St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR RPR CONGENITAL AV FISTULA EXTREMITIES

Professional

Both

$4,293.42

Service Code	HCPCS 35184
Min. Negotiated Rate	$3,220.06
Max. Negotiated Rate	$3,220.06
Rate for Payer: Cash Price	$1,137.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,220.06
Rate for Payer: SOMOS Essential	$3,220.06

PR RPR CONGENITAL AV FISTULA THORAX & ABDOMEN

Professional

Both

$7,972.76

Service Code	HCPCS 35182
Min. Negotiated Rate	$5,979.57
Max. Negotiated Rate	$5,979.57
Rate for Payer: Cash Price	$2,121.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,979.57
Rate for Payer: SOMOS Essential	$5,979.57

PR RPR CORONARY AV/ARTERIOCAR CHMBR FSTL W/BYPASS

Professional

Both

$6,879.08

Service Code	HCPCS 33500
Min. Negotiated Rate	$5,159.31
Max. Negotiated Rate	$5,159.31
Rate for Payer: Cash Price	$1,827.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,159.31
Rate for Payer: SOMOS Essential	$5,159.31

PR RPR CORONARY AV/ARTERIOCAR CHMBR FSTL W/O BYPASS

Professional

Both

$4,912.92

Service Code	HCPCS 33501
Min. Negotiated Rate	$3,684.69
Max. Negotiated Rate	$3,684.69
Rate for Payer: Cash Price	$1,308.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,684.69
Rate for Payer: SOMOS Essential	$3,684.69

PR RPR COR TRIATM/SUPVALVR RING RESCJ L ATRIAL MEMB

Professional

Both

$7,339.78

Service Code	HCPCS 33732
Min. Negotiated Rate	$5,504.84
Max. Negotiated Rate	$5,504.84
Rate for Payer: Cash Price	$1,954.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,504.84
Rate for Payer: SOMOS Essential	$5,504.84

PR RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT

Professional

Both

$795.24

Service Code	HCPCS 36576
Min. Negotiated Rate	$596.43
Max. Negotiated Rate	$596.43
Rate for Payer: Cash Price	$213.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$596.43
Rate for Payer: SOMOS Essential	$596.43

PR RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC AQT

Professional

Both

$3,881.05

Service Code	HCPCS 39540
Min. Negotiated Rate	$2,910.79
Max. Negotiated Rate	$2,910.79
Rate for Payer: Cash Price	$1,037.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,910.79
Rate for Payer: SOMOS Essential	$2,910.79

PR RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC CHRNC

Professional

Both

$4,188.70

Service Code	HCPCS 39541
Min. Negotiated Rate	$3,141.52
Max. Negotiated Rate	$3,141.52
Rate for Payer: Cash Price	$1,115.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,141.52
Rate for Payer: SOMOS Essential	$3,141.52

PR RPR DISLOC PERONEAL TENDON W/O FIBULAR OSTEOTOMY

Professional

Both

$2,144.10

Service Code	HCPCS 27675
Min. Negotiated Rate	$1,608.08
Max. Negotiated Rate	$1,608.08
Rate for Payer: Cash Price	$583.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,608.08
Rate for Payer: SOMOS Essential	$1,608.08

PR RPR & DIV SYMBLEPHARON W/WO CONFORM/CONTACT LE

Professional

Both

$1,648.64

Service Code	HCPCS 68340
Min. Negotiated Rate	$1,236.48
Max. Negotiated Rate	$1,236.48
Rate for Payer: Cash Price	$453.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,236.48
Rate for Payer: SOMOS Essential	$1,236.48

PR RPR DURAL/CEREBROSPINAL FLUID LEAK X REQ LAM

Professional

Both

$4,397.79

Service Code	HCPCS 63707
Min. Negotiated Rate	$3,298.34
Max. Negotiated Rate	$3,298.34
Rate for Payer: Cash Price	$1,167.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,298.34
Rate for Payer: SOMOS Essential	$3,298.34

PR RPR DURAL/CSF LEAK/PSEUDOMENINGOCELE W/LAM

Professional

Both

$5,191.52

Service Code	HCPCS 63709
Min. Negotiated Rate	$3,893.64
Max. Negotiated Rate	$3,893.64
Rate for Payer: Cash Price	$1,381.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,893.64
Rate for Payer: SOMOS Essential	$3,893.64

PR RPR ENCEPHALOCELE SKULL VAULT W/CRANIOPLASTY

Professional

Both

$9,874.80

Service Code	HCPCS 62120
Min. Negotiated Rate	$7,406.10
Max. Negotiated Rate	$7,406.10
Rate for Payer: Cash Price	$2,613.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,406.10
Rate for Payer: SOMOS Essential	$7,406.10

