St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR CYSTOURETHROSCOPY W/DIL BLADDER GENERAL ANESTH

Professional

Both

$879.52

Service Code	HCPCS 52260
Min. Negotiated Rate	$659.64
Max. Negotiated Rate	$659.64
Rate for Payer: Cash Price	$238.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$659.64
Rate for Payer: SOMOS Essential	$659.64

PR CYSTOURETHROSCOPY W/DIL BLADDER LOCAL ANESTHESIA

Professional

Both

$679.21

Service Code	HCPCS 52265
Min. Negotiated Rate	$509.41
Max. Negotiated Rate	$509.41
Rate for Payer: Cash Price	$185.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$509.41
Rate for Payer: SOMOS Essential	$509.41

PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY FEMALE

Professional

Both

$751.66

Service Code	HCPCS 52270
Min. Negotiated Rate	$563.74
Max. Negotiated Rate	$563.74
Rate for Payer: Cash Price	$205.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$563.74
Rate for Payer: SOMOS Essential	$563.74

PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE

Professional

Both

$1,092.60

Service Code	HCPCS 52276
Min. Negotiated Rate	$819.45
Max. Negotiated Rate	$819.45
Rate for Payer: Cash Price	$298.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$819.45
Rate for Payer: SOMOS Essential	$819.45

PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE

Professional

Both

$1,025.40

Service Code	HCPCS 52275
Min. Negotiated Rate	$769.05
Max. Negotiated Rate	$769.05
Rate for Payer: Cash Price	$279.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$769.05
Rate for Payer: SOMOS Essential	$769.05

PR CYSTOURETHROSCOPY WITH BIOPSY

Professional

Both

$583.28

Service Code	HCPCS 52204
Min. Negotiated Rate	$437.46
Max. Negotiated Rate	$437.46
Rate for Payer: Cash Price	$160.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$437.46
Rate for Payer: SOMOS Essential	$437.46

PR CYSTOURETHROSCOPY W/RESECJ EXTERNAL SPHINCTER

Professional

Both

$1,336.41

Service Code	HCPCS 52277
Min. Negotiated Rate	$1,002.31
Max. Negotiated Rate	$1,002.31
Rate for Payer: Cash Price	$364.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,002.31
Rate for Payer: SOMOS Essential	$1,002.31

PR CYSTOURETHROSCOPY W/RMVL URETERAL CALCULUS

Professional

Both

$1,016.79

Service Code	HCPCS 52320
Min. Negotiated Rate	$762.59
Max. Negotiated Rate	$762.59
Rate for Payer: Cash Price	$277.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$762.59
Rate for Payer: SOMOS Essential	$762.59

PR CYSTOURETHROSCOPY W/STEROID INJECTION STRICTURE

Professional

Both

$833.39

Service Code	HCPCS 52283
Min. Negotiated Rate	$625.04
Max. Negotiated Rate	$625.04
Rate for Payer: Cash Price	$228.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$625.04
Rate for Payer: SOMOS Essential	$625.04

PR CYSTOURETHROSCOPY W/URETERAL MEATOTOMY UNI/BI

Professional

Both

$1,010.17

Service Code	HCPCS 52290
Min. Negotiated Rate	$757.63
Max. Negotiated Rate	$757.63
Rate for Payer: Cash Price	$274.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$757.63
Rate for Payer: SOMOS Essential	$757.63

PR CYSTO W/COMPLEX REMOVAL STONE & STENT

Professional

Both

$1,141.21

Service Code	HCPCS 52315
Min. Negotiated Rate	$855.91
Max. Negotiated Rate	$855.91
Rate for Payer: Cash Price	$309.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$855.91
Rate for Payer: SOMOS Essential	$855.91

PR CYSTO W/DESTRUCTION OF LESIONS

Professional

Both

$725.80

Service Code	HCPCS 52214
Min. Negotiated Rate	$544.35
Max. Negotiated Rate	$544.35
Rate for Payer: Cash Price	$196.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$544.35
Rate for Payer: SOMOS Essential	$544.35

PR CYSTO W/DIL & URTL RX DEL F/URTL STRIX/STENOSIS

Professional

Both

$653.42

Service Code	HCPCS 0499T
Min. Negotiated Rate	$490.06
Max. Negotiated Rate	$490.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$490.06
Rate for Payer: SOMOS Essential	$490.06

