St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR I&D HEMATOMA SEROMA/FLUID COLLECTION

Professional

Both

$501.31

Service Code	HCPCS 10140
Min. Negotiated Rate	$375.98
Max. Negotiated Rate	$375.98
Rate for Payer: Cash Price	$138.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$375.98
Rate for Payer: SOMOS Essential	$375.98

PR I&D INTRAMURAL IM/ABSC TRANSANAL ANES

Professional

Both

$1,932.77

Service Code	HCPCS 46045
Min. Negotiated Rate	$1,449.58
Max. Negotiated Rate	$1,449.58
Rate for Payer: Cash Price	$524.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,449.58
Rate for Payer: SOMOS Essential	$1,449.58

PR I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON

Professional

Both

$2,138.57

Service Code	HCPCS 46060
Min. Negotiated Rate	$1,603.93
Max. Negotiated Rate	$1,603.93
Rate for Payer: Cash Price	$577.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,603.93
Rate for Payer: SOMOS Essential	$1,603.93

PR I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX

Professional

Both

$1,884.51

Service Code	HCPCS 46040
Min. Negotiated Rate	$1,413.38
Max. Negotiated Rate	$1,413.38
Rate for Payer: Cash Price	$510.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,413.38
Rate for Payer: SOMOS Essential	$1,413.38

PR I&D OF BARTHOLINS GLAND ABSCESS

Professional

Both

$487.38

Service Code	HCPCS 56420
Min. Negotiated Rate	$365.54
Max. Negotiated Rate	$365.54
Rate for Payer: Cash Price	$130.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$365.54
Rate for Payer: SOMOS Essential	$365.54

PR I&D PELVIS/HIP JOINT AREA INFECTED BURSA

Professional

Both

$2,347.63

Service Code	HCPCS 26991
Min. Negotiated Rate	$1,760.72
Max. Negotiated Rate	$1,760.72
Rate for Payer: Cash Price	$634.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,760.72
Rate for Payer: SOMOS Essential	$1,760.72

PR I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA

Professional

Both

$3,022.67

Service Code	HCPCS 26990
Min. Negotiated Rate	$2,267.00
Max. Negotiated Rate	$2,267.00
Rate for Payer: Cash Price	$816.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,267.00
Rate for Payer: SOMOS Essential	$2,267.00

PR I&D PENIS DEEP

Professional

Both

$1,279.01

Service Code	HCPCS 54015
Min. Negotiated Rate	$959.26
Max. Negotiated Rate	$959.26
Rate for Payer: Cash Price	$350.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$959.26
Rate for Payer: SOMOS Essential	$959.26

PR I&D PERIANAL ABSCESS SUPERFICIAL

Professional

Both

$446.53

Service Code	HCPCS 46050
Min. Negotiated Rate	$334.90
Max. Negotiated Rate	$334.90
Rate for Payer: Cash Price	$120.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$334.90
Rate for Payer: SOMOS Essential	$334.90

PR I&D SHOULDER DEEP ABSCESS/HEMATOMA

Professional

Both

$1,125.08

Service Code	HCPCS 23030
Min. Negotiated Rate	$843.81
Max. Negotiated Rate	$843.81
Rate for Payer: Cash Price	$304.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$843.81
Rate for Payer: SOMOS Essential	$843.81

PR I&D SHOULDER INFECTED BURSA

Professional

Both

$982.80

Service Code	HCPCS 23031
Min. Negotiated Rate	$737.10
Max. Negotiated Rate	$737.10
Rate for Payer: Cash Price	$266.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$737.10
Rate for Payer: SOMOS Essential	$737.10

PR I&D SUBMUCOSAL ABSCESS RECTUM

Professional

Both

$749.04

Service Code	HCPCS 45005
Min. Negotiated Rate	$561.78
Max. Negotiated Rate	$561.78
Rate for Payer: Cash Price	$199.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$561.78
Rate for Payer: SOMOS Essential	$561.78

