St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR AMPUTATION ARM THRU HUMERUS OPEN CIRCULAR

Professional

Both

$3,255.81

Service Code	HCPCS 24920
Min. Negotiated Rate	$2,441.86
Max. Negotiated Rate	$2,441.86
Rate for Payer: Cash Price	$879.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,441.86
Rate for Payer: SOMOS Essential	$2,441.86

PR AMPUTATION ARM THRU HUMERUS RE-AMPUTATION

Professional

Both

$3,428.08

Service Code	HCPCS 24930
Min. Negotiated Rate	$2,571.06
Max. Negotiated Rate	$2,571.06
Rate for Payer: Cash Price	$927.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,571.06
Rate for Payer: SOMOS Essential	$2,571.06

PR AMPUTATION ARM THRU HUMERUS W/IMPLANT

Professional

Both

$4,122.51

Service Code	HCPCS 24931
Min. Negotiated Rate	$3,091.88
Max. Negotiated Rate	$3,091.88
Rate for Payer: Cash Price	$1,111.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,091.88
Rate for Payer: SOMOS Essential	$3,091.88

PR AMPUTATION ARM THRU HUMERUS W/PRIMARY CLOSURE

Professional

Both

$3,269.14

Service Code	HCPCS 24900
Min. Negotiated Rate	$2,451.86
Max. Negotiated Rate	$2,451.86
Rate for Payer: Cash Price	$887.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,451.86
Rate for Payer: SOMOS Essential	$2,451.86

PR AMPUTATION FOOT MIDTARSAL

Professional

Both

$2,221.52

Service Code	HCPCS 28800
Min. Negotiated Rate	$1,666.14
Max. Negotiated Rate	$1,666.14
Rate for Payer: Cash Price	$608.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,666.14
Rate for Payer: SOMOS Essential	$1,666.14

PR AMPUTATION FOOT TRANSMETARSAL

Professional

Both

$2,994.25

Service Code	HCPCS 28805
Min. Negotiated Rate	$2,245.69
Max. Negotiated Rate	$2,245.69
Rate for Payer: Cash Price	$812.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,245.69
Rate for Payer: SOMOS Essential	$2,245.69

PR AMPUTATION FOREARM THROUGH RADIUS & ULNA

Professional

Both

$3,171.49

Service Code	HCPCS 25900
Min. Negotiated Rate	$2,378.62
Max. Negotiated Rate	$2,378.62
Rate for Payer: Cash Price	$859.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,378.62
Rate for Payer: SOMOS Essential	$2,378.62

PR AMPUTATION LEG THROUGH TIBIA&FIBULA

Professional

Both

$4,024.58

Service Code	HCPCS 27880
Min. Negotiated Rate	$3,018.44
Max. Negotiated Rate	$3,018.44
Rate for Payer: Cash Price	$1,071.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,018.44
Rate for Payer: SOMOS Essential	$3,018.44

PR AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR

Professional

Both

$2,648.73

Service Code	HCPCS 27882
Min. Negotiated Rate	$1,986.55
Max. Negotiated Rate	$1,986.55
Rate for Payer: Cash Price	$706.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,986.55
Rate for Payer: SOMOS Essential	$1,986.55

PR AMPUTATION METATARSAL W/TOE SINGLE

Professional

Both

$1,814.23

Service Code	HCPCS 28810
Min. Negotiated Rate	$1,360.67
Max. Negotiated Rate	$1,360.67
Rate for Payer: Cash Price	$494.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,360.67
Rate for Payer: SOMOS Essential	$1,360.67

PR AMPUTATION PENIS COMPLETE

Professional

Both

$3,471.30

Service Code	HCPCS 54125
Min. Negotiated Rate	$2,603.48
Max. Negotiated Rate	$2,603.48
Rate for Payer: Cash Price	$945.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,603.48
Rate for Payer: SOMOS Essential	$2,603.48

PR AMPUTATION PENIS PARTIAL

Professional

Both

$2,651.67

Service Code	HCPCS 54120
Min. Negotiated Rate	$1,988.75
Max. Negotiated Rate	$1,988.75
Rate for Payer: Cash Price	$727.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,988.75
Rate for Payer: SOMOS Essential	$1,988.75

