St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR LAPS GASTRIC RESTRICTIVE PX REMOVE&RPLCMT DEVICE

Professional

Both

$5,791.70

Service Code	HCPCS 43773
Min. Negotiated Rate	$4,343.78
Max. Negotiated Rate	$4,343.78
Rate for Payer: Cash Price	$1,542.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,343.78
Rate for Payer: SOMOS Essential	$4,343.78

PR LAPS GASTRIC RESTRICTIVE PX REVISION DEVICE

Professional

Both

$5,791.70

Service Code	HCPCS 43771
Min. Negotiated Rate	$4,343.78
Max. Negotiated Rate	$4,343.78
Rate for Payer: Cash Price	$1,542.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,343.78
Rate for Payer: SOMOS Essential	$4,343.78

PR LAPS GSTRC RSTRICTIV PX LONGITUDINAL GASTRECTOMY

Professional

Both

$5,023.55

Service Code	HCPCS 43775
Min. Negotiated Rate	$3,767.66
Max. Negotiated Rate	$3,767.66
Rate for Payer: Cash Price	$1,328.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,767.66
Rate for Payer: SOMOS Essential	$3,767.66

PR LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM

Professional

Both

$7,858.55

Service Code	HCPCS 43644
Min. Negotiated Rate	$5,893.91
Max. Negotiated Rate	$5,893.91
Rate for Payer: Cash Price	$2,092.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,893.91
Rate for Payer: SOMOS Essential	$5,893.91

PR LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ

Professional

Both

$8,334.10

Service Code	HCPCS 43645
Min. Negotiated Rate	$6,250.58
Max. Negotiated Rate	$6,250.58
Rate for Payer: Cash Price	$2,219.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,250.58
Rate for Payer: SOMOS Essential	$6,250.58

PR LAPS IMPLTJ/RPLCMT GASTRIC NSTIM ELTRD ANTRUM

Professional

Both

$4,033.72

Service Code	HCPCS 43647
Min. Negotiated Rate	$3,025.29
Max. Negotiated Rate	$3,025.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,025.29
Rate for Payer: SOMOS Essential	$3,025.29

PR LAPS INSERTION TUNNELED INTRAPERITONEAL CATHETER

Professional

Both

$1,750.28

Service Code	HCPCS 49324
Min. Negotiated Rate	$1,312.71
Max. Negotiated Rate	$1,312.71
Rate for Payer: Cash Price	$466.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,312.71
Rate for Payer: SOMOS Essential	$1,312.71

PR LAPS LIGATION SPERMATIC VEINS VARICOCELE

Professional

Both

$1,807.12

Service Code	HCPCS 55550
Min. Negotiated Rate	$1,355.34
Max. Negotiated Rate	$1,355.34
Rate for Payer: Cash Price	$496.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,355.34
Rate for Payer: SOMOS Essential	$1,355.34

PR LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY

Professional

Both

$814.03

Service Code	HCPCS 44213
Min. Negotiated Rate	$610.52
Max. Negotiated Rate	$610.52
Rate for Payer: Cash Price	$217.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$610.52
Rate for Payer: SOMOS Essential	$610.52

PR LAPS MYOMECTOMY EXC 1-4 MYOMAS 250 GM/<

Professional

Both

$3,937.96

Service Code	HCPCS 58545
Min. Negotiated Rate	$2,953.47
Max. Negotiated Rate	$2,953.47
Rate for Payer: Cash Price	$1,062.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,953.47
Rate for Payer: SOMOS Essential	$2,953.47

PR LAPS MYOMECTOMY EXC 5/> MYOMAS >250 GRAMS

Professional

Both

$4,856.71

Service Code	HCPCS 58546
Min. Negotiated Rate	$3,642.53
Max. Negotiated Rate	$3,642.53
Rate for Payer: Cash Price	$1,306.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,642.53
Rate for Payer: SOMOS Essential	$3,642.53

PR LAPS PROCTECTOMY ABDOMINOPERINEAL W/COLOSTOMY

Professional

Both

$8,481.59

Service Code	HCPCS 45395
Min. Negotiated Rate	$6,361.19
Max. Negotiated Rate	$6,361.19
Rate for Payer: Cash Price	$2,279.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,361.19
Rate for Payer: SOMOS Essential	$6,361.19

