St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR RCNSTJ TOE MACRODACTYLY SOFT TISSUE RESECTION

Professional

Both

$1,682.84

Service Code	HCPCS 28340
Min. Negotiated Rate	$1,262.13
Max. Negotiated Rate	$1,262.13
Rate for Payer: Cash Price	$465.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,262.13
Rate for Payer: SOMOS Essential	$1,262.13

PR RCNSTJ TOE SYNDACTYLY W/WO SKIN GRAFT EACH WEB

Professional

Both

$1,492.37

Service Code	HCPCS 28345
Min. Negotiated Rate	$1,119.28
Max. Negotiated Rate	$1,119.28
Rate for Payer: Cash Price	$414.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,119.28
Rate for Payer: SOMOS Essential	$1,119.28

PR RCNSTJ XTRNL AUD CANAL CONGENITAL ATRESIA 1 STG

Professional

Both

$6,782.41

Service Code	HCPCS 69320
Min. Negotiated Rate	$5,086.81
Max. Negotiated Rate	$5,086.81
Rate for Payer: Cash Price	$1,826.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,086.81
Rate for Payer: SOMOS Essential	$5,086.81

PR RCNSTJ ZYGMTC ARCH/GLENOID FOSSA W/BONE CARTLG

Professional

Both

$5,642.81

Service Code	HCPCS 21255
Min. Negotiated Rate	$4,232.11
Max. Negotiated Rate	$4,232.11
Rate for Payer: Cash Price	$1,528.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,232.11
Rate for Payer: SOMOS Essential	$4,232.11

PR RDCTJ CRANIOMEGALIC CRANIO&RECNSTJ W/WO GRAFT

Professional

Both

$9,496.48

Service Code	HCPCS 62117
Min. Negotiated Rate	$7,122.36
Max. Negotiated Rate	$7,122.36
Rate for Payer: Cash Price	$2,500.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,122.36
Rate for Payer: SOMOS Essential	$7,122.36

PR RDCTJ CRANIOMEGALIC SKULL W/O GRAFT/CRANIOPLASTY

Professional

Both

$8,116.99

Service Code	HCPCS 62115
Min. Negotiated Rate	$6,087.74
Max. Negotiated Rate	$6,087.74
Rate for Payer: Cash Price	$2,147.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,087.74
Rate for Payer: SOMOS Essential	$6,087.74

PR RDCTJ FHD CNTRG & PROSTHETIC MATRL/BONE GRAFT

Professional

Both

$4,000.47

Service Code	HCPCS 21138
Min. Negotiated Rate	$3,000.35
Max. Negotiated Rate	$3,000.35
Rate for Payer: Cash Price	$1,078.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,000.35
Rate for Payer: SOMOS Essential	$3,000.35

PR RDCTJ FHD CNTRG & SETBACK ANT FRONTAL SINUS WALL

Professional

Both

$4,768.93

Service Code	HCPCS 21139
Min. Negotiated Rate	$3,576.70
Max. Negotiated Rate	$3,576.70
Rate for Payer: Cash Price	$1,282.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,576.70
Rate for Payer: SOMOS Essential	$3,576.70

PR RDCTJ PROCIDENTIA UNDER ANES SEPARATE PROCEDURE

Professional

Both

$959.21

Service Code	HCPCS 45900
Min. Negotiated Rate	$719.41
Max. Negotiated Rate	$719.41
Rate for Payer: Cash Price	$256.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$719.41
Rate for Payer: SOMOS Essential	$719.41

PR RDCTJ TORSION TSTIS W/WO FIXJ CLAT TESTIS

Professional

Both

$1,904.49

Service Code	HCPCS 54600
Min. Negotiated Rate	$1,428.37
Max. Negotiated Rate	$1,428.37
Rate for Payer: Cash Price	$523.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,428.37
Rate for Payer: SOMOS Essential	$1,428.37

PR RDCTJ VOLVULUS INTUSSUSCEPTION INT HRNA LAPT

Professional

Both

$4,216.52

Service Code	HCPCS 44050
Min. Negotiated Rate	$3,162.39
Max. Negotiated Rate	$3,162.39
Rate for Payer: Cash Price	$1,125.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,162.39
Rate for Payer: SOMOS Essential	$3,162.39

PR REALIGNMENT EXTENSOR TENDON HAND EACH TENDON

Professional

Both

$2,958.48

Service Code	HCPCS 26437
Min. Negotiated Rate	$2,218.86
Max. Negotiated Rate	$2,218.86
Rate for Payer: Cash Price	$797.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,218.86
Rate for Payer: SOMOS Essential	$2,218.86

