St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM

Professional

Both

$562.91

Service Code	HCPCS 12016
Min. Negotiated Rate	$422.18
Max. Negotiated Rate	$422.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$422.18
Rate for Payer: SOMOS Essential	$422.18

PR SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0 CM

Professional

Both

$683.83

Service Code	HCPCS 12017
Min. Negotiated Rate	$512.87
Max. Negotiated Rate	$512.87
Rate for Payer: Cash Price	$182.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$512.87
Rate for Payer: SOMOS Essential	$512.87

PR SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<

Professional

Both

$241.92

Service Code	HCPCS 12011
Min. Negotiated Rate	$181.44
Max. Negotiated Rate	$181.44
Rate for Payer: Cash Price	$65.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$181.44
Rate for Payer: SOMOS Essential	$181.44

PR SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM

Professional

Both

$260.02

Service Code	HCPCS 12013
Min. Negotiated Rate	$195.02
Max. Negotiated Rate	$195.02
Rate for Payer: Cash Price	$68.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$195.02
Rate for Payer: SOMOS Essential	$195.02

PR SIMPLE REPAIR F/E/E/N/L/M >30.0 CM

Professional

Both

$772.35

Service Code	HCPCS 12018
Min. Negotiated Rate	$579.26
Max. Negotiated Rate	$579.26
Rate for Payer: Cash Price	$205.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$579.26
Rate for Payer: SOMOS Essential	$579.26

PR SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM

Professional

Both

$329.04

Service Code	HCPCS 12014
Min. Negotiated Rate	$246.78
Max. Negotiated Rate	$246.78
Rate for Payer: Cash Price	$88.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$246.78
Rate for Payer: SOMOS Essential	$246.78

PR SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM

Professional

Both

$415.21

Service Code	HCPCS 12015
Min. Negotiated Rate	$311.41
Max. Negotiated Rate	$311.41
Rate for Payer: Cash Price	$110.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$311.41
Rate for Payer: SOMOS Essential	$311.41

PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<

Professional

Both

$199.15

Service Code	HCPCS 12001
Min. Negotiated Rate	$149.36
Max. Negotiated Rate	$149.36
Rate for Payer: Cash Price	$52.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$149.36
Rate for Payer: SOMOS Essential	$149.36

PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM

Professional

Both

$637.21

Service Code	HCPCS 12007
Min. Negotiated Rate	$477.91
Max. Negotiated Rate	$477.91
Rate for Payer: Cash Price	$169.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$477.91
Rate for Payer: SOMOS Essential	$477.91

PR SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM

Professional

Both

$320.36

Service Code	HCPCS 12004
Min. Negotiated Rate	$240.27
Max. Negotiated Rate	$240.27
Rate for Payer: Cash Price	$86.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$240.27
Rate for Payer: SOMOS Essential	$240.27

PR SIMPLE UROFLOMETRY

Professional

Both

$56.95

Service Code	HCPCS 51736
Min. Negotiated Rate	$42.71
Max. Negotiated Rate	$42.71
Rate for Payer: Cash Price	$15.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$42.71
Rate for Payer: SOMOS Essential	$42.71

PR SIMPLE UROFLOMETRY

Professional

Both

$32.66

Service Code	HCPCS 51736 26
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$24.50
Rate for Payer: Cash Price	$8.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24.50
Rate for Payer: SOMOS Essential	$24.50

PR SIMPLE UROFLOMETRY

Professional

Both

$24.29

Service Code	HCPCS 51736 TC
Min. Negotiated Rate	$18.22
Max. Negotiated Rate	$18.22
Rate for Payer: Cash Price	$6.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18.22
Rate for Payer: SOMOS Essential	$18.22

PR SINGLE ENERGY X-RAY STUDY

Professional

Both

$152.36

Service Code	HCPCS G0130
Min. Negotiated Rate	$114.27
Max. Negotiated Rate	$114.27
Rate for Payer: Cash Price	$42.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$114.27
Rate for Payer: SOMOS Essential	$114.27