PR AMPUTATION PENIS RADICAL W/LYMPH NODES

Professional

Both

$6,290.59

Service Code	HCPCS 54135
Min. Negotiated Rate	$4,717.94
Max. Negotiated Rate	$4,717.94
Rate for Payer: Cash Price	$1,717.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,717.94
Rate for Payer: SOMOS Essential	$4,717.94

PR AMPUTATION PENIS RADW/BI INGUINOFEMORAL LMPHADE

Professional

Both

$4,981.94

Service Code	HCPCS 54130
Min. Negotiated Rate	$3,736.46
Max. Negotiated Rate	$3,736.46
Rate for Payer: Cash Price	$1,361.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,736.46
Rate for Payer: SOMOS Essential	$3,736.46

PR AMPUTATION THIGH THROUGH FEMUR ANY LEVEL

Professional

Both

$3,516.00

Service Code	HCPCS 27590
Min. Negotiated Rate	$2,637.00
Max. Negotiated Rate	$2,637.00
Rate for Payer: Cash Price	$937.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,637.00
Rate for Payer: SOMOS Essential	$2,637.00

PR AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION

Professional

Both

$3,185.32

Service Code	HCPCS 27596
Min. Negotiated Rate	$2,388.99
Max. Negotiated Rate	$2,388.99
Rate for Payer: Cash Price	$849.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,388.99
Rate for Payer: SOMOS Essential	$2,388.99

PR AMPUTATION THIGH THRU FEMUR OPEN CIRCULAR

Professional

Both

$2,999.99

Service Code	HCPCS 27592
Min. Negotiated Rate	$2,249.99
Max. Negotiated Rate	$2,249.99
Rate for Payer: Cash Price	$801.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,249.99
Rate for Payer: SOMOS Essential	$2,249.99

PR AMPUTATION TOE INTERPHALANGEAL JOINT

Professional

Both

$720.83

Service Code	HCPCS 28825
Min. Negotiated Rate	$540.62
Max. Negotiated Rate	$540.62
Rate for Payer: Cash Price	$197.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$540.62
Rate for Payer: SOMOS Essential	$540.62

PR AMPUTATION TOE METATARSOPHALANGEAL JOINT

Professional

Both

$748.62

Service Code	HCPCS 28820
Min. Negotiated Rate	$561.46
Max. Negotiated Rate	$561.46
Rate for Payer: Cash Price	$202.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$561.46
Rate for Payer: SOMOS Essential	$561.46

PR ANALYSIS COCHLEAR IMPLT 7 YR/> PRGRMG

Professional

Both

$473.59

Service Code	HCPCS 92603
Min. Negotiated Rate	$355.19
Max. Negotiated Rate	$355.19
Rate for Payer: Cash Price	$129.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$355.19
Rate for Payer: SOMOS Essential	$355.19

PR ANALYSIS COCHLEAR IMPLT 7 YR/> SBSQ REPRGRMG

Professional

Both

$265.27

Service Code	HCPCS 92604
Min. Negotiated Rate	$198.95
Max. Negotiated Rate	$198.95
Rate for Payer: Cash Price	$71.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$198.95
Rate for Payer: SOMOS Essential	$198.95

PR ANALYSIS COCHLEAR IMPLT PT <7 YR PRGRMG

Professional

Both

$487.06

Service Code	HCPCS 92601
Min. Negotiated Rate	$365.30
Max. Negotiated Rate	$365.30
Rate for Payer: Cash Price	$133.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$365.30
Rate for Payer: SOMOS Essential	$365.30

PR ANALYSIS COCHLEAR IMPLT PT <7 YR SBSQ REPRGRMG

Professional

Both

$277.27

Service Code	HCPCS 92602
Min. Negotiated Rate	$207.95
Max. Negotiated Rate	$207.95
Rate for Payer: Cash Price	$75.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$207.95
Rate for Payer: SOMOS Essential	$207.95

PR ANALYSIS, NERVE

Professional

Both

$466.87

Service Code	HCPCS 88356 26
Min. Negotiated Rate	$350.15
Max. Negotiated Rate	$350.15
Rate for Payer: Cash Price	$127.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$350.15
Rate for Payer: SOMOS Essential	$350.15

PR ANALYSIS, NERVE

Professional

Both

$486.75

Service Code	HCPCS 88356 TC
Min. Negotiated Rate	$365.06
Max. Negotiated Rate	$365.06
Rate for Payer: Cash Price	$139.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$365.06
Rate for Payer: SOMOS Essential	$365.06

Know your out-of-pocket cost for care.

All Charges