PR I&D THYROGLOSSAL DUCT CYST INFECTED

Professional

Both

$678.93

Service Code	HCPCS 60000
Min. Negotiated Rate	$509.20
Max. Negotiated Rate	$509.20
Rate for Payer: Cash Price	$186.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$509.20
Rate for Payer: SOMOS Essential	$509.20

PR I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA

Professional

Both

$959.28

Service Code	HCPCS 23930
Min. Negotiated Rate	$719.46
Max. Negotiated Rate	$719.46
Rate for Payer: Cash Price	$258.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$719.46
Rate for Payer: SOMOS Essential	$719.46

PR I&D VAGINAL HEMATOMA NON-OBSTETRICAL

Professional

Both

$1,395.98

Service Code	HCPCS 57023
Min. Negotiated Rate	$1,046.98
Max. Negotiated Rate	$1,046.98
Rate for Payer: Cash Price	$377.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,046.98
Rate for Payer: SOMOS Essential	$1,046.98

PR I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM

Professional

Both

$791.49

Service Code	HCPCS 57022
Min. Negotiated Rate	$593.62
Max. Negotiated Rate	$593.62
Rate for Payer: Cash Price	$213.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$593.62
Rate for Payer: SOMOS Essential	$593.62

PR I&D VULVA/PERINEAL ABSCESS

Professional

Both

$555.45

Service Code	HCPCS 56405
Min. Negotiated Rate	$416.59
Max. Negotiated Rate	$416.59
Rate for Payer: Cash Price	$150.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$416.59
Rate for Payer: SOMOS Essential	$416.59

PR IIV3 VACCINE SPLIT VIRUS 0.25 ML DOSAGE IM USE

Professional

Both

$35.00

Service Code	HCPCS 90657
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26.25
Rate for Payer: SOMOS Essential	$26.25

PR IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE

Professional

Both

$71.82

Service Code	HCPCS 90658
Min. Negotiated Rate	$53.86
Max. Negotiated Rate	$53.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$53.86
Rate for Payer: SOMOS Essential	$53.86

PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE

Professional

Both

$635.25

Service Code	HCPCS 90686
Min. Negotiated Rate	$476.44
Max. Negotiated Rate	$476.44
Rate for Payer: Cash Price	$22.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$476.44
Rate for Payer: SOMOS Essential	$476.44

PR IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM

Professional

Both

$107.00

Service Code	HCPCS 90662
Min. Negotiated Rate	$80.25
Max. Negotiated Rate	$80.25
Rate for Payer: Cash Price	$73.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$80.25
Rate for Payer: SOMOS Essential	$80.25

PR ILEOSCOPY STOMA W/BALLOON DILATION

Professional

Both

$358.51

Service Code	HCPCS 44381
Min. Negotiated Rate	$268.88
Max. Negotiated Rate	$268.88
Rate for Payer: Cash Price	$97.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$268.88
Rate for Payer: SOMOS Essential	$268.88

PR ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE

Professional

Both

$315.25

Service Code	HCPCS 44382
Min. Negotiated Rate	$236.44
Max. Negotiated Rate	$236.44
Rate for Payer: Cash Price	$84.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$236.44
Rate for Payer: SOMOS Essential	$236.44

PR ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT

Professional

Both

$648.10

Service Code	HCPCS 44384
Min. Negotiated Rate	$486.08
Max. Negotiated Rate	$486.08
Rate for Payer: Cash Price	$172.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$486.08
Rate for Payer: SOMOS Essential	$486.08

PR ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD

Professional

Both

$239.68

Service Code	HCPCS 44380
Min. Negotiated Rate	$179.76
Max. Negotiated Rate	$179.76
Rate for Payer: Cash Price	$65.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$179.76
Rate for Payer: SOMOS Essential	$179.76

Know your out-of-pocket cost for care.

All Charges