St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR SEQUESTRECTOMY HUMERAL HEAD SURGERY NECK

Professional

Both

$3,391.26

Service Code	HCPCS 23174
Min. Negotiated Rate	$2,543.44
Max. Negotiated Rate	$2,543.44
Rate for Payer: Cash Price	$919.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,543.44
Rate for Payer: SOMOS Essential	$2,543.44

PR SEQUESTRECTOMY OLECRANON PROCESS

Professional

Both

$3,056.24

Service Code	HCPCS 24138
Min. Negotiated Rate	$2,292.18
Max. Negotiated Rate	$2,292.18
Rate for Payer: Cash Price	$828.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,292.18
Rate for Payer: SOMOS Essential	$2,292.18

PR SEQUESTRECTOMY RADIAL HEAD OR NECK

Professional

Both

$2,814.00

Service Code	HCPCS 24136
Min. Negotiated Rate	$2,110.50
Max. Negotiated Rate	$2,110.50
Rate for Payer: Cash Price	$761.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,110.50
Rate for Payer: SOMOS Essential	$2,110.50

PR SEQUESTRECTOMY SCAPULA

Professional

Both

$2,540.97

Service Code	HCPCS 23172
Min. Negotiated Rate	$1,905.73
Max. Negotiated Rate	$1,905.73
Rate for Payer: Cash Price	$689.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,905.73
Rate for Payer: SOMOS Essential	$1,905.73

PR SEQUESTRECTOMY SHAFT/DISTAL HUMERUS

Professional

Both

$3,318.70

Service Code	HCPCS 24134
Min. Negotiated Rate	$2,489.02
Max. Negotiated Rate	$2,489.02
Rate for Payer: Cash Price	$897.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,489.02
Rate for Payer: SOMOS Essential	$2,489.02

PR SERIAL TONOMETRY SPX W/MLT MEAS INTRAOCULAR PRS

Professional

Both

$127.89

Service Code	HCPCS 92100
Min. Negotiated Rate	$95.92
Max. Negotiated Rate	$95.92
Rate for Payer: Cash Price	$35.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$95.92
Rate for Payer: SOMOS Essential	$95.92

PR SESAMOIDECTOMY FIRST TOE SPX

Professional

Both

$1,375.29

Service Code	HCPCS 28315
Min. Negotiated Rate	$1,031.47
Max. Negotiated Rate	$1,031.47
Rate for Payer: Cash Price	$377.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,031.47
Rate for Payer: SOMOS Essential	$1,031.47

PR SESAMOIDECTOMY THUMB/FINGER SEPARATE PROCEDURE

Professional

Both

$2,478.88

Service Code	HCPCS 26185
Min. Negotiated Rate	$1,859.16
Max. Negotiated Rate	$1,859.16
Rate for Payer: Cash Price	$675.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,859.16
Rate for Payer: SOMOS Essential	$1,859.16

PR SET UP PORT XRAY EQUIPMENT

Professional

Both

$107.66

Service Code	HCPCS Q0092
Min. Negotiated Rate	$80.74
Max. Negotiated Rate	$80.74
Rate for Payer: Cash Price	$30.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$80.74
Rate for Payer: SOMOS Essential	$80.74

PR SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX

Professional

Both

$1,016.58

Service Code	HCPCS 65860
Min. Negotiated Rate	$762.44
Max. Negotiated Rate	$762.44
Rate for Payer: Cash Price	$280.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$762.44
Rate for Payer: SOMOS Essential	$762.44

PR SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE

Professional

Both

$2,455.92

Service Code	HCPCS 65870
Min. Negotiated Rate	$1,841.94
Max. Negotiated Rate	$1,841.94
Rate for Payer: Cash Price	$675.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,841.94
Rate for Payer: SOMOS Essential	$1,841.94

PR SEVERING ADS ANT SEG INCAL SPX CORNEOVITREAL

Professional

Both

$2,754.43

Service Code	HCPCS 65880
Min. Negotiated Rate	$2,065.82
Max. Negotiated Rate	$2,065.82
Rate for Payer: Cash Price	$757.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,065.82
Rate for Payer: SOMOS Essential	$2,065.82

