St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<

Professional

Both

$643.79

Service Code	HCPCS 12031
Min. Negotiated Rate	$482.84
Max. Negotiated Rate	$482.84
Rate for Payer: Cash Price	$175.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$482.84
Rate for Payer: SOMOS Essential	$482.84

PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM

Professional

Both

$801.78

Service Code	HCPCS 12032
Min. Negotiated Rate	$601.34
Max. Negotiated Rate	$601.34
Rate for Payer: Cash Price	$219.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$601.34
Rate for Payer: SOMOS Essential	$601.34

PR REPAIR INTERMEDIATE S/A/T/E >30.0 CM

Professional

Both

$1,438.78

Service Code	HCPCS 12037
Min. Negotiated Rate	$1,079.08
Max. Negotiated Rate	$1,079.08
Rate for Payer: Cash Price	$389.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,079.08
Rate for Payer: SOMOS Essential	$1,079.08

PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM

Professional

Both

$873.88

Service Code	HCPCS 12034
Min. Negotiated Rate	$655.41
Max. Negotiated Rate	$655.41
Rate for Payer: Cash Price	$237.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$655.41
Rate for Payer: SOMOS Essential	$655.41

PR REPAIR INTRINSIC MUSCLES HAND EACH MUSCLE

Professional

Both

$2,161.01

Service Code	HCPCS 26591
Min. Negotiated Rate	$1,620.76
Max. Negotiated Rate	$1,620.76
Rate for Payer: Cash Price	$585.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,620.76
Rate for Payer: SOMOS Essential	$1,620.76

PR REPAIR IRIS CILIARY BODY

Professional

Both

$2,154.85

Service Code	HCPCS 66680
Min. Negotiated Rate	$1,616.14
Max. Negotiated Rate	$1,616.14
Rate for Payer: Cash Price	$592.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,616.14
Rate for Payer: SOMOS Essential	$1,616.14

PR REPAIR ISOLATED PARTIAL PULM VENOUS RETURN

Professional

Both

$6,837.11

Service Code	HCPCS 33724
Min. Negotiated Rate	$5,127.83
Max. Negotiated Rate	$5,127.83
Rate for Payer: Cash Price	$1,816.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,127.83
Rate for Payer: SOMOS Essential	$5,127.83

PR REPAIR LACERATION DIAPHRAGM ANY APPROACH

Professional

Both

$3,793.37

Service Code	HCPCS 39501
Min. Negotiated Rate	$2,845.03
Max. Negotiated Rate	$2,845.03
Rate for Payer: Cash Price	$1,020.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,845.03
Rate for Payer: SOMOS Essential	$2,845.03

PR REPAIR LACERATION PALATE <2 CM

Professional

Both

$808.89

Service Code	HCPCS 42180
Min. Negotiated Rate	$606.67
Max. Negotiated Rate	$606.67
Rate for Payer: Cash Price	$220.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$606.67
Rate for Payer: SOMOS Essential	$606.67

PR REPAIR LACERATION PALATE >2 CM/COMPLEX

Professional

Both

$1,113.88

Service Code	HCPCS 42182
Min. Negotiated Rate	$835.41
Max. Negotiated Rate	$835.41
Rate for Payer: Cash Price	$302.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$835.41
Rate for Payer: SOMOS Essential	$835.41

PR REPAIR LATERAL COLLATERAL LIGAMENT ELBOW

Professional

Both

$3,161.34

Service Code	HCPCS 24343
Min. Negotiated Rate	$2,371.00
Max. Negotiated Rate	$2,371.00
Rate for Payer: Cash Price	$858.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,371.00
Rate for Payer: SOMOS Essential	$2,371.00

PR REPAIR LIP FULL THICKNESS <HALF VERTICAL HEIGHT

Professional

Both

$1,575.11

Service Code	HCPCS 40652
Min. Negotiated Rate	$1,181.33
Max. Negotiated Rate	$1,181.33
Rate for Payer: Cash Price	$429.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,181.33
Rate for Payer: SOMOS Essential	$1,181.33

PR REPAIR LIP FULL THICKNESS VERMILION ONLY

Professional

Both

$1,383.31

Service Code	HCPCS 40650
Min. Negotiated Rate	$1,037.48
Max. Negotiated Rate	$1,037.48
Rate for Payer: Cash Price	$378.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,037.48
Rate for Payer: SOMOS Essential	$1,037.48

