St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR RETROBULBAR INJECTION MEDICATION SPX

Professional

Both

$261.42

Service Code	HCPCS 67500
Min. Negotiated Rate	$196.06
Max. Negotiated Rate	$196.06
Rate for Payer: Cash Price	$72.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$196.06
Rate for Payer: SOMOS Essential	$196.06

PR REVASCULARIZATION ILIAC ART ANGIOP EA IPSI VSL

Professional

Both

$809.69

Service Code	HCPCS 37222
Min. Negotiated Rate	$607.27
Max. Negotiated Rate	$607.27
Rate for Payer: Cash Price	$213.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$607.27
Rate for Payer: SOMOS Essential	$607.27

PR REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL

Professional

Both

$1,750.46

Service Code	HCPCS 37220
Min. Negotiated Rate	$1,312.84
Max. Negotiated Rate	$1,312.84
Rate for Payer: Cash Price	$462.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,312.84
Rate for Payer: SOMOS Essential	$1,312.84

PR REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT

Professional

Both

$7,765.17

Service Code	HCPCS 24371
Min. Negotiated Rate	$5,823.88
Max. Negotiated Rate	$5,823.88
Rate for Payer: Cash Price	$2,090.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,823.88
Rate for Payer: SOMOS Essential	$5,823.88

PR REVIS ELBOW ARTHRPLSTY HUMERAL/ULNA COMPNT

Professional

Both

$6,759.59

Service Code	HCPCS 24370
Min. Negotiated Rate	$5,069.69
Max. Negotiated Rate	$5,069.69
Rate for Payer: Cash Price	$1,817.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,069.69
Rate for Payer: SOMOS Essential	$5,069.69

PR REVISION FEMORAL ANAST OPEN W/AUTOG GRAFT

Professional

Both

$5,514.22

Service Code	HCPCS 35884
Min. Negotiated Rate	$4,135.66
Max. Negotiated Rate	$4,135.66
Rate for Payer: Cash Price	$1,459.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,135.66
Rate for Payer: SOMOS Essential	$4,135.66

PR REVISION OF RECONSTRUCTED BREAST

Professional

Both

$3,534.27

Service Code	HCPCS 19380
Min. Negotiated Rate	$2,650.70
Max. Negotiated Rate	$2,650.70
Rate for Payer: Cash Price	$954.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,650.70
Rate for Payer: SOMOS Essential	$2,650.70

PR REVISION OPEN GASTRIC RESTRICTIVE PX NOT DEVICE

Professional

Both

$8,720.32

Service Code	HCPCS 43848
Min. Negotiated Rate	$6,540.24
Max. Negotiated Rate	$6,540.24
Rate for Payer: Cash Price	$2,331.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,540.24
Rate for Payer: SOMOS Essential	$6,540.24

PR REVISION PERI-IMPLANT CAPSULE BREAST

Professional

Both

$2,939.48

Service Code	HCPCS 19370
Min. Negotiated Rate	$2,204.61
Max. Negotiated Rate	$2,204.61
Rate for Payer: Cash Price	$794.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,204.61
Rate for Payer: SOMOS Essential	$2,204.61

PR REVISION PRIOR HYPOSPADIAS REPAIR DSJ&EXC RCNSTJ

Professional

Both

$5,894.67

Service Code	HCPCS 54352
Min. Negotiated Rate	$4,421.00
Max. Negotiated Rate	$4,421.00
Rate for Payer: Cash Price	$1,609.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,421.00
Rate for Payer: SOMOS Essential	$4,421.00

PR REVISION PROSTHETIC VAGINAL GRAFT LAPAROSCOPIC

Professional

Both

$3,766.49

Service Code	HCPCS 57426
Min. Negotiated Rate	$2,824.87
Max. Negotiated Rate	$2,824.87
Rate for Payer: Cash Price	$1,023.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,824.87
Rate for Payer: SOMOS Essential	$2,824.87

PR REVISION/REPLMT NEUROSTIMLATOR ELTRD CRANIAL NRV

Professional

Both

$3,580.40

Service Code	HCPCS 64569
Min. Negotiated Rate	$2,685.30
Max. Negotiated Rate	$2,685.30
Rate for Payer: Cash Price	$962.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,685.30
Rate for Payer: SOMOS Essential	$2,685.30

PR REVISION/RMVL GASTRIC NSTIM ELTRDE ANTRUM OPEN

Professional

Both

$3,585.47

Service Code	HCPCS 43882
Min. Negotiated Rate	$2,689.10
Max. Negotiated Rate	$2,689.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,689.10
Rate for Payer: SOMOS Essential	$2,689.10

