St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

Professional

Both

$7,737.77

Service Code	HCPCS 43865
Min. Negotiated Rate	$5,803.33
Max. Negotiated Rate	$5,803.33
Rate for Payer: Cash Price	$2,059.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,803.33
Rate for Payer: SOMOS Essential	$5,803.33

PR REVJ ILEOSTOMY COMPLIC RCNSTJ IN-DEPTH SPX

Professional

Both

$4,415.95

Service Code	HCPCS 44314
Min. Negotiated Rate	$3,311.96
Max. Negotiated Rate	$3,311.96
Rate for Payer: Cash Price	$1,184.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,311.96
Rate for Payer: SOMOS Essential	$3,311.96

PR REVJ ILEOSTOMY SIMPLE RLS SUPERFICIAL SCAR SPX

Professional

Both

$2,633.75

Service Code	HCPCS 44312
Min. Negotiated Rate	$1,975.31
Max. Negotiated Rate	$1,975.31
Rate for Payer: Cash Price	$709.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,975.31
Rate for Payer: SOMOS Essential	$1,975.31

PR REVJ IMPLANTED INTRA-ARTERIAL INFUSION PUMP

Professional

Both

$1,847.34

Service Code	HCPCS 36261
Min. Negotiated Rate	$1,385.50
Max. Negotiated Rate	$1,385.50
Rate for Payer: Cash Price	$499.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,385.50
Rate for Payer: SOMOS Essential	$1,385.50

PR REVJ INCL RPLCMT NSTIM ELTRD PLT/PDLE INCL FLUOR

Professional

Both

$4,152.54

Service Code	HCPCS 63664
Min. Negotiated Rate	$3,114.40
Max. Negotiated Rate	$3,114.40
Rate for Payer: Cash Price	$1,108.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,114.40
Rate for Payer: SOMOS Essential	$3,114.40

PR REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR

Professional

Both

$1,927.14

Service Code	HCPCS 63663
Min. Negotiated Rate	$1,445.36
Max. Negotiated Rate	$1,445.36
Rate for Payer: Cash Price	$525.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,445.36
Rate for Payer: SOMOS Essential	$1,445.36

PR REVJ LXTR ARTL BYP OPN VEIN PATCH ANGIOP

Professional

Both

$4,097.10

Service Code	HCPCS 35879
Min. Negotiated Rate	$3,072.82
Max. Negotiated Rate	$3,072.82
Rate for Payer: Cash Price	$1,084.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,072.82
Rate for Payer: SOMOS Essential	$3,072.82

PR REVJ LXTR ARTL BYP OPN W/SGMTL VEIN INTERPOS

Professional

Both

$4,545.17

Service Code	HCPCS 35881
Min. Negotiated Rate	$3,408.88
Max. Negotiated Rate	$3,408.88
Rate for Payer: Cash Price	$1,211.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,408.88
Rate for Payer: SOMOS Essential	$3,408.88

PR REVJ MASTOIDECTOMY RSLTG COMPL MASTOIDECTOMY

Professional

Both

$4,423.55

Service Code	HCPCS 69601
Min. Negotiated Rate	$3,317.66
Max. Negotiated Rate	$3,317.66
Rate for Payer: Cash Price	$1,192.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,317.66
Rate for Payer: SOMOS Essential	$3,317.66

PR REVJ MASTOIDECTOMY RSLTG MODF RAD MSTDC

Professional

Both

$4,729.31

Service Code	HCPCS 69602
Min. Negotiated Rate	$3,546.98
Max. Negotiated Rate	$3,546.98
Rate for Payer: Cash Price	$1,276.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,546.98
Rate for Payer: SOMOS Essential	$3,546.98

PR REVJ MASTOIDECTOMY RSLTG RAD MASTOIDECTOMY

Professional

Both

$5,584.29

Service Code	HCPCS 69603
Min. Negotiated Rate	$4,188.22
Max. Negotiated Rate	$4,188.22
Rate for Payer: Cash Price	$1,504.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,188.22
Rate for Payer: SOMOS Essential	$4,188.22

PR REVJ MASTOIDECTOMY RSLTG TYMPANOPLASTY

Professional

Both

$4,831.02

Service Code	HCPCS 69604
Min. Negotiated Rate	$3,623.26
Max. Negotiated Rate	$3,623.26
Rate for Payer: Cash Price	$1,303.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,623.26
Rate for Payer: SOMOS Essential	$3,623.26

PR REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF

Professional

Both

$3,352.20

Service Code	HCPCS 36832
Min. Negotiated Rate	$2,514.15
Max. Negotiated Rate	$2,514.15
Rate for Payer: Cash Price	$891.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,514.15
Rate for Payer: SOMOS Essential	$2,514.15

