St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<

Professional

Both

$621.64

Service Code	HCPCS 40830
Min. Negotiated Rate	$466.23
Max. Negotiated Rate	$466.23
Rate for Payer: Cash Price	$168.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$466.23
Rate for Payer: SOMOS Essential	$466.23

PR CLOSURE LACERATION VESTIBULE MOUTH > 2.5 CM/CPL

Professional

Both

$855.47

Service Code	HCPCS 40831
Min. Negotiated Rate	$641.60
Max. Negotiated Rate	$641.60
Rate for Payer: Cash Price	$232.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$641.60
Rate for Payer: SOMOS Essential	$641.60

PR CLOSURE LACRIMAL FISTULA SPX

Professional

Both

$2,581.78

Service Code	HCPCS 68770
Min. Negotiated Rate	$1,936.34
Max. Negotiated Rate	$1,936.34
Rate for Payer: Cash Price	$709.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,936.34
Rate for Payer: SOMOS Essential	$1,936.34

PR CLOSURE MULTIPLE VENTRICULAR SEPTAL DEFECTS

Professional

Both

$8,761.34

Service Code	HCPCS 33675
Min. Negotiated Rate	$6,571.00
Max. Negotiated Rate	$6,571.00
Rate for Payer: Cash Price	$2,327.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,571.00
Rate for Payer: SOMOS Essential	$6,571.00

PR CLOSURE MULTIPLE VSD W/REMOVAL ARTERY BAND

Professional

Both

$9,341.99

Service Code	HCPCS 33677
Min. Negotiated Rate	$7,006.49
Max. Negotiated Rate	$7,006.49
Rate for Payer: Cash Price	$2,481.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,006.49
Rate for Payer: SOMOS Essential	$7,006.49

PR CLOSURE MULTIPLE VSD W/RESECTION

Professional

Both

$9,000.71

Service Code	HCPCS 33676
Min. Negotiated Rate	$6,750.53
Max. Negotiated Rate	$6,750.53
Rate for Payer: Cash Price	$2,389.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,750.53
Rate for Payer: SOMOS Essential	$6,750.53

PR CLOSURE NEPHROCUTANEOUS/PYELOCUTANEOUS FISTULA

Professional

Both

$5,252.94

Service Code	HCPCS 50520
Min. Negotiated Rate	$3,939.70
Max. Negotiated Rate	$3,939.70
Rate for Payer: Cash Price	$1,399.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,939.70
Rate for Payer: SOMOS Essential	$3,939.70

PR CLOSURE POSTAURICULAR FISTULA MASTOID SPX

Professional

Both

$2,891.91

Service Code	HCPCS 69700
Min. Negotiated Rate	$2,168.93
Max. Negotiated Rate	$2,168.93
Rate for Payer: Cash Price	$782.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,168.93
Rate for Payer: SOMOS Essential	$2,168.93

PR CLOSURE RECTOURETHRAL FISTULA

Professional

Both

$5,765.06

Service Code	HCPCS 45820
Min. Negotiated Rate	$4,323.80
Max. Negotiated Rate	$4,323.80
Rate for Payer: Cash Price	$1,534.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,323.80
Rate for Payer: SOMOS Essential	$4,323.80

PR CLOSURE RECTOURETHRAL FISTULA W/COLOSTOMY

Professional

Both

$6,945.12

Service Code	HCPCS 45825
Min. Negotiated Rate	$5,208.84
Max. Negotiated Rate	$5,208.84
Rate for Payer: Cash Price	$1,848.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,208.84
Rate for Payer: SOMOS Essential	$5,208.84

PR CLOSURE RECTOVESICAL FISTULA

Professional

Both

$5,750.50

Service Code	HCPCS 45800
Min. Negotiated Rate	$4,312.88
Max. Negotiated Rate	$4,312.88
Rate for Payer: Cash Price	$1,530.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,312.88
Rate for Payer: SOMOS Essential	$4,312.88

PR CLOSURE SALIVARY FISTULA

Professional

Both

$1,543.26

Service Code	HCPCS 42600
Min. Negotiated Rate	$1,157.44
Max. Negotiated Rate	$1,157.44
Rate for Payer: Cash Price	$420.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,157.44
Rate for Payer: SOMOS Essential	$1,157.44

