St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR CLSR VESICOUTERINE FISTULA W/HYSTERECTOMY

Professional

Both

$4,698.54

Service Code	HCPCS 51925
Min. Negotiated Rate	$3,523.90
Max. Negotiated Rate	$3,523.90
Rate for Payer: Cash Price	$1,265.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,523.90
Rate for Payer: SOMOS Essential	$3,523.90

PR CLSR VESICOVAG FSTL TRANSVESICAL&VAG APPR

Professional

Both

$3,229.94

Service Code	HCPCS 57330
Min. Negotiated Rate	$2,422.46
Max. Negotiated Rate	$2,422.46
Rate for Payer: Cash Price	$883.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,422.46
Rate for Payer: SOMOS Essential	$2,422.46

PR CLSR VESICOVAGINAL FISTUL AABDL APPROACH

Professional

Both

$3,449.85

Service Code	HCPCS 51900
Min. Negotiated Rate	$2,587.39
Max. Negotiated Rate	$2,587.39
Rate for Payer: Cash Price	$943.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,587.39
Rate for Payer: SOMOS Essential	$2,587.39

PR CLSR V-SEPTAL DFCT W/RMVL P-ART BAND W/WO GUSSET

Professional

Both

$8,372.00

Service Code	HCPCS 33688
Min. Negotiated Rate	$6,279.00
Max. Negotiated Rate	$6,279.00
Rate for Payer: Cash Price	$2,220.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,279.00
Rate for Payer: SOMOS Essential	$6,279.00

PR CLSR V-SEPTL DFCT W/PULM VLVT/INFUND RESCJ

Professional

Both

$8,398.85

Service Code	HCPCS 33684
Min. Negotiated Rate	$6,299.14
Max. Negotiated Rate	$6,299.14
Rate for Payer: Cash Price	$2,229.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,299.14
Rate for Payer: SOMOS Essential	$6,299.14

PR CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT 1ST 25CM/<

Professional

Both

$3,185.11

Service Code	HCPCS 15155
Min. Negotiated Rate	$2,388.83
Max. Negotiated Rate	$2,388.83
Rate for Payer: Cash Price	$857.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,388.83
Rate for Payer: SOMOS Essential	$2,388.83

PR CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT ADDL 1-75CM

Professional

Both

$678.41

Service Code	HCPCS 15156
Min. Negotiated Rate	$508.81
Max. Negotiated Rate	$508.81
Rate for Payer: Cash Price	$180.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$508.81
Rate for Payer: SOMOS Essential	$508.81

PR CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT EA 100 EA

Professional

Both

$740.53

Service Code	HCPCS 15157
Min. Negotiated Rate	$555.40
Max. Negotiated Rate	$555.40
Rate for Payer: Cash Price	$196.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$555.40
Rate for Payer: SOMOS Essential	$555.40

PR CLTR SKIN AGRFT T/A/L ADDL 1 CM-75 CM

Professional

Both

$496.41

Service Code	HCPCS 15151
Min. Negotiated Rate	$372.31
Max. Negotiated Rate	$372.31
Rate for Payer: Cash Price	$130.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$372.31
Rate for Payer: SOMOS Essential	$372.31

PR CLTR SKIN AGRFT T/A/L EA 100 CM/EA 1%BODY AREA

Professional

Both

$622.30

Service Code	HCPCS 15152
Min. Negotiated Rate	$466.72
Max. Negotiated Rate	$466.72
Rate for Payer: Cash Price	$163.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$466.72
Rate for Payer: SOMOS Essential	$466.72

PR CLTR SKIN AUTOGRAFT T/A/L 1ST 25 CM/<

Professional

Both

$2,882.71

Service Code	HCPCS 15150
Min. Negotiated Rate	$2,162.03
Max. Negotiated Rate	$2,162.03
Rate for Payer: Cash Price	$770.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,162.03
Rate for Payer: SOMOS Essential	$2,162.03

PR CLTX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ

Professional

Both

$4,366.78

Service Code	HCPCS 27222
Min. Negotiated Rate	$3,275.08
Max. Negotiated Rate	$3,275.08
Rate for Payer: Cash Price	$1,169.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,275.08
Rate for Payer: SOMOS Essential	$3,275.08

