St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR SUTR ESOPHGL WND/INJ TTHRC/TABDL APPR

Professional

Both

$11,495.02

Service Code	HCPCS 43415
Min. Negotiated Rate	$8,621.26
Max. Negotiated Rate	$8,621.26
Rate for Payer: Cash Price	$3,066.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,621.26
Rate for Payer: SOMOS Essential	$8,621.26

PR SUTR INFRAPATELLAR TDN 2 RCNSTJ W/FSCAL/TDN GRF

Professional

Both

$3,632.90

Service Code	HCPCS 27381
Min. Negotiated Rate	$2,724.68
Max. Negotiated Rate	$2,724.68
Rate for Payer: Cash Price	$981.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,724.68
Rate for Payer: SOMOS Essential	$2,724.68

PR SUTR LG INTESTINE 1/MULT PERFORAT W/COLOSTOMY

Professional

Both

$5,780.18

Service Code	HCPCS 44605
Min. Negotiated Rate	$4,335.14
Max. Negotiated Rate	$4,335.14
Rate for Payer: Cash Price	$1,531.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,335.14
Rate for Payer: SOMOS Essential	$4,335.14

PR SUTR LG INTESTINE 1/MULT PERFORAT W/O COLOSTOMY

Professional

Both

$4,715.55

Service Code	HCPCS 44604
Min. Negotiated Rate	$3,536.66
Max. Negotiated Rate	$3,536.66
Rate for Payer: Cash Price	$1,256.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,536.66
Rate for Payer: SOMOS Essential	$3,536.66

PR SUTR&/LIG THORACIC DUCT ABDOMINAL APPROACH

Professional

Both

$3,052.25

Service Code	HCPCS 38382
Min. Negotiated Rate	$2,289.19
Max. Negotiated Rate	$2,289.19
Rate for Payer: Cash Price	$817.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,289.19
Rate for Payer: SOMOS Essential	$2,289.19

PR SUTR&/LIG THORACIC DUCT CERVICAL APPROACH

Professional

Both

$2,494.35

Service Code	HCPCS 38380
Min. Negotiated Rate	$1,870.76
Max. Negotiated Rate	$1,870.76
Rate for Payer: Cash Price	$682.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,870.76
Rate for Payer: SOMOS Essential	$1,870.76

PR SUTR&/LIG THORACIC DUCT THORACIC APPROACH

Professional

Both

$3,585.37

Service Code	HCPCS 38381
Min. Negotiated Rate	$2,689.03
Max. Negotiated Rate	$2,689.03
Rate for Payer: Cash Price	$959.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,689.03
Rate for Payer: SOMOS Essential	$2,689.03

PR SUTR NRV ITPRL W/WO GRF/DCMPRN LAT GENICULATE

Professional

Both

$5,028.63

Service Code	HCPCS 69740
Min. Negotiated Rate	$3,771.47
Max. Negotiated Rate	$3,771.47
Rate for Payer: Cash Price	$1,355.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,771.47
Rate for Payer: SOMOS Essential	$3,771.47

PR SUTR NRV ITPRL W/WO GRF/DCMPRN MEDIAL GENICULATE

Professional

Both

$5,361.23

Service Code	HCPCS 69745
Min. Negotiated Rate	$4,020.92
Max. Negotiated Rate	$4,020.92
Rate for Payer: Cash Price	$1,445.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,020.92
Rate for Payer: SOMOS Essential	$4,020.92

PR SUTR PRPH NRV ARM/LEG XCP SCIATIC W/O TRPOS

Professional

Both

$4,627.77

Service Code	HCPCS 64857
Min. Negotiated Rate	$3,470.83
Max. Negotiated Rate	$3,470.83
Rate for Payer: Cash Price	$1,248.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,470.83
Rate for Payer: SOMOS Essential	$3,470.83

PR SUTR PRPH NRV ARM/LEG XCP SCIATIC W/TRPOS

Professional

Both

$4,487.04

Service Code	HCPCS 64856
Min. Negotiated Rate	$3,365.28
Max. Negotiated Rate	$3,365.28
Rate for Payer: Cash Price	$1,196.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,365.28
Rate for Payer: SOMOS Essential	$3,365.28

PR SUTR QUADRICEPS/HAMSTRING MUSC RPT RCNSTJ

Professional

Both

$3,784.76

Service Code	HCPCS 27386
Min. Negotiated Rate	$2,838.57
Max. Negotiated Rate	$2,838.57
Rate for Payer: Cash Price	$1,024.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,838.57
Rate for Payer: SOMOS Essential	$2,838.57

