St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR TRANSFUSION BLOOD/BLOOD COMPONENTS

Professional

Both

$170.80

Service Code	HCPCS 36430
Min. Negotiated Rate	$128.10
Max. Negotiated Rate	$128.10
Rate for Payer: Cash Price	$50.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$128.10
Rate for Payer: SOMOS Essential	$128.10

PR TRANSFUSION INTRAUTERINE FETAL

Professional

Both

$1,491.67

Service Code	HCPCS 36460
Min. Negotiated Rate	$1,118.75
Max. Negotiated Rate	$1,118.75
Rate for Payer: Cash Price	$399.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,118.75
Rate for Payer: SOMOS Essential	$1,118.75

PR TRANSJ CARE MGMT HIGH MDM F2F 7 CAL D DISCHARGE

Professional

Both

$771.65

Service Code	HCPCS 99496
Min. Negotiated Rate	$578.74
Max. Negotiated Rate	$578.74
Rate for Payer: Cash Price	$210.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$578.74
Rate for Payer: SOMOS Essential	$578.74

PR TRANSJ CARE MGMT MOD MDM F2F 14 CAL D DISCHARGE

Professional

Both

$565.64

Service Code	HCPCS 99495
Min. Negotiated Rate	$424.23
Max. Negotiated Rate	$424.23
Rate for Payer: Cash Price	$155.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$424.23
Rate for Payer: SOMOS Essential	$424.23

PR TRANSMASTOID ANTROTOMY

Professional

Both

$3,087.46

Service Code	HCPCS 69501
Min. Negotiated Rate	$2,315.60
Max. Negotiated Rate	$2,315.60
Rate for Payer: Cash Price	$833.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,315.60
Rate for Payer: SOMOS Essential	$2,315.60

PR TRANSMETACARPAL AMPUTATION

Professional

Both

$3,838.45

Service Code	HCPCS 25927
Min. Negotiated Rate	$2,878.84
Max. Negotiated Rate	$2,878.84
Rate for Payer: Cash Price	$1,032.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,878.84
Rate for Payer: SOMOS Essential	$2,878.84

PR TRANSMETACARPAL AMPUTATION RE-AMPUTATION

Professional

Both

$3,547.71

Service Code	HCPCS 25931
Min. Negotiated Rate	$2,660.78
Max. Negotiated Rate	$2,660.78
Rate for Payer: Cash Price	$955.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,660.78
Rate for Payer: SOMOS Essential	$2,660.78

PR TRANSMETACARPAL AMPUTATION SEC CLOSURE/SCAR REVJ

Professional

Both

$2,663.96

Service Code	HCPCS 25929
Min. Negotiated Rate	$1,997.97
Max. Negotiated Rate	$1,997.97
Rate for Payer: Cash Price	$722.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,997.97
Rate for Payer: SOMOS Essential	$1,997.97

PR TRANSMYOCARDIAL LASER REVASCULAR THORACOTOMY SPX

Professional

Both

$6,860.35

Service Code	HCPCS 33140
Min. Negotiated Rate	$5,145.26
Max. Negotiated Rate	$5,145.26
Rate for Payer: Cash Price	$1,820.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,145.26
Rate for Payer: SOMOS Essential	$5,145.26

PR TRANSMYOCRD LASER REVSC PFRMD TM OTH OPN CAR PX

Professional

Both

$584.36

Service Code	HCPCS 33141
Min. Negotiated Rate	$438.27
Max. Negotiated Rate	$438.27
Rate for Payer: Cash Price	$154.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$438.27
Rate for Payer: SOMOS Essential	$438.27

PR TRANSORAL LOWER ESOPHAGEAL MYOTOMY

Professional

Both

$3,389.65

Service Code	HCPCS 43497
Min. Negotiated Rate	$2,542.24
Max. Negotiated Rate	$2,542.24
Rate for Payer: Cash Price	$908.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,542.24
Rate for Payer: SOMOS Essential	$2,542.24

PR TRANSPEDICULAR DCMPRN 1 SEG EA THORACIC/LUMBAR

Professional

Both

$1,505.95

Service Code	HCPCS 63057
Min. Negotiated Rate	$1,129.46
Max. Negotiated Rate	$1,129.46
Rate for Payer: Cash Price	$396.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,129.46
Rate for Payer: SOMOS Essential	$1,129.46

