St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR PROPH TX N/P/PLTWR W/WO METHYLMECRYLATE RAD&UL

Professional

Both

$4,018.42

Service Code	HCPCS 25492
Min. Negotiated Rate	$3,013.82
Max. Negotiated Rate	$3,013.82
Rate for Payer: Cash Price	$1,085.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,013.82
Rate for Payer: SOMOS Essential	$3,013.82

PR PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE FEMUR

Professional

Both

$4,992.65

Service Code	HCPCS 27495
Min. Negotiated Rate	$3,744.49
Max. Negotiated Rate	$3,744.49
Rate for Payer: Cash Price	$1,345.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,744.49
Rate for Payer: SOMOS Essential	$3,744.49

PR PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE TIBIA

Professional

Both

$3,338.27

Service Code	HCPCS 27745
Min. Negotiated Rate	$2,503.70
Max. Negotiated Rate	$2,503.70
Rate for Payer: Cash Price	$889.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,503.70
Rate for Payer: SOMOS Essential	$2,503.70

PR PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE ULNA

Professional

Both

$3,282.76

Service Code	HCPCS 25491
Min. Negotiated Rate	$2,462.07
Max. Negotiated Rate	$2,462.07
Rate for Payer: Cash Price	$888.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,462.07
Rate for Payer: SOMOS Essential	$2,462.07

PR PROPH TX N/P/PLTWR W/WO MMA FEM NCK & PROX FEMUR

Professional

Both

$4,403.67

Service Code	HCPCS 27187
Min. Negotiated Rate	$3,302.75
Max. Negotiated Rate	$3,302.75
Rate for Payer: Cash Price	$1,188.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,302.75
Rate for Payer: SOMOS Essential	$3,302.75

PR PROPH TX W/WO METHYLMETHACRYLATE CLAVICLE

Professional

Both

$3,816.30

Service Code	HCPCS 23490
Min. Negotiated Rate	$2,862.22
Max. Negotiated Rate	$2,862.22
Rate for Payer: Cash Price	$1,030.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,862.22
Rate for Payer: SOMOS Essential	$2,862.22

PR PROPH TX W/WO METHYLMETHACRYLATE HUMERAL SHAFT

Professional

Both

$3,842.58

Service Code	HCPCS 24498
Min. Negotiated Rate	$2,881.94
Max. Negotiated Rate	$2,881.94
Rate for Payer: Cash Price	$1,037.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,881.94
Rate for Payer: SOMOS Essential	$2,881.94

PR PROPH TX W/WO METHYLMETHACRYLATE PROX HUMERUS

Professional

Both

$4,494.56

Service Code	HCPCS 23491
Min. Negotiated Rate	$3,370.92
Max. Negotiated Rate	$3,370.92
Rate for Payer: Cash Price	$1,212.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,370.92
Rate for Payer: SOMOS Essential	$3,370.92

PR PROSTATE CA SCREENING; DRE

Professional

Both

$35.35

Service Code	HCPCS G0102
Min. Negotiated Rate	$26.51
Max. Negotiated Rate	$26.51
Rate for Payer: Cash Price	$9.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26.51
Rate for Payer: SOMOS Essential	$26.51

PR PROSTATECTOMY PERINEAL RADICAL

Professional

Both

$5,444.60

Service Code	HCPCS 55810
Min. Negotiated Rate	$4,083.45
Max. Negotiated Rate	$4,083.45
Rate for Payer: Cash Price	$1,486.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,083.45
Rate for Payer: SOMOS Essential	$4,083.45

PR PROSTATECTOMY PERINEAL RADICAL W/LYMPH NODE BX

Professional

Both

$6,699.91

Service Code	HCPCS 55812
Min. Negotiated Rate	$5,024.93
Max. Negotiated Rate	$5,024.93
Rate for Payer: Cash Price	$1,827.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,024.93
Rate for Payer: SOMOS Essential	$5,024.93

PR PROSTATECTOMY PERINEAL RAD W/BI PELVIC LYMPH EXC

Professional

Both

$7,332.61

Service Code	HCPCS 55815
Min. Negotiated Rate	$5,499.46
Max. Negotiated Rate	$5,499.46
Rate for Payer: Cash Price	$1,999.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,499.46
Rate for Payer: SOMOS Essential	$5,499.46

PR PROSTATECTOMY PERINEAL SUBTOTAL

Professional

Both

$4,577.51

Service Code	HCPCS 55801
Min. Negotiated Rate	$3,433.13
Max. Negotiated Rate	$3,433.13
Rate for Payer: Cash Price	$1,250.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,433.13
Rate for Payer: SOMOS Essential	$3,433.13