PR CYSTO W/EJACULATORY DUCT CATHETERIZATION

Professional

Both

$685.20

Service Code	HCPCS 52010
Min. Negotiated Rate	$513.90
Max. Negotiated Rate	$513.90
Rate for Payer: Cash Price	$187.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$513.90
Rate for Payer: SOMOS Essential	$513.90

PR CYSTO W/INSERT URETERAL STENT

Professional

Both

$647.33

Service Code	HCPCS 52332
Min. Negotiated Rate	$485.50
Max. Negotiated Rate	$485.50
Rate for Payer: Cash Price	$176.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$485.50
Rate for Payer: SOMOS Essential	$485.50

PR CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS

Professional

Both

$1,188.39

Service Code	HCPCS 52001
Min. Negotiated Rate	$891.29
Max. Negotiated Rate	$891.29
Rate for Payer: Cash Price	$324.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$891.29
Rate for Payer: SOMOS Essential	$891.29

PR CYSTO W/REMOVAL OF LESIONS SMALL

Professional

Both

$841.12

Service Code	HCPCS 52224
Min. Negotiated Rate	$630.84
Max. Negotiated Rate	$630.84
Rate for Payer: Cash Price	$227.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$630.84
Rate for Payer: SOMOS Essential	$630.84

PR CYSTO W/REMOVAL OF TUMORS SMALL

Professional

Both

$1,018.08

Service Code	HCPCS 52234
Min. Negotiated Rate	$763.56
Max. Negotiated Rate	$763.56
Rate for Payer: Cash Price	$277.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$763.56
Rate for Payer: SOMOS Essential	$763.56

PR CYSTO W/RESCJ/FULG ORTHOPIC URETEROCELE UNI/BI

Professional

Both

$1,163.68

Service Code	HCPCS 52300
Min. Negotiated Rate	$872.76
Max. Negotiated Rate	$872.76
Rate for Payer: Cash Price	$315.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$872.76
Rate for Payer: SOMOS Essential	$872.76

PR CYSTO W/RESECJ ECTOPIC URETEROCELE UNI/BI

Professional

Both

$1,198.79

Service Code	HCPCS 52301
Min. Negotiated Rate	$899.09
Max. Negotiated Rate	$899.09
Rate for Payer: Cash Price	$327.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$899.09
Rate for Payer: SOMOS Essential	$899.09

PR CYSTO W/SIMPLE REMOVAL STONE & STENT

Professional

Both

$630.28

Service Code	HCPCS 52310
Min. Negotiated Rate	$472.71
Max. Negotiated Rate	$472.71
Rate for Payer: Cash Price	$171.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$472.71
Rate for Payer: SOMOS Essential	$472.71

PR CYSTO W/SUBURTRIC NJX IMPLT MATRL

Professional

Both

$1,068.83

Service Code	HCPCS 52327
Min. Negotiated Rate	$801.62
Max. Negotiated Rate	$801.62
Rate for Payer: Cash Price	$290.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$801.62
Rate for Payer: SOMOS Essential	$801.62

PR CYSTO W/TX INTRA-RENAL STRICTURE

Professional

Both

$1,423.35

Service Code	HCPCS 52343
Min. Negotiated Rate	$1,067.51
Max. Negotiated Rate	$1,067.51
Rate for Payer: Cash Price	$387.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,067.51
Rate for Payer: SOMOS Essential	$1,067.51

PR CYSTO W/TX URETERAL STRICTURE

Professional

Both

$1,178.56

Service Code	HCPCS 52341
Min. Negotiated Rate	$883.92
Max. Negotiated Rate	$883.92
Rate for Payer: Cash Price	$320.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$883.92
Rate for Payer: SOMOS Essential	$883.92

PR CYSTO W/TX URETEROPELVIC JUNCTION STRICTURE

Professional

Both

$1,276.56

Service Code	HCPCS 52342
Min. Negotiated Rate	$957.42
Max. Negotiated Rate	$957.42
Rate for Payer: Cash Price	$349.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$957.42
Rate for Payer: SOMOS Essential	$957.42

Know your out-of-pocket cost for care.

All Charges