PR RPR EXTENSOR TENDON LEG PRIMARY W/O GRAFT EACH

Professional

Both

$1,583.96

Service Code	HCPCS 27664
Min. Negotiated Rate	$1,187.97
Max. Negotiated Rate	$1,187.97
Rate for Payer: Cash Price	$430.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,187.97
Rate for Payer: SOMOS Essential	$1,187.97

PR RPR EXTENSOR TENDON LEG SECONDRY W/WO GRAFT EACH

Professional

Both

$1,829.94

Service Code	HCPCS 27665
Min. Negotiated Rate	$1,372.46
Max. Negotiated Rate	$1,372.46
Rate for Payer: Cash Price	$504.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,372.46
Rate for Payer: SOMOS Essential	$1,372.46

PR RPR FLEXOR TENDON LEG SECONDARY W/O GRAFT EACH

Professional

Both

$2,016.42

Service Code	HCPCS 27659
Min. Negotiated Rate	$1,512.32
Max. Negotiated Rate	$1,512.32
Rate for Payer: Cash Price	$554.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,512.32
Rate for Payer: SOMOS Essential	$1,512.32

PR RPR GRF-ENTERIC FSTL

Professional

Both

$5,557.51

Service Code	HCPCS 35870
Min. Negotiated Rate	$4,168.13
Max. Negotiated Rate	$4,168.13
Rate for Payer: Cash Price	$1,471.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,168.13
Rate for Payer: SOMOS Essential	$4,168.13

PR RPR HI IMPRF ANUS W/FSTL PRNL/SACROPRNL APPR

Professional

Both

$9,795.84

Service Code	HCPCS 46740
Min. Negotiated Rate	$7,346.88
Max. Negotiated Rate	$7,346.88
Rate for Payer: Cash Price	$2,615.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,346.88
Rate for Payer: SOMOS Essential	$7,346.88

PR RPR HI IMPRF ANUS W/FSTL TABDL & SACROPRNL

Professional

Both

$11,320.47

Service Code	HCPCS 46742
Min. Negotiated Rate	$8,490.35
Max. Negotiated Rate	$8,490.35
Rate for Payer: Cash Price	$3,020.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,490.35
Rate for Payer: SOMOS Essential	$8,490.35

PR RPR HI IMPRF ANUS W/O FISTULA CMBN APPR

Professional

Both

$10,333.12

Service Code	HCPCS 46735
Min. Negotiated Rate	$7,749.84
Max. Negotiated Rate	$7,749.84
Rate for Payer: Cash Price	$2,757.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,749.84
Rate for Payer: SOMOS Essential	$7,749.84

PR RPR HI IMPRF ANUS W/O FSTL PRNL/SACROPRNL APPR

Professional

Both

$8,978.83

Service Code	HCPCS 46730
Min. Negotiated Rate	$6,734.12
Max. Negotiated Rate	$6,734.12
Rate for Payer: Cash Price	$2,397.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,734.12
Rate for Payer: SOMOS Essential	$6,734.12

PR RPR HYPOPLSTC A-ARCH W/AGRFT/PROSTC W/BYPASS

Professional

Both

$8,158.01

Service Code	HCPCS 33853
Min. Negotiated Rate	$6,118.51
Max. Negotiated Rate	$6,118.51
Rate for Payer: Cash Price	$2,171.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,118.51
Rate for Payer: SOMOS Essential	$6,118.51

PR RPR HYPOPLSTC A-ARCH W/AGRFT/PROSTC W/O BYPASS

Professional

Both

$6,235.92

Service Code	HCPCS 33852
Min. Negotiated Rate	$4,676.94
Max. Negotiated Rate	$4,676.94
Rate for Payer: Cash Price	$1,660.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,676.94
Rate for Payer: SOMOS Essential	$4,676.94

PR RPR HYPOSPADIAS COMPLCTJS CLSR INC/EXC SIMPLE

Professional

Both

$2,390.43

Service Code	HCPCS 54340
Min. Negotiated Rate	$1,792.82
Max. Negotiated Rate	$1,792.82
Rate for Payer: Cash Price	$656.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,792.82
Rate for Payer: SOMOS Essential	$1,792.82

PR RPR HYPOSPADIAS COMPLCTJS DSJ & URTP FLAP/GRF

Professional

Both

$4,215.23

Service Code	HCPCS 54348
Min. Negotiated Rate	$3,161.42
Max. Negotiated Rate	$3,161.42
Rate for Payer: Cash Price	$1,153.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,161.42
Rate for Payer: SOMOS Essential	$3,161.42

Know your out-of-pocket cost for care.

All Charges