St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR SUBQ HOSPITAL CARE PER DAY E/M NORMAL NEWBORN

Professional

Both

$166.18

Service Code	HCPCS 99462
Min. Negotiated Rate	$124.64
Max. Negotiated Rate	$124.64
Rate for Payer: Cash Price	$45.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$124.64
Rate for Payer: SOMOS Essential	$124.64

PR SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE

Professional

Both

$241.50

Service Code	HCPCS 96371
Min. Negotiated Rate	$181.12
Max. Negotiated Rate	$181.12
Rate for Payer: Cash Price	$71.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$181.12
Rate for Payer: SOMOS Essential	$181.12

PR SUBQ I/P CRITICAL CARE PR DAY AGE 28 DAYS/<

Professional

Both

$1,565.34

Service Code	HCPCS 99469
Min. Negotiated Rate	$1,174.00
Max. Negotiated Rate	$1,174.00
Rate for Payer: Cash Price	$427.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,174.00
Rate for Payer: SOMOS Essential	$1,174.00

PR SUBSEQUENT INTENSIVE CARE INFANT 1500-2500 GRAMS

Professional

Both

$493.19

Service Code	HCPCS 99479
Min. Negotiated Rate	$369.89
Max. Negotiated Rate	$369.89
Rate for Payer: Cash Price	$133.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$369.89
Rate for Payer: SOMOS Essential	$369.89

PR SUBSEQUENT INTENSIVE CARE INFANT < 1500 GRAMS

Professional

Both

$540.16

Service Code	HCPCS 99478
Min. Negotiated Rate	$405.12
Max. Negotiated Rate	$405.12
Rate for Payer: Cash Price	$147.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$405.12
Rate for Payer: SOMOS Essential	$405.12

PR SUBSEQUENT INTENSIVE CARE INFANT 2501-5000 GRAMS

Professional

Both

$476.35

Service Code	HCPCS 99480
Min. Negotiated Rate	$357.26
Max. Negotiated Rate	$357.26
Rate for Payer: Cash Price	$128.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$357.26
Rate for Payer: SOMOS Essential	$357.26

PR SUBSEQUENT PED CRITICAL CARE 2 THRU 5 YEARS

Professional

Both

$1,373.96

Service Code	HCPCS 99476
Min. Negotiated Rate	$1,030.47
Max. Negotiated Rate	$1,030.47
Rate for Payer: Cash Price	$374.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,030.47
Rate for Payer: SOMOS Essential	$1,030.47

PR SUBSQ PED CRITICAL CARE 29 DAYS THRU 24 MO

Professional

Both

$1,596.14

Service Code	HCPCS 99472
Min. Negotiated Rate	$1,197.10
Max. Negotiated Rate	$1,197.10
Rate for Payer: Cash Price	$441.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,197.10
Rate for Payer: SOMOS Essential	$1,197.10

PR SUBTEMPORAL CRANIAL DECOMPRESSION

Professional

Both

$6,949.53

Service Code	HCPCS 61340
Min. Negotiated Rate	$5,212.15
Max. Negotiated Rate	$5,212.15
Rate for Payer: Cash Price	$1,833.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,212.15
Rate for Payer: SOMOS Essential	$5,212.15

PR SUPRACERVICAL ABDL HYSTER W/WO RMVL TUBE OVARY

Professional

Both

$4,179.95

Service Code	HCPCS 58180
Min. Negotiated Rate	$3,134.96
Max. Negotiated Rate	$3,134.96
Rate for Payer: Cash Price	$1,130.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,134.96
Rate for Payer: SOMOS Essential	$3,134.96

PR SUPRAHYOID LYMPHADENECTOMY

Professional

Both

$3,483.27

Service Code	HCPCS 38700
Min. Negotiated Rate	$2,612.45
Max. Negotiated Rate	$2,612.45
Rate for Payer: Cash Price	$941.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,612.45
Rate for Payer: SOMOS Essential	$2,612.45

PR SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I

Professional

Both

$1,807.51

Service Code	HCPCS 36254
Min. Negotiated Rate	$1,355.63
Max. Negotiated Rate	$1,355.63
Rate for Payer: Cash Price	$482.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,355.63
Rate for Payer: SOMOS Essential	$1,355.63

PR SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I

Professional

Both

$1,455.79

Service Code	HCPCS 36253
Min. Negotiated Rate	$1,091.84
Max. Negotiated Rate	$1,091.84
Rate for Payer: Cash Price	$392.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,091.84
Rate for Payer: SOMOS Essential	$1,091.84

