St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR RPR TDN FLXR FOOT 1/2 W/O FREE GRAFG EACH TENDON

Professional

Both

$1,386.88

Service Code	HCPCS 28200
Min. Negotiated Rate	$1,040.16
Max. Negotiated Rate	$1,040.16
Rate for Payer: Cash Price	$381.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,040.16
Rate for Payer: SOMOS Essential	$1,040.16

PR RPR TDN/MUSC FLXR F/ARM&/WRIST SEC 1 EA TDN/MUS

Professional

Both

$2,820.34

Service Code	HCPCS 25263
Min. Negotiated Rate	$2,115.26
Max. Negotiated Rate	$2,115.26
Rate for Payer: Cash Price	$765.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,115.26
Rate for Payer: SOMOS Essential	$2,115.26

PR RPR TDN/MUSC FLXR F/ARM&/WRISTSEC FR GRF EA

Professional

Both

$3,310.48

Service Code	HCPCS 25265
Min. Negotiated Rate	$2,482.86
Max. Negotiated Rate	$2,482.86
Rate for Payer: Cash Price	$906.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,482.86
Rate for Payer: SOMOS Essential	$2,482.86

PR RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MU

Professional

Both

$2,815.68

Service Code	HCPCS 25260
Min. Negotiated Rate	$2,111.76
Max. Negotiated Rate	$2,111.76
Rate for Payer: Cash Price	$762.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,111.76
Rate for Payer: SOMOS Essential	$2,111.76

PR RPR TDN/MUSC XTNSR F/ARM&/WRIST PRIM 1 EA TDN

Professional

Both

$2,190.13

Service Code	HCPCS 25270
Min. Negotiated Rate	$1,642.60
Max. Negotiated Rate	$1,642.60
Rate for Payer: Cash Price	$596.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,642.60
Rate for Payer: SOMOS Essential	$1,642.60

PR RPR TDN/MUSC XTNSR F/ARM&/WRIST SEC 1 EA TDN/MU

Professional

Both

$2,494.35

Service Code	HCPCS 25272
Min. Negotiated Rate	$1,870.76
Max. Negotiated Rate	$1,870.76
Rate for Payer: Cash Price	$676.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,870.76
Rate for Payer: SOMOS Essential	$1,870.76

PR RPR TDN/MUSC XTNSR F/ARM&/WRST SEC FR GRF EA TDN

Professional

Both

$2,934.61

Service Code	HCPCS 25274
Min. Negotiated Rate	$2,200.96
Max. Negotiated Rate	$2,200.96
Rate for Payer: Cash Price	$795.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,200.96
Rate for Payer: SOMOS Essential	$2,200.96

PR RPR TENDON FLXR FOOT SEC W/FREE GRAFT EA TENDON

Professional

Both

$1,796.34

Service Code	HCPCS 28202
Min. Negotiated Rate	$1,347.26
Max. Negotiated Rate	$1,347.26
Rate for Payer: Cash Price	$493.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,347.26
Rate for Payer: SOMOS Essential	$1,347.26

PR RPR TENDON SHEATH EXTENSOR F/ARM&/WRIST W/GRAFT

Professional

Both

$2,972.10

Service Code	HCPCS 25275
Min. Negotiated Rate	$2,229.08
Max. Negotiated Rate	$2,229.08
Rate for Payer: Cash Price	$806.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,229.08
Rate for Payer: SOMOS Essential	$2,229.08

PR RPR TENDON XTNSR FOOT SEC W/FREE GRAFT EA TENDON

Professional

Both

$1,803.83

Service Code	HCPCS 28210
Min. Negotiated Rate	$1,352.87
Max. Negotiated Rate	$1,352.87
Rate for Payer: Cash Price	$493.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,352.87
Rate for Payer: SOMOS Essential	$1,352.87

PR RPR TGV AORTIC P-ART RCNSTJ RPR SBPULMC OBSTRCJ

Professional

Both

$10,277.30

Service Code	HCPCS 33781
Min. Negotiated Rate	$7,707.98
Max. Negotiated Rate	$7,707.98
Rate for Payer: Cash Price	$2,723.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,707.98
Rate for Payer: SOMOS Essential	$7,707.98

PR RPR TGV AORTIC P-ART RCNSTJ W/CLSR V-SEPTL DFCT

Professional

Both

$10,525.34

Service Code	HCPCS 33780
Min. Negotiated Rate	$7,894.00
Max. Negotiated Rate	$7,894.00
Rate for Payer: Cash Price	$2,791.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,894.00
Rate for Payer: SOMOS Essential	$7,894.00

PR RPR TGV AORTIC PULM ART RCNSTJ W/RMVL PULM BAND

Professional

Both

$10,331.55

Service Code	HCPCS 33779
Min. Negotiated Rate	$7,748.66
Max. Negotiated Rate	$7,748.66
Rate for Payer: Cash Price	$2,739.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,748.66
Rate for Payer: SOMOS Essential	$7,748.66

