St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR PLACE POSTERIOR INTRAFACET IMPLANT ADDL SEGMENT

Professional

Both

$1,322.55

Service Code	HCPCS 0222T
Min. Negotiated Rate	$991.91
Max. Negotiated Rate	$991.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$991.91
Rate for Payer: SOMOS Essential	$991.91

PR PLASTIC PENIS EPISPADIAS DSTL SPHNCTR W/INCONT

Professional

Both

$3,893.93

Service Code	HCPCS 54385
Min. Negotiated Rate	$2,920.45
Max. Negotiated Rate	$2,920.45
Rate for Payer: Cash Price	$1,065.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,920.45
Rate for Payer: SOMOS Essential	$2,920.45

PR PLASTIC REPAIR CANALICULI

Professional

Both

$2,475.24

Service Code	HCPCS 68700
Min. Negotiated Rate	$1,856.43
Max. Negotiated Rate	$1,856.43
Rate for Payer: Cash Price	$682.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,856.43
Rate for Payer: SOMOS Essential	$1,856.43

PR PLASTIC REPAIR INTROITUS

Professional

Both

$1,107.09

Service Code	HCPCS 56800
Min. Negotiated Rate	$830.32
Max. Negotiated Rate	$830.32
Rate for Payer: Cash Price	$298.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$830.32
Rate for Payer: SOMOS Essential	$830.32

PR PLASTIC REPAIR URETHROCELE

Professional

Both

$1,839.53

Service Code	HCPCS 57230
Min. Negotiated Rate	$1,379.65
Max. Negotiated Rate	$1,379.65
Rate for Payer: Cash Price	$496.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,379.65
Rate for Payer: SOMOS Essential	$1,379.65

PR PLASTIC RPR PENIS CORRECT ANGULATION

Professional

Both

$3,024.11

Service Code	HCPCS 54360
Min. Negotiated Rate	$2,268.08
Max. Negotiated Rate	$2,268.08
Rate for Payer: Cash Price	$826.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,268.08
Rate for Payer: SOMOS Essential	$2,268.08

PR PLASTIC RPR PENIS EPISPADIAS DSTL SPHNCTR

Professional

Both

$3,344.15

Service Code	HCPCS 54380
Min. Negotiated Rate	$2,508.11
Max. Negotiated Rate	$2,508.11
Rate for Payer: Cash Price	$915.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,508.11
Rate for Payer: SOMOS Essential	$2,508.11

PR PLASTIC RPR PENIS EPISPADIAS W/EXSTROPHY BLADDER

Professional

Both

$5,181.82

Service Code	HCPCS 54390
Min. Negotiated Rate	$3,886.36
Max. Negotiated Rate	$3,886.36
Rate for Payer: Cash Price	$1,414.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,886.36
Rate for Payer: SOMOS Essential	$3,886.36

PR PLASTIC URETHRAL SPHINCTER VAGINAL APPROACH

Professional

Both

$1,505.53

Service Code	HCPCS 57220
Min. Negotiated Rate	$1,129.15
Max. Negotiated Rate	$1,129.15
Rate for Payer: Cash Price	$408.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,129.15
Rate for Payer: SOMOS Essential	$1,129.15

PR PLCMT VAD PMP IMPLTBL ICORP 1 VENTR W/O BYPASS

Professional

Both

$8,567.97

Service Code	HCPCS 33982
Min. Negotiated Rate	$6,425.98
Max. Negotiated Rate	$6,425.98
Rate for Payer: Cash Price	$2,265.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,425.98
Rate for Payer: SOMOS Essential	$6,425.98

PR PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST

Professional

Both

$231.95

Service Code	HCPCS 94726
Min. Negotiated Rate	$173.96
Max. Negotiated Rate	$173.96
Rate for Payer: Cash Price	$65.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$173.96
Rate for Payer: SOMOS Essential	$173.96

PR PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST

Professional

Both

$185.15

Service Code	HCPCS 94726 TC
Min. Negotiated Rate	$138.86
Max. Negotiated Rate	$138.86
Rate for Payer: Cash Price	$52.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$138.86
Rate for Payer: SOMOS Essential	$138.86

PR PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST

Professional

Both

$46.80

Service Code	HCPCS 94726 26
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Cash Price	$12.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35.10
Rate for Payer: SOMOS Essential	$35.10

