St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON

Professional

Both

$1,373.72

Service Code	HCPCS 28208
Min. Negotiated Rate	$1,030.29
Max. Negotiated Rate	$1,030.29
Rate for Payer: Cash Price	$375.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,030.29
Rate for Payer: SOMOS Essential	$1,030.29

PR REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA

Professional

Both

$3,303.90

Service Code	HCPCS 24341
Min. Negotiated Rate	$2,477.92
Max. Negotiated Rate	$2,477.92
Rate for Payer: Cash Price	$900.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,477.92
Rate for Payer: SOMOS Essential	$2,477.92

PR REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL&M

Professional

Both

$1,333.40

Service Code	HCPCS 90867
Min. Negotiated Rate	$1,000.05
Max. Negotiated Rate	$1,000.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,000.05
Rate for Payer: SOMOS Essential	$1,000.05

PR REPET TMS TX SUBSEQ MOTR THRESHLD W/DELIV & MN

Professional

Both

$1,117.62

Service Code	HCPCS 90869
Min. Negotiated Rate	$838.22
Max. Negotiated Rate	$838.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$838.22
Rate for Payer: SOMOS Essential	$838.22

PR REPLACE AORTA VALVE W/BYP CNTRL ART/VENOUS APRCH

Professional

Both

$4,299.75

Service Code	HCPCS 33369
Min. Negotiated Rate	$3,224.81
Max. Negotiated Rate	$3,224.81
Rate for Payer: Cash Price	$1,136.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,224.81
Rate for Payer: SOMOS Essential	$3,224.81

PR REPLACE AORTIC VALVE OPEN AXILLRY ARTRY APPROACH

Professional

Both

$6,014.75

Service Code	HCPCS 33363
Min. Negotiated Rate	$4,511.06
Max. Negotiated Rate	$4,511.06
Rate for Payer: Cash Price	$1,600.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,511.06
Rate for Payer: SOMOS Essential	$4,511.06

PR REPLACE AORTIC VALVE OPENFEMORAL ARTERY APPROACH

Professional

Both

$5,810.46

Service Code	HCPCS 33362
Min. Negotiated Rate	$4,357.84
Max. Negotiated Rate	$4,357.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,357.84
Rate for Payer: SOMOS Essential	$4,357.84

PR REPLACE AORTIC VALVE OPEN ILIAC ARTERY APPROACH

Professional

Both

$6,011.99

Service Code	HCPCS 33364
Min. Negotiated Rate	$4,508.99
Max. Negotiated Rate	$4,508.99
Rate for Payer: Cash Price	$1,592.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,508.99
Rate for Payer: SOMOS Essential	$4,508.99

PR REPLACE AORTIC VALVE OPEN TRANSAORTIC APPROACH

Professional

Both

$6,274.28

Service Code	HCPCS 33365
Min. Negotiated Rate	$4,705.71
Max. Negotiated Rate	$4,705.71
Rate for Payer: Cash Price	$1,665.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,705.71
Rate for Payer: SOMOS Essential	$4,705.71

PR REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH

Professional

Both

$5,322.38

Service Code	HCPCS 33361
Min. Negotiated Rate	$3,991.78
Max. Negotiated Rate	$3,991.78
Rate for Payer: Cash Price	$1,414.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,991.78
Rate for Payer: SOMOS Essential	$3,991.78

PR REPLACE AORTIC VALVE W/BYP OPEN ART/VENOUS APRCH

Professional

Both

$3,256.65

Service Code	HCPCS 33368
Min. Negotiated Rate	$2,442.49
Max. Negotiated Rate	$2,442.49
Rate for Payer: Cash Price	$861.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,442.49
Rate for Payer: SOMOS Essential	$2,442.49

PR REPLACE AORTIC VALVE W/BYP PRQ ART/VENOUS APPRCH

Professional

Both

$2,689.86

Service Code	HCPCS 33367
Min. Negotiated Rate	$2,017.40
Max. Negotiated Rate	$2,017.40
Rate for Payer: Cash Price	$710.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,017.40
Rate for Payer: SOMOS Essential	$2,017.40

PR REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ

Professional

Both

$362.95

Service Code	HCPCS 49451
Min. Negotiated Rate	$272.21
Max. Negotiated Rate	$272.21
Rate for Payer: Cash Price	$97.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$272.21
Rate for Payer: SOMOS Essential	$272.21

