St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRDMT 3+

Professional

Both

$2,622.59

Service Code	HCPCS 29823
Min. Negotiated Rate	$1,966.94
Max. Negotiated Rate	$1,966.94
Rate for Payer: Cash Price	$710.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,966.94
Rate for Payer: SOMOS Essential	$1,966.94

PR SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS

Professional

Both

$754.39

Service Code	HCPCS 29826
Min. Negotiated Rate	$565.79
Max. Negotiated Rate	$565.79
Rate for Payer: Cash Price	$200.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$565.79
Rate for Payer: SOMOS Essential	$565.79

PR SURG NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE BI

Professional

Both

$1,038.24

Service Code	HCPCS 69706
Min. Negotiated Rate	$778.68
Max. Negotiated Rate	$778.68
Rate for Payer: Cash Price	$280.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$778.68
Rate for Payer: SOMOS Essential	$778.68

PR SURG NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE UNI

Professional

Both

$746.41

Service Code	HCPCS 69705
Min. Negotiated Rate	$559.81
Max. Negotiated Rate	$559.81
Rate for Payer: Cash Price	$200.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$559.81
Rate for Payer: SOMOS Essential	$559.81

PR SURG PATH,LEVEL II

Professional

Both

$141.05

Service Code	HCPCS 88302
Min. Negotiated Rate	$105.79
Max. Negotiated Rate	$105.79
Rate for Payer: Cash Price	$39.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$105.79
Rate for Payer: SOMOS Essential	$105.79

PR SURG PATH,LEVEL II

Professional

Both

$113.44

Service Code	HCPCS 88302 TC
Min. Negotiated Rate	$85.08
Max. Negotiated Rate	$85.08
Rate for Payer: Cash Price	$31.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$85.08
Rate for Payer: SOMOS Essential	$85.08

PR SURG PATH,LEVEL II

Professional

Both

$27.65

Service Code	HCPCS 88302 26
Min. Negotiated Rate	$20.74
Max. Negotiated Rate	$20.74
Rate for Payer: Cash Price	$7.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20.74
Rate for Payer: SOMOS Essential	$20.74

PR SURG PATH,LEVEL III

Professional

Both

$136.43

Service Code	HCPCS 88304 TC
Min. Negotiated Rate	$102.32
Max. Negotiated Rate	$102.32
Rate for Payer: Cash Price	$37.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$102.32
Rate for Payer: SOMOS Essential	$102.32

PR SURG PATH,LEVEL III

Professional

Both

$44.66

Service Code	HCPCS 88304 26
Min. Negotiated Rate	$33.50
Max. Negotiated Rate	$33.50
Rate for Payer: Cash Price	$12.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33.50
Rate for Payer: SOMOS Essential	$33.50

PR SURG PATH,LEVEL III

Professional

Both

$181.09

Service Code	HCPCS 88304
Min. Negotiated Rate	$135.82
Max. Negotiated Rate	$135.82
Rate for Payer: Cash Price	$50.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$135.82
Rate for Payer: SOMOS Essential	$135.82

PR SURG PATH,LEVEL IV

Professional

Both

$142.66

Service Code	HCPCS 88305 26
Min. Negotiated Rate	$107.00
Max. Negotiated Rate	$107.00
Rate for Payer: Cash Price	$39.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$107.00
Rate for Payer: SOMOS Essential	$107.00

PR SURG PATH,LEVEL IV

Professional

Both

$150.82

Service Code	HCPCS 88305 TC
Min. Negotiated Rate	$113.12
Max. Negotiated Rate	$113.12
Rate for Payer: Cash Price	$42.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$113.12
Rate for Payer: SOMOS Essential	$113.12

PR SURG PATH,LEVEL IV

Professional

Both

$293.48

Service Code	HCPCS 88305
Min. Negotiated Rate	$220.11
Max. Negotiated Rate	$220.11
Rate for Payer: Cash Price	$81.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$220.11
Rate for Payer: SOMOS Essential	$220.11

