St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL

Professional

Both

$2,453.89

Service Code	HCPCS 67904
Min. Negotiated Rate	$1,840.42
Max. Negotiated Rate	$1,840.42
Rate for Payer: Cash Price	$675.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,840.42
Rate for Payer: SOMOS Essential	$1,840.42

PR RPR BLEPHAROPTOSIS SUPERIOR RECTUS FASCIAL SLING

Professional

Both

$2,075.15

Service Code	HCPCS 67906
Min. Negotiated Rate	$1,556.36
Max. Negotiated Rate	$1,556.36
Rate for Payer: Cash Price	$570.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,556.36
Rate for Payer: SOMOS Essential	$1,556.36

PR RPR BLOOD VESSEL DIRECT INTRA-ABDOMINAL

Professional

Both

$6,574.51

Service Code	HCPCS 35221
Min. Negotiated Rate	$4,930.88
Max. Negotiated Rate	$4,930.88
Rate for Payer: Cash Price	$1,743.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,930.88
Rate for Payer: SOMOS Essential	$4,930.88

PR RPR BLOOD VESSEL DIRECT INTRATHORACIC W/BYPASS

Professional

Both

$6,150.06

Service Code	HCPCS 35211
Min. Negotiated Rate	$4,612.54
Max. Negotiated Rate	$4,612.54
Rate for Payer: Cash Price	$1,643.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,612.54
Rate for Payer: SOMOS Essential	$4,612.54

PR RPR BLOOD VESSEL DIRECT INTRATHORACIC W/O BYPASS

Professional

Both

$9,287.32

Service Code	HCPCS 35216
Min. Negotiated Rate	$6,965.49
Max. Negotiated Rate	$6,965.49
Rate for Payer: Cash Price	$2,481.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,965.49
Rate for Payer: SOMOS Essential	$6,965.49

PR RPR BLOOD VESSEL DIRECT LOWER EXTREMITY

Professional

Both

$3,694.11

Service Code	HCPCS 35226
Min. Negotiated Rate	$2,770.58
Max. Negotiated Rate	$2,770.58
Rate for Payer: Cash Price	$975.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,770.58
Rate for Payer: SOMOS Essential	$2,770.58

PR RPR BLOOD VESSEL VEIN GRAFT INTRATHORACIC W/BYP

Professional

Both

$6,328.07

Service Code	HCPCS 35241
Min. Negotiated Rate	$4,746.05
Max. Negotiated Rate	$4,746.05
Rate for Payer: Cash Price	$1,682.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,746.05
Rate for Payer: SOMOS Essential	$4,746.05

PR RPR BLOOD VESSEL VEIN GRF INTRATHORACIC W/O BYP

Professional

Both

$6,884.68

Service Code	HCPCS 35246
Min. Negotiated Rate	$5,163.51
Max. Negotiated Rate	$5,163.51
Rate for Payer: Cash Price	$1,829.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,163.51
Rate for Payer: SOMOS Essential	$5,163.51

PR RPR BLOOD VSL GRF OTH/THN VEIN INTRATHRC W/BYP

Professional

Both

$6,141.00

Service Code	HCPCS 35271
Min. Negotiated Rate	$4,605.75
Max. Negotiated Rate	$4,605.75
Rate for Payer: Cash Price	$1,633.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,605.75
Rate for Payer: SOMOS Essential	$4,605.75

PR RPR BLOOD VSL GRF OTH/THN VEIN INTRATHRC W/O BYP

Professional

Both

$6,426.11

Service Code	HCPCS 35276
Min. Negotiated Rate	$4,819.58
Max. Negotiated Rate	$4,819.58
Rate for Payer: Cash Price	$1,709.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,819.58
Rate for Payer: SOMOS Essential	$4,819.58

PR RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY

Professional

Both

$3,823.40

Service Code	HCPCS 35266
Min. Negotiated Rate	$2,867.55
Max. Negotiated Rate	$2,867.55
Rate for Payer: Cash Price	$1,019.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,867.55
Rate for Payer: SOMOS Essential	$2,867.55

PR RPR BLPOS CONJUNCTIVO-TARSO-MUSC-LEVATOR RESCJ

Professional

Both

$1,785.11

Service Code	HCPCS 67908
Min. Negotiated Rate	$1,338.83
Max. Negotiated Rate	$1,338.83
Rate for Payer: Cash Price	$491.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,338.83
Rate for Payer: SOMOS Essential	$1,338.83

PR RPR BLVSL W/GRF OTHER/THAN VEIN LOWER EXTREMITY

Professional

Both

$4,128.32

Service Code	HCPCS 35286
Min. Negotiated Rate	$3,096.24
Max. Negotiated Rate	$3,096.24
Rate for Payer: Cash Price	$1,091.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,096.24
Rate for Payer: SOMOS Essential	$3,096.24

