St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR NERVE GRAFT 1 STRAND HAND/FOOT <4 CM

Professional

Both

$4,763.01

Service Code	HCPCS 64890
Min. Negotiated Rate	$3,572.26
Max. Negotiated Rate	$3,572.26
Rate for Payer: Cash Price	$1,282.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,572.26
Rate for Payer: SOMOS Essential	$3,572.26

PR NERVE GRAFT 1 STRAND HAND/FOOT >4 CM

Professional

Both

$5,062.86

Service Code	HCPCS 64891
Min. Negotiated Rate	$3,797.14
Max. Negotiated Rate	$3,797.14
Rate for Payer: Cash Price	$1,363.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,797.14
Rate for Payer: SOMOS Essential	$3,797.14

PR NERVE GRAFT EACH NERVE 1 STRAND

Professional

Both

$2,598.89

Service Code	HCPCS 64901
Min. Negotiated Rate	$1,949.17
Max. Negotiated Rate	$1,949.17
Rate for Payer: Cash Price	$694.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,949.17
Rate for Payer: SOMOS Essential	$1,949.17

PR NERVE GRAFT EACH NERVE MULTIPLE STRANDS

Professional

Both

$3,011.58

Service Code	HCPCS 64902
Min. Negotiated Rate	$2,258.68
Max. Negotiated Rate	$2,258.68
Rate for Payer: Cash Price	$803.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,258.68
Rate for Payer: SOMOS Essential	$2,258.68

PR NERVE GRAFT HEAD/NECK <4 CM

Professional

Both

$4,610.80

Service Code	HCPCS 64885
Min. Negotiated Rate	$3,458.10
Max. Negotiated Rate	$3,458.10
Rate for Payer: Cash Price	$1,249.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,458.10
Rate for Payer: SOMOS Essential	$3,458.10

PR NERVE GRAFT HEAD/NECK >4 CM

Professional

Both

$5,555.17

Service Code	HCPCS 64886
Min. Negotiated Rate	$4,166.38
Max. Negotiated Rate	$4,166.38
Rate for Payer: Cash Price	$1,499.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,166.38
Rate for Payer: SOMOS Essential	$4,166.38

PR NERVE GRAFT MLT STRANDS ARM/LEG <4 CM

Professional

Both

$5,580.23

Service Code	HCPCS 64897
Min. Negotiated Rate	$4,185.17
Max. Negotiated Rate	$4,185.17
Rate for Payer: Cash Price	$1,500.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,185.17
Rate for Payer: SOMOS Essential	$4,185.17

PR NERVE GRAFT MLT STRANDS ARM/LEG >4 CM

Professional

Both

$6,040.86

Service Code	HCPCS 64898
Min. Negotiated Rate	$4,530.64
Max. Negotiated Rate	$4,530.64
Rate for Payer: Cash Price	$1,625.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,530.64
Rate for Payer: SOMOS Essential	$4,530.64

PR NERVE GRAFT MLT STRANDS HAND/FOOT <4 CM

Professional

Both

$5,843.11

Service Code	HCPCS 64895
Min. Negotiated Rate	$4,382.33
Max. Negotiated Rate	$4,382.33
Rate for Payer: Cash Price	$1,569.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,382.33
Rate for Payer: SOMOS Essential	$4,382.33

PR NERVE GRAFT MLT STRANDS HAND/FOOT > 4 CM

Professional

Both

$6,290.17

Service Code	HCPCS 64896
Min. Negotiated Rate	$4,717.63
Max. Negotiated Rate	$4,717.63
Rate for Payer: Cash Price	$1,693.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,717.63
Rate for Payer: SOMOS Essential	$4,717.63

PR NERVE PEDICAL TRANSFER SECOND STAGE

Professional

Both

$5,727.40

Service Code	HCPCS 64907
Min. Negotiated Rate	$4,295.55
Max. Negotiated Rate	$4,295.55
Rate for Payer: Cash Price	$1,540.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,295.55
Rate for Payer: SOMOS Essential	$4,295.55

PR NERVE PEDICLE TRANSFER FIRST STAGE

Professional

Both

$4,411.82

Service Code	HCPCS 64905
Min. Negotiated Rate	$3,308.86
Max. Negotiated Rate	$3,308.86
Rate for Payer: Cash Price	$1,185.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,308.86
Rate for Payer: SOMOS Essential	$3,308.86

