St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES

Professional

Both

$903.49

Service Code	HCPCS 30310
Min. Negotiated Rate	$677.62
Max. Negotiated Rate	$677.62
Rate for Payer: Cash Price	$245.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$677.62
Rate for Payer: SOMOS Essential	$677.62

PR REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE

Professional

Both

$540.96

Service Code	HCPCS 30300
Min. Negotiated Rate	$405.72
Max. Negotiated Rate	$405.72
Rate for Payer: Cash Price	$145.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$405.72
Rate for Payer: SOMOS Essential	$405.72

PR REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE

Professional

Both

$632.42

Service Code	HCPCS 20520
Min. Negotiated Rate	$474.32
Max. Negotiated Rate	$474.32
Rate for Payer: Cash Price	$173.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$474.32
Rate for Payer: SOMOS Essential	$474.32

PR REMOVAL FOREIGN BODY PELVIS/HIP DEEP

Professional

Both

$2,766.68

Service Code	HCPCS 27087
Min. Negotiated Rate	$2,075.01
Max. Negotiated Rate	$2,075.01
Rate for Payer: Cash Price	$742.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,075.01
Rate for Payer: SOMOS Essential	$2,075.01

PR REMOVAL FOREIGN BODY PHARYNX

Professional

Both

$548.07

Service Code	HCPCS 42809
Min. Negotiated Rate	$411.05
Max. Negotiated Rate	$411.05
Rate for Payer: Cash Price	$149.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$411.05
Rate for Payer: SOMOS Essential	$411.05

PR REMOVAL FOREIGN BODY SCROTUM

Professional

Both

$1,494.85

Service Code	HCPCS 55120
Min. Negotiated Rate	$1,121.14
Max. Negotiated Rate	$1,121.14
Rate for Payer: Cash Price	$412.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,121.14
Rate for Payer: SOMOS Essential	$1,121.14

PR REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS

Professional

Both

$735.95

Service Code	HCPCS 23330
Min. Negotiated Rate	$551.96
Max. Negotiated Rate	$551.96
Rate for Payer: Cash Price	$201.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$551.96
Rate for Payer: SOMOS Essential	$551.96

PR REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP

Professional

Both

$1,633.21

Service Code	HCPCS 24201
Min. Negotiated Rate	$1,224.91
Max. Negotiated Rate	$1,224.91
Rate for Payer: Cash Price	$483.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,224.91
Rate for Payer: SOMOS Essential	$1,224.91

PR REMOVAL HIP PROSTHESIS SEPARATE PROCEDURE

Professional

Both

$3,684.21

Service Code	HCPCS 27090
Min. Negotiated Rate	$2,763.16
Max. Negotiated Rate	$2,763.16
Rate for Payer: Cash Price	$990.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,763.16
Rate for Payer: SOMOS Essential	$2,763.16

PR REMOVAL HYPOGLOSSAL NERVE NSTIM RA PG&RESPIR SNR

Professional

Both

$3,128.34

Service Code	HCPCS 64584
Min. Negotiated Rate	$2,346.26
Max. Negotiated Rate	$2,346.26
Rate for Payer: Cash Price	$847.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,346.26
Rate for Payer: SOMOS Essential	$2,346.26

PR REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT

Professional

Both

$138.53

Service Code	HCPCS 69210
Min. Negotiated Rate	$103.90
Max. Negotiated Rate	$103.90
Rate for Payer: Cash Price	$37.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$103.90
Rate for Payer: SOMOS Essential	$103.90

PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT

Professional

Both

$67.41

Service Code	HCPCS 69209
Min. Negotiated Rate	$50.56
Max. Negotiated Rate	$50.56
Rate for Payer: Cash Price	$19.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$50.56
Rate for Payer: SOMOS Essential	$50.56

PR REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL

Professional

Both

$760.83

Service Code	HCPCS 57415
Min. Negotiated Rate	$570.62
Max. Negotiated Rate	$570.62
Rate for Payer: Cash Price	$207.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$570.62
Rate for Payer: SOMOS Essential	$570.62

PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES

Professional

Both

$401.49

Service Code	HCPCS 11976
Min. Negotiated Rate	$301.12
Max. Negotiated Rate	$301.12
Rate for Payer: Cash Price	$107.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$301.12
Rate for Payer: SOMOS Essential	$301.12

PR REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY

Professional

Both

$946.44

Service Code	HCPCS 33241
Min. Negotiated Rate	$709.83
Max. Negotiated Rate	$709.83
Rate for Payer: Cash Price	$253.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$709.83
Rate for Payer: SOMOS Essential	$709.83

PR REMOVAL IMPLANT DEEP

Professional

Both

$1,827.70

Service Code	HCPCS 20680
Min. Negotiated Rate	$1,370.78
Max. Negotiated Rate	$1,370.78
Rate for Payer: Cash Price	$497.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,370.78
Rate for Payer: SOMOS Essential	$1,370.78

PR REMOVAL IMPLANTED INTRA-ARTERIAL INFUSION PUMP

Professional

Both

$1,413.27

Service Code	HCPCS 36262
Min. Negotiated Rate	$1,059.95
Max. Negotiated Rate	$1,059.95
Rate for Payer: Cash Price	$381.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,059.95
Rate for Payer: SOMOS Essential	$1,059.95

PR REMOVAL IMPLANT FROM FINGER/HAND

Professional

Both

$1,549.59

Service Code	HCPCS 26320
Min. Negotiated Rate	$1,162.19
Max. Negotiated Rate	$1,162.19
Rate for Payer: Cash Price	$421.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,162.19
Rate for Payer: SOMOS Essential	$1,162.19

PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE

Professional

Both

$624.37

Service Code	HCPCS 20670
Min. Negotiated Rate	$468.28
Max. Negotiated Rate	$468.28
Rate for Payer: Cash Price	$170.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$468.28
Rate for Payer: SOMOS Essential	$468.28

PR REMOVAL INDWELLING URETERAL STENT PRQ

Professional

Both

$932.86

Service Code	HCPCS 50384
Min. Negotiated Rate	$699.64
Max. Negotiated Rate	$699.64
Rate for Payer: Cash Price	$250.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$699.64
Rate for Payer: SOMOS Essential	$699.64

PR REMOVAL INTACT BREAST IMPLANT

Professional

Both

$2,430.68

Service Code	HCPCS 19328
Min. Negotiated Rate	$1,823.01
Max. Negotiated Rate	$1,823.01
Rate for Payer: Cash Price	$656.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,823.01
Rate for Payer: SOMOS Essential	$1,823.01

PR REMOVAL INTRA-AORTIC BALLOON ASSIST DEVICE PRQ

Professional

Both

$148.65

Service Code	HCPCS 33968
Min. Negotiated Rate	$111.49
Max. Negotiated Rate	$111.49
Rate for Payer: Cash Price	$39.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$111.49
Rate for Payer: SOMOS Essential	$111.49

PR REMOVAL INTRA-ARTICULAR DRUG DELIVERY DEVICE

Professional

Both

$547.93

Service Code	HCPCS 20705
Min. Negotiated Rate	$410.95
Max. Negotiated Rate	$410.95
Rate for Payer: Cash Price	$145.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$410.95
Rate for Payer: SOMOS Essential	$410.95

PR REMOVAL INTRAMEDULLARY DRUG DELIVERY DEVICE

Professional

Both

$450.59

Service Code	HCPCS 20703
Min. Negotiated Rate	$337.94
Max. Negotiated Rate	$337.94
Rate for Payer: Cash Price	$122.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$337.94
Rate for Payer: SOMOS Essential	$337.94

PR REMOVAL INTRAUTERINE DEVICE IUD

Professional

Both

$285.67

Service Code	HCPCS 58301
Min. Negotiated Rate	$214.25
Max. Negotiated Rate	$214.25
Rate for Payer: Cash Price	$77.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$214.25
Rate for Payer: SOMOS Essential	$214.25

Know your out-of-pocket cost for care.

All Charges