St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR PERQ NL/PL LITHOTRP SIMPLE UP TO 2 CM 1 LOCATION

Professional

Both

$2,917.95

Service Code	HCPCS 50080
Min. Negotiated Rate	$2,188.46
Max. Negotiated Rate	$2,188.46
Rate for Payer: Cash Price	$797.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,188.46
Rate for Payer: SOMOS Essential	$2,188.46

PR PERQ P-ART REVSC ST 1ST ABNOR CONNJ UNILATERAL

Professional

Both

$3,228.44

Service Code	HCPCS 33902
Min. Negotiated Rate	$2,421.33
Max. Negotiated Rate	$2,421.33
Rate for Payer: Cash Price	$844.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,421.33
Rate for Payer: SOMOS Essential	$2,421.33

PR PERQ P-ART REVSC ST 1ST ABNORMAL CONNJ BILATERAL

Professional

Both

$3,803.56

Service Code	HCPCS 33903
Min. Negotiated Rate	$2,852.67
Max. Negotiated Rate	$2,852.67
Rate for Payer: Cash Price	$995.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,852.67
Rate for Payer: SOMOS Essential	$2,852.67

PR PERQ P-ART REVSC ST 1ST NML NATIVE CONNJ BI

Professional

Both

$3,338.83

Service Code	HCPCS 33901
Min. Negotiated Rate	$2,504.12
Max. Negotiated Rate	$2,504.12
Rate for Payer: Cash Price	$874.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,504.12
Rate for Payer: SOMOS Essential	$2,504.12

PR PERQ P-ART REVSC ST 1ST NML NATIVE CONNJ UNI

Professional

Both

$2,541.32

Service Code	HCPCS 33900
Min. Negotiated Rate	$1,905.99
Max. Negotiated Rate	$1,905.99
Rate for Payer: Cash Price	$665.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,905.99
Rate for Payer: SOMOS Essential	$1,905.99

PR PERQ P-ART REVSC ST EA ADDL VSL/SEP LES NM/ABNL

Professional

Both

$1,278.10

Service Code	HCPCS 33904
Min. Negotiated Rate	$958.58
Max. Negotiated Rate	$958.58
Rate for Payer: Cash Price	$334.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$958.58
Rate for Payer: SOMOS Essential	$958.58

PR PERQ PERICARDIAL DRG W/INSJ NDWELLG CATH W/CT

Professional

Both

$882.14

Service Code	HCPCS 33019
Min. Negotiated Rate	$661.60
Max. Negotiated Rate	$661.60
Rate for Payer: Cash Price	$234.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$661.60
Rate for Payer: SOMOS Essential	$661.60

PR PERQ PRCRD DRG 0-5YR/ANY AGE W/CGEN CAR ANOMALY

Professional

Both

$1,271.90

Service Code	HCPCS 33018
Min. Negotiated Rate	$953.92
Max. Negotiated Rate	$953.92
Rate for Payer: Cash Price	$337.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$953.92
Rate for Payer: SOMOS Essential	$953.92

PR PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY

Professional

Both

$1,076.78

Service Code	HCPCS 33017
Min. Negotiated Rate	$807.58
Max. Negotiated Rate	$807.58
Rate for Payer: Cash Price	$288.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$807.58
Rate for Payer: SOMOS Essential	$807.58

PR PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC

Professional

Both

$158.41

Service Code	HCPCS 43762
Min. Negotiated Rate	$118.81
Max. Negotiated Rate	$118.81
Rate for Payer: Cash Price	$43.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$118.81
Rate for Payer: SOMOS Essential	$118.81

PR PERQ REPLACEMENT GTUBE REQ REVJ GSTRST TRC

Professional

Both

$381.29

Service Code	HCPCS 43763
Min. Negotiated Rate	$285.97
Max. Negotiated Rate	$285.97
Rate for Payer: Cash Price	$102.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$285.97
Rate for Payer: SOMOS Essential	$285.97

PR PERQ SAC AGMNTJ BI W/WO BALO/MCHNL DEV 2/> NDLS

Professional

Both

$8,140.93

Service Code	HCPCS 0201T
Min. Negotiated Rate	$6,105.70
Max. Negotiated Rate	$6,105.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,105.70
Rate for Payer: SOMOS Essential	$6,105.70