PR REVJ OPN ARVEN FSTL W/THRMBC DIAL GRF

Professional

Both

$3,585.82

Service Code	HCPCS 36833
Min. Negotiated Rate	$2,689.36
Max. Negotiated Rate	$2,689.36
Rate for Payer: Cash Price	$951.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,689.36
Rate for Payer: SOMOS Essential	$2,689.36

PR REVJ/RMVL IMPL SPI NPG/RCVR DTCH CONNJ ELTRD RA

Professional

Both

$1,667.93

Service Code	HCPCS 63688
Min. Negotiated Rate	$1,250.95
Max. Negotiated Rate	$1,250.95
Rate for Payer: Cash Price	$361.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,250.95
Rate for Payer: SOMOS Essential	$1,250.95

PR REVJ/RMVL INTRACRANIAL NEUROSTIMULATOR ELTRDS

Professional

Both

$2,799.41

Service Code	HCPCS 61880
Min. Negotiated Rate	$2,099.56
Max. Negotiated Rate	$2,099.56
Rate for Payer: Cash Price	$744.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,099.56
Rate for Payer: SOMOS Essential	$2,099.56

PR REVJ/RMVL NEUROSTIMULATOR PULSE GENERATOR

Professional

Both

$1,903.23

Service Code	HCPCS 61888
Min. Negotiated Rate	$1,427.42
Max. Negotiated Rate	$1,427.42
Rate for Payer: Cash Price	$503.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,427.42
Rate for Payer: SOMOS Essential	$1,427.42

PR REVJ/RMVL PERPH NEUROSTIMULATOR ELECTRODE ARRAY

Professional

Both

$611.00

Service Code	HCPCS 64585
Min. Negotiated Rate	$458.25
Max. Negotiated Rate	$458.25
Rate for Payer: Cash Price	$167.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$458.25
Rate for Payer: SOMOS Essential	$458.25

PR REVJ/RMVL PROSTHETIC VAGINAL GRAFT VAGINAL APP

Professional

Both

$2,174.87

Service Code	HCPCS 57295
Min. Negotiated Rate	$1,631.15
Max. Negotiated Rate	$1,631.15
Rate for Payer: Cash Price	$589.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,631.15
Rate for Payer: SOMOS Essential	$1,631.15

PR REVJ RPLCMT DISC ARTHROPLASTY ANT 1 NTRSPC CRV

Professional

Both

$11,181.24

Service Code	HCPCS 22861
Min. Negotiated Rate	$8,385.93
Max. Negotiated Rate	$8,385.93
Rate for Payer: Cash Price	$2,945.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,385.93
Rate for Payer: SOMOS Essential	$8,385.93

PR REVJ RPLCMT DISC ARTHROPLASTY ANT 1 NTRSPC LMBR

Professional

Both

$11,157.09

Service Code	HCPCS 22862
Min. Negotiated Rate	$8,367.82
Max. Negotiated Rate	$8,367.82
Rate for Payer: Cash Price	$2,944.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,367.82
Rate for Payer: SOMOS Essential	$8,367.82

PR REVJ/RPLCMT HPGLSL NERVE NSTIM RA PG&RESPIR SNR

Professional

Both

$3,713.61

Service Code	HCPCS 64583
Min. Negotiated Rate	$2,785.21
Max. Negotiated Rate	$2,785.21
Rate for Payer: Cash Price	$1,004.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,785.21
Rate for Payer: SOMOS Essential	$2,785.21

PR REVJ/RPR OPRATIVE WOUND ANTERIOR SEGMENT

Professional

Both

$2,291.80

Service Code	HCPCS 66250
Min. Negotiated Rate	$1,718.85
Max. Negotiated Rate	$1,718.85
Rate for Payer: Cash Price	$631.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,718.85
Rate for Payer: SOMOS Essential	$1,718.85

PR REVJ SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT

Professional

Both

$3,269.81

Service Code	HCPCS 66184
Min. Negotiated Rate	$2,452.36
Max. Negotiated Rate	$2,452.36
Rate for Payer: Cash Price	$901.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,452.36
Rate for Payer: SOMOS Essential	$2,452.36

PR REVJ TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT

Professional

Both

$6,189.02

Service Code	HCPCS 27486
Min. Negotiated Rate	$4,641.76
Max. Negotiated Rate	$4,641.76
Rate for Payer: Cash Price	$1,667.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,641.76
Rate for Payer: SOMOS Essential	$4,641.76

Know your out-of-pocket cost for care.

All Charges