St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR RMVL EMBEDDED FB FROM DENTALVLR STRUXS SOFT TISS

Professional

Both

$844.38

Service Code	HCPCS 41805
Min. Negotiated Rate	$633.28
Max. Negotiated Rate	$633.28
Rate for Payer: Cash Price	$227.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$633.28
Rate for Payer: SOMOS Essential	$633.28

PR RMVL EMBEDDED FB FROM DENTOALVEOLAR STRUXS BONE

Professional

Both

$1,182.30

Service Code	HCPCS 41806
Min. Negotiated Rate	$886.72
Max. Negotiated Rate	$886.72
Rate for Payer: Cash Price	$320.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$886.72
Rate for Payer: SOMOS Essential	$886.72

PR RMVL EMBEDDED FB VESTIBULE MOUTH COMP

Professional

Both

$827.40

Service Code	HCPCS 40805
Min. Negotiated Rate	$620.55
Max. Negotiated Rate	$620.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$620.55
Rate for Payer: SOMOS Essential	$620.55

PR RMVL EMBEDDED FB VESTIBULE MOUTH SMPL

Professional

Both

$483.91

Service Code	HCPCS 40804
Min. Negotiated Rate	$362.93
Max. Negotiated Rate	$362.93
Rate for Payer: Cash Price	$132.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$362.93
Rate for Payer: SOMOS Essential	$362.93

PR RMVL ENTIRE LUMBOSARACH SHUNT SYS W/O RPLCMT

Professional

Both

$2,918.23

Service Code	HCPCS 63746
Min. Negotiated Rate	$2,188.67
Max. Negotiated Rate	$2,188.67
Rate for Payer: Cash Price	$777.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,188.67
Rate for Payer: SOMOS Essential	$2,188.67

PR RMVL ENTIRE OI IMPLT SKL MAG TC ATTCH ESP>=100

Professional

Both

$2,563.96

Service Code	HCPCS 69728
Min. Negotiated Rate	$1,922.97
Max. Negotiated Rate	$1,922.97
Rate for Payer: Cash Price	$707.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,922.97
Rate for Payer: SOMOS Essential	$1,922.97

PR RMVL EPITHELIAL DOWNGROWTH ANT CHAMBER EYE

Professional

Both

$4,097.87

Service Code	HCPCS 65900
Min. Negotiated Rate	$3,073.40
Max. Negotiated Rate	$3,073.40
Rate for Payer: Cash Price	$1,125.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,073.40
Rate for Payer: SOMOS Essential	$3,073.40

PR RMVL FB/DACRYOLITH LACRIMAL PASSAGES

Professional

Both

$1,040.13

Service Code	HCPCS 68530
Min. Negotiated Rate	$780.10
Max. Negotiated Rate	$780.10
Rate for Payer: Cash Price	$286.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$780.10
Rate for Payer: SOMOS Essential	$780.10

PR RMVL FB INTRAOCULAR ANT CHAMBER EYE/LENS

Professional

Both

$3,023.58

Service Code	HCPCS 65235
Min. Negotiated Rate	$2,267.68
Max. Negotiated Rate	$2,267.68
Rate for Payer: Cash Price	$833.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,267.68
Rate for Payer: SOMOS Essential	$2,267.68

PR RMVL FB IO FROM POST SEG MAG XTRJ ANT/POST ROUTE

Professional

Both

$4,054.19

Service Code	HCPCS 65260
Min. Negotiated Rate	$3,040.64
Max. Negotiated Rate	$3,040.64
Rate for Payer: Cash Price	$1,113.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,040.64
Rate for Payer: SOMOS Essential	$3,040.64

PR RMVL FB IO FROM POST SEG NONMAGNETIC XTRJ

Professional

Both

$4,562.18

Service Code	HCPCS 65265
Min. Negotiated Rate	$3,421.64
Max. Negotiated Rate	$3,421.64
Rate for Payer: Cash Price	$1,253.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,421.64
Rate for Payer: SOMOS Essential	$3,421.64

PR RMVL FB XTRNL AUDITORY CANAL ANES

Professional

Both

$415.00

Service Code	HCPCS 69205
Min. Negotiated Rate	$311.25
Max. Negotiated Rate	$311.25
Rate for Payer: Cash Price	$111.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$311.25
Rate for Payer: SOMOS Essential	$311.25