PR PERQ SAC AGMNTJ UNI W/WO BALO/MCHNL DEV 1/> NDL

Professional

Both

$8,140.93

Service Code	HCPCS 0200T
Min. Negotiated Rate	$6,105.70
Max. Negotiated Rate	$6,105.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,105.70
Rate for Payer: SOMOS Essential	$6,105.70

PR PERQ SKELETAL FIXATION PST PELVIC BONE FX&/DIS

Professional

Both

$2,995.00

Service Code	HCPCS 27216
Min. Negotiated Rate	$2,246.25
Max. Negotiated Rate	$2,246.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,246.25
Rate for Payer: SOMOS Essential	$2,246.25

PR PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP

Professional

Both

$2,966.01

Service Code	HCPCS 25606
Min. Negotiated Rate	$2,224.51
Max. Negotiated Rate	$2,224.51
Rate for Payer: Cash Price	$807.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,224.51
Rate for Payer: SOMOS Essential	$2,224.51

PR PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT

Professional

Both

$2,136.96

Service Code	HCPCS 36906
Min. Negotiated Rate	$1,602.72
Max. Negotiated Rate	$1,602.72
Rate for Payer: Cash Price	$572.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,602.72
Rate for Payer: SOMOS Essential	$1,602.72

PR PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP

Professional

Both

$1,844.99

Service Code	HCPCS 36905
Min. Negotiated Rate	$1,383.74
Max. Negotiated Rate	$1,383.74
Rate for Payer: Cash Price	$494.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,383.74
Rate for Payer: SOMOS Essential	$1,383.74

PR PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH

Professional

Both

$1,543.92

Service Code	HCPCS 36904
Min. Negotiated Rate	$1,157.94
Max. Negotiated Rate	$1,157.94
Rate for Payer: Cash Price	$414.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,157.94
Rate for Payer: SOMOS Essential	$1,157.94

PR PERQ TRANSCATH CLS PARAVALVR LEAK 1 AORTIC VALVE

Professional

Both

$3,545.96

Service Code	HCPCS 93591
Min. Negotiated Rate	$2,659.47
Max. Negotiated Rate	$2,659.47
Rate for Payer: Cash Price	$961.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,659.47
Rate for Payer: SOMOS Essential	$2,659.47

PR PERQ TRANSCATH CLS PARAVALVR LEAK 1 MITRAL VALVE

Professional

Both

$4,320.82

Service Code	HCPCS 93590
Min. Negotiated Rate	$3,240.62
Max. Negotiated Rate	$3,240.62
Rate for Payer: Cash Price	$1,173.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,240.62
Rate for Payer: SOMOS Essential	$3,240.62

PR PERQ TRANSCATH CLS PARAVALVR LEAK EACH OCCLS DEV

Professional

Both

$1,572.27

Service Code	HCPCS 93592
Min. Negotiated Rate	$1,179.20
Max. Negotiated Rate	$1,179.20
Rate for Payer: Cash Price	$419.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,179.20
Rate for Payer: SOMOS Essential	$1,179.20

PR PERQ TRANSLUMINAL ANGIOPLASTY NATIVE/RECR COA

Professional

Both

$2,551.99

Service Code	HCPCS 33897
Min. Negotiated Rate	$1,913.99
Max. Negotiated Rate	$1,913.99
Rate for Payer: Cash Price	$677.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,913.99
Rate for Payer: SOMOS Essential	$1,913.99

PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION

Professional

Both

$2,225.55

Service Code	HCPCS 22513
Min. Negotiated Rate	$1,669.16
Max. Negotiated Rate	$1,669.16
Rate for Payer: Cash Price	$597.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,669.16
Rate for Payer: SOMOS Essential	$1,669.16

PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH

Professional

Both

$957.22

Service Code	HCPCS 22515
Min. Negotiated Rate	$717.92
Max. Negotiated Rate	$717.92
Rate for Payer: Cash Price	$254.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$717.92
Rate for Payer: SOMOS Essential	$717.92

PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR

Professional

Both

$2,075.57

Service Code	HCPCS 22514
Min. Negotiated Rate	$1,556.68
Max. Negotiated Rate	$1,556.68
Rate for Payer: Cash Price	$556.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,556.68
Rate for Payer: SOMOS Essential	$1,556.68

Know your out-of-pocket cost for care.

All Charges