St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR INCISION & DRAINAGE PILONIDAL CYST SIMPLE

Professional

Both

$450.59

Service Code	HCPCS 10080
Min. Negotiated Rate	$337.94
Max. Negotiated Rate	$337.94
Rate for Payer: Cash Price	$124.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$337.94
Rate for Payer: SOMOS Essential	$337.94

PR INCISION&DRAINAGE UPPER ARM/ELBOW BURSA

Professional

Both

$710.05

Service Code	HCPCS 23931
Min. Negotiated Rate	$532.54
Max. Negotiated Rate	$532.54
Rate for Payer: Cash Price	$193.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$532.54
Rate for Payer: SOMOS Essential	$532.54

PR INCISION EXTENSOR TENDON SHEATH WRIST

Professional

Both

$1,533.70

Service Code	HCPCS 25000
Min. Negotiated Rate	$1,150.28
Max. Negotiated Rate	$1,150.28
Rate for Payer: Cash Price	$419.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,150.28
Rate for Payer: SOMOS Essential	$1,150.28

PR INCISION FLEXOR TENDON SHEATH WRIST

Professional

Both

$1,534.61

Service Code	HCPCS 25001
Min. Negotiated Rate	$1,150.96
Max. Negotiated Rate	$1,150.96
Rate for Payer: Cash Price	$421.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,150.96
Rate for Payer: SOMOS Essential	$1,150.96

PR INCISION LABIAL FRENUM FRENOTOMY

Professional

Both

$123.10

Service Code	HCPCS 40806
Min. Negotiated Rate	$92.32
Max. Negotiated Rate	$92.32
Rate for Payer: Cash Price	$34.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$92.32
Rate for Payer: SOMOS Essential	$92.32

PR INCISION LEG/ANKLE

Professional

Both

$2,601.20

Service Code	HCPCS 27607
Min. Negotiated Rate	$1,950.90
Max. Negotiated Rate	$1,950.90
Rate for Payer: Cash Price	$711.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,950.90
Rate for Payer: SOMOS Essential	$1,950.90

PR INCISION LINGUAL FRENUM FRENOTOMY

Professional

Both

$478.80

Service Code	HCPCS 41010
Min. Negotiated Rate	$359.10
Max. Negotiated Rate	$359.10
Rate for Payer: Cash Price	$129.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$359.10
Rate for Payer: SOMOS Essential	$359.10

PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMP

Professional

Both

$784.98

Service Code	HCPCS 10121
Min. Negotiated Rate	$588.74
Max. Negotiated Rate	$588.74
Rate for Payer: Cash Price	$214.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$588.74
Rate for Payer: SOMOS Essential	$588.74

PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE

Professional

Both

$450.87

Service Code	HCPCS 10120
Min. Negotiated Rate	$338.15
Max. Negotiated Rate	$338.15
Rate for Payer: Cash Price	$123.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$338.15
Rate for Payer: SOMOS Essential	$338.15

PR INCISION & SUBCUTANEOUS PLMT CRANIAL BONE GRAF

Professional

Both

$423.64

Service Code	HCPCS 61316
Min. Negotiated Rate	$317.73
Max. Negotiated Rate	$317.73
Rate for Payer: Cash Price	$110.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$317.73
Rate for Payer: SOMOS Essential	$317.73

PR INCISION THROMBOSED HEMORRHOID EXTERNAL

Professional

Both

$481.18

Service Code	HCPCS 46083
Min. Negotiated Rate	$360.88
Max. Negotiated Rate	$360.88
Rate for Payer: Cash Price	$130.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$360.88
Rate for Payer: SOMOS Essential	$360.88

PR INDOCYANINE-GREEN ANGRPH W/MULTIFRAME I&R UNI/BI

Professional

Both

$619.43

Service Code	HCPCS 92240 TC
Min. Negotiated Rate	$464.57
Max. Negotiated Rate	$464.57
Rate for Payer: Cash Price	$167.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$464.57
Rate for Payer: SOMOS Essential	$464.57

PR INDOCYANINE-GREEN ANGRPH W/MULTIFRAME I&R UNI/BI

Professional

Both

$195.41

Service Code	HCPCS 92240 26
Min. Negotiated Rate	$146.56
Max. Negotiated Rate	$146.56
Rate for Payer: Cash Price	$52.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$146.56
Rate for Payer: SOMOS Essential	$146.56

