St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR LASER VAPORIZATION OF PROSTATE FOR URINE FLOW

Professional

Both

$2,901.75

Service Code	HCPCS 52648
Min. Negotiated Rate	$2,176.31
Max. Negotiated Rate	$2,176.31
Rate for Payer: Cash Price	$795.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,176.31
Rate for Payer: SOMOS Essential	$2,176.31

PR LATERAL CANTHOPEXY

Professional

Both

$1,701.88

Service Code	HCPCS 21282
Min. Negotiated Rate	$1,276.41
Max. Negotiated Rate	$1,276.41
Rate for Payer: Cash Price	$467.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,276.41
Rate for Payer: SOMOS Essential	$1,276.41

PR LATERAL RETINACULAR RELEASE OPEN

Professional

Both

$2,018.80

Service Code	HCPCS 27425
Min. Negotiated Rate	$1,514.10
Max. Negotiated Rate	$1,514.10
Rate for Payer: Cash Price	$550.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,514.10
Rate for Payer: SOMOS Essential	$1,514.10

PR LAVAGE CANNULATION MAXILLARY SINUS

Professional

Both

$478.42

Service Code	HCPCS 31000
Min. Negotiated Rate	$358.82
Max. Negotiated Rate	$358.82
Rate for Payer: Cash Price	$130.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$358.82
Rate for Payer: SOMOS Essential	$358.82

PR LAVAGE CANNULATION SPHENOID SINUS

Professional

Both

$823.17

Service Code	HCPCS 31002
Min. Negotiated Rate	$617.38
Max. Negotiated Rate	$617.38
Rate for Payer: Cash Price	$220.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$617.38
Rate for Payer: SOMOS Essential	$617.38

PR LEFT HEART CATH BY TRANSEPTAL PUNCTURE

Professional

Both

$915.78

Service Code	HCPCS 93462
Min. Negotiated Rate	$686.84
Max. Negotiated Rate	$686.84
Rate for Payer: Cash Price	$241.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$686.84
Rate for Payer: SOMOS Essential	$686.84

PR LENGTHENING HAMSTRING TENDON MULTIPLE 1 LEG

Professional

Both

$2,906.44

Service Code	HCPCS 27394
Min. Negotiated Rate	$2,179.83
Max. Negotiated Rate	$2,179.83
Rate for Payer: Cash Price	$788.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,179.83
Rate for Payer: SOMOS Essential	$2,179.83

PR LENGTHENING HAMSTRING TENDON MULTIPLE BILATERAL

Professional

Both

$3,909.57

Service Code	HCPCS 27395
Min. Negotiated Rate	$2,932.18
Max. Negotiated Rate	$2,932.18
Rate for Payer: Cash Price	$1,057.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,932.18
Rate for Payer: SOMOS Essential	$2,932.18

PR LENGTHENING HAMSTRING TENDON SINGLE

Professional

Both

$2,226.70

Service Code	HCPCS 27393
Min. Negotiated Rate	$1,670.02
Max. Negotiated Rate	$1,670.02
Rate for Payer: Cash Price	$603.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,670.02
Rate for Payer: SOMOS Essential	$1,670.02

PR LENGTHENING PALATE & PHARYNGEAL FLAP

Professional

Both

$3,923.64

Service Code	HCPCS 42226
Min. Negotiated Rate	$2,942.73
Max. Negotiated Rate	$2,942.73
Rate for Payer: Cash Price	$1,061.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,942.73
Rate for Payer: SOMOS Essential	$2,942.73

PR LENGTHENING PALATE W/ISLAND FLAP

Professional

Both

$3,650.01

Service Code	HCPCS 42227
Min. Negotiated Rate	$2,737.51
Max. Negotiated Rate	$2,737.51
Rate for Payer: Cash Price	$988.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,737.51
Rate for Payer: SOMOS Essential	$2,737.51

PR LENGTHENING TENDON EXTENSOR HAND/FINGER EACH

Professional

Both

$2,864.51

Service Code	HCPCS 26476
Min. Negotiated Rate	$2,148.38
Max. Negotiated Rate	$2,148.38
Rate for Payer: Cash Price	$773.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,148.38
Rate for Payer: SOMOS Essential	$2,148.38

