St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR SPONTANEOUS NYSTAGMUS TEST

Professional

Both

$103.01

Service Code	HCPCS 92541
Min. Negotiated Rate	$77.26
Max. Negotiated Rate	$77.26
Rate for Payer: Cash Price	$28.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$77.26
Rate for Payer: SOMOS Essential	$77.26

PR SPONTANEOUS NYSTAGMUS TEST

Professional

Both

$19.99

Service Code	HCPCS 92541 TC
Min. Negotiated Rate	$14.99
Max. Negotiated Rate	$14.99
Rate for Payer: Cash Price	$5.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$14.99
Rate for Payer: SOMOS Essential	$14.99

PR SPUTUM SPECIMEN COLLECTION

Professional

Both

$78.93

Service Code	HCPCS 89220
Min. Negotiated Rate	$59.20
Max. Negotiated Rate	$59.20
Rate for Payer: Cash Price	$23.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$59.20
Rate for Payer: SOMOS Essential	$59.20

PR STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS

Professional

Both

$1,193.12

Service Code	HCPCS 37765
Min. Negotiated Rate	$894.84
Max. Negotiated Rate	$894.84
Rate for Payer: Cash Price	$317.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$894.84
Rate for Payer: SOMOS Essential	$894.84

PR STAB PHLEBT VARICOSE VEINS 1 XTR > 20 INCS

Professional

Both

$1,456.63

Service Code	HCPCS 37766
Min. Negotiated Rate	$1,092.47
Max. Negotiated Rate	$1,092.47
Rate for Payer: Cash Price	$389.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,092.47
Rate for Payer: SOMOS Essential	$1,092.47

PR STAGGERED SPONDAIC WORD

Professional

Both

$203.98

Service Code	HCPCS 92572
Min. Negotiated Rate	$152.98
Max. Negotiated Rate	$152.98
Rate for Payer: Cash Price	$63.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$152.98
Rate for Payer: SOMOS Essential	$152.98

PR STANDARDIZED COGNITIVE PERFORMANCE TESTING

Professional

Both

$414.79

Service Code	HCPCS 96125
Min. Negotiated Rate	$311.09
Max. Negotiated Rate	$311.09
Rate for Payer: Cash Price	$114.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$311.09
Rate for Payer: SOMOS Essential	$311.09

PR STAPEDECTOMY/STAPEDOTOMY

Professional

Both

$4,021.19

Service Code	HCPCS 69660
Min. Negotiated Rate	$3,015.89
Max. Negotiated Rate	$3,015.89
Rate for Payer: Cash Price	$1,083.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,015.89
Rate for Payer: SOMOS Essential	$3,015.89

PR STAPEDECTOMY/STAPEDOTOMY W/FOOTPLATE DRILL OUT

Professional

Both

$5,234.04

Service Code	HCPCS 69661
Min. Negotiated Rate	$3,925.53
Max. Negotiated Rate	$3,925.53
Rate for Payer: Cash Price	$1,410.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,925.53
Rate for Payer: SOMOS Essential	$3,925.53

PR STAPES MOBILIZATION

Professional

Both

$3,489.57

Service Code	HCPCS 69650
Min. Negotiated Rate	$2,617.18
Max. Negotiated Rate	$2,617.18
Rate for Payer: Cash Price	$943.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,617.18
Rate for Payer: SOMOS Essential	$2,617.18

PR STENGER TEST PURE TONE

Professional

Both

$87.54

Service Code	HCPCS 92565
Min. Negotiated Rate	$65.66
Max. Negotiated Rate	$65.66
Rate for Payer: Cash Price	$24.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$65.66
Rate for Payer: SOMOS Essential	$65.66

PR STENGER TEST SPEECH

Professional

Both

$88.97

Service Code	HCPCS 92577
Min. Negotiated Rate	$66.73
Max. Negotiated Rate	$66.73
Rate for Payer: Cash Price	$26.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$66.73
Rate for Payer: SOMOS Essential	$66.73

PR STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR

Professional

Both

$872.31

Service Code	HCPCS 36908
Min. Negotiated Rate	$654.23
Max. Negotiated Rate	$654.23
Rate for Payer: Cash Price	$234.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$654.23
Rate for Payer: SOMOS Essential	$654.23