PR SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE

Professional

Both

$2,620.24

Service Code	HCPCS 65875
Min. Negotiated Rate	$1,965.18
Max. Negotiated Rate	$1,965.18
Rate for Payer: Cash Price	$721.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,965.18
Rate for Payer: SOMOS Essential	$1,965.18

PR SEVERING ADS ANT SEG INCAL TQ SPX GONIOSYNECHIAE

Professional

Both

$1,978.69

Service Code	HCPCS 65865
Min. Negotiated Rate	$1,484.02
Max. Negotiated Rate	$1,484.02
Rate for Payer: Cash Price	$544.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,484.02
Rate for Payer: SOMOS Essential	$1,484.02

PR SEVERING TARSORRHAPHY

Professional

Both

$410.06

Service Code	HCPCS 67710
Min. Negotiated Rate	$307.54
Max. Negotiated Rate	$307.54
Rate for Payer: Cash Price	$112.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$307.54
Rate for Payer: SOMOS Essential	$307.54

PR SEVERING VITREOUS STRANS LASER 1/> STAGES

Professional

Both

$1,460.62

Service Code	HCPCS 67031
Min. Negotiated Rate	$1,095.46
Max. Negotiated Rate	$1,095.46
Rate for Payer: Cash Price	$401.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,095.46
Rate for Payer: SOMOS Essential	$1,095.46

PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST

Professional

Both

$282.14

Service Code	HCPCS 45335
Min. Negotiated Rate	$211.60
Max. Negotiated Rate	$211.60
Rate for Payer: Cash Price	$76.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$211.60
Rate for Payer: SOMOS Essential	$211.60

PR SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ

Professional

Both

$503.27

Service Code	HCPCS 45338
Min. Negotiated Rate	$377.45
Max. Negotiated Rate	$377.45
Rate for Payer: Cash Price	$136.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$377.45
Rate for Payer: SOMOS Essential	$377.45

PR SGMDSC FLX W/DCMPRN W/PLMT DCMPRN TUBE

Professional

Both

$479.22

Service Code	HCPCS 45337
Min. Negotiated Rate	$359.42
Max. Negotiated Rate	$359.42
Rate for Payer: Cash Price	$129.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$359.42
Rate for Payer: SOMOS Essential	$359.42

PR SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION

Professional

Both

$826.04

Service Code	HCPCS 45349
Min. Negotiated Rate	$619.53
Max. Negotiated Rate	$619.53
Rate for Payer: Cash Price	$223.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$619.53
Rate for Payer: SOMOS Essential	$619.53

PR SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<

Professional

Both

$193.69

Service Code	HCPCS 11310
Min. Negotiated Rate	$145.27
Max. Negotiated Rate	$145.27
Rate for Payer: Cash Price	$51.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$145.27
Rate for Payer: SOMOS Essential	$145.27

PR SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM

Professional

Both

$400.40

Service Code	HCPCS 11313
Min. Negotiated Rate	$300.30
Max. Negotiated Rate	$300.30
Rate for Payer: Cash Price	$108.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$300.30
Rate for Payer: SOMOS Essential	$300.30

PR SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<

Professional

Both

$153.86

Service Code	HCPCS 11305
Min. Negotiated Rate	$115.40
Max. Negotiated Rate	$115.40
Rate for Payer: Cash Price	$41.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$115.40
Rate for Payer: SOMOS Essential	$115.40

PR SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM

Professional

Both

$205.10

Service Code	HCPCS 11306
Min. Negotiated Rate	$153.82
Max. Negotiated Rate	$153.82
Rate for Payer: Cash Price	$54.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$153.82
Rate for Payer: SOMOS Essential	$153.82

PR SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM

Professional

Both

$260.75

Service Code	HCPCS 11307
Min. Negotiated Rate	$195.56
Max. Negotiated Rate	$195.56
Rate for Payer: Cash Price	$70.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$195.56
Rate for Payer: SOMOS Essential	$195.56

Know your out-of-pocket cost for care.

All Charges