PR REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS

Professional

Both

$277.24

Service Code	HCPCS 49450
Min. Negotiated Rate	$207.93
Max. Negotiated Rate	$207.93
Rate for Payer: Cash Price	$72.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$207.93
Rate for Payer: SOMOS Essential	$207.93

PR REPLACEMENT AORTIC&PULMON VALVES ROSS PROCEDUR

Professional

Both

$14,175.67

Service Code	HCPCS 33413
Min. Negotiated Rate	$10,631.75
Max. Negotiated Rate	$10,631.75
Rate for Payer: Cash Price	$3,761.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10,631.75
Rate for Payer: SOMOS Essential	$10,631.75

PR REPLACEMENT AORTIC VALVE KONNO PROCEDURE

Professional

Both

$13,843.52

Service Code	HCPCS 33412
Min. Negotiated Rate	$10,382.64
Max. Negotiated Rate	$10,382.64
Rate for Payer: Cash Price	$3,670.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10,382.64
Rate for Payer: SOMOS Essential	$10,382.64

PR REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS

Professional

Both

$559.76

Service Code	HCPCS 49452
Min. Negotiated Rate	$419.82
Max. Negotiated Rate	$419.82
Rate for Payer: Cash Price	$150.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$419.82
Rate for Payer: SOMOS Essential	$419.82

PR REPLACEMENT MITRAL VALVE W/CARDIOPULMONARY BYP

Professional

Both

$12,393.01

Service Code	HCPCS 33430
Min. Negotiated Rate	$9,294.76
Max. Negotiated Rate	$9,294.76
Rate for Payer: Cash Price	$3,295.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9,294.76
Rate for Payer: SOMOS Essential	$9,294.76

PR REPLACEMENT OF CONTACT LENS

Professional

Both

$168.04

Service Code	HCPCS 92326
Min. Negotiated Rate	$126.03
Max. Negotiated Rate	$126.03
Rate for Payer: Cash Price	$46.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$126.03
Rate for Payer: SOMOS Essential	$126.03

PR REPLACEMENT PULMONARY VALVE

Professional

Both

$10,237.54

Service Code	HCPCS 33475
Min. Negotiated Rate	$7,678.16
Max. Negotiated Rate	$7,678.16
Rate for Payer: Cash Price	$2,722.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,678.16
Rate for Payer: SOMOS Essential	$7,678.16

PR REPLACEMENT TISSUE EXPANDER W/PERMANENT IMPLANT

Professional

Both

$2,454.76

Service Code	HCPCS 11970
Min. Negotiated Rate	$1,841.07
Max. Negotiated Rate	$1,841.07
Rate for Payer: Cash Price	$665.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,841.07
Rate for Payer: SOMOS Essential	$1,841.07

PR REPLACEMENT TRICUSPID VALVE W/CARD BYPASS

Professional

Both

$12,172.76

Service Code	HCPCS 33465
Min. Negotiated Rate	$9,129.57
Max. Negotiated Rate	$9,129.57
Rate for Payer: Cash Price	$3,235.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9,129.57
Rate for Payer: SOMOS Essential	$9,129.57

PR REPLANTATION ARM COMPLETE AMPUTATION

Professional

Both

$12,073.08

Service Code	HCPCS 20802
Min. Negotiated Rate	$9,054.81
Max. Negotiated Rate	$9,054.81
Rate for Payer: Cash Price	$3,246.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9,054.81
Rate for Payer: SOMOS Essential	$9,054.81

PR REPLANTATION FOOT COMPLETE AMPUTATION

Professional

Both

$12,254.45

Service Code	HCPCS 20838
Min. Negotiated Rate	$9,190.84
Max. Negotiated Rate	$9,190.84
Rate for Payer: Cash Price	$3,294.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9,190.84
Rate for Payer: SOMOS Essential	$9,190.84

PR REPLANTATION FOREARM COMPLETE AMPUTATION

Professional

Both

$14,349.86

Service Code	HCPCS 20805
Min. Negotiated Rate	$10,762.40
Max. Negotiated Rate	$10,762.40
Rate for Payer: Cash Price	$3,854.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10,762.40
Rate for Payer: SOMOS Essential	$10,762.40

Know your out-of-pocket cost for care.

All Charges