St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR BLADDER PRESSURE MEASUREMENT DURING FILLING

Professional

Both

$944.16

Service Code	HCPCS 51726 TC
Min. Negotiated Rate	$708.12
Max. Negotiated Rate	$708.12
Rate for Payer: Cash Price	$257.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$708.12
Rate for Payer: SOMOS Essential	$708.12

PR BLADDER PRESSURE MEASUREMENT DURING FILLING

Professional

Both

$348.39

Service Code	HCPCS 51726 26
Min. Negotiated Rate	$261.29
Max. Negotiated Rate	$261.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$261.29
Rate for Payer: SOMOS Essential	$261.29

PR BLADDER PRESSURE MEASUREMENT DURING FILLING

Professional

Both

$1,292.52

Service Code	HCPCS 51726
Min. Negotiated Rate	$969.39
Max. Negotiated Rate	$969.39
Rate for Payer: Cash Price	$350.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$969.39
Rate for Payer: SOMOS Essential	$969.39

PR BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ ALGNC

Professional

Both

$341.74

Service Code	HCPCS 38205
Min. Negotiated Rate	$256.30
Max. Negotiated Rate	$256.30
Rate for Payer: Cash Price	$93.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$256.30
Rate for Payer: SOMOS Essential	$256.30

PR BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL

Professional

Both

$338.87

Service Code	HCPCS 38206
Min. Negotiated Rate	$254.15
Max. Negotiated Rate	$254.15
Rate for Payer: Cash Price	$91.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$254.15
Rate for Payer: SOMOS Essential	$254.15

PR BLDR IRRIGATION SMPL LAVAGE &/INSTLJ

Professional

Both

$127.23

Service Code	HCPCS 51700
Min. Negotiated Rate	$95.42
Max. Negotiated Rate	$95.42
Rate for Payer: Cash Price	$34.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$95.42
Rate for Payer: SOMOS Essential	$95.42

PR BLEPHAROPLASTY LOWER EYELID

Professional

Both

$2,142.95

Service Code	HCPCS 15820
Min. Negotiated Rate	$1,607.21
Max. Negotiated Rate	$1,607.21
Rate for Payer: Cash Price	$591.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,607.21
Rate for Payer: SOMOS Essential	$1,607.21

PR BLEPHAROPLASTY LOWER EYELID HERNIATED FAT PAD

Professional

Both

$2,308.04

Service Code	HCPCS 15821
Min. Negotiated Rate	$1,731.03
Max. Negotiated Rate	$1,731.03
Rate for Payer: Cash Price	$633.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,731.03
Rate for Payer: SOMOS Essential	$1,731.03

PR BLEPHAROPLASTY UPPER EYELID

Professional

Both

$1,689.94

Service Code	HCPCS 15822
Min. Negotiated Rate	$1,267.46
Max. Negotiated Rate	$1,267.46
Rate for Payer: Cash Price	$462.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,267.46
Rate for Payer: SOMOS Essential	$1,267.46

PR BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN

Professional

Both

$2,301.08

Service Code	HCPCS 15823
Min. Negotiated Rate	$1,725.81
Max. Negotiated Rate	$1,725.81
Rate for Payer: Cash Price	$632.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,725.81
Rate for Payer: SOMOS Essential	$1,725.81

PR BLEPHAROTOMY DRAINAGE ABSCESS EYELID

Professional

Both

$481.46

Service Code	HCPCS 67700
Min. Negotiated Rate	$361.10
Max. Negotiated Rate	$361.10
Rate for Payer: Cash Price	$132.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$361.10
Rate for Payer: SOMOS Essential	$361.10

PR BLOOD EXCHANGE TRANSFUSION NEWBORN

Professional

Both

$683.87

Service Code	HCPCS 36450
Min. Negotiated Rate	$512.90
Max. Negotiated Rate	$512.90
Rate for Payer: Cash Price	$187.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$512.90
Rate for Payer: SOMOS Essential	$512.90

PR BLOOD EXCHANGE TRANSFUSION OTHER THAN NEWBORN

Professional

Both

$560.81

Service Code	HCPCS 36455
Min. Negotiated Rate	$420.61
Max. Negotiated Rate	$420.61
Rate for Payer: Cash Price	$147.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$420.61
Rate for Payer: SOMOS Essential	$420.61

