St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR EXC/FULGURATION CARCINOMA URETHRA

Professional

Both

$1,900.40

Service Code	HCPCS 53220
Min. Negotiated Rate	$1,425.30
Max. Negotiated Rate	$1,425.30
Rate for Payer: Cash Price	$521.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,425.30
Rate for Payer: SOMOS Essential	$1,425.30

PR EXC/FULGURATION URETHRAL CARUNCLE

Professional

Both

$806.37

Service Code	HCPCS 53265
Min. Negotiated Rate	$604.78
Max. Negotiated Rate	$604.78
Rate for Payer: Cash Price	$219.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$604.78
Rate for Payer: SOMOS Essential	$604.78

PR EXC/FULGURATION URETHRAL POLYP DSTL URETHRA

Professional

Both

$772.00

Service Code	HCPCS 53260
Min. Negotiated Rate	$579.00
Max. Negotiated Rate	$579.00
Rate for Payer: Cash Price	$210.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$579.00
Rate for Payer: SOMOS Essential	$579.00

PR EXCHANGE BILIARY DRG CATHETER PRQ W/IMG GID RS&I

Professional

Both

$536.03

Service Code	HCPCS 47536
Min. Negotiated Rate	$402.02
Max. Negotiated Rate	$402.02
Rate for Payer: Cash Price	$145.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$402.02
Rate for Payer: SOMOS Essential	$402.02

PR EXCHANGE INTRAOCULAR LENS

Professional

Both

$3,704.89

Service Code	HCPCS 66986
Min. Negotiated Rate	$2,778.67
Max. Negotiated Rate	$2,778.67
Rate for Payer: Cash Price	$1,020.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,778.67
Rate for Payer: SOMOS Essential	$2,778.67

PR EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMG GID RS&I

Professional

Both

$410.76

Service Code	HCPCS 50435
Min. Negotiated Rate	$308.07
Max. Negotiated Rate	$308.07
Rate for Payer: Cash Price	$111.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$308.07
Rate for Payer: SOMOS Essential	$308.07

PR EXCHNG ABSC/CST DRG CATH RAD GID SPX

Professional

Both

$294.07

Service Code	HCPCS 49423
Min. Negotiated Rate	$220.55
Max. Negotiated Rate	$220.55
Rate for Payer: Cash Price	$78.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$220.55
Rate for Payer: SOMOS Essential	$220.55

PR EXC HYDROCELE SPRMATIC CORD UNI SPX

Professional

Both

$1,682.10

Service Code	HCPCS 55500
Min. Negotiated Rate	$1,261.58
Max. Negotiated Rate	$1,261.58
Rate for Payer: Cash Price	$457.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,261.58
Rate for Payer: SOMOS Essential	$1,261.58

PR EXC HYPRPLSTC ALVEOLAR MUCOSA EA QUADRANT SPEC

Professional

Both

$970.55

Service Code	HCPCS 41828
Min. Negotiated Rate	$727.91
Max. Negotiated Rate	$727.91
Rate for Payer: Cash Price	$261.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$727.91
Rate for Payer: SOMOS Essential	$727.91

PR EXC ILEOANAL RSVR W/ILEOSTOMY

Professional

Both

$7,554.05

Service Code	HCPCS 45136
Min. Negotiated Rate	$5,665.54
Max. Negotiated Rate	$5,665.54
Rate for Payer: Cash Price	$2,044.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,665.54
Rate for Payer: SOMOS Essential	$5,665.54

PR EXCIMER LASER TX PSORIASIS 250-500 SQ CM

Professional

Both

$288.51

Service Code	HCPCS 96921
Min. Negotiated Rate	$216.38
Max. Negotiated Rate	$216.38
Rate for Payer: Cash Price	$79.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$216.38
Rate for Payer: SOMOS Essential	$216.38

PR EXCIMER LASER TX PSORIASIS >500 SQ CM

Professional

Both

$467.18

Service Code	HCPCS 96922
Min. Negotiated Rate	$350.38
Max. Negotiated Rate	$350.38
Rate for Payer: Cash Price	$127.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$350.38
Rate for Payer: SOMOS Essential	$350.38

PR EXCIMER LASER TX PSORIASIS TOT AREA <250 SQ CM

Professional

Both

$252.74

Service Code	HCPCS 96920
Min. Negotiated Rate	$189.56
Max. Negotiated Rate	$189.56
Rate for Payer: Cash Price	$69.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$189.56
Rate for Payer: SOMOS Essential	$189.56

