St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR RPR PATENT DUXUS ARTERIOSUS DIV UNDER 18 YR

Professional

Both

$4,543.81

Service Code	HCPCS 33822
Min. Negotiated Rate	$3,407.86
Max. Negotiated Rate	$3,407.86
Rate for Payer: Cash Price	$1,210.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,407.86
Rate for Payer: SOMOS Essential	$3,407.86

PR RPR POSTINFRCJ VENTRICULAR SEPTAL DEFECT

Professional

Both

$13,494.50

Service Code	HCPCS 33545
Min. Negotiated Rate	$10,120.88
Max. Negotiated Rate	$10,120.88
Rate for Payer: Cash Price	$3,579.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10,120.88
Rate for Payer: SOMOS Essential	$10,120.88

PR RPR PRIMARY DISRUPTED LIGAMENT ANKLE COLLATERAL

Professional

Both

$2,102.94

Service Code	HCPCS 27695
Min. Negotiated Rate	$1,577.20
Max. Negotiated Rate	$1,577.20
Rate for Payer: Cash Price	$576.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,577.20
Rate for Payer: SOMOS Essential	$1,577.20

PR RPR PRIMARY OPEN/PRQ RUPTURED ACHILLES W/GRAFT

Professional

Both

$2,822.68

Service Code	HCPCS 27652
Min. Negotiated Rate	$2,117.01
Max. Negotiated Rate	$2,117.01
Rate for Payer: Cash Price	$783.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,117.01
Rate for Payer: SOMOS Essential	$2,117.01

PR RPR PRIMARY TORN LIGM&/CAPSULE KNEE COLLATERAL

Professional

Both

$2,995.65

Service Code	HCPCS 27405
Min. Negotiated Rate	$2,246.74
Max. Negotiated Rate	$2,246.74
Rate for Payer: Cash Price	$812.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,246.74
Rate for Payer: SOMOS Essential	$2,246.74

PR RPR PRIM DISRUPTED LIGM ANKLE BTH COLTRL LIGMS

Professional

Both

$2,348.78

Service Code	HCPCS 27696
Min. Negotiated Rate	$1,761.58
Max. Negotiated Rate	$1,761.58
Rate for Payer: Cash Price	$640.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,761.58
Rate for Payer: SOMOS Essential	$1,761.58

PR RPR PULMONARY ART STENOSIS RCNSTJ W/PATCH/GRAFT

Professional

Both

$6,495.41

Service Code	HCPCS 33917
Min. Negotiated Rate	$4,871.56
Max. Negotiated Rate	$4,871.56
Rate for Payer: Cash Price	$1,730.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,871.56
Rate for Payer: SOMOS Essential	$4,871.56

PR RPR PULMONARY ATRESIA W/CONSTJ/RPLCMT CONDUIT

Professional

Both

$8,057.77

Service Code	HCPCS 33920
Min. Negotiated Rate	$6,043.33
Max. Negotiated Rate	$6,043.33
Rate for Payer: Cash Price	$2,138.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,043.33
Rate for Payer: SOMOS Essential	$6,043.33

PR RPR & RCNSTJ FINGER VOLAR PLATE INTERPHALANGEAL

Professional

Both

$3,546.76

Service Code	HCPCS 26548
Min. Negotiated Rate	$2,660.07
Max. Negotiated Rate	$2,660.07
Rate for Payer: Cash Price	$955.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,660.07
Rate for Payer: SOMOS Essential	$2,660.07

PR RPR RECRT FEM HERNIA REDUCIBLE

Professional

Both

$2,744.70

Service Code	HCPCS 49555
Min. Negotiated Rate	$2,058.52
Max. Negotiated Rate	$2,058.52
Rate for Payer: Cash Price	$732.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,058.52
Rate for Payer: SOMOS Essential	$2,058.52

PR RPR RECRT FEM HRNA INCARCERATED

Professional

Both

$3,278.56

Service Code	HCPCS 49557
Min. Negotiated Rate	$2,458.92
Max. Negotiated Rate	$2,458.92
Rate for Payer: Cash Price	$872.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,458.92
Rate for Payer: SOMOS Essential	$2,458.92

PR RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE

Professional

Both

$2,865.91

Service Code	HCPCS 49520
Min. Negotiated Rate	$2,149.43
Max. Negotiated Rate	$2,149.43
Rate for Payer: Cash Price	$766.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,149.43
Rate for Payer: SOMOS Essential	$2,149.43