PR SUTR RPR AORTA/GREAT VESSEL W/SHUNT BYPASS

Professional

Both

$5,235.30

Service Code	HCPCS 33321
Min. Negotiated Rate	$3,926.48
Max. Negotiated Rate	$3,926.48
Rate for Payer: Cash Price	$1,393.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,926.48
Rate for Payer: SOMOS Essential	$3,926.48

PR SUTR RPR AORTA/GRT VSL W/O SHUNT/CARD BYP

Professional

Both

$4,764.17

Service Code	HCPCS 33320
Min. Negotiated Rate	$3,573.13
Max. Negotiated Rate	$3,573.13
Rate for Payer: Cash Price	$1,267.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,573.13
Rate for Payer: SOMOS Essential	$3,573.13

PR SUTR WND EYELID/MARGIN/TARSUS/CONJUNC FULL THICK

Professional

Both

$1,810.87

Service Code	HCPCS 67935
Min. Negotiated Rate	$1,358.15
Max. Negotiated Rate	$1,358.15
Rate for Payer: Cash Price	$496.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,358.15
Rate for Payer: SOMOS Essential	$1,358.15

PR SUTR WND EYELID/MARGIN/TARSUS/CONJUNC PRTL THICK

Professional

Both

$967.61

Service Code	HCPCS 67930
Min. Negotiated Rate	$725.71
Max. Negotiated Rate	$725.71
Rate for Payer: Cash Price	$265.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$725.71
Rate for Payer: SOMOS Essential	$725.71

PR SUTURE 1 NERVE HAND/FOOT COMMON SENSORY NERVE

Professional

Both

$3,221.61

Service Code	HCPCS 64834
Min. Negotiated Rate	$2,416.21
Max. Negotiated Rate	$2,416.21
Rate for Payer: Cash Price	$879.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,416.21
Rate for Payer: SOMOS Essential	$2,416.21

PR SUTURE 1 NERVE MEDIAN MOTOR THENAR

Professional

Both

$3,611.34

Service Code	HCPCS 64835
Min. Negotiated Rate	$2,708.50
Max. Negotiated Rate	$2,708.50
Rate for Payer: Cash Price	$974.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,708.50
Rate for Payer: SOMOS Essential	$2,708.50

PR SUTURE 1 NERVE ULNAR MOTOR

Professional

Both

$3,611.34

Service Code	HCPCS 64836
Min. Negotiated Rate	$2,708.50
Max. Negotiated Rate	$2,708.50
Rate for Payer: Cash Price	$974.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,708.50
Rate for Payer: SOMOS Essential	$2,708.50

PR SUTURE BRACHIAL PLEXUS

Professional

Both

$7,334.60

Service Code	HCPCS 64861
Min. Negotiated Rate	$5,500.95
Max. Negotiated Rate	$5,500.95
Rate for Payer: Cash Price	$1,936.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,500.95
Rate for Payer: SOMOS Essential	$5,500.95

PR SUTURE DIGITAL NERVE HAND/FOOT 1 NERVE

Professional

Both

$3,047.45

Service Code	HCPCS 64831
Min. Negotiated Rate	$2,285.59
Max. Negotiated Rate	$2,285.59
Rate for Payer: Cash Price	$826.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,285.59
Rate for Payer: SOMOS Essential	$2,285.59

PR SUTURE EACH ADDITIONAL NERVE HAND/FOOT

Professional

Both

$1,593.31

Service Code	HCPCS 64837
Min. Negotiated Rate	$1,194.98
Max. Negotiated Rate	$1,194.98
Rate for Payer: Cash Price	$425.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,194.98
Rate for Payer: SOMOS Essential	$1,194.98

PR SUTURE EACH ADDITIONAL PERIPHERAL NERVE

Professional

Both

$1,082.55

Service Code	HCPCS 64859
Min. Negotiated Rate	$811.91
Max. Negotiated Rate	$811.91
Rate for Payer: Cash Price	$289.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$811.91
Rate for Payer: SOMOS Essential	$811.91

PR SUTURE EXTRAHEPATIC BILE DUCT PRE-EXIST INJURY

Professional

Both

$6,245.65

Service Code	HCPCS 47900
Min. Negotiated Rate	$4,684.24
Max. Negotiated Rate	$4,684.24
Rate for Payer: Cash Price	$1,661.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,684.24
Rate for Payer: SOMOS Essential	$4,684.24

PR SUTURE FACIAL NERVE EXTRACRANIAL

Professional

Both

$3,739.86

Service Code	HCPCS 64864
Min. Negotiated Rate	$2,804.90
Max. Negotiated Rate	$2,804.90
Rate for Payer: Cash Price	$1,005.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,804.90
Rate for Payer: SOMOS Essential	$2,804.90

Know your out-of-pocket cost for care.

All Charges