St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR LAPAROSCOPY W/OMENTOPEXY

Professional

Both

$847.63

Service Code	HCPCS 49326
Min. Negotiated Rate	$635.72
Max. Negotiated Rate	$635.72
Rate for Payer: Cash Price	$224.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$635.72
Rate for Payer: SOMOS Essential	$635.72

PR LAPAROSCOPY W/PLMT OCCLUSION DEVICE OVIDUCTS

Professional

Both

$1,623.76

Service Code	HCPCS 58671
Min. Negotiated Rate	$1,217.82
Max. Negotiated Rate	$1,217.82
Rate for Payer: Cash Price	$439.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,217.82
Rate for Payer: SOMOS Essential	$1,217.82

PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES

Professional

Both

$2,848.51

Service Code	HCPCS 58661
Min. Negotiated Rate	$2,136.38
Max. Negotiated Rate	$2,136.38
Rate for Payer: Cash Price	$766.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,136.38
Rate for Payer: SOMOS Essential	$2,136.38

PR LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/<

Professional

Both

$3,525.48

Service Code	HCPCS 58570
Min. Negotiated Rate	$2,644.11
Max. Negotiated Rate	$2,644.11
Rate for Payer: Cash Price	$950.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,644.11
Rate for Payer: SOMOS Essential	$2,644.11

PR LAPAROTOMY ISLET CELL TRANSP

Professional

Both

$5,591.04

Service Code	HCPCS G0343
Min. Negotiated Rate	$4,193.28
Max. Negotiated Rate	$4,193.28
Rate for Payer: Cash Price	$1,488.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,193.28
Rate for Payer: SOMOS Essential	$4,193.28

PR LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX

Professional

Both

$1,472.63

Service Code	HCPCS 49320
Min. Negotiated Rate	$1,104.47
Max. Negotiated Rate	$1,104.47
Rate for Payer: Cash Price	$396.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,104.47
Rate for Payer: SOMOS Essential	$1,104.47

PR LAPS ABLTJ RENAL MASS LESION W/INTRAOP US

Professional

Both

$4,881.56

Service Code	HCPCS 50542
Min. Negotiated Rate	$3,661.17
Max. Negotiated Rate	$3,661.17
Rate for Payer: Cash Price	$1,323.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,661.17
Rate for Payer: SOMOS Essential	$3,661.17

PR LAPS ABLTJ UTERINE FIBROIDS W/INTRAOP US GDN

Professional

Both

$3,551.03

Service Code	HCPCS 58674
Min. Negotiated Rate	$2,663.27
Max. Negotiated Rate	$2,663.27
Rate for Payer: Cash Price	$955.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,663.27
Rate for Payer: SOMOS Essential	$2,663.27

PR LAPS BI TOT PEL LMPHADEC & PRI-AORTIC LYMPH BX 1

Professional

Both

$3,900.72

Service Code	HCPCS 38572
Min. Negotiated Rate	$2,925.54
Max. Negotiated Rate	$2,925.54
Rate for Payer: Cash Price	$1,046.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,925.54
Rate for Payer: SOMOS Essential	$2,925.54

PR LAPS CLSR NTRSTM LG/SM INT W/RESCJ & ANASTOMOSIS

Professional

Both

$7,343.25

Service Code	HCPCS 44227
Min. Negotiated Rate	$5,507.44
Max. Negotiated Rate	$5,507.44
Rate for Payer: Cash Price	$1,958.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,507.44
Rate for Payer: SOMOS Essential	$5,507.44

PR LAPS COLCT TTL ABD W/PRCTECT ILEOANAL ANASTOMSIS

Professional

Both

$8,934.52

Service Code	HCPCS 44211
Min. Negotiated Rate	$6,700.89
Max. Negotiated Rate	$6,700.89
Rate for Payer: Cash Price	$2,417.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,700.89
Rate for Payer: SOMOS Essential	$6,700.89

PR LAPS COLECTMY PRTL W/COLOPXTSTMY LW ANAST W/CLST

Professional

Both

$8,623.23

Service Code	HCPCS 44208
Min. Negotiated Rate	$6,467.42
Max. Negotiated Rate	$6,467.42
Rate for Payer: Cash Price	$2,311.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,467.42
Rate for Payer: SOMOS Essential	$6,467.42

PR LAPS COLECTOMY ABDL W/PROCTECTOMY W/ILEOSTOMY

Professional

Both

$8,704.15

Service Code	HCPCS 44212
Min. Negotiated Rate	$6,528.11
Max. Negotiated Rate	$6,528.11
Rate for Payer: Cash Price	$2,346.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,528.11
Rate for Payer: SOMOS Essential	$6,528.11

