St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR RPR HYPOSPADIAS COMPLCTJS MOBLJ FLAPS & URTP

Professional

Both

$3,944.36

Service Code	HCPCS 54344
Min. Negotiated Rate	$2,958.27
Max. Negotiated Rate	$2,958.27
Rate for Payer: Cash Price	$1,079.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,958.27
Rate for Payer: SOMOS Essential	$2,958.27

PR RPR ILEOANAL POUCH FSTL/POUCH ADVMNT CMBN APPR

Professional

Both

$10,021.66

Service Code	HCPCS 46712
Min. Negotiated Rate	$7,516.24
Max. Negotiated Rate	$7,516.24
Rate for Payer: Cash Price	$2,663.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,516.24
Rate for Payer: SOMOS Essential	$7,516.24

PR RPR ILEOANAL POUCH FSTL/POUCH ADVMNT TPRNL APPR

Professional

Both

$5,023.73

Service Code	HCPCS 46710
Min. Negotiated Rate	$3,767.80
Max. Negotiated Rate	$3,767.80
Rate for Payer: Cash Price	$1,338.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,767.80
Rate for Payer: SOMOS Essential	$3,767.80

PR RPR INCPLT/PRTL AV CANAL W/WO AV VALVE RPR

Professional

Both

$7,806.26

Service Code	HCPCS 33660
Min. Negotiated Rate	$5,854.70
Max. Negotiated Rate	$5,854.70
Rate for Payer: Cash Price	$2,074.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,854.70
Rate for Payer: SOMOS Essential	$5,854.70

PR RPR INGUN HERNIA SLIDING ANY AGE

Professional

Both

$2,597.42

Service Code	HCPCS 49525
Min. Negotiated Rate	$1,948.06
Max. Negotiated Rate	$1,948.06
Rate for Payer: Cash Price	$694.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,948.06
Rate for Payer: SOMOS Essential	$1,948.06

PR RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM

Professional

Both

$1,424.89

Service Code	HCPCS 12046
Min. Negotiated Rate	$1,068.67
Max. Negotiated Rate	$1,068.67
Rate for Payer: Cash Price	$383.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,068.67
Rate for Payer: SOMOS Essential	$1,068.67

PR RPR INTRM/TRANSJ AV CANAL W/WO AV VALVE RPR

Professional

Both

$8,505.00

Service Code	HCPCS 33665
Min. Negotiated Rate	$6,378.75
Max. Negotiated Rate	$6,378.75
Rate for Payer: Cash Price	$2,259.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,378.75
Rate for Payer: SOMOS Essential	$6,378.75

PR RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG

Professional

Both

$674.49

Service Code	HCPCS 41250
Min. Negotiated Rate	$505.87
Max. Negotiated Rate	$505.87
Rate for Payer: Cash Price	$182.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$505.87
Rate for Payer: SOMOS Essential	$505.87

PR RPR LAC 2.5 CM/< PST ONE-THIRD TONGUE

Professional

Both

$812.77

Service Code	HCPCS 41251
Min. Negotiated Rate	$609.58
Max. Negotiated Rate	$609.58
Rate for Payer: Cash Price	$218.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$609.58
Rate for Payer: SOMOS Essential	$609.58

PR RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA

Professional

Both

$2,039.42

Service Code	HCPCS 65286
Min. Negotiated Rate	$1,529.56
Max. Negotiated Rate	$1,529.56
Rate for Payer: Cash Price	$560.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,529.56
Rate for Payer: SOMOS Essential	$1,529.56

PR RPR LAC CJNC MOBLJ & REARGMT W/HOSPIZATION

Professional

Both

$1,563.59

Service Code	HCPCS 65273
Min. Negotiated Rate	$1,172.69
Max. Negotiated Rate	$1,172.69
Rate for Payer: Cash Price	$429.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,172.69
Rate for Payer: SOMOS Essential	$1,172.69

PR RPR LAC CJNC MOBLJ& REARGMT W/O HOSPITALIZATION

Professional

Both

$1,453.52

Service Code	HCPCS 65272
Min. Negotiated Rate	$1,090.14
Max. Negotiated Rate	$1,090.14
Rate for Payer: Cash Price	$400.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,090.14
Rate for Payer: SOMOS Essential	$1,090.14

PR RPR LAC CJNC W/WO NONPERFOR LAC SCLERA DIR CLSR

Professional

Both

$585.45

Service Code	HCPCS 65270
Min. Negotiated Rate	$439.09
Max. Negotiated Rate	$439.09
Rate for Payer: Cash Price	$158.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$439.09
Rate for Payer: SOMOS Essential	$439.09

