St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR ANT SGM IMAGING I&R SPECLR MICROSCOPY&NDTHL ALYS

Professional

Both

$84.46

Service Code	HCPCS 92286 26
Min. Negotiated Rate	$63.34
Max. Negotiated Rate	$63.34
Rate for Payer: Cash Price	$23.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$63.34
Rate for Payer: SOMOS Essential	$63.34

PR ANT SGM IMAGING W/I&R W/FLUOROSCEIN ANGRPH

Professional

Both

$614.74

Service Code	HCPCS 92287
Min. Negotiated Rate	$461.06
Max. Negotiated Rate	$461.06
Rate for Payer: Cash Price	$166.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$461.06
Rate for Payer: SOMOS Essential	$461.06

PR ANT SGM IMAGING W/I&R W/FLUOROSCEIN ANGRPH

Professional

Both

$467.04

Service Code	HCPCS 92287 TC
Min. Negotiated Rate	$350.28
Max. Negotiated Rate	$350.28
Rate for Payer: Cash Price	$134.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$350.28
Rate for Payer: SOMOS Essential	$350.28

PR ANT SGM IMAGING W/I&R W/FLUOROSCEIN ANGRPH

Professional

Both

$147.70

Service Code	HCPCS 92287 26
Min. Negotiated Rate	$110.78
Max. Negotiated Rate	$110.78
Rate for Payer: Cash Price	$32.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$110.78
Rate for Payer: SOMOS Essential	$110.78

PR ANT VESICOURETHROPEXY/URETHROPEXY COMP

Professional

Both

$3,384.26

Service Code	HCPCS 51841
Min. Negotiated Rate	$2,538.20
Max. Negotiated Rate	$2,538.20
Rate for Payer: Cash Price	$924.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,538.20
Rate for Payer: SOMOS Essential	$2,538.20

PR ANT VESICOURETHROPEXY/URETHROPEXY SMPL

Professional

Both

$2,957.36

Service Code	HCPCS 51840
Min. Negotiated Rate	$2,218.02
Max. Negotiated Rate	$2,218.02
Rate for Payer: Cash Price	$805.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,218.02
Rate for Payer: SOMOS Essential	$2,218.02

PR AORTIC HEMIARCH GRAFT W/ISOL & CTRL ARCH VESSELS

Professional

Both

$4,077.43

Service Code	HCPCS 33866
Min. Negotiated Rate	$3,058.07
Max. Negotiated Rate	$3,058.07
Rate for Payer: Cash Price	$1,076.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,058.07
Rate for Payer: SOMOS Essential	$3,058.07

PR AORTIC SUSPENSION TRACHEAL DECOMPRESSION SPX

Professional

Both

$4,387.99

Service Code	HCPCS 33800
Min. Negotiated Rate	$3,290.99
Max. Negotiated Rate	$3,290.99
Rate for Payer: Cash Price	$1,168.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,290.99
Rate for Payer: SOMOS Essential	$3,290.99

PR AORTOPLASTY SUPRAVALVULAR STENOSIS

Professional

Both

$7,426.58

Service Code	HCPCS 33417
Min. Negotiated Rate	$5,569.94
Max. Negotiated Rate	$5,569.94
Rate for Payer: Cash Price	$1,977.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,569.94
Rate for Payer: SOMOS Essential	$5,569.94

PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX

Professional

Both

$372.33

Service Code	HCPCS 44955
Min. Negotiated Rate	$279.25
Max. Negotiated Rate	$279.25
Rate for Payer: Cash Price	$98.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$279.25
Rate for Payer: SOMOS Essential	$279.25

PR APPENDEC RPTD APPENDIX ABSC/PRITONITIS

Professional

Both

$3,959.27

Service Code	HCPCS 44960
Min. Negotiated Rate	$2,969.45
Max. Negotiated Rate	$2,969.45
Rate for Payer: Cash Price	$1,055.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,969.45
Rate for Payer: SOMOS Essential	$2,969.45

PR APPENDECTOMY

Professional

Both

$2,896.50

Service Code	HCPCS 44950
Min. Negotiated Rate	$2,172.38
Max. Negotiated Rate	$2,172.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,172.38
Rate for Payer: SOMOS Essential	$2,172.38