PR STEREOSCOPIC X-RAY GUIDANCE

Professional

Both

$83.06

Service Code	HCPCS G6002 26
Min. Negotiated Rate	$62.30
Max. Negotiated Rate	$62.30
Rate for Payer: Cash Price	$22.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$62.30
Rate for Payer: SOMOS Essential	$62.30

PR STEREOSCOPIC X-RAY GUIDANCE

Professional

Both

$317.24

Service Code	HCPCS G6002
Min. Negotiated Rate	$237.93
Max. Negotiated Rate	$237.93
Rate for Payer: Cash Price	$87.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$237.93
Rate for Payer: SOMOS Essential	$237.93

PR STEREOSCOPIC X-RAY GUIDANCE

Professional

Both

$234.19

Service Code	HCPCS G6002 TC
Min. Negotiated Rate	$175.64
Max. Negotiated Rate	$175.64
Rate for Payer: Cash Price	$65.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$175.64
Rate for Payer: SOMOS Essential	$175.64

PR STEREOTACTIC BX ASPIR/EXC BURR INTRACRANIAL LES

Professional

Both

$6,784.86

Service Code	HCPCS 61750
Min. Negotiated Rate	$5,088.64
Max. Negotiated Rate	$5,088.64
Rate for Payer: Cash Price	$1,791.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,088.64
Rate for Payer: SOMOS Essential	$5,088.64

PR STEREOTACTIC COMPUTER ASSISTED PX SPINAL

Professional

Both

$1,095.36

Service Code	HCPCS 61783
Min. Negotiated Rate	$821.52
Max. Negotiated Rate	$821.52
Rate for Payer: Cash Price	$287.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$821.52
Rate for Payer: SOMOS Essential	$821.52

PR STEREOTACTIC RADIOSURGERY 1 COMPLEX CRANIAL LES

Professional

Both

$6,639.82

Service Code	HCPCS 61798
Min. Negotiated Rate	$4,979.86
Max. Negotiated Rate	$4,979.86
Rate for Payer: Cash Price	$1,754.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,979.86
Rate for Payer: SOMOS Essential	$4,979.86

PR STEREOTACTIC RADIOSURGERY 1 SIMPLE CRANIAL LES

Professional

Both

$4,901.33

Service Code	HCPCS 61796
Min. Negotiated Rate	$3,676.00
Max. Negotiated Rate	$3,676.00
Rate for Payer: Cash Price	$1,296.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,676.00
Rate for Payer: SOMOS Essential	$3,676.00

PR STEREOTACTIC RADIOSURGERY 1 SPINAL LESION

Professional

Both

$5,431.13

Service Code	HCPCS 63620
Min. Negotiated Rate	$4,073.35
Max. Negotiated Rate	$4,073.35
Rate for Payer: Cash Price	$1,434.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,073.35
Rate for Payer: SOMOS Essential	$4,073.35

PR STEREOTACTIC RADIOSURGERY EA ADDL SPINAL LESION

Professional

Both

$1,218.95

Service Code	HCPCS 63621
Min. Negotiated Rate	$914.21
Max. Negotiated Rate	$914.21
Rate for Payer: Cash Price	$318.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$914.21
Rate for Payer: SOMOS Essential	$914.21

PR STERNAL DEBRIDEMENT

Professional

Both

$2,425.50

Service Code	HCPCS 21627
Min. Negotiated Rate	$1,819.12
Max. Negotiated Rate	$1,819.12
Rate for Payer: Cash Price	$656.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,819.12
Rate for Payer: SOMOS Essential	$1,819.12

PR STIMULUS EVOKED RESPONSE

Professional

Both

$1,169.39

Service Code	HCPCS 51792
Min. Negotiated Rate	$877.04
Max. Negotiated Rate	$877.04
Rate for Payer: Cash Price	$322.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$877.04
Rate for Payer: SOMOS Essential	$877.04

PR STIMULUS EVOKED RESPONSE

Professional

Both

$221.20

Service Code	HCPCS 51792 26
Min. Negotiated Rate	$165.90
Max. Negotiated Rate	$165.90
Rate for Payer: Cash Price	$62.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$165.90
Rate for Payer: SOMOS Essential	$165.90

Know your out-of-pocket cost for care.

All Charges