St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR RENAL NDSC NEPHROS/PYELOSTOMY RMVL FB/CALCULUS

Professional

Both

$1,631.07

Service Code	HCPCS 50561
Min. Negotiated Rate	$1,223.30
Max. Negotiated Rate	$1,223.30
Rate for Payer: Cash Price	$445.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,223.30
Rate for Payer: SOMOS Essential	$1,223.30

PR RENAL NDSC NEPHROST W/URETERAL CATH W/WO DILA

Professional

Both

$1,303.93

Service Code	HCPCS 50553
Min. Negotiated Rate	$977.95
Max. Negotiated Rate	$977.95
Rate for Payer: Cash Price	$354.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$977.95
Rate for Payer: SOMOS Essential	$977.95

PR RENAL NDSC NEPHROTOMY W/BIOPSY

Professional

Both

$2,331.42

Service Code	HCPCS 50574
Min. Negotiated Rate	$1,748.56
Max. Negotiated Rate	$1,748.56
Rate for Payer: Cash Price	$635.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,748.56
Rate for Payer: SOMOS Essential	$1,748.56

PR RENAL NDSC NEPHROTOMY W/WO IRRIGATION

Professional

Both

$2,027.48

Service Code	HCPCS 50570
Min. Negotiated Rate	$1,520.61
Max. Negotiated Rate	$1,520.61
Rate for Payer: Cash Price	$553.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,520.61
Rate for Payer: SOMOS Essential	$1,520.61

PR REOPENING RECENT LAPAROTOMY

Professional

Both

$4,677.93

Service Code	HCPCS 49002
Min. Negotiated Rate	$3,508.45
Max. Negotiated Rate	$3,508.45
Rate for Payer: Cash Price	$1,248.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,508.45
Rate for Payer: SOMOS Essential	$3,508.45

PR REPAIR ANAL FISTULA W/FIBRIN GLUE

Professional

Both

$806.16

Service Code	HCPCS 46706
Min. Negotiated Rate	$604.62
Max. Negotiated Rate	$604.62
Rate for Payer: Cash Price	$217.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$604.62
Rate for Payer: SOMOS Essential	$604.62

PR REPAIR ANORECTAL FISTULA PLUG

Professional

Both

$2,270.24

Service Code	HCPCS 46707
Min. Negotiated Rate	$1,702.68
Max. Negotiated Rate	$1,702.68
Rate for Payer: Cash Price	$609.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,702.68
Rate for Payer: SOMOS Essential	$1,702.68

PR REPAIR ANTERIOR PALATE W/VOMER FLAP

Professional

Both

$3,212.79

Service Code	HCPCS 42235
Min. Negotiated Rate	$2,409.59
Max. Negotiated Rate	$2,409.59
Rate for Payer: Cash Price	$871.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,409.59
Rate for Payer: SOMOS Essential	$2,409.59

PR REPAIR BLOOD VESSEL DIRECT HAND FINGER

Professional

Both

$3,324.48

Service Code	HCPCS 35207
Min. Negotiated Rate	$2,493.36
Max. Negotiated Rate	$2,493.36
Rate for Payer: Cash Price	$893.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,493.36
Rate for Payer: SOMOS Essential	$2,493.36

PR REPAIR BLOOD VESSEL DIRECT NECK

Professional

Both

$4,148.13

Service Code	HCPCS 35201
Min. Negotiated Rate	$3,111.10
Max. Negotiated Rate	$3,111.10
Rate for Payer: Cash Price	$1,099.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,111.10
Rate for Payer: SOMOS Essential	$3,111.10

PR REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY

Professional

Both

$3,478.97

Service Code	HCPCS 35206
Min. Negotiated Rate	$2,609.23
Max. Negotiated Rate	$2,609.23
Rate for Payer: Cash Price	$932.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,609.23
Rate for Payer: SOMOS Essential	$2,609.23

PR REPAIR BLOOD VESSEL VEIN GRAFT INTRA-ABDOMINAL

Professional

Both

$7,805.53

Service Code	HCPCS 35251
Min. Negotiated Rate	$5,854.15
Max. Negotiated Rate	$5,854.15
Rate for Payer: Cash Price	$2,055.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,854.15
Rate for Payer: SOMOS Essential	$5,854.15

