St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR CLSD TX PELVIC RING FX W/O MANIPULATION

Professional

Both

$588.53

Service Code	HCPCS 27197
Min. Negotiated Rate	$441.40
Max. Negotiated Rate	$441.40
Rate for Payer: Cash Price	$159.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$441.40
Rate for Payer: SOMOS Essential	$441.40

PR CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES

Professional

Both

$1,818.22

Service Code	HCPCS 23655
Min. Negotiated Rate	$1,363.66
Max. Negotiated Rate	$1,363.66
Rate for Payer: Cash Price	$496.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,363.66
Rate for Payer: SOMOS Essential	$1,363.66

PR CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES

Professional

Both

$1,352.12

Service Code	HCPCS 23650
Min. Negotiated Rate	$1,014.09
Max. Negotiated Rate	$1,014.09
Rate for Payer: Cash Price	$370.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,014.09
Rate for Payer: SOMOS Essential	$1,014.09

PR CLSD TX STERNOCLAVICULAR DISLC W/O MANIPULATION

Professional

Both

$1,069.88

Service Code	HCPCS 23520
Min. Negotiated Rate	$802.41
Max. Negotiated Rate	$802.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$802.41
Rate for Payer: SOMOS Essential	$802.41

PR CLSR 1 VENTRICULAR SEPTAL DEFECT W/WO PATCH

Professional

Both

$8,207.57

Service Code	HCPCS 33681
Min. Negotiated Rate	$6,155.68
Max. Negotiated Rate	$6,155.68
Rate for Payer: Cash Price	$2,184.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,155.68
Rate for Payer: SOMOS Essential	$6,155.68

PR CLSR ANAL FSTL W/RCT ADVMNT FLAP

Professional

Both

$2,433.45

Service Code	HCPCS 46288
Min. Negotiated Rate	$1,825.09
Max. Negotiated Rate	$1,825.09
Rate for Payer: Cash Price	$660.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,825.09
Rate for Payer: SOMOS Essential	$1,825.09

PR CLSR CH WALL FLWG OPN FLAP DRG EMPYEMA

Professional

Both

$4,013.38

Service Code	HCPCS 32810
Min. Negotiated Rate	$3,010.04
Max. Negotiated Rate	$3,010.04
Rate for Payer: Cash Price	$1,073.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,010.04
Rate for Payer: SOMOS Essential	$3,010.04

PR CLSR ENTEROENTERIC/ENTEROCOLIC FSTL

Professional

Both

$6,379.38

Service Code	HCPCS 44650
Min. Negotiated Rate	$4,784.54
Max. Negotiated Rate	$4,784.54
Rate for Payer: Cash Price	$1,702.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,784.54
Rate for Payer: SOMOS Essential	$4,784.54

PR CLSR ENTEROVES FSTL W/INTESTINE&/BLADDER RESCJ

Professional

Both

$6,809.15

Service Code	HCPCS 44661
Min. Negotiated Rate	$5,106.86
Max. Negotiated Rate	$5,106.86
Rate for Payer: Cash Price	$1,815.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,106.86
Rate for Payer: SOMOS Essential	$5,106.86

PR CLSR ENTEROVES FSTL W/O INTSTINAL/BLADDER RESCJ

Professional

Both

$5,804.51

Service Code	HCPCS 44660
Min. Negotiated Rate	$4,353.38
Max. Negotiated Rate	$4,353.38
Rate for Payer: Cash Price	$1,575.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,353.38
Rate for Payer: SOMOS Essential	$4,353.38

PR CLSR ESOPHAGOSTOMY/FSTL CRV APPR

Professional

Both

$4,387.01

Service Code	HCPCS 43420
Min. Negotiated Rate	$3,290.26
Max. Negotiated Rate	$3,290.26
Rate for Payer: Cash Price	$1,185.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,290.26
Rate for Payer: SOMOS Essential	$3,290.26

PR CLSR ESOPHAGOSTOMY/FSTL TTHRC/TABDL APPR

Professional

Both

$6,439.27

Service Code	HCPCS 43425
Min. Negotiated Rate	$4,829.45
Max. Negotiated Rate	$4,829.45
Rate for Payer: Cash Price	$1,714.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,829.45
Rate for Payer: SOMOS Essential	$4,829.45

PR CLSR LACRIMAL PUNCTUM PLUG EACH

Professional

Both

$481.67

Service Code	HCPCS 68761
Min. Negotiated Rate	$361.25
Max. Negotiated Rate	$361.25
Rate for Payer: Cash Price	$132.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$361.25
Rate for Payer: SOMOS Essential	$361.25