PR INDOCYANINE-GREEN ANGRPH W/MULTIFRAME I&R UNI/BI

Professional

Both

$814.84

Service Code	HCPCS 92240
Min. Negotiated Rate	$611.13
Max. Negotiated Rate	$611.13
Rate for Payer: Cash Price	$219.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$611.13
Rate for Payer: SOMOS Essential	$611.13

PR INDUCE ABORT 1/> AMNIOT NJXS DLVR FETUS D&C

Professional

Both

$1,979.15

Service Code	HCPCS 59851
Min. Negotiated Rate	$1,484.36
Max. Negotiated Rate	$1,484.36
Rate for Payer: Cash Price	$527.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,484.36
Rate for Payer: SOMOS Essential	$1,484.36

PR INDUCE ABORT 1/> AMNIOT NJXS DLVR FETUS HYSTOTM

Professional

Both

$2,728.85

Service Code	HCPCS 59852
Min. Negotiated Rate	$2,046.64
Max. Negotiated Rate	$2,046.64
Rate for Payer: Cash Price	$725.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,046.64
Rate for Payer: SOMOS Essential	$2,046.64

PR INDUCED ABORT 1/> VAG SUPP DLVR FETUS D&C &/EVAC

Professional

Both

$2,316.16

Service Code	HCPCS 59856
Min. Negotiated Rate	$1,737.12
Max. Negotiated Rate	$1,737.12
Rate for Payer: Cash Price	$614.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,737.12
Rate for Payer: SOMOS Essential	$1,737.12

PR INDUCED ABORT 1/> VAG SUPPOS DLVR FETUS HYSTOT

Professional

Both

$2,703.89

Service Code	HCPCS 59857
Min. Negotiated Rate	$2,027.92
Max. Negotiated Rate	$2,027.92
Rate for Payer: Cash Price	$715.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,027.92
Rate for Payer: SOMOS Essential	$2,027.92

PR INDUCED ABORT 1/> VAG SUPPOSITORIES DLVR FETUS

Professional

Both

$1,977.43

Service Code	HCPCS 59855
Min. Negotiated Rate	$1,483.07
Max. Negotiated Rate	$1,483.07
Rate for Payer: Cash Price	$525.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,483.07
Rate for Payer: SOMOS Essential	$1,483.07

PR INDUCED ABORTION 1/> AMNIOTIC INJX W/D&C/EVACJ

Professional

Both

$1,815.80

Service Code	HCPCS 59850
Min. Negotiated Rate	$1,361.85
Max. Negotiated Rate	$1,361.85
Rate for Payer: Cash Price	$483.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,361.85
Rate for Payer: SOMOS Essential	$1,361.85

PR INDUCED ABORTION DILATION AND CURETTAGE

Professional

Both

$1,025.75

Service Code	HCPCS 59840
Min. Negotiated Rate	$769.31
Max. Negotiated Rate	$769.31
Rate for Payer: Cash Price	$273.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$769.31
Rate for Payer: SOMOS Essential	$769.31

PR INDUCED ABORTION DILATION & EVACUATION

Professional

Both

$1,726.66

Service Code	HCPCS 59841
Min. Negotiated Rate	$1,295.00
Max. Negotiated Rate	$1,295.00
Rate for Payer: Cash Price	$459.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,295.00
Rate for Payer: SOMOS Essential	$1,295.00

PR INDUCTION ARRHYTHMIA ELECTRICAL PACING

Professional

Both

$808.54

Service Code	HCPCS 93618 TC
Min. Negotiated Rate	$606.40
Max. Negotiated Rate	$606.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$606.40
Rate for Payer: SOMOS Essential	$606.40

PR INDUCTION ARRHYTHMIA ELECTRICAL PACING

Professional

Both

$935.20

Service Code	HCPCS 93618 26
Min. Negotiated Rate	$701.40
Max. Negotiated Rate	$701.40
Rate for Payer: Cash Price	$245.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$701.40
Rate for Payer: SOMOS Essential	$701.40

PR INDUCTION ARRHYTHMIA ELECTRICAL PACING

Professional

Both

$1,743.74

Service Code	HCPCS 93618
Min. Negotiated Rate	$1,307.80
Max. Negotiated Rate	$1,307.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,307.80
Rate for Payer: SOMOS Essential	$1,307.80

Know your out-of-pocket cost for care.

All Charges