St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ

Professional

Both

$8,666.28

Service Code	HCPCS 43633
Min. Negotiated Rate	$6,499.71
Max. Negotiated Rate	$6,499.71
Rate for Payer: Cash Price	$2,311.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,499.71
Rate for Payer: SOMOS Essential	$6,499.71

PR GSTRCT TOT W/ESOPHAGOENTEROSTOMY

Professional

Both

$8,972.01

Service Code	HCPCS 43620
Min. Negotiated Rate	$6,729.01
Max. Negotiated Rate	$6,729.01
Rate for Payer: Cash Price	$2,385.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,729.01
Rate for Payer: SOMOS Essential	$6,729.01

PR GSTRCT TOT W/FRMJ INTSTINAL POUCH ANY TYPE

Professional

Both

$10,451.81

Service Code	HCPCS 43622
Min. Negotiated Rate	$7,838.86
Max. Negotiated Rate	$7,838.86
Rate for Payer: Cash Price	$2,778.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,838.86
Rate for Payer: SOMOS Essential	$7,838.86

PR GSTRCT TOT W/ROUX-EN-Y RCNSTJ

Professional

Both

$10,224.76

Service Code	HCPCS 43621
Min. Negotiated Rate	$7,668.57
Max. Negotiated Rate	$7,668.57
Rate for Payer: Cash Price	$2,727.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,668.57
Rate for Payer: SOMOS Essential	$7,668.57

PR GSTR RSTCV OPN RMVL & RPLCMT SUBQ PORT

Professional

Both

$2,100.98

Service Code	HCPCS 43888
Min. Negotiated Rate	$1,575.74
Max. Negotiated Rate	$1,575.74
Rate for Payer: Cash Price	$563.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,575.74
Rate for Payer: SOMOS Essential	$1,575.74

PR GSTR RSTCV PX OPN REVJ SUBQ PORT COMPONENT ONLY

Professional

Both

$1,658.86

Service Code	HCPCS 43886
Min. Negotiated Rate	$1,244.14
Max. Negotiated Rate	$1,244.14
Rate for Payer: Cash Price	$447.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,244.14
Rate for Payer: SOMOS Essential	$1,244.14

PR GSTR RSTCV PX OPN RMVL SUBQ PORT COMPONENT ONLY

Professional

Both

$1,496.39

Service Code	HCPCS 43887
Min. Negotiated Rate	$1,122.29
Max. Negotiated Rate	$1,122.29
Rate for Payer: Cash Price	$404.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,122.29
Rate for Payer: SOMOS Essential	$1,122.29

PR GSTR RSTCV W/O BYP OTH/THN VER-BANDED GSTP

Professional

Both

$5,814.31

Service Code	HCPCS 43843
Min. Negotiated Rate	$4,360.73
Max. Negotiated Rate	$4,360.73
Rate for Payer: Cash Price	$1,549.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,360.73
Rate for Payer: SOMOS Essential	$4,360.73

PR GSTRT W/ESOPHGL DILAT&INSJ PRM INTRAL TUBE

Professional

Both

$4,299.02

Service Code	HCPCS 43510
Min. Negotiated Rate	$3,224.26
Max. Negotiated Rate	$3,224.26
Rate for Payer: Cash Price	$1,148.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,224.26
Rate for Payer: SOMOS Essential	$3,224.26

PR HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/IMPLT

Professional

Both

$2,024.96

Service Code	HCPCS 28291
Min. Negotiated Rate	$1,518.72
Max. Negotiated Rate	$1,518.72
Rate for Payer: Cash Price	$552.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,518.72
Rate for Payer: SOMOS Essential	$1,518.72

PR HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/O IMPLT

Professional

Both

$1,951.50

Service Code	HCPCS 28289
Min. Negotiated Rate	$1,463.62
Max. Negotiated Rate	$1,463.62
Rate for Payer: Cash Price	$537.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,463.62
Rate for Payer: SOMOS Essential	$1,463.62

PR HARVEST FEMPOP VEIN 1 SGM VASC RCNSTJ PX

Professional

Both

$1,519.14

Service Code	HCPCS 35572
Min. Negotiated Rate	$1,139.36
Max. Negotiated Rate	$1,139.36
Rate for Payer: Cash Price	$402.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,139.36
Rate for Payer: SOMOS Essential	$1,139.36

