St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR RECTAL TUMOR EXCISION TRANSANAL ENDOSCOPIC

Professional

Both

$3,227.56

Service Code	HCPCS 0184T
Min. Negotiated Rate	$2,420.67
Max. Negotiated Rate	$2,420.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,420.67
Rate for Payer: SOMOS Essential	$2,420.67

PR REDUCTION FOREHEAD CONTOURING ONLY

Professional

Both

$3,289.34

Service Code	HCPCS 21137
Min. Negotiated Rate	$2,467.00
Max. Negotiated Rate	$2,467.00
Rate for Payer: Cash Price	$886.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,467.00
Rate for Payer: SOMOS Essential	$2,467.00

PR REDUCTION MASSETER MUSCLE & BONE EXTRAORAL

Professional

Both

$850.92

Service Code	HCPCS 21295
Min. Negotiated Rate	$638.19
Max. Negotiated Rate	$638.19
Rate for Payer: Cash Price	$234.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$638.19
Rate for Payer: SOMOS Essential	$638.19

PR REDUCTION MASSETER MUSCLE & BONE INTRAORAL

Professional

Both

$1,763.83

Service Code	HCPCS 21296
Min. Negotiated Rate	$1,322.87
Max. Negotiated Rate	$1,322.87
Rate for Payer: Cash Price	$480.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,322.87
Rate for Payer: SOMOS Essential	$1,322.87

PR REDUCTION OVERCORRECTION PTOSIS

Professional

Both

$1,816.40

Service Code	HCPCS 67909
Min. Negotiated Rate	$1,362.30
Max. Negotiated Rate	$1,362.30
Rate for Payer: Cash Price	$497.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,362.30
Rate for Payer: SOMOS Essential	$1,362.30

PR REEXPL PEL WND W/RMVL PREPERITONEAL PEL PACKING

Professional

Both

$1,708.11

Service Code	HCPCS 49014
Min. Negotiated Rate	$1,281.08
Max. Negotiated Rate	$1,281.08
Rate for Payer: Cash Price	$453.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,281.08
Rate for Payer: SOMOS Essential	$1,281.08

PR REFILLING & MAINTENANCE PORTABLE PUMP

Professional

Both

$547.16

Service Code	HCPCS 96521
Min. Negotiated Rate	$410.37
Max. Negotiated Rate	$410.37
Rate for Payer: Cash Price	$146.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$410.37
Rate for Payer: SOMOS Essential	$410.37

PR REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN

Professional

Both

$390.46

Service Code	HCPCS 95990
Min. Negotiated Rate	$292.84
Max. Negotiated Rate	$292.84
Rate for Payer: Cash Price	$107.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$292.84
Rate for Payer: SOMOS Essential	$292.84

PR REFILL&MAINTENANCE PUMP DRUG DLVR SYSTEMIC

Professional

Both

$505.47

Service Code	HCPCS 96522
Min. Negotiated Rate	$379.10
Max. Negotiated Rate	$379.10
Rate for Payer: Cash Price	$139.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$379.10
Rate for Payer: SOMOS Essential	$379.10

PR REIMPLANTATION ANOMALOUS PULMONARY ARTERY

Professional

Both

$6,823.01

Service Code	HCPCS 33788
Min. Negotiated Rate	$5,117.26
Max. Negotiated Rate	$5,117.26
Rate for Payer: Cash Price	$1,813.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,117.26
Rate for Payer: SOMOS Essential	$5,117.26

PR REINSERTION OCULAR IMPLT RNFCMT &/ ATTACH MUSCLE

Professional

Both

$4,054.40

Service Code	HCPCS 65155
Min. Negotiated Rate	$3,040.80
Max. Negotiated Rate	$3,040.80
Rate for Payer: Cash Price	$1,107.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,040.80
Rate for Payer: SOMOS Essential	$3,040.80

PR REINSERTION OCULAR IMPLT W/WO CONJUNCTIVAL GRAFT

Professional

Both

$2,966.15

Service Code	HCPCS 65150
Min. Negotiated Rate	$2,224.61
Max. Negotiated Rate	$2,224.61
Rate for Payer: Cash Price	$807.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,224.61
Rate for Payer: SOMOS Essential	$2,224.61