PR REPAIR BLOOD VESSEL VEIN GRAFT LOWER EXTREMITY

Professional

Both

$4,528.02

Service Code	HCPCS 35256
Min. Negotiated Rate	$3,396.02
Max. Negotiated Rate	$3,396.02
Rate for Payer: Cash Price	$1,189.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,396.02
Rate for Payer: SOMOS Essential	$3,396.02

PR REPAIR BLOOD VESSEL W/GRAFT OTHER/THAN VEIN NECK

Professional

Both

$4,359.43

Service Code	HCPCS 35261
Min. Negotiated Rate	$3,269.57
Max. Negotiated Rate	$3,269.57
Rate for Payer: Cash Price	$1,156.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,269.57
Rate for Payer: SOMOS Essential	$3,269.57

PR REPAIR BLOOD VESSEL W/VEIN GRAFT NECK

Professional

Both

$5,436.87

Service Code	HCPCS 35231
Min. Negotiated Rate	$4,077.65
Max. Negotiated Rate	$4,077.65
Rate for Payer: Cash Price	$1,452.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,077.65
Rate for Payer: SOMOS Essential	$4,077.65

PR REPAIR BLOOD VESSEL W/VEIN GRAFT UPPER EXTREMITY

Professional

Both

$4,411.12

Service Code	HCPCS 35236
Min. Negotiated Rate	$3,308.34
Max. Negotiated Rate	$3,308.34
Rate for Payer: Cash Price	$1,176.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,308.34
Rate for Payer: SOMOS Essential	$3,308.34

PR REPAIR BROW PTOSIS

Professional

Both

$2,089.29

Service Code	HCPCS 67900
Min. Negotiated Rate	$1,566.97
Max. Negotiated Rate	$1,566.97
Rate for Payer: Cash Price	$574.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,566.97
Rate for Payer: SOMOS Essential	$1,566.97

PR REPAIR CARDIAC WOUND W/CARDIOPULMONARY BYPASS

Professional

Both

$18,061.09

Service Code	HCPCS 33305
Min. Negotiated Rate	$13,545.82
Max. Negotiated Rate	$13,545.82
Rate for Payer: Cash Price	$4,814.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$13,545.82
Rate for Payer: SOMOS Essential	$13,545.82

PR REPAIR CARDIAC WOUND W/O BYPASS

Professional

Both

$10,781.37

Service Code	HCPCS 33300
Min. Negotiated Rate	$8,086.03
Max. Negotiated Rate	$8,086.03
Rate for Payer: Cash Price	$2,875.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,086.03
Rate for Payer: SOMOS Essential	$8,086.03

PR REPAIR CHOANAL ATRESIA INTRANASAL

Professional

Both

$3,225.95

Service Code	HCPCS 30540
Min. Negotiated Rate	$2,419.46
Max. Negotiated Rate	$2,419.46
Rate for Payer: Cash Price	$870.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,419.46
Rate for Payer: SOMOS Essential	$2,419.46

PR REPAIR CHOANAL ATRESIA TRANSPALATINE

Professional

Both

$4,373.46

Service Code	HCPCS 30545
Min. Negotiated Rate	$3,280.10
Max. Negotiated Rate	$3,280.10
Rate for Payer: Cash Price	$1,177.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,280.10
Rate for Payer: SOMOS Essential	$3,280.10

PR REPAIR CLEFT HAND

Professional

Both

$6,827.49

Service Code	HCPCS 26580
Min. Negotiated Rate	$5,120.62
Max. Negotiated Rate	$5,120.62
Rate for Payer: Cash Price	$1,838.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,120.62
Rate for Payer: SOMOS Essential	$5,120.62

PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM

Professional

Both

$1,175.76

Service Code	HCPCS 13151
Min. Negotiated Rate	$881.82
Max. Negotiated Rate	$881.82
Rate for Payer: Cash Price	$318.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$881.82
Rate for Payer: SOMOS Essential	$881.82

PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM

Professional

Both

$1,414.49

Service Code	HCPCS 13152
Min. Negotiated Rate	$1,060.87
Max. Negotiated Rate	$1,060.87
Rate for Payer: Cash Price	$383.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,060.87
Rate for Payer: SOMOS Essential	$1,060.87

PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM

Professional

Both

$1,017.38

Service Code	HCPCS 13131
Min. Negotiated Rate	$763.04
Max. Negotiated Rate	$763.04
Rate for Payer: Cash Price	$277.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$763.04
Rate for Payer: SOMOS Essential	$763.04

Know your out-of-pocket cost for care.

All Charges