St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM

Professional

Both

$1,272.43

Service Code	HCPCS 13132
Min. Negotiated Rate	$954.32
Max. Negotiated Rate	$954.32
Rate for Payer: Cash Price	$345.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$954.32
Rate for Payer: SOMOS Essential	$954.32

PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<

Professional

Both

$524.97

Service Code	HCPCS 13133
Min. Negotiated Rate	$393.73
Max. Negotiated Rate	$393.73
Rate for Payer: Cash Price	$143.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$393.73
Rate for Payer: SOMOS Essential	$393.73

PR REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM

Professional

Both

$982.63

Service Code	HCPCS 13120
Min. Negotiated Rate	$736.97
Max. Negotiated Rate	$736.97
Rate for Payer: Cash Price	$266.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$736.97
Rate for Payer: SOMOS Essential	$736.97

PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM

Professional

Both

$1,078.49

Service Code	HCPCS 13121
Min. Negotiated Rate	$808.87
Max. Negotiated Rate	$808.87
Rate for Payer: Cash Price	$295.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$808.87
Rate for Payer: SOMOS Essential	$808.87

PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<

Professional

Both

$354.13

Service Code	HCPCS 13122
Min. Negotiated Rate	$265.60
Max. Negotiated Rate	$265.60
Rate for Payer: Cash Price	$95.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$265.60
Rate for Payer: SOMOS Essential	$265.60

PR REPAIR COMPLEX TRUNK 1.1-2.5 CM

Professional

Both

$847.84

Service Code	HCPCS 13100
Min. Negotiated Rate	$635.88
Max. Negotiated Rate	$635.88
Rate for Payer: Cash Price	$230.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$635.88
Rate for Payer: SOMOS Essential	$635.88

PR REPAIR COMPLEX TRUNK 2.6-7.5 CM

Professional

Both

$1,043.60

Service Code	HCPCS 13101
Min. Negotiated Rate	$782.70
Max. Negotiated Rate	$782.70
Rate for Payer: Cash Price	$283.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$782.70
Rate for Payer: SOMOS Essential	$782.70

PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<

Professional

Both

$306.50

Service Code	HCPCS 13102
Min. Negotiated Rate	$229.88
Max. Negotiated Rate	$229.88
Rate for Payer: Cash Price	$82.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$229.88
Rate for Payer: SOMOS Essential	$229.88

PR REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/<

Professional

Both

$584.92

Service Code	HCPCS 13153
Min. Negotiated Rate	$438.69
Max. Negotiated Rate	$438.69
Rate for Payer: Cash Price	$157.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$438.69
Rate for Payer: SOMOS Essential	$438.69

PR REPAIR CONGENITAL AV FISTULA HEAD & NECK

Professional

Both

$3,492.27

Service Code	HCPCS 35180
Min. Negotiated Rate	$2,619.20
Max. Negotiated Rate	$2,619.20
Rate for Payer: Cash Price	$926.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,619.20
Rate for Payer: SOMOS Essential	$2,619.20

PR REPAIR CONGENITAL PSEUDARTHROSIS TIBIA

Professional

Both

$4,597.29

Service Code	HCPCS 27727
Min. Negotiated Rate	$3,447.97
Max. Negotiated Rate	$3,447.97
Rate for Payer: Cash Price	$1,240.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,447.97
Rate for Payer: SOMOS Essential	$3,447.97

PR REPAIR DEFECT W/AUTOGRAFT RADIUS&ULNA

Professional

Both

$4,965.56

Service Code	HCPCS 25426
Min. Negotiated Rate	$3,724.17
Max. Negotiated Rate	$3,724.17
Rate for Payer: Cash Price	$1,338.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,724.17
Rate for Payer: SOMOS Essential	$3,724.17

PR REPAIR DEFECT W/AUTOGRAFT RADIUS/ULNA

Professional

Both

$4,269.02

Service Code	HCPCS 25425
Min. Negotiated Rate	$3,201.76
Max. Negotiated Rate	$3,201.76
Rate for Payer: Cash Price	$1,151.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,201.76
Rate for Payer: SOMOS Essential	$3,201.76