PR RPR THORACOABDOMINAL AORTIC ANEURYS W/WO BYPASS

Professional

Both

$15,990.94

Service Code	HCPCS 33877
Min. Negotiated Rate	$11,993.20
Max. Negotiated Rate	$11,993.20
Rate for Payer: Cash Price	$4,236.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$11,993.20
Rate for Payer: SOMOS Essential	$11,993.20

PR RPR/TRAUMATIC AV FISTULA EXTREMITIES

Professional

Both

$3,395.21

Service Code	HCPCS 35190
Min. Negotiated Rate	$2,546.41
Max. Negotiated Rate	$2,546.41
Rate for Payer: Cash Price	$894.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,546.41
Rate for Payer: SOMOS Essential	$2,546.41

PR RPR/TRAUMATIC AV FISTULA HEAD & NECK

Professional

Both

$6,181.28

Service Code	HCPCS 35188
Min. Negotiated Rate	$4,635.96
Max. Negotiated Rate	$4,635.96
Rate for Payer: Cash Price	$1,632.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,635.96
Rate for Payer: SOMOS Essential	$4,635.96

PR RPR/TRAUMATIC AV FISTULA THORAX & ABDOMEN

Professional

Both

$6,713.14

Service Code	HCPCS 35189
Min. Negotiated Rate	$5,034.86
Max. Negotiated Rate	$5,034.86
Rate for Payer: Cash Price	$1,779.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,034.86
Rate for Payer: SOMOS Essential	$5,034.86

PR RPR TRPOS GREAT VSLS ATR BAFFLE W/RMVL PULM BAND

Professional

Both

$8,256.43

Service Code	HCPCS 33775
Min. Negotiated Rate	$6,192.32
Max. Negotiated Rate	$6,192.32
Rate for Payer: Cash Price	$2,194.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,192.32
Rate for Payer: SOMOS Essential	$6,192.32

PR RPR TRPOS GREAT VSLS ATRIAL BAFFLE PX W/BYPASS

Professional

Both

$8,015.25

Service Code	HCPCS 33774
Min. Negotiated Rate	$6,011.44
Max. Negotiated Rate	$6,011.44
Rate for Payer: Cash Price	$2,132.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,011.44
Rate for Payer: SOMOS Essential	$6,011.44

PR RPR TRPOS GREAT VSLS W/ENLGMNT V-SEPTL DFCT

Professional

Both

$9,682.30

Service Code	HCPCS 33771
Min. Negotiated Rate	$7,261.72
Max. Negotiated Rate	$7,261.72
Rate for Payer: Cash Price	$2,566.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,261.72
Rate for Payer: SOMOS Essential	$7,261.72

PR RPR TRPOS GREAT VSLS W/O ENLGMNT V-SEPTL DFCT

Professional

Both

$9,408.95

Service Code	HCPCS 33770
Min. Negotiated Rate	$7,056.71
Max. Negotiated Rate	$7,056.71
Rate for Payer: Cash Price	$2,496.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,056.71
Rate for Payer: SOMOS Essential	$7,056.71

PR RPR TRPOS GRT VESSEL AORTIC PULMONARY ART RCNSTJ

Professional

Both

$10,454.22

Service Code	HCPCS 33778
Min. Negotiated Rate	$7,840.66
Max. Negotiated Rate	$7,840.66
Rate for Payer: Cash Price	$2,778.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,840.66
Rate for Payer: SOMOS Essential	$7,840.66

PR RPR TRPOS GRT VSL ATR BAFFLE W/BYP SBPULM OBSTRC

Professional

Both

$8,415.02

Service Code	HCPCS 33777
Min. Negotiated Rate	$6,311.26
Max. Negotiated Rate	$6,311.26
Rate for Payer: Cash Price	$2,235.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,311.26
Rate for Payer: SOMOS Essential	$6,311.26

PR RPR TRPOS GRT VSL ATR BAFFLE W/CLSR V-SEPTL DFCT

Professional

Both

$8,722.74

Service Code	HCPCS 33776
Min. Negotiated Rate	$6,542.06
Max. Negotiated Rate	$6,542.06
Rate for Payer: Cash Price	$2,322.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,542.06
Rate for Payer: SOMOS Essential	$6,542.06

PR RPR TUNICA VAGINALIS HYDROCELE BOTTLE TYPE

Professional

Both

$1,605.10

Service Code	HCPCS 55060
Min. Negotiated Rate	$1,203.82
Max. Negotiated Rate	$1,203.82
Rate for Payer: Cash Price	$440.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,203.82
Rate for Payer: SOMOS Essential	$1,203.82

Know your out-of-pocket cost for care.

All Charges