PR REVISION STAPEDECTOMY/STAPEDOTOMY

Professional

Both

$5,024.04

Service Code	HCPCS 69662
Min. Negotiated Rate	$3,768.03
Max. Negotiated Rate	$3,768.03
Rate for Payer: Cash Price	$1,356.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,768.03
Rate for Payer: SOMOS Essential	$3,768.03

PR REVISION TRACHEOSTOMY SCAR

Professional

Both

$1,594.43

Service Code	HCPCS 31830
Min. Negotiated Rate	$1,195.82
Max. Negotiated Rate	$1,195.82
Rate for Payer: Cash Price	$433.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,195.82
Rate for Payer: SOMOS Essential	$1,195.82

PR REVIS PERITONEAL-VENOUS SHUNT

Professional

Both

$3,038.46

Service Code	HCPCS 49426
Min. Negotiated Rate	$2,278.84
Max. Negotiated Rate	$2,278.84
Rate for Payer: Cash Price	$811.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,278.84
Rate for Payer: SOMOS Essential	$2,278.84

PR REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT

Professional

Both

$7,640.15

Service Code	HCPCS 23474
Min. Negotiated Rate	$5,730.11
Max. Negotiated Rate	$5,730.11
Rate for Payer: Cash Price	$2,052.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,730.11
Rate for Payer: SOMOS Essential	$5,730.11

PR REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT

Professional

Both

$7,073.47

Service Code	HCPCS 23473
Min. Negotiated Rate	$5,305.10
Max. Negotiated Rate	$5,305.10
Rate for Payer: Cash Price	$1,901.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,305.10
Rate for Payer: SOMOS Essential	$5,305.10

PR REVJ AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/GRAFT

Professional

Both

$3,511.66

Service Code	HCPCS 66185
Min. Negotiated Rate	$2,633.74
Max. Negotiated Rate	$2,633.74
Rate for Payer: Cash Price	$967.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,633.74
Rate for Payer: SOMOS Essential	$2,633.74

PR REVJ ARTHRP W/REMOVAL IMPLANT WRIST JOINT

Professional

Both

$4,547.76

Service Code	HCPCS 25449
Min. Negotiated Rate	$3,410.82
Max. Negotiated Rate	$3,410.82
Rate for Payer: Cash Price	$1,226.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,410.82
Rate for Payer: SOMOS Essential	$3,410.82

PR REVJ COLOSTOMY COMP RCNSTJ IN-DEPTH SPX

Professional

Both

$4,658.96

Service Code	HCPCS 44345
Min. Negotiated Rate	$3,494.22
Max. Negotiated Rate	$3,494.22
Rate for Payer: Cash Price	$1,246.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,494.22
Rate for Payer: SOMOS Essential	$3,494.22

PR REVJ COLOSTOMY SMPL RLS SUPFC SCAR SPX

Professional

Both

$2,791.71

Service Code	HCPCS 44340
Min. Negotiated Rate	$2,093.78
Max. Negotiated Rate	$2,093.78
Rate for Payer: Cash Price	$754.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,093.78
Rate for Payer: SOMOS Essential	$2,093.78

PR REVJ COLOSTOMY W/RPR PARACLST HERNIA SPX

Professional

Both

$5,243.70

Service Code	HCPCS 44346
Min. Negotiated Rate	$3,932.78
Max. Negotiated Rate	$3,932.78
Rate for Payer: Cash Price	$1,404.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,932.78
Rate for Payer: SOMOS Essential	$3,932.78

PR REVJ FEM ANAST BPG GRN OPN W/NONAUTOG PATCH GRF

Professional

Both

$5,321.58

Service Code	HCPCS 35883
Min. Negotiated Rate	$3,991.18
Max. Negotiated Rate	$3,991.18
Rate for Payer: Cash Price	$1,406.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,991.18
Rate for Payer: SOMOS Essential	$3,991.18

PR REVJ GSTR/JJ ANAST W/RCNSTJ W/O VGTMY

Professional

Both

$7,373.14

Service Code	HCPCS 43860
Min. Negotiated Rate	$5,529.86
Max. Negotiated Rate	$5,529.86
Rate for Payer: Cash Price	$1,962.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,529.86
Rate for Payer: SOMOS Essential	$5,529.86

Know your out-of-pocket cost for care.

All Charges