PR NERVE REPAIR W/AUTOGENOUS VEIN GRAFT EA NERVE

Professional

Both

$4,515.88

Service Code	HCPCS 64911
Min. Negotiated Rate	$3,386.91
Max. Negotiated Rate	$3,386.91
Rate for Payer: Cash Price	$1,216.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,386.91
Rate for Payer: SOMOS Essential	$3,386.91

PR NERVE REPAIR W/CONDUIT EACH NERVE

Professional

Both

$3,308.55

Service Code	HCPCS 64910
Min. Negotiated Rate	$2,481.41
Max. Negotiated Rate	$2,481.41
Rate for Payer: Cash Price	$898.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,481.41
Rate for Payer: SOMOS Essential	$2,481.41

PR NERVE REPAIR W/NERVE ALLOGRAFT EA ADDL STRAND

Professional

Both

$750.75

Service Code	HCPCS 64913
Min. Negotiated Rate	$563.06
Max. Negotiated Rate	$563.06
Rate for Payer: Cash Price	$200.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$563.06
Rate for Payer: SOMOS Essential	$563.06

PR NERVE REPAIR W/NERVE ALLOGRAFT FIRST STRAND

Professional

Both

$3,923.82

Service Code	HCPCS 64912
Min. Negotiated Rate	$2,942.86
Max. Negotiated Rate	$2,942.86
Rate for Payer: Cash Price	$1,060.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,942.86
Rate for Payer: SOMOS Essential	$2,942.86

PR NERVE TEASING PREPARATIONS

Professional

Both

$426.48

Service Code	HCPCS 88362 26
Min. Negotiated Rate	$319.86
Max. Negotiated Rate	$319.86
Rate for Payer: Cash Price	$118.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$319.86
Rate for Payer: SOMOS Essential	$319.86

PR NERVE TEASING PREPARATIONS

Professional

Both

$521.26

Service Code	HCPCS 88362 TC
Min. Negotiated Rate	$390.94
Max. Negotiated Rate	$390.94
Rate for Payer: Cash Price	$144.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$390.94
Rate for Payer: SOMOS Essential	$390.94

PR NERVE TEASING PREPARATIONS

Professional

Both

$947.73

Service Code	HCPCS 88362
Min. Negotiated Rate	$710.80
Max. Negotiated Rate	$710.80
Rate for Payer: Cash Price	$262.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$710.80
Rate for Payer: SOMOS Essential	$710.80

PR NEURECTOMY HAMSTRING MUSCLE

Professional

Both

$2,513.21

Service Code	HCPCS 27325
Min. Negotiated Rate	$1,884.91
Max. Negotiated Rate	$1,884.91
Rate for Payer: Cash Price	$681.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,884.91
Rate for Payer: SOMOS Essential	$1,884.91

PR NEURECTOMY INTRINSIC MUSCULATURE OF FOOT

Professional

Both

$1,606.05

Service Code	HCPCS 28055
Min. Negotiated Rate	$1,204.54
Max. Negotiated Rate	$1,204.54
Rate for Payer: Cash Price	$450.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,204.54
Rate for Payer: SOMOS Essential	$1,204.54

PR NEURECTOMY POPLITEAL

Professional

Both

$2,326.10

Service Code	HCPCS 27326
Min. Negotiated Rate	$1,744.58
Max. Negotiated Rate	$1,744.58
Rate for Payer: Cash Price	$631.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,744.58
Rate for Payer: SOMOS Essential	$1,744.58

PR NEUROBEHAVIORAL STATUS XM PHYS/QHP 1ST HOUR

Professional

Both

$316.65

Service Code	HCPCS 96116
Min. Negotiated Rate	$237.49
Max. Negotiated Rate	$237.49
Rate for Payer: Cash Price	$86.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$237.49
Rate for Payer: SOMOS Essential	$237.49

PR NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR

Professional

Both

$258.20

Service Code	HCPCS 96121
Min. Negotiated Rate	$193.65
Max. Negotiated Rate	$193.65
Rate for Payer: Cash Price	$70.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$193.65
Rate for Payer: SOMOS Essential	$193.65

PR NEUROENDOSCOPY ICRA W/RETRIEVAL FOREIGN BODY

Professional

Both

$10,101.46

Service Code	HCPCS 62164
Min. Negotiated Rate	$7,576.10
Max. Negotiated Rate	$7,576.10
Rate for Payer: Cash Price	$2,665.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,576.10
Rate for Payer: SOMOS Essential	$7,576.10

Know your out-of-pocket cost for care.

All Charges