PR RMVL FB XTRNL AUDITORY CANAL W/O ANES

Professional

Both

$202.72

Service Code	HCPCS 69200
Min. Negotiated Rate	$152.04
Max. Negotiated Rate	$152.04
Rate for Payer: Cash Price	$54.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$152.04
Rate for Payer: SOMOS Essential	$152.04

PR RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP

Professional

Both

$176.65

Service Code	HCPCS 65220
Min. Negotiated Rate	$132.49
Max. Negotiated Rate	$132.49
Rate for Payer: Cash Price	$47.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$132.49
Rate for Payer: SOMOS Essential	$132.49

PR RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP

Professional

Both

$200.97

Service Code	HCPCS 65222
Min. Negotiated Rate	$150.73
Max. Negotiated Rate	$150.73
Rate for Payer: Cash Price	$56.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$150.73
Rate for Payer: SOMOS Essential	$150.73

PR RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR

Professional

Both

$146.30

Service Code	HCPCS 65210
Min. Negotiated Rate	$109.72
Max. Negotiated Rate	$109.72
Rate for Payer: Cash Price	$39.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$109.72
Rate for Payer: SOMOS Essential	$109.72

PR RMVL FECAL IMPACTION/FB SPX UNDER ANES

Professional

Both

$1,002.44

Service Code	HCPCS 45915
Min. Negotiated Rate	$751.83
Max. Negotiated Rate	$751.83
Rate for Payer: Cash Price	$270.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$751.83
Rate for Payer: SOMOS Essential	$751.83

PR RMVL FOREIGN BODY INTRANASAL LATERAL RHINOTOMY

Professional

Both

$2,133.11

Service Code	HCPCS 30320
Min. Negotiated Rate	$1,599.83
Max. Negotiated Rate	$1,599.83
Rate for Payer: Cash Price	$576.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,599.83
Rate for Payer: SOMOS Essential	$1,599.83

PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP

Professional

Both

$1,081.22

Service Code	HCPCS 20525
Min. Negotiated Rate	$810.92
Max. Negotiated Rate	$810.92
Rate for Payer: Cash Price	$292.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$810.92
Rate for Payer: SOMOS Essential	$810.92

PR RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS

Professional

Both

$742.63

Service Code	HCPCS 27086
Min. Negotiated Rate	$556.97
Max. Negotiated Rate	$556.97
Rate for Payer: Cash Price	$203.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$556.97
Rate for Payer: SOMOS Essential	$556.97

PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS

Professional

Both

$609.07

Service Code	HCPCS 24200
Min. Negotiated Rate	$456.80
Max. Negotiated Rate	$456.80
Rate for Payer: Cash Price	$168.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$456.80
Rate for Payer: SOMOS Essential	$456.80

PR RMVL HIP PROSTH COMP W/TOT HIP PROSTH MMA

Professional

Both

$7,022.72

Service Code	HCPCS 27091
Min. Negotiated Rate	$5,267.04
Max. Negotiated Rate	$5,267.04
Rate for Payer: Cash Price	$1,888.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,267.04
Rate for Payer: SOMOS Essential	$5,267.04

PR RMVL I-AORT BALO ASST DEV W/RPR FEM ART W/WO GRF

Professional

Both

$3,126.73

Service Code	HCPCS 33971
Min. Negotiated Rate	$2,345.05
Max. Negotiated Rate	$2,345.05
Rate for Payer: Cash Price	$834.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,345.05
Rate for Payer: SOMOS Essential	$2,345.05

PR RMVL IMPLANTED MATERIAL ANTERIO SEGMENT EYE

Professional

Both

$3,268.83

Service Code	HCPCS 65920
Min. Negotiated Rate	$2,451.62
Max. Negotiated Rate	$2,451.62
Rate for Payer: Cash Price	$899.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,451.62
Rate for Payer: SOMOS Essential	$2,451.62

PR RMVL IMPLNT MATL POSTERIOR SEGMENT EXTRAOCULAR

Professional

Both

$2,284.63

Service Code	HCPCS 67120
Min. Negotiated Rate	$1,713.47
Max. Negotiated Rate	$1,713.47
Rate for Payer: Cash Price	$629.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,713.47
Rate for Payer: SOMOS Essential	$1,713.47

Know your out-of-pocket cost for care.

All Charges