St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR PLMT NEPHROURETERAL CATH PRQ NEW ACCESS RS&I

Professional

Both

$1,039.43

Service Code	HCPCS 50433
Min. Negotiated Rate	$779.57
Max. Negotiated Rate	$779.57
Rate for Payer: Cash Price	$280.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$779.57
Rate for Payer: SOMOS Essential	$779.57

PR PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT

Professional

Both

$720.09

Service Code	HCPCS 32553
Min. Negotiated Rate	$540.07
Max. Negotiated Rate	$540.07
Rate for Payer: Cash Price	$194.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$540.07
Rate for Payer: SOMOS Essential	$540.07

PR PLMT POST FACET IMPLANT UNI/BI W/IMG & GRFT CERV

Professional

Both

$2,645.09

Service Code	HCPCS 0219T
Min. Negotiated Rate	$1,983.82
Max. Negotiated Rate	$1,983.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,983.82
Rate for Payer: SOMOS Essential	$1,983.82

PR PLMT POST FACET IMPLT UNI/BI W/IMG & GRFT LUMB

Professional

Both

$2,645.09

Service Code	HCPCS 0221T
Min. Negotiated Rate	$1,983.82
Max. Negotiated Rate	$1,983.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,983.82
Rate for Payer: SOMOS Essential	$1,983.82

PR PLMT PROX XTN PROSTH EVASC RPR DTA 1ST XTN

Professional

Both

$4,908.37

Service Code	HCPCS 33883
Min. Negotiated Rate	$3,681.28
Max. Negotiated Rate	$3,681.28
Rate for Payer: Cash Price	$1,304.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,681.28
Rate for Payer: SOMOS Essential	$3,681.28

PR PLMT PROX XTN PROSTH EVASC RPR DTA EA PROX XTN

Professional

Both

$1,756.97

Service Code	HCPCS 33884
Min. Negotiated Rate	$1,317.73
Max. Negotiated Rate	$1,317.73
Rate for Payer: Cash Price	$463.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,317.73
Rate for Payer: SOMOS Essential	$1,317.73

PR PLMT RADTHX BRACHYTX BRST FOLLOWING PRTL MAST

Professional

Both

$1,304.87

Service Code	HCPCS 19298
Min. Negotiated Rate	$978.65
Max. Negotiated Rate	$978.65
Rate for Payer: Cash Price	$356.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$978.65
Rate for Payer: SOMOS Essential	$978.65

PR PLMT SFT TISS LOCLZJ DEV PERQ 1ST LESION

Professional

Both

$351.30

Service Code	HCPCS 10035
Min. Negotiated Rate	$263.48
Max. Negotiated Rate	$263.48
Rate for Payer: Cash Price	$93.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$263.48
Rate for Payer: SOMOS Essential	$263.48

PR PLMT SFT TISS LOCLZJ DEV PERQ EACH ADDL LESION

Professional

Both

$178.40

Service Code	HCPCS 10036
Min. Negotiated Rate	$133.80
Max. Negotiated Rate	$133.80
Rate for Payer: Cash Price	$47.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$133.80
Rate for Payer: SOMOS Essential	$133.80

PR PLMT URTRL STENT PRQ NEW ACCESS W/SEP NFROS CATH

Professional

Both

$1,388.91

Service Code	HCPCS 50695
Min. Negotiated Rate	$1,041.68
Max. Negotiated Rate	$1,041.68
Rate for Payer: Cash Price	$376.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,041.68
Rate for Payer: SOMOS Essential	$1,041.68

PR PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT

Professional

Both

$828.52

Service Code	HCPCS 50693
Min. Negotiated Rate	$621.39
Max. Negotiated Rate	$621.39
Rate for Payer: Cash Price	$224.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$621.39
Rate for Payer: SOMOS Essential	$621.39

PR PLMT URTRL STNT PRQ NEW ACESS W/O SEP NFROS CATH

Professional

Both

$1,086.02

Service Code	HCPCS 50694
Min. Negotiated Rate	$814.52
Max. Negotiated Rate	$814.52
Rate for Payer: Cash Price	$293.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$814.52
Rate for Payer: SOMOS Essential	$814.52

PR PLMT VEIN PATCH/CUFF DSTL ANAST BYP CONDUIT

Professional

Both

$880.53

Service Code	HCPCS 35685
Min. Negotiated Rate	$660.40
Max. Negotiated Rate	$660.40
Rate for Payer: Cash Price	$232.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$660.40
Rate for Payer: SOMOS Essential	$660.40