PR REPAIR LUMBAR HERNIA

Professional

Both

$3,071.32

Service Code	HCPCS 49540
Min. Negotiated Rate	$2,303.49
Max. Negotiated Rate	$2,303.49
Rate for Payer: Cash Price	$809.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,303.49
Rate for Payer: SOMOS Essential	$2,303.49

PR REPAIR LUNG HERNIA THROUGH CHEST WALL

Professional

Both

$4,216.00

Service Code	HCPCS 32800
Min. Negotiated Rate	$3,162.00
Max. Negotiated Rate	$3,162.00
Rate for Payer: Cash Price	$1,119.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,162.00
Rate for Payer: SOMOS Essential	$3,162.00

PR REPAIR MACRODACTYLIA EACH DIGIT

Professional

Both

$6,358.49

Service Code	HCPCS 26590
Min. Negotiated Rate	$4,768.87
Max. Negotiated Rate	$4,768.87
Rate for Payer: Cash Price	$1,706.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,768.87
Rate for Payer: SOMOS Essential	$4,768.87

PR REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW

Professional

Both

$3,145.38

Service Code	HCPCS 24345
Min. Negotiated Rate	$2,359.04
Max. Negotiated Rate	$2,359.04
Rate for Payer: Cash Price	$854.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,359.04
Rate for Payer: SOMOS Essential	$2,359.04

PR REPAIR MENINGOCELE < 5 CM DIAMETER

Professional

Both

$6,316.21

Service Code	HCPCS 63700
Min. Negotiated Rate	$4,737.16
Max. Negotiated Rate	$4,737.16
Rate for Payer: Cash Price	$1,672.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,737.16
Rate for Payer: SOMOS Essential	$4,737.16

PR REPAIR MENINGOCELE > 5 CM DIAMETER

Professional

Both

$6,906.27

Service Code	HCPCS 63702
Min. Negotiated Rate	$5,179.70
Max. Negotiated Rate	$5,179.70
Rate for Payer: Cash Price	$1,826.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,179.70
Rate for Payer: SOMOS Essential	$5,179.70

PR REPAIR MYELOMENINGOCELE < 5 CM DIAMETER

Professional

Both

$8,026.45

Service Code	HCPCS 63704
Min. Negotiated Rate	$6,019.84
Max. Negotiated Rate	$6,019.84
Rate for Payer: Cash Price	$2,124.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,019.84
Rate for Payer: SOMOS Essential	$6,019.84

PR REPAIR MYELOMENINGOCELE > 5 CM DIAMETER

Professional

Both

$8,920.49

Service Code	HCPCS 63706
Min. Negotiated Rate	$6,690.37
Max. Negotiated Rate	$6,690.37
Rate for Payer: Cash Price	$2,357.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,690.37
Rate for Payer: SOMOS Essential	$6,690.37

PR REPAIR NAIL BED

Professional

Both

$467.46

Service Code	HCPCS 11760
Min. Negotiated Rate	$350.60
Max. Negotiated Rate	$350.60
Rate for Payer: Cash Price	$126.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$350.60
Rate for Payer: SOMOS Essential	$350.60

PR REPAIR NASAL SEPTAL PERFORATIONS

Professional

Both

$2,930.97

Service Code	HCPCS 30630
Min. Negotiated Rate	$2,198.23
Max. Negotiated Rate	$2,198.23
Rate for Payer: Cash Price	$788.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,198.23
Rate for Payer: SOMOS Essential	$2,198.23

PR REPAIR NASAL VESTIBULAR STENOSIS

Professional

Both

$4,473.11

Service Code	HCPCS 30465
Min. Negotiated Rate	$3,354.83
Max. Negotiated Rate	$3,354.83
Rate for Payer: Cash Price	$1,205.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,354.83
Rate for Payer: SOMOS Essential	$3,354.83

PR REPAIR NASOLABIAL FISTULA

Professional

Both

$2,894.33

Service Code	HCPCS 42260
Min. Negotiated Rate	$2,170.75
Max. Negotiated Rate	$2,170.75
Rate for Payer: Cash Price	$785.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,170.75
Rate for Payer: SOMOS Essential	$2,170.75

Know your out-of-pocket cost for care.

All Charges