PR LAPS COLECTOMY PRTL W/COLOPXTSTMY LW ANAST

Professional

Both

$7,930.69

Service Code	HCPCS 44207
Min. Negotiated Rate	$5,948.02
Max. Negotiated Rate	$5,948.02
Rate for Payer: Cash Price	$2,122.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,948.02
Rate for Payer: SOMOS Essential	$5,948.02

PR LAPS COLECTOMY PRTL W/END CLST & CLSR DSTL SGM

Professional

Both

$7,702.49

Service Code	HCPCS 44206
Min. Negotiated Rate	$5,776.87
Max. Negotiated Rate	$5,776.87
Rate for Payer: Cash Price	$2,059.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,776.87
Rate for Payer: SOMOS Essential	$5,776.87

PR LAPS COLECTOMY PRTL W/RMVL TERMINAL ILEUM

Professional

Both

$5,882.42

Service Code	HCPCS 44205
Min. Negotiated Rate	$4,411.81
Max. Negotiated Rate	$4,411.81
Rate for Payer: Cash Price	$1,572.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,411.81
Rate for Payer: SOMOS Essential	$4,411.81

PR LAPS COLECTOMY TOT W/O PRCTECT W/ILEOST/ILEOPXTS

Professional

Both

$7,691.01

Service Code	HCPCS 44210
Min. Negotiated Rate	$5,768.26
Max. Negotiated Rate	$5,768.26
Rate for Payer: Cash Price	$2,064.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,768.26
Rate for Payer: SOMOS Essential	$5,768.26

PR LAPS ENTERECT RESCJ 1 SMALL INTEST RESCJ & ANA

Professional

Both

$6,213.62

Service Code	HCPCS 44202
Min. Negotiated Rate	$4,660.22
Max. Negotiated Rate	$4,660.22
Rate for Payer: Cash Price	$1,656.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,660.22
Rate for Payer: SOMOS Essential	$4,660.22

PR LAPS ESOPHAGEAL LENGTHENING ADDL

Professional

Both

$707.35

Service Code	HCPCS 43283
Min. Negotiated Rate	$530.51
Max. Negotiated Rate	$530.51
Rate for Payer: Cash Price	$187.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$530.51
Rate for Payer: SOMOS Essential	$530.51

PR LAPS ESOPHAGOMYOTOMY W/FUNDOPLASTY IF PERFORMED

Professional

Both

$5,779.62

Service Code	HCPCS 43279
Min. Negotiated Rate	$4,334.72
Max. Negotiated Rate	$4,334.72
Rate for Payer: Cash Price	$1,538.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,334.72
Rate for Payer: SOMOS Essential	$4,334.72

PR LAPS ESOPHGL SPHNCTR AGMNTJ PLMT DEV CRRPL

Professional

Both

$2,948.58

Service Code	HCPCS 43284
Min. Negotiated Rate	$2,211.43
Max. Negotiated Rate	$2,211.43
Rate for Payer: Cash Price	$789.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,211.43
Rate for Payer: SOMOS Essential	$2,211.43

PR LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE

Professional

Both

$3,107.90

Service Code	HCPCS 58662
Min. Negotiated Rate	$2,330.93
Max. Negotiated Rate	$2,330.93
Rate for Payer: Cash Price	$840.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,330.93
Rate for Payer: SOMOS Essential	$2,330.93

PR LAPS GASTRIC RESTRICTIVE PROCEDURE PLACE DEVICE

Professional

Both

$5,095.62

Service Code	HCPCS 43770
Min. Negotiated Rate	$3,821.72
Max. Negotiated Rate	$3,821.72
Rate for Payer: Cash Price	$1,359.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,821.72
Rate for Payer: SOMOS Essential	$3,821.72

PR LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE

Professional

Both

$4,283.65

Service Code	HCPCS 43772
Min. Negotiated Rate	$3,212.74
Max. Negotiated Rate	$3,212.74
Rate for Payer: Cash Price	$1,146.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,212.74
Rate for Payer: SOMOS Essential	$3,212.74

PR LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE & PORT

Professional

Both

$4,351.59

Service Code	HCPCS 43774
Min. Negotiated Rate	$3,263.69
Max. Negotiated Rate	$3,263.69
Rate for Payer: Cash Price	$1,159.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,263.69
Rate for Payer: SOMOS Essential	$3,263.69

Know your out-of-pocket cost for care.

All Charges