PR HARVESTING CONJUNCIVAL ALLOGRAPHY LIVING DONOR

Professional

Both

$1,696.00

Service Code	HCPCS 68371
Min. Negotiated Rate	$1,272.00
Max. Negotiated Rate	$1,272.00
Rate for Payer: Cash Price	$468.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,272.00
Rate for Payer: SOMOS Essential	$1,272.00

PR HARVEST SKIN TISSUE CLTR SKIN AGRFT 100 CM/<

Professional

Both

$540.05

Service Code	HCPCS 15040
Min. Negotiated Rate	$405.04
Max. Negotiated Rate	$405.04
Rate for Payer: Cash Price	$147.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$405.04
Rate for Payer: SOMOS Essential	$405.04

PR HARVEST UXTR VEIN 1 SGM LOWER EXTREMITY/CABG PX

Professional

Both

$1,410.40

Service Code	HCPCS 35500
Min. Negotiated Rate	$1,057.80
Max. Negotiated Rate	$1,057.80
Rate for Payer: Cash Price	$372.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,057.80
Rate for Payer: SOMOS Essential	$1,057.80

PR HBOT, FULL BODY CHAMBER, 30M

Professional

Both

$732.83

Service Code	HCPCS G0277
Min. Negotiated Rate	$549.62
Max. Negotiated Rate	$549.62
Rate for Payer: Cash Price	$215.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$549.62
Rate for Payer: SOMOS Essential	$549.62

PR HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT

Professional

Both

$326.87

Service Code	HCPCS 96156
Min. Negotiated Rate	$245.15
Max. Negotiated Rate	$245.15
Rate for Payer: Cash Price	$95.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$245.15
Rate for Payer: SOMOS Essential	$245.15

PR HEALTH BEHAVIOR IVNTJ FAM W/PT F2F 1ST 30 MIN

Professional

Both

$233.84

Service Code	HCPCS 96167
Min. Negotiated Rate	$175.38
Max. Negotiated Rate	$175.38
Rate for Payer: Cash Price	$66.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$175.38
Rate for Payer: SOMOS Essential	$175.38

PR HEALTH BEHAVIOR IVNTJ FAM W/PT F2F EA ADD 15 MIN

Professional

Both

$81.69

Service Code	HCPCS 96168
Min. Negotiated Rate	$61.27
Max. Negotiated Rate	$61.27
Rate for Payer: Cash Price	$23.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$61.27
Rate for Payer: SOMOS Essential	$61.27

PR HEALTH BEHAVIOR IVNTJ GROUP F2F 1ST 30 MIN

Professional

Both

$34.79

Service Code	HCPCS 96164
Min. Negotiated Rate	$26.09
Max. Negotiated Rate	$26.09
Rate for Payer: Cash Price	$10.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26.09
Rate for Payer: SOMOS Essential	$26.09

PR HEALTH BEHAVIOR IVNTJ GROUP F2F EA ADDL 15 MIN

Professional

Both

$15.40

Service Code	HCPCS 96165
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$11.55
Rate for Payer: Cash Price	$4.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$11.55
Rate for Payer: SOMOS Essential	$11.55

PR HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 MIN

Professional

Both

$221.31

Service Code	HCPCS 96158
Min. Negotiated Rate	$165.98
Max. Negotiated Rate	$165.98
Rate for Payer: Cash Price	$63.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$165.98
Rate for Payer: SOMOS Essential	$165.98

PR HEALTH BEHAVIOR IVNTJ INDIV F2F EA ADDL 15 MIN

Professional

Both

$75.43

Service Code	HCPCS 96159
Min. Negotiated Rate	$56.57
Max. Negotiated Rate	$56.57
Rate for Payer: Cash Price	$21.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$56.57
Rate for Payer: SOMOS Essential	$56.57

PR HEART-LUNG TRNSPL W/RECIPIENT CARDIECTOMY-PNUMEC

Professional

Both

$21,686.25

Service Code	HCPCS 33935
Min. Negotiated Rate	$16,264.69
Max. Negotiated Rate	$16,264.69
Rate for Payer: Cash Price	$5,750.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,264.69
Rate for Payer: SOMOS Essential	$16,264.69

PR HEART TRANSPLANT W/WO RECIPIENT CARDIECTOMY

Professional

Both

$21,523.53

Service Code	HCPCS 33945
Min. Negotiated Rate	$16,142.65
Max. Negotiated Rate	$16,142.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,142.65
Rate for Payer: SOMOS Essential	$16,142.65

Know your out-of-pocket cost for care.

All Charges