PR SINGLE ENERGY X-RAY STUDY

Professional

Both

$43.23

Service Code	HCPCS G0130 26
Min. Negotiated Rate	$32.42
Max. Negotiated Rate	$32.42
Rate for Payer: Cash Price	$11.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32.42
Rate for Payer: SOMOS Essential	$32.42

PR SINGLE ENERGY X-RAY STUDY

Professional

Both

$109.10

Service Code	HCPCS G0130 TC
Min. Negotiated Rate	$81.82
Max. Negotiated Rate	$81.82
Rate for Payer: Cash Price	$30.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$81.82
Rate for Payer: SOMOS Essential	$81.82

PR SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING

Professional

Both

$543.34

Service Code	HCPCS 92546
Min. Negotiated Rate	$407.50
Max. Negotiated Rate	$407.50
Rate for Payer: Cash Price	$155.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$407.50
Rate for Payer: SOMOS Essential	$407.50

PR SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING

Professional

Both

$59.19

Service Code	HCPCS 92546 26
Min. Negotiated Rate	$44.39
Max. Negotiated Rate	$44.39
Rate for Payer: Cash Price	$16.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44.39
Rate for Payer: SOMOS Essential	$44.39

PR SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING

Professional

Both

$484.16

Service Code	HCPCS 92546 TC
Min. Negotiated Rate	$363.12
Max. Negotiated Rate	$363.12
Rate for Payer: Cash Price	$139.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$363.12
Rate for Payer: SOMOS Essential	$363.12

PR SINUSOT FRNT NONOBLIT W/OSTPL FLAP BROW INC

Professional

Both

$5,122.50

Service Code	HCPCS 31086
Min. Negotiated Rate	$3,841.88
Max. Negotiated Rate	$3,841.88
Rate for Payer: Cash Price	$1,380.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,841.88
Rate for Payer: SOMOS Essential	$3,841.88

PR SINUSOT FRNT NONOBLIT W/OSTPL FLAP CORONAL INC

Professional

Both

$4,872.21

Service Code	HCPCS 31087
Min. Negotiated Rate	$3,654.16
Max. Negotiated Rate	$3,654.16
Rate for Payer: Cash Price	$1,314.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,654.16
Rate for Payer: SOMOS Essential	$3,654.16

PR SINUSOT FRNT OBLIT W/O OSTPL FLAP CORONAL INC

Professional

Both

$5,081.48

Service Code	HCPCS 31081
Min. Negotiated Rate	$3,811.11
Max. Negotiated Rate	$3,811.11
Rate for Payer: Cash Price	$1,370.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,811.11
Rate for Payer: SOMOS Essential	$3,811.11

PR SINUSOT FRNT OBLIT W/OSTPL FLAP BROW INC

Professional

Both

$5,253.05

Service Code	HCPCS 31084
Min. Negotiated Rate	$3,939.79
Max. Negotiated Rate	$3,939.79
Rate for Payer: Cash Price	$1,418.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,939.79
Rate for Payer: SOMOS Essential	$3,939.79

PR SINUSOT FRNT OBLIT W/OSTPL FLAP CORONAL INC

Professional

Both

$5,423.78

Service Code	HCPCS 31085
Min. Negotiated Rate	$4,067.84
Max. Negotiated Rate	$4,067.84
Rate for Payer: Cash Price	$1,460.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,067.84
Rate for Payer: SOMOS Essential	$4,067.84

PR SINUSOT MAX ANTRT RAD W/RMVL ANTROCH POLYPS

Professional

Both

$2,582.16

Service Code	HCPCS 31032
Min. Negotiated Rate	$1,936.62
Max. Negotiated Rate	$1,936.62
Rate for Payer: Cash Price	$697.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,936.62
Rate for Payer: SOMOS Essential	$1,936.62

Know your out-of-pocket cost for care.

All Charges