PR TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG LUMBAR

Professional

Both

$6,972.00

Service Code	HCPCS 63056
Min. Negotiated Rate	$5,229.00
Max. Negotiated Rate	$5,229.00
Rate for Payer: Cash Price	$1,847.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,229.00
Rate for Payer: SOMOS Essential	$5,229.00

PR TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG THORACIC

Professional

Both

$7,708.02

Service Code	HCPCS 63055
Min. Negotiated Rate	$5,781.02
Max. Negotiated Rate	$5,781.02
Rate for Payer: Cash Price	$2,038.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,781.02
Rate for Payer: SOMOS Essential	$5,781.02

PR TRANSPERINEAL PLMT BIODEGRADABLE MATRL 1/MLT NJX

Professional

Both

$677.22

Service Code	HCPCS 55874
Min. Negotiated Rate	$507.92
Max. Negotiated Rate	$507.92
Rate for Payer: Cash Price	$185.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$507.92
Rate for Payer: SOMOS Essential	$507.92

PR TRANSPERINEAL PLMT NDL/CATHS PROSTATE RADJ INSJ

Professional

Both

$3,240.58

Service Code	HCPCS 55875
Min. Negotiated Rate	$2,430.44
Max. Negotiated Rate	$2,430.44
Rate for Payer: Cash Price	$889.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,430.44
Rate for Payer: SOMOS Essential	$2,430.44

PR TRANSPLANTATION PANCREATIC ALLOGRAFT

Professional

Both

$11,738.90

Service Code	HCPCS 48554
Min. Negotiated Rate	$8,804.18
Max. Negotiated Rate	$8,804.18
Rate for Payer: Cash Price	$3,165.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,804.18
Rate for Payer: SOMOS Essential	$8,804.18

PR TRANSPLANTATION TESTIS TO THIGH

Professional

Both

$3,297.84

Service Code	HCPCS 54680
Min. Negotiated Rate	$2,473.38
Max. Negotiated Rate	$2,473.38
Rate for Payer: Cash Price	$901.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,473.38
Rate for Payer: SOMOS Essential	$2,473.38

PR TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR 1 TENDON

Professional

Both

$2,751.60

Service Code	HCPCS 27396
Min. Negotiated Rate	$2,063.70
Max. Negotiated Rate	$2,063.70
Rate for Payer: Cash Price	$744.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,063.70
Rate for Payer: SOMOS Essential	$2,063.70

PR TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR MULT TDN

Professional

Both

$4,051.50

Service Code	HCPCS 27397
Min. Negotiated Rate	$3,038.62
Max. Negotiated Rate	$3,038.62
Rate for Payer: Cash Price	$1,096.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,038.62
Rate for Payer: SOMOS Essential	$3,038.62

PR TRANSPORT PORTABLE X-RAY

Professional

Both

$769.51

Service Code	HCPCS R0070
Min. Negotiated Rate	$577.13
Max. Negotiated Rate	$577.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$577.13
Rate for Payer: SOMOS Essential	$577.13

PR TRANSPORT PORT X-RAY MULTIPL

Professional

Both

$769.51

Service Code	HCPCS R0075
Min. Negotiated Rate	$577.13
Max. Negotiated Rate	$577.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$577.13
Rate for Payer: SOMOS Essential	$577.13

PR TRANSPOSITION OVARY

Professional

Both

$3,100.16

Service Code	HCPCS 58825
Min. Negotiated Rate	$2,325.12
Max. Negotiated Rate	$2,325.12
Rate for Payer: Cash Price	$836.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,325.12
Rate for Payer: SOMOS Essential	$2,325.12

PR TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC

Professional

Both

$833.98

Service Code	HCPCS 67320
Min. Negotiated Rate	$625.48
Max. Negotiated Rate	$625.48
Rate for Payer: Cash Price	$194.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$625.48
Rate for Payer: SOMOS Essential	$625.48

PR TRANSPTRSAL POST CRNL FOSSA CLIVUS/FORAMN MAGNUM

Professional

Both

$13,650.35

Service Code	HCPCS 61598
Min. Negotiated Rate	$10,237.76
Max. Negotiated Rate	$10,237.76
Rate for Payer: Cash Price	$3,594.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10,237.76
Rate for Payer: SOMOS Essential	$10,237.76

Know your out-of-pocket cost for care.

All Charges