PR PLSTC RPR CL LIP/NSL DFRM PRIM BI 1 2 STGS

Professional

Both

$4,363.70

Service Code	HCPCS 40702
Min. Negotiated Rate	$3,272.78
Max. Negotiated Rate	$3,272.78
Rate for Payer: Cash Price	$1,177.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,272.78
Rate for Payer: SOMOS Essential	$3,272.78

PR PLSTC RPR CL LIP/NSL DFRM PRIM BI 1 STG PX

Professional

Both

$5,199.71

Service Code	HCPCS 40701
Min. Negotiated Rate	$3,899.78
Max. Negotiated Rate	$3,899.78
Rate for Payer: Cash Price	$1,401.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,899.78
Rate for Payer: SOMOS Essential	$3,899.78

PR PLSTC RPR CL LIP/NSL DFRM PRIM PRTL/COMPL UNI

Professional

Both

$4,401.60

Service Code	HCPCS 40700
Min. Negotiated Rate	$3,301.20
Max. Negotiated Rate	$3,301.20
Rate for Payer: Cash Price	$1,188.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,301.20
Rate for Payer: SOMOS Essential	$3,301.20

PR PLSTC RPR CL LIP/NSL DFRM SEC RECRTJ DFCT & RECL

Professional

Both

$4,487.53

Service Code	HCPCS 40720
Min. Negotiated Rate	$3,365.65
Max. Negotiated Rate	$3,365.65
Rate for Payer: Cash Price	$1,208.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,365.65
Rate for Payer: SOMOS Essential	$3,365.65

PR PLSTC RPR CL LIP/NSL DFRM W/CROSS LIP PEDCL FLAP

Professional

Both

$4,714.29

Service Code	HCPCS 40761
Min. Negotiated Rate	$3,535.72
Max. Negotiated Rate	$3,535.72
Rate for Payer: Cash Price	$1,268.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,535.72
Rate for Payer: SOMOS Essential	$3,535.72

PR PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM

Professional

Both

$1,492.72

Service Code	HCPCS 42500
Min. Negotiated Rate	$1,119.54
Max. Negotiated Rate	$1,119.54
Rate for Payer: Cash Price	$406.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,119.54
Rate for Payer: SOMOS Essential	$1,119.54

PR PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY SEC/COMP

Professional

Both

$1,985.27

Service Code	HCPCS 42505
Min. Negotiated Rate	$1,488.95
Max. Negotiated Rate	$1,488.95
Rate for Payer: Cash Price	$539.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,488.95
Rate for Payer: SOMOS Essential	$1,488.95

PR PNCRTECT DSTL NR-TOT W/PRSRV DUO CHLD-TYP PX

Professional

Both

$8,517.43

Service Code	HCPCS 48146
Min. Negotiated Rate	$6,388.07
Max. Negotiated Rate	$6,388.07
Rate for Payer: Cash Price	$2,267.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,388.07
Rate for Payer: SOMOS Essential	$6,388.07

PR PNCRTECT DSTL STOT W/O PNCRTCOJEJUNOSTOMY

Professional

Both

$7,063.18

Service Code	HCPCS 48140
Min. Negotiated Rate	$5,297.38
Max. Negotiated Rate	$5,297.38
Rate for Payer: Cash Price	$1,881.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,297.38
Rate for Payer: SOMOS Essential	$5,297.38

PR PNCRTECT DSTL STOT W/PNCRTCOJEJUNOSTOMY

Professional

Both

$7,391.79

Service Code	HCPCS 48145
Min. Negotiated Rate	$5,543.84
Max. Negotiated Rate	$5,543.84
Rate for Payer: Cash Price	$1,966.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,543.84
Rate for Payer: SOMOS Essential	$5,543.84

PR PNCRTECT PROX STOT W/O PANCREATOJEJUNOSTOMY

Professional

Both

$13,105.05

Service Code	HCPCS 48154
Min. Negotiated Rate	$9,828.79
Max. Negotiated Rate	$9,828.79
Rate for Payer: Cash Price	$3,482.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9,828.79
Rate for Payer: SOMOS Essential	$9,828.79

PR PNCRTECT PROX STOT W/PANCREATOJEJUNOSTOMY

Professional

Both

$14,028.28

Service Code	HCPCS 48150
Min. Negotiated Rate	$10,521.21
Max. Negotiated Rate	$10,521.21
Rate for Payer: Cash Price	$3,736.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10,521.21
Rate for Payer: SOMOS Essential	$10,521.21

Know your out-of-pocket cost for care.

All Charges