St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR MENISCECTOMY PRTL/COMPL TEMPOROMANDIBULAR JT SPX

Professional

Both

$3,311.56

Service Code	HCPCS 21060
Min. Negotiated Rate	$2,483.67
Max. Negotiated Rate	$2,483.67
Rate for Payer: Cash Price	$898.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,483.67
Rate for Payer: SOMOS Essential	$2,483.67

PR METATARSECTOMY

Professional

Both

$1,816.01

Service Code	HCPCS 28140
Min. Negotiated Rate	$1,362.01
Max. Negotiated Rate	$1,362.01
Rate for Payer: Cash Price	$494.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,362.01
Rate for Payer: SOMOS Essential	$1,362.01

PR METHYLPREDNISOLONE 40 MG INJ

Professional

Both

$16.00

Service Code	HCPCS J1030
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$12.00
Rate for Payer: SOMOS Essential	$12.00

PR METHYLPREDNISOLONE 80 MG INJ

Professional

Both

$30.00

Service Code	HCPCS J1040
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22.50
Rate for Payer: SOMOS Essential	$22.50

PR METHYLPREDNISOLONE INJECTION

Professional

Both

$16.00

Service Code	HCPCS J2920
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$12.00
Rate for Payer: SOMOS Essential	$12.00

PR MGMT LVR HEMRRG CPLX SUTR WND/INJ

Professional

Both

$8,475.92

Service Code	HCPCS 47360
Min. Negotiated Rate	$6,356.94
Max. Negotiated Rate	$6,356.94
Rate for Payer: Cash Price	$2,253.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,356.94
Rate for Payer: SOMOS Essential	$6,356.94

PR MGMT LVR HEMRRG EXPL WND DBRDMT COAGJ/SUTR

Professional

Both

$13,566.39

Service Code	HCPCS 47361
Min. Negotiated Rate	$10,174.79
Max. Negotiated Rate	$10,174.79
Rate for Payer: Cash Price	$3,587.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10,174.79
Rate for Payer: SOMOS Essential	$10,174.79

PR MGMT LVR HEMRRG RE-EXPL WND RMVL PACKING

Professional

Both

$6,438.88

Service Code	HCPCS 47362
Min. Negotiated Rate	$4,829.16
Max. Negotiated Rate	$4,829.16
Rate for Payer: Cash Price	$1,746.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,829.16
Rate for Payer: SOMOS Essential	$4,829.16

PR MGMT LVR HEMRRG SMPL SUTR LVR WND/INJ

Professional

Both

$6,141.35

Service Code	HCPCS 47350
Min. Negotiated Rate	$4,606.01
Max. Negotiated Rate	$4,606.01
Rate for Payer: Cash Price	$1,630.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,606.01
Rate for Payer: SOMOS Essential	$4,606.01

PR MICRODISSECTION, LASER

Professional

Both

$201.57

Service Code	HCPCS 88380 26
Min. Negotiated Rate	$151.18
Max. Negotiated Rate	$151.18
Rate for Payer: Cash Price	$54.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$151.18
Rate for Payer: SOMOS Essential	$151.18

PR MICRODISSECTION, LASER

Professional

Both

$307.34

Service Code	HCPCS 88380 TC
Min. Negotiated Rate	$230.50
Max. Negotiated Rate	$230.50
Rate for Payer: Cash Price	$87.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$230.50
Rate for Payer: SOMOS Essential	$230.50

PR MICRODISSECTION, LASER

Professional

Both

$508.94

Service Code	HCPCS 88380
Min. Negotiated Rate	$381.70
Max. Negotiated Rate	$381.70
Rate for Payer: Cash Price	$142.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$381.70
Rate for Payer: SOMOS Essential	$381.70

PR MICRODISSECTION, MANUAL

Professional

Both

$771.37

Service Code	HCPCS 88381 TC
Min. Negotiated Rate	$578.53
Max. Negotiated Rate	$578.53
Rate for Payer: Cash Price	$211.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$578.53
Rate for Payer: SOMOS Essential	$578.53