PR CLSR LACRIMAL PUNCTUM THERMOCAUT LIG/LASER

Professional

Both

$601.93

Service Code	HCPCS 68760
Min. Negotiated Rate	$451.45
Max. Negotiated Rate	$451.45
Rate for Payer: Cash Price	$166.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$451.45
Rate for Payer: SOMOS Essential	$451.45

PR CLSR NEPHROVISCERAL FISTULA W/VISC RPR ABDL APPR

Professional

Both

$6,657.18

Service Code	HCPCS 50525
Min. Negotiated Rate	$4,992.88
Max. Negotiated Rate	$4,992.88
Rate for Payer: Cash Price	$1,773.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,992.88
Rate for Payer: SOMOS Essential	$4,992.88

PR CLSR NEPHROVISCERAL FISTULA W/VISC RPR THRC APPR

Professional

Both

$7,132.48

Service Code	HCPCS 50526
Min. Negotiated Rate	$5,349.36
Max. Negotiated Rate	$5,349.36
Rate for Payer: Cash Price	$1,898.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,349.36
Rate for Payer: SOMOS Essential	$5,349.36

PR CLSR NTRSTM LG/SM RESCJ & ANAST OTH/THN CLRCT

Professional

Both

$4,438.63

Service Code	HCPCS 44625
Min. Negotiated Rate	$3,328.97
Max. Negotiated Rate	$3,328.97
Rate for Payer: Cash Price	$1,190.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,328.97
Rate for Payer: SOMOS Essential	$3,328.97

PR CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS

Professional

Both

$7,077.95

Service Code	HCPCS 44626
Min. Negotiated Rate	$5,308.46
Max. Negotiated Rate	$5,308.46
Rate for Payer: Cash Price	$1,883.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,308.46
Rate for Payer: SOMOS Essential	$5,308.46

PR CLSR RECTOVAG FSTL ABDL APPR W/CONCOMITANT CLST

Professional

Both

$4,634.46

Service Code	HCPCS 57307
Min. Negotiated Rate	$3,475.84
Max. Negotiated Rate	$3,475.84
Rate for Payer: Cash Price	$1,253.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,475.84
Rate for Payer: SOMOS Essential	$3,475.84

PR CLSR RECTOVAG FSTL TPRNL PRNL BDY RCNSTJ

Professional

Both

$2,839.45

Service Code	HCPCS 57308
Min. Negotiated Rate	$2,129.59
Max. Negotiated Rate	$2,129.59
Rate for Payer: Cash Price	$773.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,129.59
Rate for Payer: SOMOS Essential	$2,129.59

PR CLSR RECTOVAGINAL FISTULA ABDOMINAL APPROACH

Professional

Both

$4,339.13

Service Code	HCPCS 57305
Min. Negotiated Rate	$3,254.35
Max. Negotiated Rate	$3,254.35
Rate for Payer: Cash Price	$1,157.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,254.35
Rate for Payer: SOMOS Essential	$3,254.35

PR CLSR RECTOVAGINAL FISTULA VAGINAL/TRANSANAL APPR

Professional

Both

$2,674.60

Service Code	HCPCS 57300
Min. Negotiated Rate	$2,005.95
Max. Negotiated Rate	$2,005.95
Rate for Payer: Cash Price	$725.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,005.95
Rate for Payer: SOMOS Essential	$2,005.95

PR CLSR RECTOVESICAL FISTULA W/COLOSTOMY

Professional

Both

$6,634.57

Service Code	HCPCS 45805
Min. Negotiated Rate	$4,975.93
Max. Negotiated Rate	$4,975.93
Rate for Payer: Cash Price	$1,766.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,975.93
Rate for Payer: SOMOS Essential	$4,975.93

PR CLSR URETHROSTOMY/URETHROQ FSTL MALE SPX

Professional

Both

$2,348.96

Service Code	HCPCS 53520
Min. Negotiated Rate	$1,761.72
Max. Negotiated Rate	$1,761.72
Rate for Payer: Cash Price	$645.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,761.72
Rate for Payer: SOMOS Essential	$1,761.72

PR CLSR URETHROVAG FSTL W/BULBOCAVERNOSUS TRNSPL

Professional

Both

$2,350.43

Service Code	HCPCS 57311
Min. Negotiated Rate	$1,762.82
Max. Negotiated Rate	$1,762.82
Rate for Payer: Cash Price	$644.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,762.82
Rate for Payer: SOMOS Essential	$1,762.82

Know your out-of-pocket cost for care.

All Charges