GRAFT

Professional

Both

$2,844.59

Service Code	HCPCS 67255
Min. Negotiated Rate	$2,133.44
Max. Negotiated Rate	$2,133.44
Rate for Payer: Cash Price	$784.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,133.44
Rate for Payer: SOMOS Essential	$2,133.44

PR SCLERAL REINFORCEMENT SPX W/O GRAFT

Professional

Both

$3,792.36

Service Code	HCPCS 67250
Min. Negotiated Rate	$2,844.27
Max. Negotiated Rate	$2,844.27
Rate for Payer: Cash Price	$1,035.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,844.27
Rate for Payer: SOMOS Essential	$2,844.27

PR SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID

Professional

Both

$489.23

Service Code	HCPCS 49185
Min. Negotiated Rate	$366.92
Max. Negotiated Rate	$366.92
Rate for Payer: Cash Price	$133.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$366.92
Rate for Payer: SOMOS Essential	$366.92

PR SCR C/V CYTO,AUTOSYS AND MD

Professional

Both

$94.26

Service Code	HCPCS G0141
Min. Negotiated Rate	$70.70
Max. Negotiated Rate	$70.70
Rate for Payer: Cash Price	$27.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70.70
Rate for Payer: SOMOS Essential	$70.70

PR SCREEN C/V THIN LAYER BY MD

Professional

Both

$94.26

Service Code	HCPCS G0124
Min. Negotiated Rate	$70.70
Max. Negotiated Rate	$70.70
Rate for Payer: Cash Price	$27.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70.70
Rate for Payer: SOMOS Essential	$70.70

PR SCREENING PAP SMEAR BY PHYS

Professional

Both

$94.26

Service Code	HCPCS P3001
Min. Negotiated Rate	$70.70
Max. Negotiated Rate	$70.70
Rate for Payer: Cash Price	$27.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70.70
Rate for Payer: SOMOS Essential	$70.70

PR SCREENING TEST PURE TONE AIR ONLY

Professional

Both

$35.00

Service Code	HCPCS 92551
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26.25
Rate for Payer: SOMOS Essential	$26.25

PR SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT

Professional

Both

$11.00

Service Code	HCPCS 99173
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$8.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.25
Rate for Payer: SOMOS Essential	$8.25

Know your out-of-pocket cost for care.

All Charges