PR CLTX ACETABULUM HIP/SOCKT FX W/O MANJ

Professional

Both

$1,839.25

Service Code	HCPCS 27220
Min. Negotiated Rate	$1,379.44
Max. Negotiated Rate	$1,379.44
Rate for Payer: Cash Price	$498.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,379.44
Rate for Payer: SOMOS Essential	$1,379.44

PR CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ

Professional

Both

$2,176.76

Service Code	HCPCS 27842
Min. Negotiated Rate	$1,632.57
Max. Negotiated Rate	$1,632.57
Rate for Payer: Cash Price	$594.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,632.57
Rate for Payer: SOMOS Essential	$1,632.57

PR CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ

Professional

Both

$1,511.13

Service Code	HCPCS 26742
Min. Negotiated Rate	$1,133.35
Max. Negotiated Rate	$1,133.35
Rate for Payer: Cash Price	$410.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,133.35
Rate for Payer: SOMOS Essential	$1,133.35

PR CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ

Professional

Both

$987.25

Service Code	HCPCS 26740
Min. Negotiated Rate	$740.44
Max. Negotiated Rate	$740.44
Rate for Payer: Cash Price	$272.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$740.44
Rate for Payer: SOMOS Essential	$740.44

PR CLTX CARPAL BONE FX W/MANJ EACH BONE

Professional

Both

$1,894.45

Service Code	HCPCS 25635
Min. Negotiated Rate	$1,420.84
Max. Negotiated Rate	$1,420.84
Rate for Payer: Cash Price	$519.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,420.84
Rate for Payer: SOMOS Essential	$1,420.84

PR CLTX CARPAL BONE FX W/O MANJ EACH BONE

Professional

Both

$1,279.95

Service Code	HCPCS 25630
Min. Negotiated Rate	$959.96
Max. Negotiated Rate	$959.96
Rate for Payer: Cash Price	$350.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$959.96
Rate for Payer: SOMOS Essential	$959.96

PR CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ

Professional

Both

$1,713.39

Service Code	HCPCS 26641
Min. Negotiated Rate	$1,285.04
Max. Negotiated Rate	$1,285.04
Rate for Payer: Cash Price	$470.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,285.04
Rate for Payer: SOMOS Essential	$1,285.04

PR CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ

Professional

Both

$1,772.82

Service Code	HCPCS 26645
Min. Negotiated Rate	$1,329.62
Max. Negotiated Rate	$1,329.62
Rate for Payer: Cash Price	$484.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,329.62
Rate for Payer: SOMOS Essential	$1,329.62

PR CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES

Professional

Both

$1,403.68

Service Code	HCPCS 26670
Min. Negotiated Rate	$1,052.76
Max. Negotiated Rate	$1,052.76
Rate for Payer: Cash Price	$386.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,052.76
Rate for Payer: SOMOS Essential	$1,052.76

PR CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES

Professional

Both

$1,895.29

Service Code	HCPCS 26675
Min. Negotiated Rate	$1,421.47
Max. Negotiated Rate	$1,421.47
Rate for Payer: Cash Price	$518.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,421.47
Rate for Payer: SOMOS Essential	$1,421.47

PR CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ

Professional

Both

$2,169.37

Service Code	HCPCS 27516
Min. Negotiated Rate	$1,627.03
Max. Negotiated Rate	$1,627.03
Rate for Payer: Cash Price	$592.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,627.03
Rate for Payer: SOMOS Essential	$1,627.03

PR CLTX DSTL FEM EPIPHYSL SEP W/MANJ W/WO SKIN/SKEL

Professional

Both

$3,071.57

Service Code	HCPCS 27517
Min. Negotiated Rate	$2,303.68
Max. Negotiated Rate	$2,303.68
Rate for Payer: Cash Price	$830.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,303.68
Rate for Payer: SOMOS Essential	$2,303.68

PR CLTX DSTL FIBULAR FX LAT MALLS W/MANJ

Professional

Both

$1,724.56

Service Code	HCPCS 27788
Min. Negotiated Rate	$1,293.42
Max. Negotiated Rate	$1,293.42
Rate for Payer: Cash Price	$470.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,293.42
Rate for Payer: SOMOS Essential	$1,293.42

Know your out-of-pocket cost for care.

All Charges