PR EXC INTRACARDIAC TUMOR RESCJ CARDIOPULMONARY BYP

Professional

Both

$9,247.39

Service Code	HCPCS 33120
Min. Negotiated Rate	$6,935.54
Max. Negotiated Rate	$6,935.54
Rate for Payer: Cash Price	$2,459.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,935.54
Rate for Payer: SOMOS Essential	$6,935.54

PR EXC ISCHIAL PRESSURE ULCER W/PRIMARY SUTURE

Professional

Both

$3,147.90

Service Code	HCPCS 15940
Min. Negotiated Rate	$2,360.92
Max. Negotiated Rate	$2,360.92
Rate for Payer: Cash Price	$846.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,360.92
Rate for Payer: SOMOS Essential	$2,360.92

PR EXC ISCHIAL PRESSURE ULCER W/SKIN FLAP CLOSURE

Professional

Both

$4,089.89

Service Code	HCPCS 15944
Min. Negotiated Rate	$3,067.42
Max. Negotiated Rate	$3,067.42
Rate for Payer: Cash Price	$1,103.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,067.42
Rate for Payer: SOMOS Essential	$3,067.42

PR EXC ISCHIAL PR ULCER W/OSTC MUSC/MYOQ FLAP/SKIN

Professional

Both

$7,111.97

Service Code	HCPCS 15946
Min. Negotiated Rate	$5,333.98
Max. Negotiated Rate	$5,333.98
Rate for Payer: Cash Price	$1,905.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,333.98
Rate for Payer: SOMOS Essential	$5,333.98

PR EXC ISCHIAL PR ULC W/PRIM SUTR W/OSTC ISCHIECT

Professional

Both

$4,129.09

Service Code	HCPCS 15941
Min. Negotiated Rate	$3,096.82
Max. Negotiated Rate	$3,096.82
Rate for Payer: Cash Price	$1,099.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,096.82
Rate for Payer: SOMOS Essential	$3,096.82

PR EXC ISCHIAL PR ULC W/SKN FLAP CLSR W/OSTECTOMY

Professional

Both

$4,460.65

Service Code	HCPCS 15945
Min. Negotiated Rate	$3,345.49
Max. Negotiated Rate	$3,345.49
Rate for Payer: Cash Price	$1,204.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,345.49
Rate for Payer: SOMOS Essential	$3,345.49

PR EXCISION 1ST &/CERVICAL RIB

Professional

Both

$2,789.54

Service Code	HCPCS 21615
Min. Negotiated Rate	$2,092.16
Max. Negotiated Rate	$2,092.16
Rate for Payer: Cash Price	$747.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,092.16
Rate for Payer: SOMOS Essential	$2,092.16

PR EXCISION 1ST &/CERVICAL RIB W/SYMPATHECTOMY

Professional

Both

$3,205.37

Service Code	HCPCS 21616
Min. Negotiated Rate	$2,404.03
Max. Negotiated Rate	$2,404.03
Rate for Payer: Cash Price	$855.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,404.03
Rate for Payer: SOMOS Essential	$2,404.03

PR EXCISION AMPULLA VATER

Professional

Both

$5,665.35

Service Code	HCPCS 48148
Min. Negotiated Rate	$4,249.01
Max. Negotiated Rate	$4,249.01
Rate for Payer: Cash Price	$1,508.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,249.01
Rate for Payer: SOMOS Essential	$4,249.01

PR EXCISION AURAL GLOMUS TUMOR EXTENDED

Professional

Both

$10,947.37

Service Code	HCPCS 69554
Min. Negotiated Rate	$8,210.53
Max. Negotiated Rate	$8,210.53
Rate for Payer: Cash Price	$2,949.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,210.53
Rate for Payer: SOMOS Essential	$8,210.53

PR EXCISION AURAL GLOMUS TUMOR TRANSCANAL

Professional

Both

$4,627.49

Service Code	HCPCS 69550
Min. Negotiated Rate	$3,470.62
Max. Negotiated Rate	$3,470.62
Rate for Payer: Cash Price	$1,246.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,470.62
Rate for Payer: SOMOS Essential	$3,470.62

PR EXCISION AURAL GLOMUS TUMOR TRANSMASTOID

Professional

Both

$6,886.74

Service Code	HCPCS 69552
Min. Negotiated Rate	$5,165.06
Max. Negotiated Rate	$5,165.06
Rate for Payer: Cash Price	$1,853.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,165.06
Rate for Payer: SOMOS Essential	$5,165.06

Know your out-of-pocket cost for care.

All Charges