PR MICRODISSECTION, MANUAL

Professional

Both

$90.69

Service Code	HCPCS 88381 26
Min. Negotiated Rate	$68.02
Max. Negotiated Rate	$68.02
Rate for Payer: Cash Price	$24.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$68.02
Rate for Payer: SOMOS Essential	$68.02

PR MICRODISSECTION, MANUAL

Professional

Both

$862.05

Service Code	HCPCS 88381
Min. Negotiated Rate	$646.54
Max. Negotiated Rate	$646.54
Rate for Payer: Cash Price	$236.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$646.54
Rate for Payer: SOMOS Essential	$646.54

PR MICROSURG TQS REQ USE OPERATING MICROSCOPE

Professional

Both

$1,045.56

Service Code	HCPCS 69990
Min. Negotiated Rate	$784.17
Max. Negotiated Rate	$784.17
Rate for Payer: Cash Price	$273.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$784.17
Rate for Payer: SOMOS Essential	$784.17

PR MICROVOLT T-WAVE ASSESS VENTRICULAR ARRHYTHMIAS

Professional

Both

$511.70

Service Code	HCPCS 93025
Min. Negotiated Rate	$383.77
Max. Negotiated Rate	$383.77
Rate for Payer: Cash Price	$144.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$383.77
Rate for Payer: SOMOS Essential	$383.77

PR MICROVOLT T-WAVE ASSESS VENTRICULAR ARRHYTHMIAS

Professional

Both

$143.96

Service Code	HCPCS 93025 26
Min. Negotiated Rate	$107.97
Max. Negotiated Rate	$107.97
Rate for Payer: Cash Price	$39.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$107.97
Rate for Payer: SOMOS Essential	$107.97

PR MICROVOLT T-WAVE ASSESS VENTRICULAR ARRHYTHMIAS

Professional

Both

$367.71

Service Code	HCPCS 93025 TC
Min. Negotiated Rate	$275.78
Max. Negotiated Rate	$275.78
Rate for Payer: Cash Price	$104.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$275.78
Rate for Payer: SOMOS Essential	$275.78

PR MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC

Professional

Both

$3,014.48

Service Code	HCPCS 69440
Min. Negotiated Rate	$2,260.86
Max. Negotiated Rate	$2,260.86
Rate for Payer: Cash Price	$815.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,260.86
Rate for Payer: SOMOS Essential	$2,260.86

PR MIDFACE FLAP W/PRESERVATION OF VASCULAR PEDICLES

Professional

Both

$3,856.30

Service Code	HCPCS 15730
Min. Negotiated Rate	$2,892.22
Max. Negotiated Rate	$2,892.22
Rate for Payer: Cash Price	$1,052.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,892.22
Rate for Payer: SOMOS Essential	$2,892.22

PR MLT OSTEOTOMIES W/RELIGNMT IMED ROD RADIUS&ULNA

Professional

Both

$4,226.57

Service Code	HCPCS 25375
Min. Negotiated Rate	$3,169.93
Max. Negotiated Rate	$3,169.93
Rate for Payer: Cash Price	$1,140.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,169.93
Rate for Payer: SOMOS Essential	$3,169.93

PR MLT OSTEOTOMIES W/RELIGNMT IMED ROD RADIUS/ULNA

Professional

Both

$4,485.11

Service Code	HCPCS 25370
Min. Negotiated Rate	$3,363.83
Max. Negotiated Rate	$3,363.83
Rate for Payer: Cash Price	$1,210.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,363.83
Rate for Payer: SOMOS Essential	$3,363.83

PR MLT OSTEOT W/RELIGNMT IMED ROD HUMERAL SHAFT

Professional

Both

$4,680.73

Service Code	HCPCS 24410
Min. Negotiated Rate	$3,510.55
Max. Negotiated Rate	$3,510.55
Rate for Payer: Cash Price	$1,263.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,510.55
Rate for Payer: SOMOS Essential	$3,510.55

PR MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG

Professional

Both

$1,569.65

Service Code	HCPCS 95805 TC
Min. Negotiated Rate	$1,177.24
Max. Negotiated Rate	$1,177.24
Rate for Payer: Cash Price	$446.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,177.24
Rate for Payer: SOMOS Essential	$1,177.24

Know your out-of-pocket cost for care.

All Charges