PR PLEURAL SCARIFICATION REPEAT PNEUMOTHORAX

Professional

Both

$3,577.39

Service Code	HCPCS 32215
Min. Negotiated Rate	$2,683.04
Max. Negotiated Rate	$2,683.04
Rate for Payer: Cash Price	$955.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,683.04
Rate for Payer: SOMOS Essential	$2,683.04

PR PLEURECTOMY PARIETAL SEPARATE PROCEDURE

Professional

Both

$4,087.20

Service Code	HCPCS 32310
Min. Negotiated Rate	$3,065.40
Max. Negotiated Rate	$3,065.40
Rate for Payer: Cash Price	$1,092.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,065.40
Rate for Payer: SOMOS Essential	$3,065.40

PR PLMT ACCESS THRU BILIARY TREE INTO SMALL BWL NEW

Professional

Both

$1,375.92

Service Code	HCPCS 47541
Min. Negotiated Rate	$1,031.94
Max. Negotiated Rate	$1,031.94
Rate for Payer: Cash Price	$369.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,031.94
Rate for Payer: SOMOS Essential	$1,031.94

PR PLMT BILE DUCT STENT PRQ EXISTING ACCESS

Professional

Both

$953.54

Service Code	HCPCS 47538
Min. Negotiated Rate	$715.16
Max. Negotiated Rate	$715.16
Rate for Payer: Cash Price	$257.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$715.16
Rate for Payer: SOMOS Essential	$715.16

PR PLMT BILE DUCT STENT PRQ NEW ACCESS W/O SEP CATH

Professional

Both

$1,738.38

Service Code	HCPCS 47539
Min. Negotiated Rate	$1,303.78
Max. Negotiated Rate	$1,303.78
Rate for Payer: Cash Price	$468.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,303.78
Rate for Payer: SOMOS Essential	$1,303.78

PR PLMT BILE DUCT STENT PRQ NEW ACCESS W/SEP CATH

Professional

Both

$1,786.79

Service Code	HCPCS 47540
Min. Negotiated Rate	$1,340.09
Max. Negotiated Rate	$1,340.09
Rate for Payer: Cash Price	$482.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,340.09
Rate for Payer: SOMOS Essential	$1,340.09

PR PLMT DSTL XTN PROSTH DLYD AFTER EVASC RPR DTA

Professional

Both

$4,261.67

Service Code	HCPCS 33886
Min. Negotiated Rate	$3,196.25
Max. Negotiated Rate	$3,196.25
Rate for Payer: Cash Price	$1,127.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,196.25
Rate for Payer: SOMOS Essential	$3,196.25

PR PLMT EXPANDABLE CATH BRST CONCURRENT PRTL MAST

Professional

Both

$425.22

Service Code	HCPCS 19297
Min. Negotiated Rate	$318.92
Max. Negotiated Rate	$318.92
Rate for Payer: Cash Price	$111.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$318.92
Rate for Payer: SOMOS Essential	$318.92

PR PLMT EXPANDABLE CATH BRST FOLLOWING PRTL MAST

Professional

Both

$945.56

Service Code	HCPCS 19296
Min. Negotiated Rate	$709.17
Max. Negotiated Rate	$709.17
Rate for Payer: Cash Price	$251.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$709.17
Rate for Payer: SOMOS Essential	$709.17

PR PLMT FEM-FEM PROSTC GRF EVASC AORTIC ARYSM RPR

Professional

Both

$1,045.56

Service Code	HCPCS 34813
Min. Negotiated Rate	$784.17
Max. Negotiated Rate	$784.17
Rate for Payer: Cash Price	$275.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$784.17
Rate for Payer: SOMOS Essential	$784.17

PR PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT

Professional

Both

$423.92

Service Code	HCPCS 55876
Min. Negotiated Rate	$317.94
Max. Negotiated Rate	$317.94
Rate for Payer: Cash Price	$116.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$317.94
Rate for Payer: SOMOS Essential	$317.94

PR PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I

Professional

Both

$837.55

Service Code	HCPCS 50432
Min. Negotiated Rate	$628.16
Max. Negotiated Rate	$628.16
Rate for Payer: Cash Price	$225.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$628.16
Rate for Payer: SOMOS Essential	$628.16

Know your out-of-pocket cost for care.

All Charges