St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR CYSTO INSERTION TRANSPROSTATIC IMPLANT EA ADDL

Professional

Both

$209.65

Service Code	HCPCS 52442
Min. Negotiated Rate	$157.24
Max. Negotiated Rate	$157.24
Rate for Payer: Cash Price	$56.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$157.24
Rate for Payer: SOMOS Essential	$157.24

PR CYSTO INSERTION TRANSPROSTATIC IMPLANT SINGLE

Professional

Both

$866.78

Service Code	HCPCS 52441
Min. Negotiated Rate	$650.08
Max. Negotiated Rate	$650.08
Rate for Payer: Cash Price	$236.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$650.08
Rate for Payer: SOMOS Essential	$650.08

PR CYSTO INSJ URTRL GD WIRE PRQ NFROS RTRGR

Professional

Both

$759.96

Service Code	HCPCS 52334
Min. Negotiated Rate	$569.97
Max. Negotiated Rate	$569.97
Rate for Payer: Cash Price	$206.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$569.97
Rate for Payer: SOMOS Essential	$569.97

PR CYSTOLITHOTOMY CYSTOTOMY W/RMVL CALCULUS

Professional

Both

$1,982.65

Service Code	HCPCS 51050
Min. Negotiated Rate	$1,486.99
Max. Negotiated Rate	$1,486.99
Rate for Payer: Cash Price	$544.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,486.99
Rate for Payer: SOMOS Essential	$1,486.99

PR CYSTO MANJ W/O RMVL URETERAL STONE

Professional

Both

$1,087.56

Service Code	HCPCS 52330
Min. Negotiated Rate	$815.67
Max. Negotiated Rate	$815.67
Rate for Payer: Cash Price	$296.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$815.67
Rate for Payer: SOMOS Essential	$815.67

PR CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION

Professional

Both

$1,721.93

Service Code	HCPCS 52354
Min. Negotiated Rate	$1,291.45
Max. Negotiated Rate	$1,291.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,291.45
Rate for Payer: SOMOS Essential	$1,291.45

PR CYSTO/PYELOSCOPY RESCJ PELVIC TUMOR

Professional

Both

$1,927.59

Service Code	HCPCS 52355
Min. Negotiated Rate	$1,445.69
Max. Negotiated Rate	$1,445.69
Rate for Payer: Cash Price	$526.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,445.69
Rate for Payer: SOMOS Essential	$1,445.69

PR CYSTORRHAPHY SUTR BLDR WND INJ/RPT COMPLICATED

Professional

Both

$3,793.51

Service Code	HCPCS 51865
Min. Negotiated Rate	$2,845.13
Max. Negotiated Rate	$2,845.13
Rate for Payer: Cash Price	$1,031.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,845.13
Rate for Payer: SOMOS Essential	$2,845.13

PR CYSTORRHAPHY SUTR BLDR WND INJ/RPT SIMPLE

Professional

Both

$3,194.66

Service Code	HCPCS 51860
Min. Negotiated Rate	$2,396.00
Max. Negotiated Rate	$2,396.00
Rate for Payer: Cash Price	$866.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,396.00
Rate for Payer: SOMOS Essential	$2,396.00

PR CYSTOSTOMY CYSTOTOMY W/DRAINAGE

Professional

Both

$1,229.06

Service Code	HCPCS 51040
Min. Negotiated Rate	$921.80
Max. Negotiated Rate	$921.80
Rate for Payer: Cash Price	$338.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$921.80
Rate for Payer: SOMOS Essential	$921.80

PR CYSTOTOMY/CYSTOSTOMY FULG&/INSJ RADACT MATRL

Professional

Both

$1,978.34

Service Code	HCPCS 51020
Min. Negotiated Rate	$1,483.76
Max. Negotiated Rate	$1,483.76
Rate for Payer: Cash Price	$544.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,483.76
Rate for Payer: SOMOS Essential	$1,483.76

PR CYSTOTOMY EXCISE BLADDER DIVERTICULUM 1/MULTIPLE

Professional

Both

$3,609.55

Service Code	HCPCS 51525
Min. Negotiated Rate	$2,707.16
Max. Negotiated Rate	$2,707.16
Rate for Payer: Cash Price	$981.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,707.16
Rate for Payer: SOMOS Essential	$2,707.16