PR RPR RECRT INGUN HERNIA ANY AGE INCARCERATED

Professional

Both

$3,244.47

Service Code	HCPCS 49521
Min. Negotiated Rate	$2,433.35
Max. Negotiated Rate	$2,433.35
Rate for Payer: Cash Price	$865.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,433.35
Rate for Payer: SOMOS Essential	$2,433.35

PR RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX

Professional

Both

$1,174.92

Service Code	HCPCS 67101
Min. Negotiated Rate	$881.19
Max. Negotiated Rate	$881.19
Rate for Payer: Cash Price	$323.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$881.19
Rate for Payer: SOMOS Essential	$881.19

PR RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID PC

Professional

Both

$1,133.97

Service Code	HCPCS 67105
Min. Negotiated Rate	$850.48
Max. Negotiated Rate	$850.48
Rate for Payer: Cash Price	$312.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$850.48
Rate for Payer: SOMOS Essential	$850.48

PR RPR RETINAL DTCHMNT INJECTION AIR/OTHER GAS

Professional

Both

$3,351.43

Service Code	HCPCS 67110
Min. Negotiated Rate	$2,513.57
Max. Negotiated Rate	$2,513.57
Rate for Payer: Cash Price	$923.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,513.57
Rate for Payer: SOMOS Essential	$2,513.57

PR RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH

Professional

Both

$4,865.74

Service Code	HCPCS 67108
Min. Negotiated Rate	$3,649.30
Max. Negotiated Rate	$3,649.30
Rate for Payer: Cash Price	$1,337.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,649.30
Rate for Payer: SOMOS Essential	$3,649.30

PR RPR RPTD SPLEEN SPLENORRHAPHY W/WO PRTL SPLENECT

Professional

Both

$5,846.72

Service Code	HCPCS 38115
Min. Negotiated Rate	$4,385.04
Max. Negotiated Rate	$4,385.04
Rate for Payer: Cash Price	$1,554.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,385.04
Rate for Payer: SOMOS Essential	$4,385.04

PR RPR SINUS VALSALVA ANEURYSM

Professional

Both

$6,892.52

Service Code	HCPCS 33720
Min. Negotiated Rate	$5,169.39
Max. Negotiated Rate	$5,169.39
Rate for Payer: Cash Price	$1,834.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,169.39
Rate for Payer: SOMOS Essential	$5,169.39

PR RPR SINUS VALSALVA FISTULA

Professional

Both

$6,890.00

Service Code	HCPCS 33702
Min. Negotiated Rate	$5,167.50
Max. Negotiated Rate	$5,167.50
Rate for Payer: Cash Price	$1,833.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,167.50
Rate for Payer: SOMOS Essential	$5,167.50

PR RPR SINUS VALSALVA FISTULA W/RPR V-SEPTAL DEFECT

Professional

Both

$9,125.31

Service Code	HCPCS 33710
Min. Negotiated Rate	$6,843.98
Max. Negotiated Rate	$6,843.98
Rate for Payer: Cash Price	$2,420.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,843.98
Rate for Payer: SOMOS Essential	$6,843.98

PR RPR SMALL OMPHALOCELE W/PRIMARY CLOSURE

Professional

Both

$3,331.30

Service Code	HCPCS 49600
Min. Negotiated Rate	$2,498.48
Max. Negotiated Rate	$2,498.48
Rate for Payer: Cash Price	$889.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,498.48
Rate for Payer: SOMOS Essential	$2,498.48

PR RPR SYMBLEPHARON CONJUNCTIVOPLASTY W/O GRAFT

Professional

Both

$1,893.71

Service Code	HCPCS 68330
Min. Negotiated Rate	$1,420.28
Max. Negotiated Rate	$1,420.28
Rate for Payer: Cash Price	$522.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,420.28
Rate for Payer: SOMOS Essential	$1,420.28

PR RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB

Professional

Both

$2,654.82

Service Code	HCPCS 68335
Min. Negotiated Rate	$1,991.12
Max. Negotiated Rate	$1,991.12
Rate for Payer: Cash Price	$732.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,991.12
Rate for Payer: SOMOS Essential	$1,991.12

PR RPR TABDL LMPHADEC EXTNSV W/PEL AORTIC&RNL

Professional

Both

$4,527.04

Service Code	HCPCS 38780
Min. Negotiated Rate	$3,395.28
Max. Negotiated Rate	$3,395.28
Rate for Payer: Cash Price	$1,239.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,395.28
Rate for Payer: SOMOS Essential	$3,395.28

Know your out-of-pocket cost for care.

All Charges