St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM

Professional

Both

$1,352.58

Service Code	HCPCS 58560
Min. Negotiated Rate	$1,014.44
Max. Negotiated Rate	$1,014.44
Rate for Payer: Cash Price	$364.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,014.44
Rate for Payer: SOMOS Essential	$1,014.44

PR HYSTEROSCOPY ENDOMETRIAL ABLATION

Professional

Both

$1,067.08

Service Code	HCPCS 58563
Min. Negotiated Rate	$800.31
Max. Negotiated Rate	$800.31
Rate for Payer: Cash Price	$286.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$800.31
Rate for Payer: SOMOS Essential	$800.31

PR HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS

Professional

Both

$1,227.56

Service Code	HCPCS 58559
Min. Negotiated Rate	$920.67
Max. Negotiated Rate	$920.67
Rate for Payer: Cash Price	$331.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$920.67
Rate for Payer: SOMOS Essential	$920.67

PR HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY

Professional

Both

$960.47

Service Code	HCPCS 58562
Min. Negotiated Rate	$720.35
Max. Negotiated Rate	$720.35
Rate for Payer: Cash Price	$258.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$720.35
Rate for Payer: SOMOS Essential	$720.35

PR HYSTEROSCOPY REMOVAL LEIOMYOMATA

Professional

Both

$1,551.69

Service Code	HCPCS 58561
Min. Negotiated Rate	$1,163.77
Max. Negotiated Rate	$1,163.77
Rate for Payer: Cash Price	$417.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,163.77
Rate for Payer: SOMOS Essential	$1,163.77

PR HYSTEROTOMY ABDOMINAL

Professional

Both

$3,976.81

Service Code	HCPCS 59100
Min. Negotiated Rate	$2,982.61
Max. Negotiated Rate	$2,982.61
Rate for Payer: Cash Price	$1,056.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,982.61
Rate for Payer: SOMOS Essential	$2,982.61

PR HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX

Professional

Both

$600.50

Service Code	HCPCS 90750
Min. Negotiated Rate	$450.38
Max. Negotiated Rate	$450.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$450.38
Rate for Payer: SOMOS Essential	$450.38

PR ICAPSULAR CATARACT XTRJ INSJ IO LENS PRSTH 1 STG

Professional

Both

$1,100.00

Service Code	HCPCS 66983
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$825.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$825.00
Rate for Payer: SOMOS Essential	$825.00

PR ICAR CATH ABLATION DISCRETE MECHANISM ARRHYTHMIA

Professional

Both

$1,357.76

Service Code	HCPCS 93655
Min. Negotiated Rate	$1,018.32
Max. Negotiated Rate	$1,018.32
Rate for Payer: Cash Price	$356.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,018.32
Rate for Payer: SOMOS Essential	$1,018.32

PR ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION

Professional

Both

$2,579.15

Service Code	HCPCS 93650
Min. Negotiated Rate	$1,934.36
Max. Negotiated Rate	$1,934.36
Rate for Payer: Cash Price	$676.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,934.36
Rate for Payer: SOMOS Essential	$1,934.36

PR ICRA CRV APPL OCCLUDING CLAMP CRV CRTD ART

Professional

Both

$6,557.22

Service Code	HCPCS 61703
Min. Negotiated Rate	$4,917.92
Max. Negotiated Rate	$4,917.92
Rate for Payer: Cash Price	$1,732.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,917.92
Rate for Payer: SOMOS Essential	$4,917.92

PR IC TSTS W/ALLGIC XTRCS DLYD TYP RXN W/READING

Professional

Both

$55.93

Service Code	HCPCS 95028
Min. Negotiated Rate	$41.95
Max. Negotiated Rate	$41.95
Rate for Payer: Cash Price	$15.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41.95
Rate for Payer: SOMOS Essential	$41.95

PR I&D ABSCESS PERITONSILLAR

Professional

Both

$589.51

Service Code	HCPCS 42700
Min. Negotiated Rate	$442.13
Max. Negotiated Rate	$442.13
Rate for Payer: Cash Price	$160.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$442.13
Rate for Payer: SOMOS Essential	$442.13