PR RPR BLVSL W/GRFT OTHER/THAN VEIN INTRA-ABDOMINAL

Professional

Both

$7,213.36

Service Code	HCPCS 35281
Min. Negotiated Rate	$5,410.02
Max. Negotiated Rate	$5,410.02
Rate for Payer: Cash Price	$1,913.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,410.02
Rate for Payer: SOMOS Essential	$5,410.02

PR RPR CAR ANOMAL CLSR SEPTL DFCT SMPL FONTAN PX

Professional

Both

$8,884.93

Service Code	HCPCS 33615
Min. Negotiated Rate	$6,663.70
Max. Negotiated Rate	$6,663.70
Rate for Payer: Cash Price	$2,362.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,663.70
Rate for Payer: SOMOS Essential	$6,663.70

PR RPR CAR ANOMAL SURG ENLGMENT VENTR SEPTL DFCT

Professional

Both

$7,906.01

Service Code	HCPCS 33610
Min. Negotiated Rate	$5,929.51
Max. Negotiated Rate	$5,929.51
Rate for Payer: Cash Price	$2,103.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,929.51
Rate for Payer: SOMOS Essential	$5,929.51

PR RPR CAR ANOMAL XCP PULM ATRESIA VENTR SEPTL DFCT

Professional

Both

$8,012.20

Service Code	HCPCS 33608
Min. Negotiated Rate	$6,009.15
Max. Negotiated Rate	$6,009.15
Rate for Payer: Cash Price	$2,132.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,009.15
Rate for Payer: SOMOS Essential	$6,009.15

PR RPR CLOACAL ANOMALY CMBN ABDL&SACROPRNL

Professional

Both

$17,605.42

Service Code	HCPCS 46746
Min. Negotiated Rate	$13,204.06
Max. Negotiated Rate	$13,204.06
Rate for Payer: Cash Price	$4,683.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$13,204.06
Rate for Payer: SOMOS Essential	$13,204.06

PR RPR CLOACAL ANOMALY CMBN ABDL & SACROPRNL W/GRF

Professional

Both

$19,079.80

Service Code	HCPCS 46748
Min. Negotiated Rate	$14,309.85
Max. Negotiated Rate	$14,309.85
Rate for Payer: Cash Price	$5,074.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$14,309.85
Rate for Payer: SOMOS Essential	$14,309.85

PR RPR CLOACAL ANOMALY SACROPERINEAL

Professional

Both

$15,981.49

Service Code	HCPCS 46744
Min. Negotiated Rate	$11,986.12
Max. Negotiated Rate	$11,986.12
Rate for Payer: Cash Price	$4,253.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$11,986.12
Rate for Payer: SOMOS Essential	$11,986.12

PR RPR COLTRL LIGM MTCARPHLNGL/IPHAL JT

Professional

Both

$3,099.78

Service Code	HCPCS 26540
Min. Negotiated Rate	$2,324.84
Max. Negotiated Rate	$2,324.84
Rate for Payer: Cash Price	$836.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,324.84
Rate for Payer: SOMOS Essential	$2,324.84

PR RPR COMPL AV CANAL W/WO PROSTC VALVE

Professional

Both

$8,765.09

Service Code	HCPCS 33670
Min. Negotiated Rate	$6,573.82
Max. Negotiated Rate	$6,573.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,573.82
Rate for Payer: SOMOS Essential	$6,573.82

PR RPR COMPLEX CARDIAC ANOMALY MODIFIED FONTAN PX

Professional

Both

$9,628.36

Service Code	HCPCS 33617
Min. Negotiated Rate	$7,221.27
Max. Negotiated Rate	$7,221.27
Rate for Payer: Cash Price	$2,559.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,221.27
Rate for Payer: SOMOS Essential	$7,221.27

PR RPR COMPLEX RETINA DETACH VITRECT &MEMBRANE PEEL

Professional

Both

$5,446.91

Service Code	HCPCS 67113
Min. Negotiated Rate	$4,085.18
Max. Negotiated Rate	$4,085.18
Rate for Payer: Cash Price	$1,496.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,085.18
Rate for Payer: SOMOS Essential	$4,085.18

PR RPR COMPONENT INFLATABLE PENILE PROSTHESIS

Professional

Both

$3,313.49

Service Code	HCPCS 54408
Min. Negotiated Rate	$2,485.12
Max. Negotiated Rate	$2,485.12
Rate for Payer: Cash Price	$907.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,485.12
Rate for Payer: SOMOS Essential	$2,485.12

Know your out-of-pocket cost for care.

All Charges