PR RECIPIENT NEPHRECTOMY SEPARATE PROCEDURE

Professional

Both

$4,325.86

Service Code	HCPCS 50340
Min. Negotiated Rate	$3,244.40
Max. Negotiated Rate	$3,244.40
Rate for Payer: Cash Price	$1,161.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,244.40
Rate for Payer: SOMOS Essential	$3,244.40

PR RECON, CTA FOR SURG PLAN

Professional

Both

$185.50

Service Code	HCPCS G0288
Min. Negotiated Rate	$139.12
Max. Negotiated Rate	$139.12
Rate for Payer: Cash Price	$53.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$139.12
Rate for Payer: SOMOS Essential	$139.12

PR RECONSTRUCTION CLEFT FOOT

Professional

Both

$4,862.90

Service Code	HCPCS 28360
Min. Negotiated Rate	$3,647.18
Max. Negotiated Rate	$3,647.18
Rate for Payer: Cash Price	$1,312.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,647.18
Rate for Payer: SOMOS Essential	$3,647.18

PR RECONSTRUCTION COMPLEX CARDIAC ANOMALY

Professional

Both

$15,247.05

Service Code	HCPCS 33622
Min. Negotiated Rate	$11,435.29
Max. Negotiated Rate	$11,435.29
Rate for Payer: Cash Price	$4,042.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$11,435.29
Rate for Payer: SOMOS Essential	$11,435.29

PR RECONSTRUCTION EXTERNAL AUDITORY CANAL SPX

Professional

Both

$4,869.17

Service Code	HCPCS 69310
Min. Negotiated Rate	$3,651.88
Max. Negotiated Rate	$3,651.88
Rate for Payer: Cash Price	$1,312.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,651.88
Rate for Payer: SOMOS Essential	$3,651.88

PR RECONSTRUCTION NAIL BED W/GRAFT

Professional

Both

$783.69

Service Code	HCPCS 11762
Min. Negotiated Rate	$587.77
Max. Negotiated Rate	$587.77
Rate for Payer: Cash Price	$215.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$587.77
Rate for Payer: SOMOS Essential	$587.77

PR RECONSTRUCTION ORBIT W/OSTEOTOMIES & BONE GRAFTS

Professional

Both

$5,415.03

Service Code	HCPCS 21256
Min. Negotiated Rate	$4,061.27
Max. Negotiated Rate	$4,061.27
Rate for Payer: Cash Price	$1,461.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,061.27
Rate for Payer: SOMOS Essential	$4,061.27

PR RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC

Professional

Both

$4,311.86

Service Code	HCPCS 23420
Min. Negotiated Rate	$3,233.90
Max. Negotiated Rate	$3,233.90
Rate for Payer: Cash Price	$1,164.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,233.90
Rate for Payer: SOMOS Essential	$3,233.90

PR RECONSTRUCTION TOE POLYDACTYLY

Professional

Both

$1,157.17

Service Code	HCPCS 28344
Min. Negotiated Rate	$867.88
Max. Negotiated Rate	$867.88
Rate for Payer: Cash Price	$321.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$867.88
Rate for Payer: SOMOS Essential	$867.88

PR RECONSTRUCTION VENA CAVA ANY METHOD

Professional

Both

$6,752.27

Service Code	HCPCS 34502
Min. Negotiated Rate	$5,064.20
Max. Negotiated Rate	$5,064.20
Rate for Payer: Cash Price	$1,818.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,064.20
Rate for Payer: SOMOS Essential	$5,064.20

PR RECTAL SESATION TONE & COMPLIANCE TEST

Professional

Both

$2,000.85

Service Code	HCPCS 91120 TC
Min. Negotiated Rate	$1,500.64
Max. Negotiated Rate	$1,500.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,500.64
Rate for Payer: SOMOS Essential	$1,500.64

PR RECTAL SESATION TONE & COMPLIANCE TEST

Professional

Both

$189.95

Service Code	HCPCS 91120 26
Min. Negotiated Rate	$142.46
Max. Negotiated Rate	$142.46
Rate for Payer: Cash Price	$52.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$142.46
Rate for Payer: SOMOS Essential	$142.46

PR RECTAL SESATION TONE & COMPLIANCE TEST

Professional

Both

$2,190.79

Service Code	HCPCS 91120
Min. Negotiated Rate	$1,643.09
Max. Negotiated Rate	$1,643.09
Rate for Payer: Cash Price	$586.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,643.09
Rate for Payer: SOMOS Essential	$1,643.09

Know your out-of-pocket cost for care.

All Charges