PR SURG PATH,LEVEL V

Professional

Both

$1,222.97

Service Code	HCPCS 88307
Min. Negotiated Rate	$917.23
Max. Negotiated Rate	$917.23
Rate for Payer: Cash Price	$334.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$917.23
Rate for Payer: SOMOS Essential	$917.23

PR SURG PATH,LEVEL V

Professional

Both

$319.34

Service Code	HCPCS 88307 26
Min. Negotiated Rate	$239.50
Max. Negotiated Rate	$239.50
Rate for Payer: Cash Price	$86.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$239.50
Rate for Payer: SOMOS Essential	$239.50

PR SURG PATH,LEVEL V

Professional

Both

$903.63

Service Code	HCPCS 88307 TC
Min. Negotiated Rate	$677.72
Max. Negotiated Rate	$677.72
Rate for Payer: Cash Price	$247.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$677.72
Rate for Payer: SOMOS Essential	$677.72

PR SURG PATH,LEVEL VI

Professional

Both

$557.13

Service Code	HCPCS 88309 26
Min. Negotiated Rate	$417.85
Max. Negotiated Rate	$417.85
Rate for Payer: Cash Price	$153.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$417.85
Rate for Payer: SOMOS Essential	$417.85

PR SURG PATH,LEVEL VI

Professional

Both

$1,274.49

Service Code	HCPCS 88309 TC
Min. Negotiated Rate	$955.87
Max. Negotiated Rate	$955.87
Rate for Payer: Cash Price	$346.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$955.87
Rate for Payer: SOMOS Essential	$955.87

PR SURG PATH,LEVEL VI

Professional

Both

$1,831.66

Service Code	HCPCS 88309
Min. Negotiated Rate	$1,373.74
Max. Negotiated Rate	$1,373.74
Rate for Payer: Cash Price	$499.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,373.74
Rate for Payer: SOMOS Essential	$1,373.74

PR SURG TX ANAL FISTULA 2ND STAGE

Professional

Both

$1,839.22

Service Code	HCPCS 46285
Min. Negotiated Rate	$1,379.42
Max. Negotiated Rate	$1,379.42
Rate for Payer: Cash Price	$502.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,379.42
Rate for Payer: SOMOS Essential	$1,379.42

PR SURG TX ANAL FISTULA INTERSPHINCTERIC

Professional

Both

$1,840.51

Service Code	HCPCS 46275
Min. Negotiated Rate	$1,380.38
Max. Negotiated Rate	$1,380.38
Rate for Payer: Cash Price	$500.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,380.38
Rate for Payer: SOMOS Essential	$1,380.38

PR SURG TX ANAL FISTULA SUBQ

Professional

Both

$1,764.53

Service Code	HCPCS 46270
Min. Negotiated Rate	$1,323.40
Max. Negotiated Rate	$1,323.40
Rate for Payer: Cash Price	$478.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,323.40
Rate for Payer: SOMOS Essential	$1,323.40

PR SURG VENTRICULAR RSTRJ PX W/PROSTC PATCH PFRMD

Professional

Both

$12,982.55

Service Code	HCPCS 33548
Min. Negotiated Rate	$9,736.91
Max. Negotiated Rate	$9,736.91
Rate for Payer: Cash Price	$3,446.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9,736.91
Rate for Payer: SOMOS Essential	$9,736.91

PR SUTR DIGITAL NRV HAND/FOOT EA DGTAL NRV

Professional

Both

$1,443.86

Service Code	HCPCS 64832
Min. Negotiated Rate	$1,082.90
Max. Negotiated Rate	$1,082.90
Rate for Payer: Cash Price	$387.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,082.90
Rate for Payer: SOMOS Essential	$1,082.90

PR SUTR ESOPHGL WND/INJ CRV APPR

Professional

Both

$4,452.21

Service Code	HCPCS 43410
Min. Negotiated Rate	$3,339.16
Max. Negotiated Rate	$3,339.16
Rate for Payer: Cash Price	$1,207.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,339.16
Rate for Payer: SOMOS Essential	$3,339.16

Know your out-of-pocket cost for care.

All Charges