St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR RESCJ OVARIAN/TUBAL/PERITONEAL MALIGNANCY W/BSO

Professional

Both

$5,024.95

Service Code	HCPCS 58950
Min. Negotiated Rate	$3,768.71
Max. Negotiated Rate	$3,768.71
Rate for Payer: Cash Price	$1,356.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,768.71
Rate for Payer: SOMOS Essential	$3,768.71

PR RESCJ PALATE/EXTENSIVE RESCJ LESION

Professional

Both

$4,334.37

Service Code	HCPCS 42120
Min. Negotiated Rate	$3,250.78
Max. Negotiated Rate	$3,250.78
Rate for Payer: Cash Price	$1,169.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,250.78
Rate for Payer: SOMOS Essential	$3,250.78

PR RESCJ PHRNGL WALL CLSR W/FLP OR FLP W/MVASC ANAS

Professional

Both

$10,191.09

Service Code	HCPCS 42894
Min. Negotiated Rate	$7,643.32
Max. Negotiated Rate	$7,643.32
Rate for Payer: Cash Price	$2,742.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,643.32
Rate for Payer: SOMOS Essential	$7,643.32

PR RESCJ PRIM PRTL MAL W/BSO & OMNTC RAD DEBULKING

Professional

Both

$7,166.95

Service Code	HCPCS 58952
Min. Negotiated Rate	$5,375.21
Max. Negotiated Rate	$5,375.21
Rate for Payer: Cash Price	$1,939.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,375.21
Rate for Payer: SOMOS Essential	$5,375.21

PR RESCJ PRIM PRTL MAL W/BSO & OMNTC TAH & LMPHAD

Professional

Both

$6,272.98

Service Code	HCPCS 58951
Min. Negotiated Rate	$4,704.74
Max. Negotiated Rate	$4,704.74
Rate for Payer: Cash Price	$1,696.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,704.74
Rate for Payer: SOMOS Essential	$4,704.74

PR RESCJ TEMPORAL BONE EXTERNAL APPROACH

Professional

Both

$11,527.57

Service Code	HCPCS 69535
Min. Negotiated Rate	$8,645.68
Max. Negotiated Rate	$8,645.68
Rate for Payer: Cash Price	$3,101.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,645.68
Rate for Payer: SOMOS Essential	$8,645.68

PR RESECJ/DBRDMT PANCREAS NECROTIZING PANCREATITIS

Professional

Both

$12,566.86

Service Code	HCPCS 48105
Min. Negotiated Rate	$9,425.14
Max. Negotiated Rate	$9,425.14
Rate for Payer: Cash Price	$3,338.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9,425.14
Rate for Payer: SOMOS Essential	$9,425.14

PR RESECJ RECUR OVARIAN/TUBAL/PERITONEAL MALIGNANCY

Professional

Both

$6,911.38

Service Code	HCPCS 58957
Min. Negotiated Rate	$5,183.54
Max. Negotiated Rate	$5,183.54
Rate for Payer: Cash Price	$1,874.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,183.54
Rate for Payer: SOMOS Essential	$5,183.54

PR RESECTION CONDYLE DISTAL END PHALANX EACH TOE

Professional

Both

$1,105.02

Service Code	HCPCS 28153
Min. Negotiated Rate	$828.76
Max. Negotiated Rate	$828.76
Rate for Payer: Cash Price	$306.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$828.76
Rate for Payer: SOMOS Essential	$828.76

PR RESECTION ELBOW JOINT ARTHRECTOMY

Professional

Both

$3,778.92

Service Code	HCPCS 24155
Min. Negotiated Rate	$2,834.19
Max. Negotiated Rate	$2,834.19
Rate for Payer: Cash Price	$1,019.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,834.19
Rate for Payer: SOMOS Essential	$2,834.19

PR RESECTION EXTERNAL CARDIAC TUMOR

Professional

Both

$6,020.77

Service Code	HCPCS 33130
Min. Negotiated Rate	$4,515.58
Max. Negotiated Rate	$4,515.58
Rate for Payer: Cash Price	$1,602.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,515.58
Rate for Payer: SOMOS Essential	$4,515.58

PR RESECTION HUMERAL HEAD

Professional

Both

$3,282.72

Service Code	HCPCS 23195
Min. Negotiated Rate	$2,462.04
Max. Negotiated Rate	$2,462.04
Rate for Payer: Cash Price	$895.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,462.04
Rate for Payer: SOMOS Essential	$2,462.04