PR SURG CLSR TRACHEOSTOMY/FISTULA W/O PLASTIC RPR

Professional

Both

$1,440.99

Service Code	HCPCS 31820
Min. Negotiated Rate	$1,080.74
Max. Negotiated Rate	$1,080.74
Rate for Payer: Cash Price	$391.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,080.74
Rate for Payer: SOMOS Essential	$1,080.74

PR SURG CLSR TRACHEOSTOMY/FISTULA W/PLASTIC RPR

Professional

Both

$2,107.04

Service Code	HCPCS 31825
Min. Negotiated Rate	$1,580.28
Max. Negotiated Rate	$1,580.28
Rate for Payer: Cash Price	$571.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,580.28
Rate for Payer: SOMOS Essential	$1,580.28

PR SURGICAL ARTHROSCOPY SHOULDER BICEPS TENODESIS

Professional

Both

$4,035.47

Service Code	HCPCS 29828
Min. Negotiated Rate	$3,026.60
Max. Negotiated Rate	$3,026.60
Rate for Payer: Cash Price	$1,090.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,026.60
Rate for Payer: SOMOS Essential	$3,026.60

PR SURGICAL ARTHROSCOPY SHOULDER CAPSULORRHAPHY

Professional

Both

$4,662.88

Service Code	HCPCS 29806
Min. Negotiated Rate	$3,497.16
Max. Negotiated Rate	$3,497.16
Rate for Payer: Cash Price	$1,261.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,497.16
Rate for Payer: SOMOS Essential	$3,497.16

PR SURGICAL ARTHROSCOPY SHOULDER COMPL SYNOVECTOMY

Professional

Both

$2,628.57

Service Code	HCPCS 29821
Min. Negotiated Rate	$1,971.43
Max. Negotiated Rate	$1,971.43
Rate for Payer: Cash Price	$709.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,971.43
Rate for Payer: SOMOS Essential	$1,971.43

PR SURGICAL ARTHROSCOPY SHOULDER DSTL CLAVICULC

Professional

Both

$2,995.20

Service Code	HCPCS 29824
Min. Negotiated Rate	$2,246.40
Max. Negotiated Rate	$2,246.40
Rate for Payer: Cash Price	$810.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,246.40
Rate for Payer: SOMOS Essential	$2,246.40

PR SURGICAL ARTHROSCOPY SHOULDER LMTD DBRDMT 1/2

Professional

Both

$2,394.00

Service Code	HCPCS 29822
Min. Negotiated Rate	$1,795.50
Max. Negotiated Rate	$1,795.50
Rate for Payer: Cash Price	$649.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,795.50
Rate for Payer: SOMOS Essential	$1,795.50

PR SURGICAL ARTHROSCOPY SHOULDER PRTL SYNOVECTOMY

Professional

Both

$2,356.17

Service Code	HCPCS 29820
Min. Negotiated Rate	$1,767.13
Max. Negotiated Rate	$1,767.13
Rate for Payer: Cash Price	$638.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,767.13
Rate for Payer: SOMOS Essential	$1,767.13

PR SURGICAL ARTHROSCOPY SHOULDER REMOVAL LOOSE/FB

Professional

Both

$2,596.34

Service Code	HCPCS 29819
Min. Negotiated Rate	$1,947.26
Max. Negotiated Rate	$1,947.26
Rate for Payer: Cash Price	$703.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,947.26
Rate for Payer: SOMOS Essential	$1,947.26

PR SURGICAL ARTHROSCOPY SHOULDER REPAIR SLAP LESION

Professional

Both

$4,563.44

Service Code	HCPCS 29807
Min. Negotiated Rate	$3,422.58
Max. Negotiated Rate	$3,422.58
Rate for Payer: Cash Price	$1,232.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,422.58
Rate for Payer: SOMOS Essential	$3,422.58

PR SURGICAL ARTHROSCOPY SHOULDER W/LSS&RESCJ ADS

Professional

Both

$2,596.34

Service Code	HCPCS 29825
Min. Negotiated Rate	$1,947.26
Max. Negotiated Rate	$1,947.26
Rate for Payer: Cash Price	$701.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,947.26
Rate for Payer: SOMOS Essential	$1,947.26

PR SURGICAL ARTHROSCOPY SHOULDER W/ROTATOR CUFF RPR

Professional

Both

$4,709.64

Service Code	HCPCS 29827
Min. Negotiated Rate	$3,532.23
Max. Negotiated Rate	$3,532.23
Rate for Payer: Cash Price	$1,270.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,532.23
Rate for Payer: SOMOS Essential	$3,532.23

Know your out-of-pocket cost for care.

All Charges