PR CYSTOTOMY EXCISE/INCISE/REPAIR URETEROCELE

Professional

Both

$3,266.10

Service Code	HCPCS 51535
Min. Negotiated Rate	$2,449.58
Max. Negotiated Rate	$2,449.58
Rate for Payer: Cash Price	$892.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,449.58
Rate for Payer: SOMOS Essential	$2,449.58

PR CYSTOTOMY EXCISION BLADDER TUMOR

Professional

Both

$3,224.03

Service Code	HCPCS 51530
Min. Negotiated Rate	$2,418.02
Max. Negotiated Rate	$2,418.02
Rate for Payer: Cash Price	$882.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,418.02
Rate for Payer: SOMOS Essential	$2,418.02

PR CYSTOTOMY SIMPLE EXCISION VESICAL NECK

Professional

Both

$2,501.10

Service Code	HCPCS 51520
Min. Negotiated Rate	$1,875.82
Max. Negotiated Rate	$1,875.82
Rate for Payer: Cash Price	$685.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,875.82
Rate for Payer: SOMOS Essential	$1,875.82

PR CYSTOTOMY W/CALCULUS BASKET XTRJ&/FRAGMENTATIO

Professional

Both

$2,438.63

Service Code	HCPCS 51065
Min. Negotiated Rate	$1,828.97
Max. Negotiated Rate	$1,828.97
Rate for Payer: Cash Price	$668.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,828.97
Rate for Payer: SOMOS Essential	$1,828.97

PR CYSTOTOMY W/INSJ URETERAL CATH/STENT SPX

Professional

Both

$2,168.81

Service Code	HCPCS 51045
Min. Negotiated Rate	$1,626.61
Max. Negotiated Rate	$1,626.61
Rate for Payer: Cash Price	$584.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,626.61
Rate for Payer: SOMOS Essential	$1,626.61

PR CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT

Professional

Both

$1,716.16

Service Code	HCPCS 52356
Min. Negotiated Rate	$1,287.12
Max. Negotiated Rate	$1,287.12
Rate for Payer: Cash Price	$468.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,287.12
Rate for Payer: SOMOS Essential	$1,287.12

PR CYSTOURETHROSCOPY

Professional

Both

$335.62

Service Code	HCPCS 52000
Min. Negotiated Rate	$251.72
Max. Negotiated Rate	$251.72
Rate for Payer: Cash Price	$91.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$251.72
Rate for Payer: SOMOS Essential	$251.72

PR CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER

Professional

Both

$707.04

Service Code	HCPCS 52287
Min. Negotiated Rate	$530.28
Max. Negotiated Rate	$530.28
Rate for Payer: Cash Price	$191.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$530.28
Rate for Payer: SOMOS Essential	$530.28

PR CYSTOURETHROSCOPY INSERTION PERM URETHRAL STENT

Professional

Both

$1,394.68

Service Code	HCPCS 52282
Min. Negotiated Rate	$1,046.01
Max. Negotiated Rate	$1,046.01
Rate for Payer: Cash Price	$381.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,046.01
Rate for Payer: SOMOS Essential	$1,046.01

PR CYSTOURETHROSCOPY INSJ RADIOACT SBST W/WOBX/FULG

Professional

Both

$991.87

Service Code	HCPCS 52250
Min. Negotiated Rate	$743.90
Max. Negotiated Rate	$743.90
Rate for Payer: Cash Price	$269.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$743.90
Rate for Payer: SOMOS Essential	$743.90

PR CYSTOURETHROSCOPY TX FEMALE URETHRAL SYNDROME

Professional

Both

$812.77

Service Code	HCPCS 52285
Min. Negotiated Rate	$609.58
Max. Negotiated Rate	$609.58
Rate for Payer: Cash Price	$222.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$609.58
Rate for Payer: SOMOS Essential	$609.58

PR CYSTOURETHROSCOPY W/DEST &/RMVL MED BLADDER TUM

Professional

Both

$1,194.13

Service Code	HCPCS 52235
Min. Negotiated Rate	$895.60
Max. Negotiated Rate	$895.60
Rate for Payer: Cash Price	$325.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$895.60
Rate for Payer: SOMOS Essential	$895.60

PR CYSTOURETHROSCOPY W/DEST &/RMVL TUMOR LARGE

Professional

Both

$1,621.17

Service Code	HCPCS 52240
Min. Negotiated Rate	$1,215.88
Max. Negotiated Rate	$1,215.88
Rate for Payer: Cash Price	$442.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,215.88
Rate for Payer: SOMOS Essential	$1,215.88

Know your out-of-pocket cost for care.

All Charges