St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR LAPS SURG ESOPG/GSTR FUNDOPLASTY

Professional

Both

$4,863.43

Service Code	HCPCS 43280
Min. Negotiated Rate	$3,647.57
Max. Negotiated Rate	$3,647.57
Rate for Payer: Cash Price	$1,295.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,647.57
Rate for Payer: SOMOS Essential	$3,647.57

PR LAPS SURG GASTROSTOMY W/O CONSTJ GSTR TUBE SPX

Professional

Both

$2,607.29

Service Code	HCPCS 43653
Min. Negotiated Rate	$1,955.47
Max. Negotiated Rate	$1,955.47
Rate for Payer: Cash Price	$699.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,955.47
Rate for Payer: SOMOS Essential	$1,955.47

PR LAPS SURG PRST8ECT SMPL STOT ROBOTIC ASSISTANCE

Professional

Both

$4,381.69

Service Code	HCPCS 55867
Min. Negotiated Rate	$3,286.27
Max. Negotiated Rate	$3,286.27
Rate for Payer: Cash Price	$1,195.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,286.27
Rate for Payer: SOMOS Essential	$3,286.27

PR LAPS SURG RETROPERITONEAL LYMPH NODE BX 1/MLT

Professional

Both

$2,237.80

Service Code	HCPCS 38570
Min. Negotiated Rate	$1,678.35
Max. Negotiated Rate	$1,678.35
Rate for Payer: Cash Price	$607.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,678.35
Rate for Payer: SOMOS Essential	$1,678.35

PR LAPS SURG RPR RECURRENT INGUINAL HERNIA

Professional

Both

$2,555.95

Service Code	HCPCS 49651
Min. Negotiated Rate	$1,916.96
Max. Negotiated Rate	$1,916.96
Rate for Payer: Cash Price	$685.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,916.96
Rate for Payer: SOMOS Essential	$1,916.96

PR LAPS SURG TRNSXJ VAGUS NRV SLCTV/HILY SLCTV

Professional

Both

$3,469.45

Service Code	HCPCS 43652
Min. Negotiated Rate	$2,602.09
Max. Negotiated Rate	$2,602.09
Rate for Payer: Cash Price	$927.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,602.09
Rate for Payer: SOMOS Essential	$2,602.09

PR LAPS SURG TRNSXJ VAGUS NRV TRUNCAL

Professional

Both

$2,971.57

Service Code	HCPCS 43651
Min. Negotiated Rate	$2,228.68
Max. Negotiated Rate	$2,228.68
Rate for Payer: Cash Price	$796.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,228.68
Rate for Payer: SOMOS Essential	$2,228.68

PR LAPS SURG W/ASPIR CAVITY/CYST SINGLE/MULTIPLE

Professional

Both

$1,679.72

Service Code	HCPCS 49322
Min. Negotiated Rate	$1,259.79
Max. Negotiated Rate	$1,259.79
Rate for Payer: Cash Price	$449.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,259.79
Rate for Payer: SOMOS Essential	$1,259.79

PR LAPS SURG W/DRG LYMPHOCELE PRTL CAVITY

Professional

Both

$2,845.26

Service Code	HCPCS 49323
Min. Negotiated Rate	$2,133.94
Max. Negotiated Rate	$2,133.94
Rate for Payer: Cash Price	$765.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,133.94
Rate for Payer: SOMOS Essential	$2,133.94

PR LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY

Professional

Both

$3,953.25

Service Code	HCPCS 58571
Min. Negotiated Rate	$2,964.94
Max. Negotiated Rate	$2,964.94
Rate for Payer: Cash Price	$1,070.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,964.94
Rate for Payer: SOMOS Essential	$2,964.94

PR LAPS TOT HYSTERECTOMY RESJ MALIGNANCY W/OMNTC

Professional

Both

$8,387.44

Service Code	HCPCS 58575
Min. Negotiated Rate	$6,290.58
Max. Negotiated Rate	$6,290.58
Rate for Payer: Cash Price	$2,271.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,290.58
Rate for Payer: SOMOS Essential	$6,290.58

PR LAPS TX ECTOPIC PREG W/O SALPING&/OOPHORECTOMY

Professional

Both

$3,682.11

Service Code	HCPCS 59150
Min. Negotiated Rate	$2,761.58
Max. Negotiated Rate	$2,761.58
Rate for Payer: Cash Price	$977.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,761.58
Rate for Payer: SOMOS Essential	$2,761.58

PR LAPS TX ECTOPIC PREG W/SALPING&/OOPHORECTOMY

Professional

Both

$3,600.31

Service Code	HCPCS 59151
Min. Negotiated Rate	$2,700.23
Max. Negotiated Rate	$2,700.23
Rate for Payer: Cash Price	$956.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,700.23
Rate for Payer: SOMOS Essential	$2,700.23