PR APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG

Professional

Both

$475.55

Service Code	HCPCS 29450
Min. Negotiated Rate	$356.66
Max. Negotiated Rate	$356.66
Rate for Payer: Cash Price	$128.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$356.66
Rate for Payer: SOMOS Essential	$356.66

PR APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX

Professional

Both

$1,131.41

Service Code	HCPCS 20660
Min. Negotiated Rate	$848.56
Max. Negotiated Rate	$848.56
Rate for Payer: Cash Price	$295.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$848.56
Rate for Payer: SOMOS Essential	$848.56

PR APPL HALO APPLIANCE MAXILLOFACIAL FIXATION SPX

Professional

Both

$1,490.51

Service Code	HCPCS 21100
Min. Negotiated Rate	$1,117.88
Max. Negotiated Rate	$1,117.88
Rate for Payer: Cash Price	$410.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,117.88
Rate for Payer: SOMOS Essential	$1,117.88

PR APPL HALO CRANIAL 6/> PINS THIN SKULL OSTEOLOGY

Professional

Both

$4,200.70

Service Code	HCPCS 20664
Min. Negotiated Rate	$3,150.52
Max. Negotiated Rate	$3,150.52
Rate for Payer: Cash Price	$1,122.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,150.52
Rate for Payer: SOMOS Essential	$3,150.52

PR APPL HIP SPICA CAST ONE&ONE-HALF SPICA/BOTH LEGS

Professional

Both

$775.81

Service Code	HCPCS 29325
Min. Negotiated Rate	$581.86
Max. Negotiated Rate	$581.86
Rate for Payer: Cash Price	$210.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$581.86
Rate for Payer: SOMOS Essential	$581.86

PR APPLICATION BODY CAST SHOULDER HIPS

Professional

Both

$629.27

Service Code	HCPCS 29035
Min. Negotiated Rate	$471.95
Max. Negotiated Rate	$471.95
Rate for Payer: Cash Price	$171.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$471.95
Rate for Payer: SOMOS Essential	$471.95

PR APPLICATION BODY CAST SHOULDER HIPS BOTH THIGHS

Professional

Both

$824.04

Service Code	HCPCS 29046
Min. Negotiated Rate	$618.03
Max. Negotiated Rate	$618.03
Rate for Payer: Cash Price	$223.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$618.03
Rate for Payer: SOMOS Essential	$618.03

PR APPLICATION BODY CAST SHOULDER HIPS HEAD MINERVA

Professional

Both

$756.39

Service Code	HCPCS 29040
Min. Negotiated Rate	$567.29
Max. Negotiated Rate	$567.29
Rate for Payer: Cash Price	$206.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$567.29
Rate for Payer: SOMOS Essential	$567.29

PR APPLICATION BODY CAST SHOULDER HIPS W/ONE THIGH

Professional

Both

$733.92

Service Code	HCPCS 29044
Min. Negotiated Rate	$550.44
Max. Negotiated Rate	$550.44
Rate for Payer: Cash Price	$199.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$550.44
Rate for Payer: SOMOS Essential	$550.44

PR APPLICATION CAST ELBOW FINGER SHORT ARM

Professional

Both

$278.08

Service Code	HCPCS 29075
Min. Negotiated Rate	$208.56
Max. Negotiated Rate	$208.56
Rate for Payer: Cash Price	$74.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$208.56
Rate for Payer: SOMOS Essential	$208.56

PR APPLICATION CAST FIGURE-OF-8

Professional

Both

$304.47

Service Code	HCPCS 29049
Min. Negotiated Rate	$228.35
Max. Negotiated Rate	$228.35
Rate for Payer: Cash Price	$83.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$228.35
Rate for Payer: SOMOS Essential	$228.35

PR APPLICATION CAST FINGER

Professional

Both

$208.92

Service Code	HCPCS 29086
Min. Negotiated Rate	$156.69
Max. Negotiated Rate	$156.69
Rate for Payer: Cash Price	$57.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$156.69
Rate for Payer: SOMOS Essential	$156.69

PR APPLICATION CAST HAND & LOWER FOREARM GAUNTLET

Professional

Both

$294.91

Service Code	HCPCS 29085
Min. Negotiated Rate	$221.18
Max. Negotiated Rate	$221.18
Rate for Payer: Cash Price	$80.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$221.18
Rate for Payer: SOMOS Essential	$221.18

Know your out-of-pocket cost for care.

All Charges