PR CLOSURE SEMILUNAR VALVE AORTIC/PULM SUTURE/PATCH

Professional

Both

$7,427.84

Service Code	HCPCS 33602
Min. Negotiated Rate	$5,570.88
Max. Negotiated Rate	$5,570.88
Rate for Payer: Cash Price	$1,978.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,570.88
Rate for Payer: SOMOS Essential	$5,570.88

PR CLOSURE URETEROCUTANEOUS FISTULA

Professional

Both

$3,686.24

Service Code	HCPCS 50920
Min. Negotiated Rate	$2,764.68
Max. Negotiated Rate	$2,764.68
Rate for Payer: Cash Price	$1,008.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,764.68
Rate for Payer: SOMOS Essential	$2,764.68

PR CLOSURE URETEROCUTANEOUS FISTULA W/VISC RPR

Professional

Both

$4,596.90

Service Code	HCPCS 50930
Min. Negotiated Rate	$3,447.68
Max. Negotiated Rate	$3,447.68
Rate for Payer: Cash Price	$1,254.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,447.68
Rate for Payer: SOMOS Essential	$3,447.68

PR CLOSURE URETHROVAGINAL FISTULA

Professional

Both

$2,088.31

Service Code	HCPCS 57310
Min. Negotiated Rate	$1,566.23
Max. Negotiated Rate	$1,566.23
Rate for Payer: Cash Price	$572.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,566.23
Rate for Payer: SOMOS Essential	$1,566.23

PR CLOSURE VESICOUTERINE FISTULA

Professional

Both

$3,199.81

Service Code	HCPCS 51920
Min. Negotiated Rate	$2,399.86
Max. Negotiated Rate	$2,399.86
Rate for Payer: Cash Price	$875.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,399.86
Rate for Payer: SOMOS Essential	$2,399.86

PR CLOSURE VESICOVAGINAL FISTULA VAGINAL APPROACH

Professional

Both

$2,474.54

Service Code	HCPCS 57320
Min. Negotiated Rate	$1,855.90
Max. Negotiated Rate	$1,855.90
Rate for Payer: Cash Price	$667.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,855.90
Rate for Payer: SOMOS Essential	$1,855.90

PR CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION

Professional

Both

$1,457.47

Service Code	HCPCS 23545
Min. Negotiated Rate	$1,093.10
Max. Negotiated Rate	$1,093.10
Rate for Payer: Cash Price	$400.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,093.10
Rate for Payer: SOMOS Essential	$1,093.10

PR CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION

Professional

Both

$1,065.44

Service Code	HCPCS 23540
Min. Negotiated Rate	$799.08
Max. Negotiated Rate	$799.08
Rate for Payer: Cash Price	$292.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$799.08
Rate for Payer: SOMOS Essential	$799.08

PR CLSD TX CLAVICULAR FRACTURE W/MANIPULATION

Professional

Both

$1,497.09

Service Code	HCPCS 23505
Min. Negotiated Rate	$1,122.82
Max. Negotiated Rate	$1,122.82
Rate for Payer: Cash Price	$410.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,122.82
Rate for Payer: SOMOS Essential	$1,122.82

PR CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION

Professional

Both

$1,029.70

Service Code	HCPCS 23500
Min. Negotiated Rate	$772.28
Max. Negotiated Rate	$772.28
Rate for Payer: Cash Price	$282.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$772.28
Rate for Payer: SOMOS Essential	$772.28

PR CLSD TX FX ORBIT EXCEPT BLOWOUT W/O MANIPULATION

Professional

Both

$731.96

Service Code	HCPCS 21400
Min. Negotiated Rate	$548.97
Max. Negotiated Rate	$548.97
Rate for Payer: Cash Price	$203.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$548.97
Rate for Payer: SOMOS Essential	$548.97

PR CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION

Professional

Both

$1,500.38

Service Code	HCPCS 24500
Min. Negotiated Rate	$1,125.28
Max. Negotiated Rate	$1,125.28
Rate for Payer: Cash Price	$412.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,125.28
Rate for Payer: SOMOS Essential	$1,125.28

PR CLSD TX PELVIC RING FX W/MANIPULATION W/ANES

Professional

Both

$1,376.90

Service Code	HCPCS 27198
Min. Negotiated Rate	$1,032.68
Max. Negotiated Rate	$1,032.68
Rate for Payer: Cash Price	$372.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,032.68
Rate for Payer: SOMOS Essential	$1,032.68

Know your out-of-pocket cost for care.

All Charges