PR LAPS URTRONEOCSTOST W/CSTSC&URTRL STENT PLMT

Professional

Both

$5,768.88

Service Code	HCPCS 50947
Min. Negotiated Rate	$4,326.66
Max. Negotiated Rate	$4,326.66
Rate for Payer: Cash Price	$1,575.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,326.66
Rate for Payer: SOMOS Essential	$4,326.66

PR LAPS URTRONEOCSTOST W/O CSTSC&URTRL STENT PLMT

Professional

Both

$5,312.27

Service Code	HCPCS 50948
Min. Negotiated Rate	$3,984.20
Max. Negotiated Rate	$3,984.20
Rate for Payer: Cash Price	$1,442.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,984.20
Rate for Payer: SOMOS Essential	$3,984.20

PR LAPS VAGINAL HYSTERECT > 250 GM RMVL TUBE&/OVAR

Professional

Both

$5,672.45

Service Code	HCPCS 58554
Min. Negotiated Rate	$4,254.34
Max. Negotiated Rate	$4,254.34
Rate for Payer: Cash Price	$1,531.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,254.34
Rate for Payer: SOMOS Essential	$4,254.34

PR LAPS VAGINAL HYSTERECTOMY UTERUS 250 GM/<

Professional

Both

$3,844.86

Service Code	HCPCS 58550
Min. Negotiated Rate	$2,883.64
Max. Negotiated Rate	$2,883.64
Rate for Payer: Cash Price	$1,037.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,883.64
Rate for Payer: SOMOS Essential	$2,883.64

PR LAPS W/BI TOT PEL LMPHADEC & OMNTC LYMPH BX

Professional

Both

$5,093.38

Service Code	HCPCS 38573
Min. Negotiated Rate	$3,820.04
Max. Negotiated Rate	$3,820.04
Rate for Payer: Cash Price	$1,378.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,820.04
Rate for Payer: SOMOS Essential	$3,820.04

PR LAPS W/INSERTION NTRSTL DEV W/IMG GUID 1/MLT

Professional

Both

$586.04

Service Code	HCPCS 49327
Min. Negotiated Rate	$439.53
Max. Negotiated Rate	$439.53
Rate for Payer: Cash Price	$155.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$439.53
Rate for Payer: SOMOS Essential	$439.53

PR LAPS W/RAD HYST W/BILAT LMPHADEC RMVL TUBE/OVARY

Professional

Both

$8,171.70

Service Code	HCPCS 58548
Min. Negotiated Rate	$6,128.78
Max. Negotiated Rate	$6,128.78
Rate for Payer: Cash Price	$2,213.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,128.78
Rate for Payer: SOMOS Essential	$6,128.78

PR LAPS W/REVISION INTRAPERITONEAL CATHETER

Professional

Both

$1,865.99

Service Code	HCPCS 49325
Min. Negotiated Rate	$1,399.49
Max. Negotiated Rate	$1,399.49
Rate for Payer: Cash Price	$497.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,399.49
Rate for Payer: SOMOS Essential	$1,399.49

PR LAPS W/VAG HYSTERECT 250 GM/&RMVL TUBE&/OVARIES

Professional

Both

$4,278.58

Service Code	HCPCS 58552
Min. Negotiated Rate	$3,208.94
Max. Negotiated Rate	$3,208.94
Rate for Payer: Cash Price	$1,151.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,208.94
Rate for Payer: SOMOS Essential	$3,208.94

PR LAPS W/VAGINAL HYSTERECTOMY > 250 GRAMS

Professional

Both

$4,882.96

Service Code	HCPCS 58553
Min. Negotiated Rate	$3,662.22
Max. Negotiated Rate	$3,662.22
Rate for Payer: Cash Price	$1,314.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,662.22
Rate for Payer: SOMOS Essential	$3,662.22

PR LAPT RPR PARAESOPH HIATAL HERNIA W/MESH

Professional

Both

$5,659.57

Service Code	HCPCS 43333
Min. Negotiated Rate	$4,244.68
Max. Negotiated Rate	$4,244.68
Rate for Payer: Cash Price	$1,508.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,244.68
Rate for Payer: SOMOS Essential	$4,244.68

PR LAPT STG/RESTG OVARIAN TUBAL/PRIM MAL 2ND LOOK

Professional

Both

$4,331.85

Service Code	HCPCS 58960
Min. Negotiated Rate	$3,248.89
Max. Negotiated Rate	$3,248.89
Rate for Payer: Cash Price	$1,175.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,248.89
Rate for Payer: SOMOS Essential	$3,248.89

Know your out-of-pocket cost for care.

All Charges