PR PROSTATECTOMY RETROPUBIC SUBTOTAL

Professional

Both

$3,603.88

Service Code	HCPCS 55831
Min. Negotiated Rate	$2,702.91
Max. Negotiated Rate	$2,702.91
Rate for Payer: Cash Price	$983.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,702.91
Rate for Payer: SOMOS Essential	$2,702.91

PR PROSTATECTOMY RETROPUBIC W/WO NERVE SPARING

Professional

Both

$4,879.53

Service Code	HCPCS 55840
Min. Negotiated Rate	$3,659.65
Max. Negotiated Rate	$3,659.65
Rate for Payer: Cash Price	$1,335.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,659.65
Rate for Payer: SOMOS Essential	$3,659.65

PR PROSTATECTOMY SUPRAPUBIC SUBTOTAL 1/2 STAGES

Professional

Both

$3,505.11

Service Code	HCPCS 55821
Min. Negotiated Rate	$2,628.83
Max. Negotiated Rate	$2,628.83
Rate for Payer: Cash Price	$959.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,628.83
Rate for Payer: SOMOS Essential	$2,628.83

PR PROSTATE NEEDLE BIOPSY ANY APPROACH

Professional

Both

$540.40

Service Code	HCPCS 55700
Min. Negotiated Rate	$405.30
Max. Negotiated Rate	$405.30
Rate for Payer: Cash Price	$147.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$405.30
Rate for Payer: SOMOS Essential	$405.30

PR PROSTATOTOMY EXTERNAL DRG ABSCESS COMPLICATED

Professional

Both

$2,504.22

Service Code	HCPCS 55725
Min. Negotiated Rate	$1,878.16
Max. Negotiated Rate	$1,878.16
Rate for Payer: Cash Price	$687.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,878.16
Rate for Payer: SOMOS Essential	$1,878.16

PR PROSTATOTOMY EXTERNAL DRG ABSCESS SIMPLE

Professional

Both

$1,897.11

Service Code	HCPCS 55720
Min. Negotiated Rate	$1,422.83
Max. Negotiated Rate	$1,422.83
Rate for Payer: Cash Price	$521.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,422.83
Rate for Payer: SOMOS Essential	$1,422.83

PR PROSTECT RETROPUBIC RAD W/WO NRV SPAR W/LYMPH BX

Professional

Both

$4,884.99

Service Code	HCPCS 55842
Min. Negotiated Rate	$3,663.74
Max. Negotiated Rate	$3,663.74
Rate for Payer: Cash Price	$1,334.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,663.74
Rate for Payer: SOMOS Essential	$3,663.74

PR PROSTECT RETROPUB RAD W/WO NRV SPAR & BI PLV LYM

Professional

Both

$5,676.30

Service Code	HCPCS 55845
Min. Negotiated Rate	$4,257.22
Max. Negotiated Rate	$4,257.22
Rate for Payer: Cash Price	$1,551.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,257.22
Rate for Payer: SOMOS Essential	$4,257.22

PR PROSTHESIS REMOVAL HUMERAL AND GLENOID COMPONENT

Professional

Both

$5,573.19

Service Code	HCPCS 23335
Min. Negotiated Rate	$4,179.89
Max. Negotiated Rate	$4,179.89
Rate for Payer: Cash Price	$1,503.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,179.89
Rate for Payer: SOMOS Essential	$4,179.89

PR PROSTHESIS REMOVAL HUMERAL AND ULNAR COMPONENTS

Professional

Both

$5,525.24

Service Code	HCPCS 24160
Min. Negotiated Rate	$4,143.93
Max. Negotiated Rate	$4,143.93
Rate for Payer: Cash Price	$1,495.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,143.93
Rate for Payer: SOMOS Essential	$4,143.93

PR PROSTHESIS REMOVAL HUMERAL/GLENOID COMPONENT

Professional

Both

$4,646.43

Service Code	HCPCS 23334
Min. Negotiated Rate	$3,484.82
Max. Negotiated Rate	$3,484.82
Rate for Payer: Cash Price	$1,257.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,484.82
Rate for Payer: SOMOS Essential	$3,484.82

PR PROSTHESIS REMOVAL RADIAL HEAD

Professional

Both

$3,216.96

Service Code	HCPCS 24164
Min. Negotiated Rate	$2,412.72
Max. Negotiated Rate	$2,412.72
Rate for Payer: Cash Price	$870.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,412.72
Rate for Payer: SOMOS Essential	$2,412.72

Know your out-of-pocket cost for care.

All Charges