PR REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT

Professional

Both

$2,636.69

Service Code	HCPCS 27676
Min. Negotiated Rate	$1,977.52
Max. Negotiated Rate	$1,977.52
Rate for Payer: Cash Price	$722.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,977.52
Rate for Payer: SOMOS Essential	$1,977.52

PR REPAIR ECTROPION EXCISION TARSAL WEDGE

Professional

Both

$1,771.32

Service Code	HCPCS 67916
Min. Negotiated Rate	$1,328.49
Max. Negotiated Rate	$1,328.49
Rate for Payer: Cash Price	$488.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,328.49
Rate for Payer: SOMOS Essential	$1,328.49

PR REPAIR ECTROPION EXTENSIVE

Professional

Both

$1,883.04

Service Code	HCPCS 67917
Min. Negotiated Rate	$1,412.28
Max. Negotiated Rate	$1,412.28
Rate for Payer: Cash Price	$518.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,412.28
Rate for Payer: SOMOS Essential	$1,412.28

PR REPAIR ECTROPION SUTURE

Professional

Both

$1,360.94

Service Code	HCPCS 67914
Min. Negotiated Rate	$1,020.70
Max. Negotiated Rate	$1,020.70
Rate for Payer: Cash Price	$377.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,020.70
Rate for Payer: SOMOS Essential	$1,020.70

PR REPAIR ECTROPION THERMOCAUTERIZATION

Professional

Both

$829.78

Service Code	HCPCS 67915
Min. Negotiated Rate	$622.34
Max. Negotiated Rate	$622.34
Rate for Payer: Cash Price	$229.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$622.34
Rate for Payer: SOMOS Essential	$622.34

PR REPAIR ENTEROCELE ABDOMINAL APPROACH SPX

Professional

Both

$3,544.59

Service Code	HCPCS 57270
Min. Negotiated Rate	$2,658.44
Max. Negotiated Rate	$2,658.44
Rate for Payer: Cash Price	$954.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,658.44
Rate for Payer: SOMOS Essential	$2,658.44

PR REPAIR ENTEROCELE VAGINAL APPROACH SPX

Professional

Both

$2,203.92

Service Code	HCPCS 57268
Min. Negotiated Rate	$1,652.94
Max. Negotiated Rate	$1,652.94
Rate for Payer: Cash Price	$597.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,652.94
Rate for Payer: SOMOS Essential	$1,652.94

PR REPAIR ENTROPION EXCISION TARSAL WEDGE

Professional

Both

$1,772.75

Service Code	HCPCS 67923
Min. Negotiated Rate	$1,329.56
Max. Negotiated Rate	$1,329.56
Rate for Payer: Cash Price	$488.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,329.56
Rate for Payer: SOMOS Essential	$1,329.56

PR REPAIR ENTROPION EXTENSIVE

Professional

Both

$1,879.01

Service Code	HCPCS 67924
Min. Negotiated Rate	$1,409.26
Max. Negotiated Rate	$1,409.26
Rate for Payer: Cash Price	$517.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,409.26
Rate for Payer: SOMOS Essential	$1,409.26

PR REPAIR ENTROPION SUTURE

Professional

Both

$1,291.92

Service Code	HCPCS 67921
Min. Negotiated Rate	$968.94
Max. Negotiated Rate	$968.94
Rate for Payer: Cash Price	$357.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$968.94
Rate for Payer: SOMOS Essential	$968.94

PR REPAIR ENTROPION THERMOCAUTERIZATION

Professional

Both

$831.22

Service Code	HCPCS 67922
Min. Negotiated Rate	$623.42
Max. Negotiated Rate	$623.42
Rate for Payer: Cash Price	$229.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$623.42
Rate for Payer: SOMOS Essential	$623.42

PR REPAIR EXTENSOR TENDON DISTAL INSERTION W/GRAFT

Professional

Both

$3,096.73

Service Code	HCPCS 26434
Min. Negotiated Rate	$2,322.55
Max. Negotiated Rate	$2,322.55
Rate for Payer: Cash Price	$834.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,322.55
Rate for Payer: SOMOS Essential	$2,322.55

Know your out-of-pocket cost for care.

All Charges