St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR DRAINAGE FINGER ABSCESS SIMPLE

Professional

Both

$616.60

Service Code	HCPCS 26010
Min. Negotiated Rate	$462.45
Max. Negotiated Rate	$462.45
Rate for Payer: Cash Price	$168.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$462.45
Rate for Payer: SOMOS Essential	$462.45

PR DRAINAGE OF PALMAR BURSA MULTIPLE BURSA

Professional

Both

$2,175.32

Service Code	HCPCS 26030
Min. Negotiated Rate	$1,631.49
Max. Negotiated Rate	$1,631.49
Rate for Payer: Cash Price	$591.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,631.49
Rate for Payer: SOMOS Essential	$1,631.49

PR DRAINAGE OF PALMAR BURSA SINGLE BURSA

Professional

Both

$1,859.17

Service Code	HCPCS 26025
Min. Negotiated Rate	$1,394.38
Max. Negotiated Rate	$1,394.38
Rate for Payer: Cash Price	$505.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,394.38
Rate for Payer: SOMOS Essential	$1,394.38

PR DRAINAGE OF RETROPERITONEAL ABSCESS OPEN

Professional

Both

$4,877.71

Service Code	HCPCS 49060
Min. Negotiated Rate	$3,658.28
Max. Negotiated Rate	$3,658.28
Rate for Payer: Cash Price	$1,304.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,658.28
Rate for Payer: SOMOS Essential	$3,658.28

PR DRAINAGE OVARIAN ABSCESS ABDOMINAL APPROACH

Professional

Both

$3,122.63

Service Code	HCPCS 58822
Min. Negotiated Rate	$2,341.97
Max. Negotiated Rate	$2,341.97
Rate for Payer: Cash Price	$842.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,341.97
Rate for Payer: SOMOS Essential	$2,341.97

PR DRAINAGE OVARIAN ABSCESS VAGINAL APPR OPEN

Professional

Both

$1,486.35

Service Code	HCPCS 58820
Min. Negotiated Rate	$1,114.76
Max. Negotiated Rate	$1,114.76
Rate for Payer: Cash Price	$401.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,114.76
Rate for Payer: SOMOS Essential	$1,114.76

PR DRAINAGE OVARIAN CYST UNI/BI SPX ABDOMINAL

Professional

Both

$1,874.67

Service Code	HCPCS 58805
Min. Negotiated Rate	$1,406.00
Max. Negotiated Rate	$1,406.00
Rate for Payer: Cash Price	$507.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,406.00
Rate for Payer: SOMOS Essential	$1,406.00

PR DRAINAGE OVARIAN CYST UNI/BI SPX VAGINAL APPR

Professional

Both

$1,378.97

Service Code	HCPCS 58800
Min. Negotiated Rate	$1,034.23
Max. Negotiated Rate	$1,034.23
Rate for Payer: Cash Price	$373.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,034.23
Rate for Payer: SOMOS Essential	$1,034.23

PR DRAINAGE PERIRENAL/RENAL ABSCESS OPEN

Professional

Both

$4,244.24

Service Code	HCPCS 50020
Min. Negotiated Rate	$3,183.18
Max. Negotiated Rate	$3,183.18
Rate for Payer: Cash Price	$1,161.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,183.18
Rate for Payer: SOMOS Essential	$3,183.18

PR DRAINAGE PERITON ABSCESS/LOCAL PERITONITIS OPEN

Professional

Both

$7,124.01

Service Code	HCPCS 49020
Min. Negotiated Rate	$5,343.01
Max. Negotiated Rate	$5,343.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,343.01
Rate for Payer: SOMOS Essential	$5,343.01

PR DRAINAGE SCROTAL WALL ABSCESS

Professional

Both

$716.00

Service Code	HCPCS 55100
Min. Negotiated Rate	$537.00
Max. Negotiated Rate	$537.00
Rate for Payer: Cash Price	$196.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$537.00
Rate for Payer: SOMOS Essential	$537.00

PR DRAINAGE SUBDIAPHRAGMATIC/SUBPHREN ABSCESS OPEN

Professional

Both

$4,497.61

Service Code	HCPCS 49040
Min. Negotiated Rate	$3,373.21
Max. Negotiated Rate	$3,373.21
Rate for Payer: Cash Price	$1,202.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,373.21
Rate for Payer: SOMOS Essential	$3,373.21