PR RESECTION/INCISION SUBVALVULAR TISSUE

Professional

Both

$8,965.92

Service Code	HCPCS 33415
Min. Negotiated Rate	$6,724.44
Max. Negotiated Rate	$6,724.44
Rate for Payer: Cash Price	$2,383.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,724.44
Rate for Payer: SOMOS Essential	$6,724.44

PR RESECTION MEDIASTINAL TUMOR

Professional

Both

$5,020.68

Service Code	HCPCS 39220
Min. Negotiated Rate	$3,765.51
Max. Negotiated Rate	$3,765.51
Rate for Payer: Cash Price	$1,342.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,765.51
Rate for Payer: SOMOS Essential	$3,765.51

PR RESECTION OF MEDIASTINAL CYST

Professional

Both

$3,880.84

Service Code	HCPCS 39200
Min. Negotiated Rate	$2,910.63
Max. Negotiated Rate	$2,910.63
Rate for Payer: Cash Price	$1,033.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,910.63
Rate for Payer: SOMOS Essential	$2,910.63

PR RESECTION PARTIAL/COMPLETE PHALANGEAL BASE EACH

Professional

Both

$1,045.91

Service Code	HCPCS 28126
Min. Negotiated Rate	$784.43
Max. Negotiated Rate	$784.43
Rate for Payer: Cash Price	$292.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$784.43
Rate for Payer: SOMOS Essential	$784.43

PR RESECTION PERICARDIAL CYST/TUMOR

Professional

Both

$4,476.78

Service Code	HCPCS 33050
Min. Negotiated Rate	$3,357.58
Max. Negotiated Rate	$3,357.58
Rate for Payer: Cash Price	$1,196.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,357.58
Rate for Payer: SOMOS Essential	$3,357.58

PR RESECTION RECRT MAL W/OMENTECTOMY PEL LMPHADEC

Professional

Both

$7,224.07

Service Code	HCPCS 58958
Min. Negotiated Rate	$5,418.05
Max. Negotiated Rate	$5,418.05
Rate for Payer: Cash Price	$1,943.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,418.05
Rate for Payer: SOMOS Essential	$5,418.05

PR RESECTION RIBS EXTRAPLEURAL ALL STAGES

Professional

Both

$6,346.34

Service Code	HCPCS 32900
Min. Negotiated Rate	$4,759.76
Max. Negotiated Rate	$4,759.76
Rate for Payer: Cash Price	$1,614.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,759.76
Rate for Payer: SOMOS Essential	$4,759.76

PR RESECTION SCROTUM

Professional

Both

$2,087.65

Service Code	HCPCS 55150
Min. Negotiated Rate	$1,565.74
Max. Negotiated Rate	$1,565.74
Rate for Payer: Cash Price	$571.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,565.74
Rate for Payer: SOMOS Essential	$1,565.74

PR RESECTION/TRANSPLANTATION LONG TENDON BICEPS

Professional

Both

$3,349.05

Service Code	HCPCS 23440
Min. Negotiated Rate	$2,511.79
Max. Negotiated Rate	$2,511.79
Rate for Payer: Cash Price	$907.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,511.79
Rate for Payer: SOMOS Essential	$2,511.79

PR RESPIRATORY FLOW VOLUME LOOP

Professional

Both

$104.79

Service Code	HCPCS 94375 TC
Min. Negotiated Rate	$78.59
Max. Negotiated Rate	$78.59
Rate for Payer: Cash Price	$29.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$78.59
Rate for Payer: SOMOS Essential	$78.59

PR RESPIRATORY FLOW VOLUME LOOP

Professional

Both

$55.93

Service Code	HCPCS 94375 26
Min. Negotiated Rate	$41.95
Max. Negotiated Rate	$41.95
Rate for Payer: Cash Price	$15.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41.95
Rate for Payer: SOMOS Essential	$41.95

PR RESPIRATORY FLOW VOLUME LOOP

Professional

Both

$160.72

Service Code	HCPCS 94375
Min. Negotiated Rate	$120.54
Max. Negotiated Rate	$120.54
Rate for Payer: Cash Price	$45.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$120.54
Rate for Payer: SOMOS Essential	$120.54

PR RETROBULBAR INJECTION ALCOHOL

Professional

Both

$297.33

Service Code	HCPCS 67505
Min. Negotiated Rate	$223.00
Max. Negotiated Rate	$223.00
Rate for Payer: Cash Price	$80.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$223.00
Rate for Payer: SOMOS Essential	$223.00

Know your out-of-pocket cost for care.

All Charges