PR LENGTHENING TENDON FLEXOR HAND/FINGER EACH

Professional

Both

$2,944.48

Service Code	HCPCS 26478
Min. Negotiated Rate	$2,208.36
Max. Negotiated Rate	$2,208.36
Rate for Payer: Cash Price	$786.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,208.36
Rate for Payer: SOMOS Essential	$2,208.36

PR LEVONORGESTREL IU 52MG 3 YR

Professional

Both

$800.00

Service Code	HCPCS J7297
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$600.00
Rate for Payer: SOMOS Essential	$600.00

PR LEVONORGESTREL IU 52MG 5 YR

Professional

Both

$1,893.01

Service Code	HCPCS J7298
Min. Negotiated Rate	$1,419.76
Max. Negotiated Rate	$1,419.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,419.76
Rate for Payer: SOMOS Essential	$1,419.76

PR L HRT CATH CHD IMG CATH TRGT ZON NML/ABNL NT CNJ

Professional

Both

$1,026.45

Service Code	HCPCS 93595 26
Min. Negotiated Rate	$769.84
Max. Negotiated Rate	$769.84
Rate for Payer: Cash Price	$277.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$769.84
Rate for Payer: SOMOS Essential	$769.84

PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I

Professional

Both

$1,006.78

Service Code	HCPCS 93452 26
Min. Negotiated Rate	$755.08
Max. Negotiated Rate	$755.08
Rate for Payer: Cash Price	$270.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$755.08
Rate for Payer: SOMOS Essential	$755.08

PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I

Professional

Both

$2,900.31

Service Code	HCPCS 93452 TC
Min. Negotiated Rate	$2,175.23
Max. Negotiated Rate	$2,175.23
Rate for Payer: Cash Price	$772.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,175.23
Rate for Payer: SOMOS Essential	$2,175.23

PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I

Professional

Both

$3,907.09

Service Code	HCPCS 93452
Min. Negotiated Rate	$2,930.32
Max. Negotiated Rate	$2,930.32
Rate for Payer: Cash Price	$1,043.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,930.32
Rate for Payer: SOMOS Essential	$2,930.32

PR LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR

Professional

Both

$3,139.40

Service Code	HCPCS 27427
Min. Negotiated Rate	$2,354.55
Max. Negotiated Rate	$2,354.55
Rate for Payer: Cash Price	$847.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,354.55
Rate for Payer: SOMOS Essential	$2,354.55

PR LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR

Professional

Both

$4,939.59

Service Code	HCPCS 27428
Min. Negotiated Rate	$3,704.69
Max. Negotiated Rate	$3,704.69
Rate for Payer: Cash Price	$1,335.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,704.69
Rate for Payer: SOMOS Essential	$3,704.69

PR LIGATION ARTERIES ETHMOIDAL

Professional

Both

$2,626.30

Service Code	HCPCS 30915
Min. Negotiated Rate	$1,969.72
Max. Negotiated Rate	$1,969.72
Rate for Payer: Cash Price	$710.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,969.72
Rate for Payer: SOMOS Essential	$1,969.72

PR LIGATION ARTERIES INT MAXILLARY TRANSANTRAL

Professional

Both

$3,798.24

Service Code	HCPCS 30920
Min. Negotiated Rate	$2,848.68
Max. Negotiated Rate	$2,848.68
Rate for Payer: Cash Price	$1,023.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,848.68
Rate for Payer: SOMOS Essential	$2,848.68

PR LIGATION/BIOPSY TEMPORAL ARTERY

Professional

Both

$904.86

Service Code	HCPCS 37609
Min. Negotiated Rate	$678.64
Max. Negotiated Rate	$678.64
Rate for Payer: Cash Price	$241.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$678.64
Rate for Payer: SOMOS Essential	$678.64

PR LIGATION DIRECT ESOPHAGEAL VARICES

Professional

Both

$6,897.56

Service Code	HCPCS 43400
Min. Negotiated Rate	$5,173.17
Max. Negotiated Rate	$5,173.17
Rate for Payer: Cash Price	$1,834.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,173.17
Rate for Payer: SOMOS Essential	$5,173.17

Know your out-of-pocket cost for care.

All Charges