St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR TISSUE EXPANDER PLACEMENT BREAST RECONSTRUCTION

Professional

Both

$5,074.86

Service Code	HCPCS 19357
Min. Negotiated Rate	$3,806.14
Max. Negotiated Rate	$3,806.14
Rate for Payer: Cash Price	$1,371.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,806.14
Rate for Payer: SOMOS Essential	$3,806.14

PR TL201 THALLIUM

Professional

Both

$214.13

Service Code	HCPCS A9505
Min. Negotiated Rate	$160.60
Max. Negotiated Rate	$160.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$160.60
Rate for Payer: SOMOS Essential	$160.60

PR TMPP ANTRT/MASTOIDOTOMY PROSTHESIS TORP

Professional

Both

$6,094.94

Service Code	HCPCS 69637
Min. Negotiated Rate	$4,571.20
Max. Negotiated Rate	$4,571.20
Rate for Payer: Cash Price	$1,642.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,571.20
Rate for Payer: SOMOS Essential	$4,571.20

PR TMPP MASTOIDECT NTC/RCNSTED CANAL WALL OCR

Professional

Both

$6,552.53

Service Code	HCPCS 69644
Min. Negotiated Rate	$4,914.40
Max. Negotiated Rate	$4,914.40
Rate for Payer: Cash Price	$1,762.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,914.40
Rate for Payer: SOMOS Essential	$4,914.40

PR TMPP MASTOIDECT NTC/RCNSTED WALL W/O OCR

Professional

Both

$5,323.92

Service Code	HCPCS 69643
Min. Negotiated Rate	$3,992.94
Max. Negotiated Rate	$3,992.94
Rate for Payer: Cash Price	$1,432.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,992.94
Rate for Payer: SOMOS Essential	$3,992.94

PR TMPP MASTOIDECTOMY W/O OSSICULAR CHAIN RECNSTJ

Professional

Both

$4,535.62

Service Code	HCPCS 69641
Min. Negotiated Rate	$3,401.72
Max. Negotiated Rate	$3,401.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,401.72
Rate for Payer: SOMOS Essential	$3,401.72

PR TMPP MASTOIDECTOMY W/OSSICULAR CHAIN RECNSTJ

Professional

Both

$5,810.42

Service Code	HCPCS 69642
Min. Negotiated Rate	$4,357.82
Max. Negotiated Rate	$4,357.82
Rate for Payer: Cash Price	$1,567.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,357.82
Rate for Payer: SOMOS Essential	$4,357.82

PR TMVI W/PROSTHETIC VALVE PERCUTANEOUS APPROACH

Professional

Both

$6,417.81

Service Code	HCPCS 0483T
Min. Negotiated Rate	$4,813.36
Max. Negotiated Rate	$4,813.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,813.36
Rate for Payer: SOMOS Essential	$4,813.36

PR TMVI W/PROSTHETIC VALVE TRANSTHORACIC EXPOSURE

Professional

Both

$6,417.81

Service Code	HCPCS 0484T
Min. Negotiated Rate	$4,813.36
Max. Negotiated Rate	$4,813.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,813.36
Rate for Payer: SOMOS Essential	$4,813.36

PR TNOLS FLXR/XTNSR TDN LEG&/ANKLE MLT TDN

Professional

Both

$2,197.27

Service Code	HCPCS 27681
Min. Negotiated Rate	$1,647.95
Max. Negotiated Rate	$1,647.95
Rate for Payer: Cash Price	$602.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,647.95
Rate for Payer: SOMOS Essential	$1,647.95

PR TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA

Professional

Both

$2,336.57

Service Code	HCPCS 25295
Min. Negotiated Rate	$1,752.43
Max. Negotiated Rate	$1,752.43
Rate for Payer: Cash Price	$634.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,752.43
Rate for Payer: SOMOS Essential	$1,752.43

PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN

Professional

Both

$2,344.72

Service Code	HCPCS 24358
Min. Negotiated Rate	$1,758.54
Max. Negotiated Rate	$1,758.54
Rate for Payer: Cash Price	$638.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,758.54
Rate for Payer: SOMOS Essential	$1,758.54

PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR

Professional

Both

$2,935.24

Service Code	HCPCS 24359
Min. Negotiated Rate	$2,201.43
Max. Negotiated Rate	$2,201.43
Rate for Payer: Cash Price	$796.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,201.43
Rate for Payer: SOMOS Essential	$2,201.43