PR BONE GRAFT ANY DONOR AREA MAJOR/LARGE

Professional

Both

$1,201.80

Service Code	HCPCS 20902
Min. Negotiated Rate	$901.35
Max. Negotiated Rate	$901.35
Rate for Payer: Cash Price	$322.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$901.35
Rate for Payer: SOMOS Essential	$901.35

PR BONE GRAFT ANY DONOR AREA MINOR/SMALL

Professional

Both

$786.98

Service Code	HCPCS 20900
Min. Negotiated Rate	$590.24
Max. Negotiated Rate	$590.24
Rate for Payer: Cash Price	$210.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$590.24
Rate for Payer: SOMOS Essential	$590.24

PR BONE GRAFT MICROVASCULAR ANAST ILIAC CREST

Professional

Both

$11,617.73

Service Code	HCPCS 20956
Min. Negotiated Rate	$8,713.30
Max. Negotiated Rate	$8,713.30
Rate for Payer: Cash Price	$3,121.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,713.30
Rate for Payer: SOMOS Essential	$8,713.30

PR BONE GRAFT MICROVASCULAR ANAST METATARSAL

Professional

Both

$12,096.28

Service Code	HCPCS 20957
Min. Negotiated Rate	$9,072.21
Max. Negotiated Rate	$9,072.21
Rate for Payer: Cash Price	$3,252.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9,072.21
Rate for Payer: SOMOS Essential	$9,072.21

PR BONE GRAFT MICROVASCULAR ANASTOMOSIS FIBULA

Professional

Both

$10,599.40

Service Code	HCPCS 20955
Min. Negotiated Rate	$7,949.55
Max. Negotiated Rate	$7,949.55
Rate for Payer: Cash Price	$2,838.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,949.55
Rate for Payer: SOMOS Essential	$7,949.55

PR BONE GRF W/MVASC ANAST OTH/THN ILIAC CREST/METAR

Professional

Both

$11,732.91

Service Code	HCPCS 20962
Min. Negotiated Rate	$8,799.68
Max. Negotiated Rate	$8,799.68
Rate for Payer: Cash Price	$3,163.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,799.68
Rate for Payer: SOMOS Essential	$8,799.68

PR BONE MARROW ASPIRATION BONE GRFG SPI SURG ONLY

Professional

Both

$323.12

Service Code	HCPCS 20939
Min. Negotiated Rate	$242.34
Max. Negotiated Rate	$242.34
Rate for Payer: Cash Price	$84.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$242.34
Rate for Payer: SOMOS Essential	$242.34

PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC

Professional

Both

$892.82

Service Code	HCPCS 38230
Min. Negotiated Rate	$669.62
Max. Negotiated Rate	$669.62
Rate for Payer: Cash Price	$238.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$669.62
Rate for Payer: SOMOS Essential	$669.62

PR BONE MARROW HARVEST TRANSPLANTATION AUTOLOGOUS

Professional

Both

$820.86

Service Code	HCPCS 38232
Min. Negotiated Rate	$615.64
Max. Negotiated Rate	$615.64
Rate for Payer: Cash Price	$216.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$615.64
Rate for Payer: SOMOS Essential	$615.64

PR BPCI ADVANCED IN HOME VISIT

Professional

Both

$197.37

Service Code	HCPCS G9987
Min. Negotiated Rate	$148.03
Max. Negotiated Rate	$148.03
Rate for Payer: Cash Price	$56.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$148.03
Rate for Payer: SOMOS Essential	$148.03

PR BPCI HOME VISIT

Professional

Both

$197.37

Service Code	HCPCS G9187
Min. Negotiated Rate	$148.03
Max. Negotiated Rate	$148.03
Rate for Payer: Cash Price	$56.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$148.03
Rate for Payer: SOMOS Essential	$148.03

PR BREAST AUGMENTATION WITH IMPLANT

Professional

Both

$2,692.73

Service Code	HCPCS 19325
Min. Negotiated Rate	$2,019.55
Max. Negotiated Rate	$2,019.55
Rate for Payer: Cash Price	$728.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,019.55
Rate for Payer: SOMOS Essential	$2,019.55

Know your out-of-pocket cost for care.

All Charges