PR RPR LAC CORNEA NONPERFOR W/WO RMVL FOREIGN BODY

Professional

Both

$1,896.51

Service Code	HCPCS 65275
Min. Negotiated Rate	$1,422.38
Max. Negotiated Rate	$1,422.38
Rate for Payer: Cash Price	$520.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,422.38
Rate for Payer: SOMOS Essential	$1,422.38

PR RPR LAC CORNEA&/SCLERA PERFOR X INVG UVEAL TIS

Professional

Both

$2,760.03

Service Code	HCPCS 65280
Min. Negotiated Rate	$2,070.02
Max. Negotiated Rate	$2,070.02
Rate for Payer: Cash Price	$758.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,070.02
Rate for Payer: SOMOS Essential	$2,070.02

PR RPR LAC CORN&/SCLRA PERF W/REPOS/RESCJ UVEAL T

Professional

Both

$4,540.76

Service Code	HCPCS 65285
Min. Negotiated Rate	$3,405.57
Max. Negotiated Rate	$3,405.57
Rate for Payer: Cash Price	$1,248.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,405.57
Rate for Payer: SOMOS Essential	$3,405.57

PR RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX

Professional

Both

$910.49

Service Code	HCPCS 41252
Min. Negotiated Rate	$682.87
Max. Negotiated Rate	$682.87
Rate for Payer: Cash Price	$245.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$682.87
Rate for Payer: SOMOS Essential	$682.87

PR RPR LG OMPHALOCELE/GASTROSCHISIS RMVL PROSTH

Professional

Both

$5,146.96

Service Code	HCPCS 49606
Min. Negotiated Rate	$3,860.22
Max. Negotiated Rate	$3,860.22
Rate for Payer: Cash Price	$1,369.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,860.22
Rate for Payer: SOMOS Essential	$3,860.22

PR RPR LG OMPHALOCELE/GASTROSCHISIS W/WO PROSTH

Professional

Both

$22,242.40

Service Code	HCPCS 49605
Min. Negotiated Rate	$16,681.80
Max. Negotiated Rate	$16,681.80
Rate for Payer: Cash Price	$5,900.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,681.80
Rate for Payer: SOMOS Essential	$16,681.80

PR RPR LIP FTH OVER ONE-HALF VERT HEIGHT/COMPLEX

Professional

Both

$1,842.23

Service Code	HCPCS 40654
Min. Negotiated Rate	$1,381.67
Max. Negotiated Rate	$1,381.67
Rate for Payer: Cash Price	$503.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,381.67
Rate for Payer: SOMOS Essential	$1,381.67

PR RPR LW IMPERFORATE ANUS W/ANOPRNL FSTL CUT-BK

Professional

Both

$2,510.41

Service Code	HCPCS 46715
Min. Negotiated Rate	$1,882.81
Max. Negotiated Rate	$1,882.81
Rate for Payer: Cash Price	$671.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,882.81
Rate for Payer: SOMOS Essential	$1,882.81

PR RPR LW IMPERFORATE ANUS W/TRPOS FISTULA

Professional

Both

$5,562.90

Service Code	HCPCS 46716
Min. Negotiated Rate	$4,172.18
Max. Negotiated Rate	$4,172.18
Rate for Payer: Cash Price	$1,491.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,172.18
Rate for Payer: SOMOS Essential	$4,172.18

PR RPR NEONATAL DIPHRG HERNIA W/WO CHEST TUBE INSJ

Professional

Both

$25,911.10

Service Code	HCPCS 39503
Min. Negotiated Rate	$19,433.32
Max. Negotiated Rate	$19,433.32
Rate for Payer: Cash Price	$6,865.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,433.32
Rate for Payer: SOMOS Essential	$19,433.32

PR RPR NFLTBL URETHRAL/BLADDER NECK SPHINCTER

Professional

Both

$2,581.36

Service Code	HCPCS 53449
Min. Negotiated Rate	$1,936.02
Max. Negotiated Rate	$1,936.02
Rate for Payer: Cash Price	$704.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,936.02
Rate for Payer: SOMOS Essential	$1,936.02

PR RPR NON/MAL FEMUR DSTL H/N W/ILIAC/AUTOG BONE

Professional

Both

$5,584.46

Service Code	HCPCS 27472
Min. Negotiated Rate	$4,188.34
Max. Negotiated Rate	$4,188.34
Rate for Payer: Cash Price	$1,505.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,188.34
Rate for Payer: SOMOS Essential	$4,188.34

Know your out-of-pocket cost for care.

All Charges