PR REINSERTION SPINAL FIXATION DEVICE

Professional

Both

$6,013.18

Service Code	HCPCS 22849
Min. Negotiated Rate	$4,509.88
Max. Negotiated Rate	$4,509.88
Rate for Payer: Cash Price	$1,603.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,509.88
Rate for Payer: SOMOS Essential	$4,509.88

PR RELEASE ENCIRCLING MATERIAL POSTERIOR SEGMENT

Professional

Both

$2,055.48

Service Code	HCPCS 67115
Min. Negotiated Rate	$1,541.61
Max. Negotiated Rate	$1,541.61
Rate for Payer: Cash Price	$567.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,541.61
Rate for Payer: SOMOS Essential	$1,541.61

PR RELEASE INTRINSIC MUSCLES HAND EACH MUSCLE

Professional

Both

$2,855.51

Service Code	HCPCS 26593
Min. Negotiated Rate	$2,141.63
Max. Negotiated Rate	$2,141.63
Rate for Payer: Cash Price	$771.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,141.63
Rate for Payer: SOMOS Essential	$2,141.63

PR RELEASE/RECESSION HAMSTRING PROXIMAL

Professional

Both

$3,039.65

Service Code	HCPCS 27097
Min. Negotiated Rate	$2,279.74
Max. Negotiated Rate	$2,279.74
Rate for Payer: Cash Price	$820.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,279.74
Rate for Payer: SOMOS Essential	$2,279.74

PR RELEASE TARSAL TUNNEL

Professional

Both

$1,530.10

Service Code	HCPCS 28035
Min. Negotiated Rate	$1,147.58
Max. Negotiated Rate	$1,147.58
Rate for Payer: Cash Price	$418.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,147.58
Rate for Payer: SOMOS Essential	$1,147.58

PR RELEASE THENAR MUSCLE

Professional

Both

$2,995.23

Service Code	HCPCS 26508
Min. Negotiated Rate	$2,246.42
Max. Negotiated Rate	$2,246.42
Rate for Payer: Cash Price	$809.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,246.42
Rate for Payer: SOMOS Essential	$2,246.42

PR RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR

Professional

Both

$1,807.65

Service Code	HCPCS 33223
Min. Negotiated Rate	$1,355.74
Max. Negotiated Rate	$1,355.74
Rate for Payer: Cash Price	$480.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,355.74
Rate for Payer: SOMOS Essential	$1,355.74

PR RELOCATION OF SKIN POCKET FOR PACEMAKER

Professional

Both

$1,513.89

Service Code	HCPCS 33222
Min. Negotiated Rate	$1,135.42
Max. Negotiated Rate	$1,135.42
Rate for Payer: Cash Price	$404.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,135.42
Rate for Payer: SOMOS Essential	$1,135.42

PR REM INTERROG DEV EVAL SS LD ICDS <90D PHY/QHP

Professional

Both

$164.68

Service Code	HCPCS 0578T
Min. Negotiated Rate	$123.51
Max. Negotiated Rate	$123.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$123.51
Rate for Payer: SOMOS Essential	$123.51

PR REM INTERROG ICPMS <30 D PHYS/QHP

Professional

Both

$104.83

Service Code	HCPCS 93297
Min. Negotiated Rate	$78.62
Max. Negotiated Rate	$78.62
Rate for Payer: Cash Price	$69.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$78.62
Rate for Payer: SOMOS Essential	$78.62

PR REM INTERROG PM/LDLS PM <90 D PHYS/QHP

Professional

Both

$120.61

Service Code	HCPCS 93294
Min. Negotiated Rate	$90.46
Max. Negotiated Rate	$90.46
Rate for Payer: Cash Price	$32.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$90.46
Rate for Payer: SOMOS Essential	$90.46

PR REM INTERROG PM/LDLS PM/IDS <90 D TECH REVIEW

Professional

Both

$97.62

Service Code	HCPCS 93296
Min. Negotiated Rate	$73.22
Max. Negotiated Rate	$73.22
Rate for Payer: Cash Price	$25.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$73.22
Rate for Payer: SOMOS Essential	$73.22

PR REM INTERROG SCRMS <30 D PHYS/QHP

Professional

Both

$106.26

Service Code	HCPCS 93298
Min. Negotiated Rate	$79.70
Max. Negotiated Rate	$79.70
Rate for Payer: Cash Price	$118.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$79.70
Rate for Payer: SOMOS Essential	$79.70

Know your out-of-pocket cost for care.

All Charges