St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM

Professional

Both

$296.94

Service Code	HCPCS 11303
Min. Negotiated Rate	$222.70
Max. Negotiated Rate	$222.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$222.70
Rate for Payer: SOMOS Essential	$222.70

PR SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM

Professional

Both

$249.31

Service Code	HCPCS 11302
Min. Negotiated Rate	$186.98
Max. Negotiated Rate	$186.98
Rate for Payer: Cash Price	$67.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$186.98
Rate for Payer: SOMOS Essential	$186.98

PR SIALOLITHOTOMY PRTD XTRORAL/COMP INTRAORAL

Professional

Both

$1,490.37

Service Code	HCPCS 42340
Min. Negotiated Rate	$1,117.78
Max. Negotiated Rate	$1,117.78
Rate for Payer: Cash Price	$406.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,117.78
Rate for Payer: SOMOS Essential	$1,117.78

PR SIALOLITHOTOMY SUBMNDBLR SUBMAX COMP INTRAORAL

Professional

Both

$1,132.15

Service Code	HCPCS 42335
Min. Negotiated Rate	$849.11
Max. Negotiated Rate	$849.11
Rate for Payer: Cash Price	$310.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$849.11
Rate for Payer: SOMOS Essential	$849.11

PR SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL

Professional

Both

$711.59

Service Code	HCPCS 42330
Min. Negotiated Rate	$533.69
Max. Negotiated Rate	$533.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$533.69
Rate for Payer: SOMOS Essential	$533.69

PR SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES

Professional

Both

$671.97

Service Code	HCPCS 45346
Min. Negotiated Rate	$503.98
Max. Negotiated Rate	$503.98
Rate for Payer: Cash Price	$181.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$503.98
Rate for Payer: SOMOS Essential	$503.98

PR SIGMOIDOSCOPY FLX CONTROL BLEEDING

Professional

Both

$492.84

Service Code	HCPCS 45334
Min. Negotiated Rate	$369.63
Max. Negotiated Rate	$369.63
Rate for Payer: Cash Price	$133.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$369.63
Rate for Payer: SOMOS Essential	$369.63

PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD

Professional

Both

$238.67

Service Code	HCPCS 45330
Min. Negotiated Rate	$179.00
Max. Negotiated Rate	$179.00
Rate for Payer: Cash Price	$65.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$179.00
Rate for Payer: SOMOS Essential	$179.00

PR SIGMOIDOSCOPY FLX NDSC US XM

Professional

Both

$515.06

Service Code	HCPCS 45341
Min. Negotiated Rate	$386.30
Max. Negotiated Rate	$386.30
Rate for Payer: Cash Price	$140.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$386.30
Rate for Payer: SOMOS Essential	$386.30

PR SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT

Professional

Both

$638.26

Service Code	HCPCS 45347
Min. Negotiated Rate	$478.70
Max. Negotiated Rate	$478.70
Rate for Payer: Cash Price	$174.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$478.70
Rate for Payer: SOMOS Essential	$478.70

PR SIGMOIDOSCOPY FLX TNDSC BALO DILAT

Professional

Both

$332.33

Service Code	HCPCS 45340
Min. Negotiated Rate	$249.25
Max. Negotiated Rate	$249.25
Rate for Payer: Cash Price	$90.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$249.25
Rate for Payer: SOMOS Essential	$249.25

PR SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX

Professional

Both

$718.45

Service Code	HCPCS 45342
Min. Negotiated Rate	$538.84
Max. Negotiated Rate	$538.84
Rate for Payer: Cash Price	$194.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$538.84
Rate for Payer: SOMOS Essential	$538.84

PR SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE

Professional

Both

$301.84

Service Code	HCPCS 45331
Min. Negotiated Rate	$226.38
Max. Negotiated Rate	$226.38
Rate for Payer: Cash Price	$82.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$226.38
Rate for Payer: SOMOS Essential	$226.38

PR SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)

Professional

Both

$422.98

Service Code	HCPCS 45350
Min. Negotiated Rate	$317.24
Max. Negotiated Rate	$317.24
Rate for Payer: Cash Price	$115.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$317.24
Rate for Payer: SOMOS Essential	$317.24

PR SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY

Professional

Both

$440.06

Service Code	HCPCS 45332
Min. Negotiated Rate	$330.04
Max. Negotiated Rate	$330.04
Rate for Payer: Cash Price	$120.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$330.04
Rate for Payer: SOMOS Essential	$330.04

PR SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS

Professional

Both

$397.95

Service Code	HCPCS 45333
Min. Negotiated Rate	$298.46
Max. Negotiated Rate	$298.46
Rate for Payer: Cash Price	$108.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$298.46
Rate for Payer: SOMOS Essential	$298.46

PR SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG

Professional

Both

$121.59

Service Code	HCPCS 93278
Min. Negotiated Rate	$91.19
Max. Negotiated Rate	$91.19
Rate for Payer: Cash Price	$36.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$91.19
Rate for Payer: SOMOS Essential	$91.19

PR SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG

Professional

Both

$73.19

Service Code	HCPCS 93278 TC
Min. Negotiated Rate	$54.89
Max. Negotiated Rate	$54.89
Rate for Payer: Cash Price	$23.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$54.89
Rate for Payer: SOMOS Essential	$54.89

PR SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG

Professional

Both

$48.44

Service Code	HCPCS 93278 26
Min. Negotiated Rate	$36.33
Max. Negotiated Rate	$36.33
Rate for Payer: Cash Price	$13.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36.33
Rate for Payer: SOMOS Essential	$36.33

PR SIGN LANG/ORAL INTERPRETER

Professional

Both

$11.00

Service Code	HCPCS T1013
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

PR SIMPLE CYSTOMETROGRAM

Professional

Both

$316.16

Service Code	HCPCS 51725 26
Min. Negotiated Rate	$237.12
Max. Negotiated Rate	$237.12
Rate for Payer: Cash Price	$85.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$237.12
Rate for Payer: SOMOS Essential	$237.12

PR SIMPLE CYSTOMETROGRAM

Professional

Both

$666.72

Service Code	HCPCS 51725 TC
Min. Negotiated Rate	$500.04
Max. Negotiated Rate	$500.04
Rate for Payer: Cash Price	$180.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$500.04
Rate for Payer: SOMOS Essential	$500.04

PR SIMPLE CYSTOMETROGRAM

Professional

Both

$982.87

Service Code	HCPCS 51725
Min. Negotiated Rate	$737.15
Max. Negotiated Rate	$737.15
Rate for Payer: Cash Price	$265.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$737.15
Rate for Payer: SOMOS Essential	$737.15

PR SIMPLE INTRACRANIAL ARYSM CAROTID CIRCULATION

Professional

Both

$16,294.32

Service Code	HCPCS 61700
Min. Negotiated Rate	$12,220.74
Max. Negotiated Rate	$12,220.74
Rate for Payer: Cash Price	$4,326.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$12,220.74
Rate for Payer: SOMOS Essential	$12,220.74

PR SIMPLE INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ

Professional

Both

$19,419.75

Service Code	HCPCS 61702
Min. Negotiated Rate	$14,564.81
Max. Negotiated Rate	$14,564.81
Rate for Payer: Cash Price	$5,098.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$14,564.81
Rate for Payer: SOMOS Essential	$14,564.81

Know your out-of-pocket cost for care.

All Charges