St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR SUTURE FACIAL NERVE INFRATEMPORAL W/WO GRAFT

Professional

Both

$4,683.07

Service Code	HCPCS 64865
Min. Negotiated Rate	$3,512.30
Max. Negotiated Rate	$3,512.30
Rate for Payer: Cash Price	$1,263.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,512.30
Rate for Payer: SOMOS Essential	$3,512.30

PR SUTURE INFRAPATELLAR TENDON PRIMARY

Professional

Both

$2,769.80

Service Code	HCPCS 27380
Min. Negotiated Rate	$2,077.35
Max. Negotiated Rate	$2,077.35
Rate for Payer: Cash Price	$748.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,077.35
Rate for Payer: SOMOS Essential	$2,077.35

PR SUTURE IRIS CILIARY BODY SPX RETRIEVAL SUTURE

Professional

Both

$2,980.29

Service Code	HCPCS 66682
Min. Negotiated Rate	$2,235.22
Max. Negotiated Rate	$2,235.22
Rate for Payer: Cash Price	$815.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,235.22
Rate for Payer: SOMOS Essential	$2,235.22

PR SUTURE LUMBAR PLEXUS

Professional

Both

$6,050.00

Service Code	HCPCS 64862
Min. Negotiated Rate	$4,537.50
Max. Negotiated Rate	$4,537.50
Rate for Payer: Cash Price	$1,627.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,537.50
Rate for Payer: SOMOS Essential	$4,537.50

PR SUTURE MESENTERY SEPARATE PROCEDURE

Professional

Both

$3,350.66

Service Code	HCPCS 44850
Min. Negotiated Rate	$2,513.00
Max. Negotiated Rate	$2,513.00
Rate for Payer: Cash Price	$897.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,513.00
Rate for Payer: SOMOS Essential	$2,513.00

PR SUTURE NERVE REQ SECONDARY/DELAYED SUTURE

Professional

Both

$506.77

Service Code	HCPCS 64872
Min. Negotiated Rate	$380.08
Max. Negotiated Rate	$380.08
Rate for Payer: Cash Price	$134.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$380.08
Rate for Payer: SOMOS Essential	$380.08

PR SUTURE NERVE REQ SHORTENING BONE EXTREMITY

Professional

Both

$856.98

Service Code	HCPCS 64876
Min. Negotiated Rate	$642.74
Max. Negotiated Rate	$642.74
Rate for Payer: Cash Price	$229.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$642.74
Rate for Payer: SOMOS Essential	$642.74

PR SUTURE NERVE REQ XTNSV MOBIL/TRPOS NERVE

Professional

Both

$756.04

Service Code	HCPCS 64874
Min. Negotiated Rate	$567.03
Max. Negotiated Rate	$567.03
Rate for Payer: Cash Price	$202.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$567.03
Rate for Payer: SOMOS Essential	$567.03

PR SUTURE PHARYNX WOUND/INJURY

Professional

Both

$1,428.39

Service Code	HCPCS 42900
Min. Negotiated Rate	$1,071.29
Max. Negotiated Rate	$1,071.29
Rate for Payer: Cash Price	$387.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,071.29
Rate for Payer: SOMOS Essential	$1,071.29

PR SUTURE POSTERIOR TIBIAL NERVE

Professional

Both

$4,253.87

Service Code	HCPCS 64840
Min. Negotiated Rate	$3,190.40
Max. Negotiated Rate	$3,190.40
Rate for Payer: Cash Price	$1,146.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,190.40
Rate for Payer: SOMOS Essential	$3,190.40

PR SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY

Professional

Both

$2,689.37

Service Code	HCPCS 27385
Min. Negotiated Rate	$2,017.03
Max. Negotiated Rate	$2,017.03
Rate for Payer: Cash Price	$729.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,017.03
Rate for Payer: SOMOS Essential	$2,017.03

PR SUTURE REPAIR AORTA/GREAT VESSEL W/BYPASS

Professional

Both

$6,123.88

Service Code	HCPCS 33322
Min. Negotiated Rate	$4,592.91
Max. Negotiated Rate	$4,592.91
Rate for Payer: Cash Price	$1,652.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,592.91
Rate for Payer: SOMOS Essential	$4,592.91