PR DRAINAGE TENDON SHEATH DIGIT&/PALM EACH

Professional

Both

$2,461.87

Service Code	HCPCS 26020
Min. Negotiated Rate	$1,846.40
Max. Negotiated Rate	$1,846.40
Rate for Payer: Cash Price	$668.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,846.40
Rate for Payer: SOMOS Essential	$1,846.40

PR DRESSING CHANGE UNDER ANESTHESIA

Professional

Both

$203.11

Service Code	HCPCS 15852
Min. Negotiated Rate	$152.33
Max. Negotiated Rate	$152.33
Rate for Payer: Cash Price	$51.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$152.33
Rate for Payer: SOMOS Essential	$152.33

PR DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS

Professional

Both

$669.20

Service Code	HCPCS 41800
Min. Negotiated Rate	$501.90
Max. Negotiated Rate	$501.90
Rate for Payer: Cash Price	$182.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$501.90
Rate for Payer: SOMOS Essential	$501.90

PR DRG ABSC CST HMTMA VESTIBULE MOUTH COMP

Professional

Both

$831.78

Service Code	HCPCS 40801
Min. Negotiated Rate	$623.84
Max. Negotiated Rate	$623.84
Rate for Payer: Cash Price	$229.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$623.84
Rate for Payer: SOMOS Essential	$623.84

PR DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL

Professional

Both

$501.69

Service Code	HCPCS 40800
Min. Negotiated Rate	$376.27
Max. Negotiated Rate	$376.27
Rate for Payer: Cash Price	$138.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$376.27
Rate for Payer: SOMOS Essential	$376.27

PR DRG ABSC SUBMAXILLARY/SUBLINGUAL INTRAORAL

Professional

Both

$577.22

Service Code	HCPCS 42310
Min. Negotiated Rate	$432.92
Max. Negotiated Rate	$432.92
Rate for Payer: Cash Price	$156.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$432.92
Rate for Payer: SOMOS Essential	$432.92

PR DRG LYMPH NODE ABSC/LYMPHADENITIS EXTNSV

Professional

Both

$2,226.53

Service Code	HCPCS 38305
Min. Negotiated Rate	$1,669.90
Max. Negotiated Rate	$1,669.90
Rate for Payer: Cash Price	$599.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,669.90
Rate for Payer: SOMOS Essential	$1,669.90

PR DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL

Professional

Both

$935.69

Service Code	HCPCS 38300
Min. Negotiated Rate	$701.77
Max. Negotiated Rate	$701.77
Rate for Payer: Cash Price	$253.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$701.77
Rate for Payer: SOMOS Essential	$701.77

PR DRG OF SKENE'S GLAND ABSCESS OR CYST

Professional

Both

$721.98

Service Code	HCPCS 53060
Min. Negotiated Rate	$541.48
Max. Negotiated Rate	$541.48
Rate for Payer: Cash Price	$195.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$541.48
Rate for Payer: SOMOS Essential	$541.48

PR DRG PERINEAL URINARY XTRVASATION COMPLIC

Professional

Both

$2,718.80

Service Code	HCPCS 53085
Min. Negotiated Rate	$2,039.10
Max. Negotiated Rate	$2,039.10
Rate for Payer: Cash Price	$744.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,039.10
Rate for Payer: SOMOS Essential	$2,039.10

PR DRG PERINEAL URINARY XTRVASATION UNCOMP SPX

Professional

Both

$1,769.57

Service Code	HCPCS 53080
Min. Negotiated Rate	$1,327.18
Max. Negotiated Rate	$1,327.18
Rate for Payer: Cash Price	$486.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,327.18
Rate for Payer: SOMOS Essential	$1,327.18

PR DRG PRIVESICAL/PREVESICAL SPACE ABSC

Professional

Both

$1,720.71

Service Code	HCPCS 51080
Min. Negotiated Rate	$1,290.53
Max. Negotiated Rate	$1,290.53
Rate for Payer: Cash Price	$472.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,290.53
Rate for Payer: SOMOS Essential	$1,290.53

PR DRG XTRAPERITONEAL LYMPHOCELE PERITON CAVITY OPN

Professional

Both

$3,480.44

Service Code	HCPCS 49062
Min. Negotiated Rate	$2,610.33
Max. Negotiated Rate	$2,610.33
Rate for Payer: Cash Price	$930.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,610.33
Rate for Payer: SOMOS Essential	$2,610.33

Know your out-of-pocket cost for care.

All Charges