St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR KERATOPROSTHESIS

Professional

Both

$5,783.12

Service Code	HCPCS 65770
Min. Negotiated Rate	$4,337.34
Max. Negotiated Rate	$4,337.34
Rate for Payer: Cash Price	$1,588.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,337.34
Rate for Payer: SOMOS Essential	$4,337.34

PR KETOROLAC TROMETHAMINE INJ

Professional

Both

$15.00

Service Code	HCPCS J1885
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Cash Price	$0.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$11.25
Rate for Payer: SOMOS Essential	$11.25

PR KRUKENBERG PROCEDURE

Professional

Both

$5,157.04

Service Code	HCPCS 25915
Min. Negotiated Rate	$3,867.78
Max. Negotiated Rate	$3,867.78
Rate for Payer: Cash Price	$1,389.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,867.78
Rate for Payer: SOMOS Essential	$3,867.78

PR KYPHECTOMY 3 OR MORE SEGMENTS

Professional

Both

$10,907.12

Service Code	HCPCS 22819
Min. Negotiated Rate	$8,180.34
Max. Negotiated Rate	$8,180.34
Rate for Payer: Cash Price	$2,928.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,180.34
Rate for Payer: SOMOS Essential	$8,180.34

PR KYPHECTOMY SINGLE OR TWO SEGMENTS

Professional

Both

$9,468.24

Service Code	HCPCS 22818
Min. Negotiated Rate	$7,101.18
Max. Negotiated Rate	$7,101.18
Rate for Payer: Cash Price	$2,544.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,101.18
Rate for Payer: SOMOS Essential	$7,101.18

PR LABYRINTHECTOMY TRANSCANAL

Professional

Both

$3,991.40

Service Code	HCPCS 69905
Min. Negotiated Rate	$2,993.55
Max. Negotiated Rate	$2,993.55
Rate for Payer: Cash Price	$1,077.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,993.55
Rate for Payer: SOMOS Essential	$2,993.55

PR LABYRINTHECTOMY W/MASTOIDECTOMY

Professional

Both

$4,290.83

Service Code	HCPCS 69910
Min. Negotiated Rate	$3,218.12
Max. Negotiated Rate	$3,218.12
Rate for Payer: Cash Price	$1,158.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,218.12
Rate for Payer: SOMOS Essential	$3,218.12

PR LABYRINTHOTOMY TRANSCANAL

Professional

Both

$532.88

Service Code	HCPCS 69801
Min. Negotiated Rate	$399.66
Max. Negotiated Rate	$399.66
Rate for Payer: Cash Price	$144.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$399.66
Rate for Payer: SOMOS Essential	$399.66

PR LAIV4 VACCINE FOR INTRANASAL USE

Professional

Both

$93.61

Service Code	HCPCS 90672
Min. Negotiated Rate	$70.21
Max. Negotiated Rate	$70.21
Rate for Payer: Cash Price	$27.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70.21
Rate for Payer: SOMOS Essential	$70.21

PR LAM BX/EXC ISPI NEO IDRL IMED CERVICAL

Professional

Both

$12,627.93

Service Code	HCPCS 63285
Min. Negotiated Rate	$9,470.95
Max. Negotiated Rate	$9,470.95
Rate for Payer: Cash Price	$3,325.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9,470.95
Rate for Payer: SOMOS Essential	$9,470.95

PR LAM BX/EXC ISPI NEO IDRL IMED THORACIC

Professional

Both

$12,504.28

Service Code	HCPCS 63286
Min. Negotiated Rate	$9,378.21
Max. Negotiated Rate	$9,378.21
Rate for Payer: Cash Price	$3,263.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9,378.21
Rate for Payer: SOMOS Essential	$9,378.21

PR LAM BX/EXC ISPI NEO IDRL IMED THORACOLMBR

Professional

Both

$13,248.73

Service Code	HCPCS 63287
Min. Negotiated Rate	$9,936.55
Max. Negotiated Rate	$9,936.55
Rate for Payer: Cash Price	$3,486.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9,936.55
Rate for Payer: SOMOS Essential	$9,936.55

PR LAM BX/EXC ISPI NEO IDRL SACRAL

Professional

Both

$9,188.20

Service Code	HCPCS 63283
Min. Negotiated Rate	$6,891.15
Max. Negotiated Rate	$6,891.15
Rate for Payer: Cash Price	$2,424.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,891.15
Rate for Payer: SOMOS Essential	$6,891.15