PR LAPS PROCTECTOMY COMBINED PULL-THRU W/RESERVOIR

Professional

Both

$9,139.10

Service Code	HCPCS 45397
Min. Negotiated Rate	$6,854.32
Max. Negotiated Rate	$6,854.32
Rate for Payer: Cash Price	$2,453.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,854.32
Rate for Payer: SOMOS Essential	$6,854.32

PR LAPS PROSTECT RETROPUBIC RAD W/NRV SPARING ROBOT

Professional

Both

$4,989.60

Service Code	HCPCS 55866
Min. Negotiated Rate	$3,742.20
Max. Negotiated Rate	$3,742.20
Rate for Payer: Cash Price	$1,360.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,742.20
Rate for Payer: SOMOS Essential	$3,742.20

PR LAPS REVISION/RMVL GASTRIC NSTIM ELTRD ANTRUM

Professional

Both

$4,033.72

Service Code	HCPCS 43648
Min. Negotiated Rate	$3,025.29
Max. Negotiated Rate	$3,025.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,025.29
Rate for Payer: SOMOS Essential	$3,025.29

PR LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/MESH

Professional

Both

$7,809.97

Service Code	HCPCS 43282
Min. Negotiated Rate	$5,857.48
Max. Negotiated Rate	$5,857.48
Rate for Payer: Cash Price	$2,077.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,857.48
Rate for Payer: SOMOS Essential	$5,857.48

PR LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/O MESH

Professional

Both

$6,943.55

Service Code	HCPCS 43281
Min. Negotiated Rate	$5,207.66
Max. Negotiated Rate	$5,207.66
Rate for Payer: Cash Price	$1,843.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,207.66
Rate for Payer: SOMOS Essential	$5,207.66

PR LAPS SUPRACERVICAL HYSTERECTOMY >250

Professional

Both

$3,682.60

Service Code	HCPCS 58543
Min. Negotiated Rate	$2,761.95
Max. Negotiated Rate	$2,761.95
Rate for Payer: Cash Price	$991.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,761.95
Rate for Payer: SOMOS Essential	$2,761.95

PR LAPS SUPRACRV HYSTEREC >250 G RMVL TUBE/OVARY

Professional

Both

$3,958.29

Service Code	HCPCS 58544
Min. Negotiated Rate	$2,968.72
Max. Negotiated Rate	$2,968.72
Rate for Payer: Cash Price	$1,065.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,968.72
Rate for Payer: SOMOS Essential	$2,968.72

PR LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TUBE/OVAR

Professional

Both

$3,617.78

Service Code	HCPCS 58542
Min. Negotiated Rate	$2,713.34
Max. Negotiated Rate	$2,713.34
Rate for Payer: Cash Price	$974.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,713.34
Rate for Payer: SOMOS Essential	$2,713.34

PR LAPS SURG ABLTJ 1 > LVR TUM CRYOSURG

Professional

Both

$5,702.38

Service Code	HCPCS 47371
Min. Negotiated Rate	$4,276.78
Max. Negotiated Rate	$4,276.78
Rate for Payer: Cash Price	$1,518.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,276.78
Rate for Payer: SOMOS Essential	$4,276.78

PR LAPS SURG ABLTJ 1/> LVR TUM RF

Professional

Both

$5,663.81

Service Code	HCPCS 47370
Min. Negotiated Rate	$4,247.86
Max. Negotiated Rate	$4,247.86
Rate for Payer: Cash Price	$1,509.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,247.86
Rate for Payer: SOMOS Essential	$4,247.86

PR LAPS SURG BILATERAL TOTAL PELVIC LMPHADECTOMY

Professional

Both

$2,792.58

Service Code	HCPCS 38571
Min. Negotiated Rate	$2,094.44
Max. Negotiated Rate	$2,094.44
Rate for Payer: Cash Price	$760.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,094.44
Rate for Payer: SOMOS Essential	$2,094.44

PR LAPS SURG CHOLECSTC W/EXPL COMMON DUCT

Professional

Both

$5,047.84

Service Code	HCPCS 47564
Min. Negotiated Rate	$3,785.88
Max. Negotiated Rate	$3,785.88
Rate for Payer: Cash Price	$1,348.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,785.88
Rate for Payer: SOMOS Essential	$3,785.88

PR LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY

Professional

Both

$3,251.68

Service Code	HCPCS 47563
Min. Negotiated Rate	$2,438.76
Max. Negotiated Rate	$2,438.76
Rate for Payer: Cash Price	$867.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,438.76
Rate for Payer: SOMOS Essential	$2,438.76

Know your out-of-pocket cost for care.

All Charges