PR I&D ABSC RTRPHRNGL/PARAPHARYNGEAL INTRAORAL

Professional

Both

$1,653.82

Service Code	HCPCS 42720
Min. Negotiated Rate	$1,240.36
Max. Negotiated Rate	$1,240.36
Rate for Payer: Cash Price	$449.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,240.36
Rate for Payer: SOMOS Essential	$1,240.36

PR I&D ABSC RTRPHRNGL/PARAPHARYNGEAL XTRNL APPR

Professional

Both

$3,432.73

Service Code	HCPCS 42725
Min. Negotiated Rate	$2,574.55
Max. Negotiated Rate	$2,574.55
Rate for Payer: Cash Price	$935.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,574.55
Rate for Payer: SOMOS Essential	$2,574.55

PR I&D BELOW FASCIA FOOT 1 BURSAL SPACE

Professional

Both

$577.40

Service Code	HCPCS 28002
Min. Negotiated Rate	$433.05
Max. Negotiated Rate	$433.05
Rate for Payer: Cash Price	$158.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$433.05
Rate for Payer: SOMOS Essential	$433.05

PR I&D BELOW FASCIA FOOT MULTIPLE AREAS

Professional

Both

$1,089.97

Service Code	HCPCS 28003
Min. Negotiated Rate	$817.48
Max. Negotiated Rate	$817.48
Rate for Payer: Cash Price	$292.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$817.48
Rate for Payer: SOMOS Essential	$817.48

PR I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION

Professional

Both

$2,254.46

Service Code	HCPCS 27301
Min. Negotiated Rate	$1,690.84
Max. Negotiated Rate	$1,690.84
Rate for Payer: Cash Price	$612.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,690.84
Rate for Payer: SOMOS Essential	$1,690.84

PR I&D DEEP ABSCESS PST SPINE CRV THRC/CERVICOTHR

Professional

Both

$4,450.36

Service Code	HCPCS 22010
Min. Negotiated Rate	$3,337.77
Max. Negotiated Rate	$3,337.77
Rate for Payer: Cash Price	$1,197.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,337.77
Rate for Payer: SOMOS Essential	$3,337.77

PR I&D DEEP ABSCESS PST SPINE LUMBAR SAC/LUMBOSAC

Professional

Both

$4,346.76

Service Code	HCPCS 22015
Min. Negotiated Rate	$3,260.07
Max. Negotiated Rate	$3,260.07
Rate for Payer: Cash Price	$1,160.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,260.07
Rate for Payer: SOMOS Essential	$3,260.07

PR I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX

Professional

Both

$1,479.38

Service Code	HCPCS 21501
Min. Negotiated Rate	$1,109.54
Max. Negotiated Rate	$1,109.54
Rate for Payer: Cash Price	$404.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,109.54
Rate for Payer: SOMOS Essential	$1,109.54

PR I&D DP ABSC/HMTMA SOFT TISS NCK/THORAX PRTL RI

Professional

Both

$2,280.36

Service Code	HCPCS 21502
Min. Negotiated Rate	$1,710.27
Max. Negotiated Rate	$1,710.27
Rate for Payer: Cash Price	$611.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,710.27
Rate for Payer: SOMOS Essential	$1,710.27

PR I&D DP SUPRALEVATOR PELVIRCT/RETRORCT ABSC

Professional

Both

$2,535.30

Service Code	HCPCS 45020
Min. Negotiated Rate	$1,901.48
Max. Negotiated Rate	$1,901.48
Rate for Payer: Cash Price	$672.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,901.48
Rate for Payer: SOMOS Essential	$1,901.48

PR I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE

Professional

Both

$898.56

Service Code	HCPCS 54700
Min. Negotiated Rate	$673.92
Max. Negotiated Rate	$673.92
Rate for Payer: Cash Price	$247.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$673.92
Rate for Payer: SOMOS Essential	$673.92

PR I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA

Professional

Both

$3,056.69

Service Code	HCPCS 25028
Min. Negotiated Rate	$2,292.52
Max. Negotiated Rate	$2,292.52
Rate for Payer: Cash Price	$826.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,292.52
Rate for Payer: SOMOS Essential	$2,292.52

Know your out-of-pocket cost for care.

All Charges