PR TNOT FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA

Professional

Both

$1,928.61

Service Code	HCPCS 25290
Min. Negotiated Rate	$1,446.46
Max. Negotiated Rate	$1,446.46
Rate for Payer: Cash Price	$526.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,446.46
Rate for Payer: SOMOS Essential	$1,446.46

PR TOBACCO USE CESSATION INTENSIVE >10 MINUTES

Professional

Both

$102.31

Service Code	HCPCS 99407
Min. Negotiated Rate	$76.73
Max. Negotiated Rate	$76.73
Rate for Payer: Cash Price	$27.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$76.73
Rate for Payer: SOMOS Essential	$76.73

PR TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES

Professional

Both

$48.48

Service Code	HCPCS 99406
Min. Negotiated Rate	$36.36
Max. Negotiated Rate	$36.36
Rate for Payer: Cash Price	$13.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36.36
Rate for Payer: SOMOS Essential	$36.36

PR TONE DECAY TEST

Professional

Both

$143.61

Service Code	HCPCS 92563
Min. Negotiated Rate	$107.71
Max. Negotiated Rate	$107.71
Rate for Payer: Cash Price	$41.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$107.71
Rate for Payer: SOMOS Essential	$107.71

PR TONGUE BASE SUSPENSION PERMANENT SUTURE TQ

Professional

Both

$2,886.98

Service Code	HCPCS 41512
Min. Negotiated Rate	$2,165.24
Max. Negotiated Rate	$2,165.24
Rate for Payer: Cash Price	$780.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,165.24
Rate for Payer: SOMOS Essential	$2,165.24

PR TONSILLECTOMY & ADENOIDECTOMY <AGE 12

Professional

Both

$1,257.80

Service Code	HCPCS 42820
Min. Negotiated Rate	$943.35
Max. Negotiated Rate	$943.35
Rate for Payer: Cash Price	$343.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$943.35
Rate for Payer: SOMOS Essential	$943.35

PR TONSILLECTOMY & ADENOIDECTOMY AGE 12/>

Professional

Both

$1,322.06

Service Code	HCPCS 42821
Min. Negotiated Rate	$991.54
Max. Negotiated Rate	$991.54
Rate for Payer: Cash Price	$358.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$991.54
Rate for Payer: SOMOS Essential	$991.54

PR TONSILLECTOMY PRIMARY/SECONDARY <AGE 12

Professional

Both

$1,164.38

Service Code	HCPCS 42825
Min. Negotiated Rate	$873.28
Max. Negotiated Rate	$873.28
Rate for Payer: Cash Price	$317.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$873.28
Rate for Payer: SOMOS Essential	$873.28

PR TONSILLECTOMY PRIMARY/SECONDARY AGE 12/>

Professional

Both

$1,109.40

Service Code	HCPCS 42826
Min. Negotiated Rate	$832.05
Max. Negotiated Rate	$832.05
Rate for Payer: Cash Price	$302.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$832.05
Rate for Payer: SOMOS Essential	$832.05

PR TOT ABD HYST W/PARAORTIC & PELVIC LYMPH NODE SAM

Professional

Both

$5,844.97

Service Code	HCPCS 58200
Min. Negotiated Rate	$4,383.73
Max. Negotiated Rate	$4,383.73
Rate for Payer: Cash Price	$1,583.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,383.73
Rate for Payer: SOMOS Essential	$4,383.73

PR TOT ABD HYST W/WO RMVL TUBE OVARY W/COLPURETHRXY

Professional

Both

$5,396.20

Service Code	HCPCS 58152
Min. Negotiated Rate	$4,047.15
Max. Negotiated Rate	$4,047.15
Rate for Payer: Cash Price	$1,452.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,047.15
Rate for Payer: SOMOS Essential	$4,047.15

PR TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY

Professional

Both

$4,415.39

Service Code	HCPCS 58150
Min. Negotiated Rate	$3,311.54
Max. Negotiated Rate	$3,311.54
Rate for Payer: Cash Price	$1,194.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,311.54
Rate for Payer: SOMOS Essential	$3,311.54

Know your out-of-pocket cost for care.

All Charges