PR SUTURE/REPAIR TESTICULAR INJURY

Professional

Both

$1,724.66

Service Code	HCPCS 54670
Min. Negotiated Rate	$1,293.50
Max. Negotiated Rate	$1,293.50
Rate for Payer: Cash Price	$473.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,293.50
Rate for Payer: SOMOS Essential	$1,293.50

PR SUTURE SCIATIC NERVE

Professional

Both

$5,182.28

Service Code	HCPCS 64858
Min. Negotiated Rate	$3,886.71
Max. Negotiated Rate	$3,886.71
Rate for Payer: Cash Price	$1,395.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,886.71
Rate for Payer: SOMOS Essential	$3,886.71

PR SUTURE TONGUE LIP MICROGNATHIA

Professional

Both

$1,973.69

Service Code	HCPCS 41510
Min. Negotiated Rate	$1,480.27
Max. Negotiated Rate	$1,480.27
Rate for Payer: Cash Price	$533.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,480.27
Rate for Payer: SOMOS Essential	$1,480.27

PR SUTURE TRACHEAL WOUND/INJURY CERVICAL

Professional

Both

$3,075.42

Service Code	HCPCS 31800
Min. Negotiated Rate	$2,306.56
Max. Negotiated Rate	$2,306.56
Rate for Payer: Cash Price	$828.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,306.56
Rate for Payer: SOMOS Essential	$2,306.56

PR SUTURE TRACHEAL WOUND/INJURY INTRATHORACIC

Professional

Both

$3,647.04

Service Code	HCPCS 31805
Min. Negotiated Rate	$2,735.28
Max. Negotiated Rate	$2,735.28
Rate for Payer: Cash Price	$974.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,735.28
Rate for Payer: SOMOS Essential	$2,735.28

PR SYMPATHECTOMY CERVICAL

Professional

Both

$4,043.66

Service Code	HCPCS 64802
Min. Negotiated Rate	$3,032.74
Max. Negotiated Rate	$3,032.74
Rate for Payer: Cash Price	$1,075.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,032.74
Rate for Payer: SOMOS Essential	$3,032.74

PR SYMPATHECTOMY CERVICOTHORACIC

Professional

Both

$5,738.43

Service Code	HCPCS 64804
Min. Negotiated Rate	$4,303.82
Max. Negotiated Rate	$4,303.82
Rate for Payer: Cash Price	$1,517.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,303.82
Rate for Payer: SOMOS Essential	$4,303.82

PR SYMPATHECTOMY DIGITAL ARTERIES EACH DIGIT

Professional

Both

$3,347.37

Service Code	HCPCS 64820
Min. Negotiated Rate	$2,510.53
Max. Negotiated Rate	$2,510.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,510.53
Rate for Payer: SOMOS Essential	$2,510.53

PR SYMPATHECTOMY LUMBAR

Professional

Both

$3,445.58

Service Code	HCPCS 64818
Min. Negotiated Rate	$2,584.18
Max. Negotiated Rate	$2,584.18
Rate for Payer: Cash Price	$928.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,584.18
Rate for Payer: SOMOS Essential	$2,584.18

PR SYMPATHECTOMY RADIAL ARTERY

Professional

Both

$3,049.80

Service Code	HCPCS 64821
Min. Negotiated Rate	$2,287.35
Max. Negotiated Rate	$2,287.35
Rate for Payer: Cash Price	$838.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,287.35
Rate for Payer: SOMOS Essential	$2,287.35

PR SYMPATHECTOMY SUPERFICIAL PALMAR ARCH

Professional

Both

$3,505.99

Service Code	HCPCS 64823
Min. Negotiated Rate	$2,629.49
Max. Negotiated Rate	$2,629.49
Rate for Payer: Cash Price	$947.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,629.49
Rate for Payer: SOMOS Essential	$2,629.49

PR SYMPATHECTOMY THORACOLUMBAR

Professional

Both

$5,251.23

Service Code	HCPCS 64809
Min. Negotiated Rate	$3,938.42
Max. Negotiated Rate	$3,938.42
Rate for Payer: Cash Price	$1,388.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,938.42
Rate for Payer: SOMOS Essential	$3,938.42

PR SYMPATHECTOMY ULNAR ARTERY

Professional

Both

$3,097.47

Service Code	HCPCS 64822
Min. Negotiated Rate	$2,323.10
Max. Negotiated Rate	$2,323.10
Rate for Payer: Cash Price	$838.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,323.10
Rate for Payer: SOMOS Essential	$2,323.10

Know your out-of-pocket cost for care.

All Charges