PR LAM BX/EXC ISPI NEO IDRL XMED CERVICAL

Professional

Both

$10,209.43

Service Code	HCPCS 63280
Min. Negotiated Rate	$7,657.07
Max. Negotiated Rate	$7,657.07
Rate for Payer: Cash Price	$2,694.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,657.07
Rate for Payer: SOMOS Essential	$7,657.07

PR LAM BX/EXC ISPI NEO IDRL XMED LUMBAR

Professional

Both

$9,533.23

Service Code	HCPCS 63282
Min. Negotiated Rate	$7,149.92
Max. Negotiated Rate	$7,149.92
Rate for Payer: Cash Price	$2,514.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,149.92
Rate for Payer: SOMOS Essential	$7,149.92

PR LAM BX/EXC ISPI NEO IDRL XMED THORACIC

Professional

Both

$10,103.77

Service Code	HCPCS 63281
Min. Negotiated Rate	$7,577.83
Max. Negotiated Rate	$7,577.83
Rate for Payer: Cash Price	$2,671.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,577.83
Rate for Payer: SOMOS Essential	$7,577.83

PR LAM BX/EXC ISPI NEO XDRL-IDRL LES ANY LVL

Professional

Both

$13,475.25

Service Code	HCPCS 63290
Min. Negotiated Rate	$10,106.44
Max. Negotiated Rate	$10,106.44
Rate for Payer: Cash Price	$3,545.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10,106.44
Rate for Payer: SOMOS Essential	$10,106.44

PR LAM EXC/EVAC ISPI LESION OTH/THN NEO XDRL LUMBAR

Professional

Both

$6,441.75

Service Code	HCPCS 63267
Min. Negotiated Rate	$4,831.31
Max. Negotiated Rate	$4,831.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,831.31
Rate for Payer: SOMOS Essential	$4,831.31

PR LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL CERVICAL

Professional

Both

$7,956.34

Service Code	HCPCS 63265
Min. Negotiated Rate	$5,967.26
Max. Negotiated Rate	$5,967.26
Rate for Payer: Cash Price	$2,106.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,967.26
Rate for Payer: SOMOS Essential	$5,967.26

PR LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL SACRAL

Professional

Both

$6,565.09

Service Code	HCPCS 63268
Min. Negotiated Rate	$4,923.82
Max. Negotiated Rate	$4,923.82
Rate for Payer: Cash Price	$1,863.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,923.82
Rate for Payer: SOMOS Essential	$4,923.82

PR LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL THORACIC

Professional

Both

$8,170.54

Service Code	HCPCS 63266
Min. Negotiated Rate	$6,127.90
Max. Negotiated Rate	$6,127.90
Rate for Payer: Cash Price	$2,158.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,127.90
Rate for Payer: SOMOS Essential	$6,127.90

PR LAM EXC ISPI LES OTH/THN NEO IDRL CERVICAL

Professional

Both

$10,039.37

Service Code	HCPCS 63270
Min. Negotiated Rate	$7,529.53
Max. Negotiated Rate	$7,529.53
Rate for Payer: Cash Price	$2,644.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,529.53
Rate for Payer: SOMOS Essential	$7,529.53

PR LAM EXC ISPI LES OTH/THN NEO IDRL LUMBAR

Professional

Both

$8,808.70

Service Code	HCPCS 63272
Min. Negotiated Rate	$6,606.52
Max. Negotiated Rate	$6,606.52
Rate for Payer: Cash Price	$2,343.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,606.52
Rate for Payer: SOMOS Essential	$6,606.52

PR LAM EXC ISPI LES OTH/THN NEO IDRL SACRAL

Professional

Both

$9,024.19

Service Code	HCPCS 63273
Min. Negotiated Rate	$6,768.14
Max. Negotiated Rate	$6,768.14
Rate for Payer: Cash Price	$2,379.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,768.14
Rate for Payer: SOMOS Essential	$6,768.14

PR LAM EXC ISPI LES OTH/THN NEO IDRL THORACIC

Professional

Both

$10,006.57

Service Code	HCPCS 63271
Min. Negotiated Rate	$7,504.93
Max. Negotiated Rate	$7,504.93
Rate for Payer: Cash Price	$2,631.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,504.93
Rate for Payer: SOMOS Essential	$7,504.93

Know your out-of-pocket cost for care.

All Charges