St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR SPECIAL STAINS,GROUP I

Professional

Both

$372.16

Service Code	HCPCS 88312 TC
Min. Negotiated Rate	$279.12
Max. Negotiated Rate	$279.12
Rate for Payer: Cash Price	$102.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$279.12
Rate for Payer: SOMOS Essential	$279.12

PR SPECIAL STAINS,GROUP I

Professional

Both

$101.99

Service Code	HCPCS 88312 26
Min. Negotiated Rate	$76.49
Max. Negotiated Rate	$76.49
Rate for Payer: Cash Price	$28.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$76.49
Rate for Payer: SOMOS Essential	$76.49

PR SPECIAL STAINS,GROUP I

Professional

Both

$474.18

Service Code	HCPCS 88312
Min. Negotiated Rate	$355.63
Max. Negotiated Rate	$355.63
Rate for Payer: Cash Price	$130.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$355.63
Rate for Payer: SOMOS Essential	$355.63

PR SPECIAL STAINS,GROUP II

Professional

Both

$47.18

Service Code	HCPCS 88313 26
Min. Negotiated Rate	$35.38
Max. Negotiated Rate	$35.38
Rate for Payer: Cash Price	$12.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35.38
Rate for Payer: SOMOS Essential	$35.38

PR SPECIAL STAINS,GROUP II

Professional

Both

$301.74

Service Code	HCPCS 88313 TC
Min. Negotiated Rate	$226.31
Max. Negotiated Rate	$226.31
Rate for Payer: Cash Price	$84.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$226.31
Rate for Payer: SOMOS Essential	$226.31

PR SPECIAL STAINS,GROUP II

Professional

Both

$348.92

Service Code	HCPCS 88313
Min. Negotiated Rate	$261.69
Max. Negotiated Rate	$261.69
Rate for Payer: Cash Price	$97.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$261.69
Rate for Payer: SOMOS Essential	$261.69

PR SPEECH AUDIOMETRY THRESHOLD

Professional

Both

$119.18

Service Code	HCPCS 92555
Min. Negotiated Rate	$89.39
Max. Negotiated Rate	$89.39
Rate for Payer: Cash Price	$34.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$89.39
Rate for Payer: SOMOS Essential	$89.39

PR SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ

Professional

Both

$183.86

Service Code	HCPCS 92556
Min. Negotiated Rate	$137.90
Max. Negotiated Rate	$137.90
Rate for Payer: Cash Price	$53.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$137.90
Rate for Payer: SOMOS Essential	$137.90

PR SPERM WASHING ARTIFICIAL INSEMINATION

Professional

Both

$52.68

Service Code	HCPCS 58323
Min. Negotiated Rate	$39.51
Max. Negotiated Rate	$39.51
Rate for Payer: Cash Price	$14.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39.51
Rate for Payer: SOMOS Essential	$39.51

PR SPHINCTEROPLASTY ANAL MUSCLE TRANSPLANT

Professional

Both

$4,704.91

Service Code	HCPCS 46760
Min. Negotiated Rate	$3,528.68
Max. Negotiated Rate	$3,528.68
Rate for Payer: Cash Price	$1,276.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,528.68
Rate for Payer: SOMOS Essential	$3,528.68

PR SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX

Professional

Both

$699.69

Service Code	HCPCS 46080
Min. Negotiated Rate	$524.77
Max. Negotiated Rate	$524.77
Rate for Payer: Cash Price	$186.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$524.77
Rate for Payer: SOMOS Essential	$524.77

PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE ADULT

Professional

Both

$3,242.96

Service Code	HCPCS 46750
Min. Negotiated Rate	$2,432.22
Max. Negotiated Rate	$2,432.22
Rate for Payer: Cash Price	$876.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,432.22
Rate for Payer: SOMOS Essential	$2,432.22

PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE CHLD

Professional

Both

$3,025.51

Service Code	HCPCS 46751
Min. Negotiated Rate	$2,269.13
Max. Negotiated Rate	$2,269.13
Rate for Payer: Cash Price	$808.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,269.13
Rate for Payer: SOMOS Essential	$2,269.13

PR SPHNCTROP ANAL LEVATOR MUSC IMBRCJ

Professional

Both

$3,966.41

Service Code	HCPCS 46761
Min. Negotiated Rate	$2,974.81
Max. Negotiated Rate	$2,974.81
Rate for Payer: Cash Price	$1,066.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,974.81
Rate for Payer: SOMOS Essential	$2,974.81

PR SPLENC TOT EN BLOC EXTNSV DS CONJUNCT W/OTH PX

Professional

Both

$1,171.17

Service Code	HCPCS 38102
Min. Negotiated Rate	$878.38
Max. Negotiated Rate	$878.38
Rate for Payer: Cash Price	$310.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$878.38
Rate for Payer: SOMOS Essential	$878.38

PR SPLENECTOMY TOTAL EN BLOC W/OTHER PROCEDURE

Professional

Both

$5,269.81

Service Code	HCPCS 38101
Min. Negotiated Rate	$3,952.36
Max. Negotiated Rate	$3,952.36
Rate for Payer: Cash Price	$1,401.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,952.36
Rate for Payer: SOMOS Essential	$3,952.36

PR SPLENECTOMY TOTAL SEPARATE PROCEDURE

Professional

Both

$5,170.48

Service Code	HCPCS 38100
Min. Negotiated Rate	$3,877.86
Max. Negotiated Rate	$3,877.86
Rate for Payer: Cash Price	$1,376.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,877.86
Rate for Payer: SOMOS Essential	$3,877.86

PR SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/</1 %

Professional

Both

$2,979.38

Service Code	HCPCS 15120
Min. Negotiated Rate	$2,234.53
Max. Negotiated Rate	$2,234.53
Rate for Payer: Cash Price	$808.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,234.53
Rate for Payer: SOMOS Essential	$2,234.53

PR SPLIT AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/EA 1 %

Professional

Both

$585.62

Service Code	HCPCS 15121
Min. Negotiated Rate	$439.21
Max. Negotiated Rate	$439.21
Rate for Payer: Cash Price	$154.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$439.21
Rate for Payer: SOMOS Essential	$439.21

PR SPLIT AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD

Professional

Both

$3,136.95

Service Code	HCPCS 15100
Min. Negotiated Rate	$2,352.71
Max. Negotiated Rate	$2,352.71
Rate for Payer: Cash Price	$846.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,352.71
Rate for Payer: SOMOS Essential	$2,352.71

PR SPLIT AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD

Professional

Both

$487.87

Service Code	HCPCS 15101
Min. Negotiated Rate	$365.90
Max. Negotiated Rate	$365.90
Rate for Payer: Cash Price	$130.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$365.90
Rate for Payer: SOMOS Essential	$365.90

PR SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ

Professional

Both

$114.45

Service Code	HCPCS 94010
Min. Negotiated Rate	$85.84
Max. Negotiated Rate	$85.84
Rate for Payer: Cash Price	$31.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$85.84
Rate for Payer: SOMOS Essential	$85.84

PR SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ

Professional

Both

$81.80

Service Code	HCPCS 94010 TC
Min. Negotiated Rate	$61.35
Max. Negotiated Rate	$61.35
Rate for Payer: Cash Price	$23.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$61.35
Rate for Payer: SOMOS Essential	$61.35

PR SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ

Professional

Both

$32.66

Service Code	HCPCS 94010 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 SPONTANEOUS NYSTAGMUS TEST

Professional

Both

$83.02

Service Code	HCPCS 92541 26
Min. Negotiated Rate	$62.27
Max. Negotiated Rate	$62.27
Rate for Payer: Cash Price	$22.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$62.27
Rate for Payer: SOMOS Essential	$62.27

Know your out-of-pocket cost for care.

All Charges