St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR TX SLP FEM EPIPHYSIS SINGLE/MULTIPL PINNING SITU

Professional

Both

$4,086.08

Service Code	HCPCS 27176
Min. Negotiated Rate	$3,064.56
Max. Negotiated Rate	$3,064.56
Rate for Payer: Cash Price	$1,102.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,064.56
Rate for Payer: SOMOS Essential	$3,064.56

PR TX SLP FEMORAL EPIPHYSIS TRCJ W/O REDUCTION

Professional

Both

$2,959.71

Service Code	HCPCS 27175
Min. Negotiated Rate	$2,219.78
Max. Negotiated Rate	$2,219.78
Rate for Payer: Cash Price	$799.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,219.78
Rate for Payer: SOMOS Essential	$2,219.78

PR TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV

Professional

Both

$97.27

Service Code	HCPCS 92508
Min. Negotiated Rate	$72.95
Max. Negotiated Rate	$72.95
Rate for Payer: Cash Price	$27.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$72.95
Rate for Payer: SOMOS Essential	$72.95

PR TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC IND

Professional

Both

$308.88

Service Code	HCPCS 92507
Min. Negotiated Rate	$231.66
Max. Negotiated Rate	$231.66
Rate for Payer: Cash Price	$84.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$231.66
Rate for Payer: SOMOS Essential	$231.66

PR TX SPON HIP DISLC ABDCT SPLNT/TRCJ W/MANJ ANES

Professional

Both

$1,596.11

Service Code	HCPCS 27257
Min. Negotiated Rate	$1,197.08
Max. Negotiated Rate	$1,197.08
Rate for Payer: Cash Price	$431.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,197.08
Rate for Payer: SOMOS Essential	$1,197.08

PR TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES

Professional

Both

$1,075.55

Service Code	HCPCS 27256
Min. Negotiated Rate	$806.66
Max. Negotiated Rate	$806.66
Rate for Payer: Cash Price	$288.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$806.66
Rate for Payer: SOMOS Essential	$806.66

PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE

Professional

Both

$814.31

Service Code	HCPCS 12020
Min. Negotiated Rate	$610.73
Max. Negotiated Rate	$610.73
Rate for Payer: Cash Price	$220.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$610.73
Rate for Payer: SOMOS Essential	$610.73

PR TX SUPERFICIAL WOUND DEHISCENCE W/PACKING

Professional

Both

$609.18

Service Code	HCPCS 12021
Min. Negotiated Rate	$456.88
Max. Negotiated Rate	$456.88
Rate for Payer: Cash Price	$165.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$456.88
Rate for Payer: SOMOS Essential	$456.88

PR TX SWALLOWING DYSFUNCTION&/ORAL FUNCJ FEEDING

Professional

Both

$344.09

Service Code	HCPCS 92526
Min. Negotiated Rate	$258.07
Max. Negotiated Rate	$258.07
Rate for Payer: Cash Price	$94.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$258.07
Rate for Payer: SOMOS Essential	$258.07

PR TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ

Professional

Both

$1,126.62

Service Code	HCPCS 28455
Min. Negotiated Rate	$844.96
Max. Negotiated Rate	$844.96
Rate for Payer: Cash Price	$267.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$844.96
Rate for Payer: SOMOS Essential	$844.96

PR TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ

Professional

Both

$831.25

Service Code	HCPCS 28450
Min. Negotiated Rate	$623.44
Max. Negotiated Rate	$623.44
Rate for Payer: Cash Price	$230.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$623.44
Rate for Payer: SOMOS Essential	$623.44

PR TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA

Professional

Both

$4,404.93

Service Code	HCPCS 27759
Min. Negotiated Rate	$3,303.70
Max. Negotiated Rate	$3,303.70
Rate for Payer: Cash Price	$1,188.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,303.70
Rate for Payer: SOMOS Essential	$3,303.70

PR TYMPANIC MEMB RPR W/WO PREPJ PERFOR PATCH

Professional

Both

$1,242.26

Service Code	HCPCS 69610
Min. Negotiated Rate	$931.70
Max. Negotiated Rate	$931.70
Rate for Payer: Cash Price	$336.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$931.70
Rate for Payer: SOMOS Essential	$931.70

PR TYMPANIC NEURECTOMY

Professional

Both

$3,625.44

Service Code	HCPCS 69676
Min. Negotiated Rate	$2,719.08
Max. Negotiated Rate	$2,719.08
Rate for Payer: Cash Price	$980.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,719.08
Rate for Payer: SOMOS Essential	$2,719.08

PR TYMPANOLYSIS TRANSCANAL

Professional

Both

$2,386.02

Service Code	HCPCS 69450
Min. Negotiated Rate	$1,789.52
Max. Negotiated Rate	$1,789.52
Rate for Payer: Cash Price	$646.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,789.52
Rate for Payer: SOMOS Essential	$1,789.52

PR TYMPANOMETRY

Professional

Both

$43.61

Service Code	HCPCS 92567
Min. Negotiated Rate	$32.71
Max. Negotiated Rate	$32.71
Rate for Payer: Cash Price	$11.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32.71
Rate for Payer: SOMOS Essential	$32.71

PR TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS

Professional

Both

$89.71

Service Code	HCPCS 92550
Min. Negotiated Rate	$67.28
Max. Negotiated Rate	$67.28
Rate for Payer: Cash Price	$24.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$67.28
Rate for Payer: SOMOS Essential	$67.28

PR TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/OCR

Professional

Both

$6,829.24

Service Code	HCPCS 69646
Min. Negotiated Rate	$5,121.93
Max. Negotiated Rate	$5,121.93
Rate for Payer: Cash Price	$1,841.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,121.93
Rate for Payer: SOMOS Essential	$5,121.93

PR TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/O OCR

Professional

Both

$6,425.51

Service Code	HCPCS 69645
Min. Negotiated Rate	$4,819.13
Max. Negotiated Rate	$4,819.13
Rate for Payer: Cash Price	$1,729.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,819.13
Rate for Payer: SOMOS Essential	$4,819.13

PR TYMPANOPLASTY W/O MASTOIDEC 1ST/REVJ PROSTH TORP

Professional

Both

$4,578.53

Service Code	HCPCS 69633
Min. Negotiated Rate	$3,433.90
Max. Negotiated Rate	$3,433.90
Rate for Payer: Cash Price	$1,237.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,433.90
Rate for Payer: SOMOS Essential	$3,433.90

PR TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ

Professional

Both

$3,876.43

Service Code	HCPCS 69631
Min. Negotiated Rate	$2,907.32
Max. Negotiated Rate	$2,907.32
Rate for Payer: Cash Price	$1,046.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,907.32
Rate for Payer: SOMOS Essential	$2,907.32

PR TYMPANOSTOMY GENERAL ANESTHESIA

Professional

Both

$687.89

Service Code	HCPCS 69436
Min. Negotiated Rate	$515.92
Max. Negotiated Rate	$515.92
Rate for Payer: Cash Price	$188.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$515.92
Rate for Payer: SOMOS Essential	$515.92

PR TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA

Professional

Both

$571.66

Service Code	HCPCS 69433
Min. Negotiated Rate	$428.74
Max. Negotiated Rate	$428.74
Rate for Payer: Cash Price	$156.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$428.74
Rate for Payer: SOMOS Essential	$428.74

PR TYMPNOPLSTY W/O MSTDC 1ST/REVJ W/OSICLE RECNSTJ

Professional

Both

$4,715.03

Service Code	HCPCS 69632
Min. Negotiated Rate	$3,536.27
Max. Negotiated Rate	$3,536.27
Rate for Payer: Cash Price	$1,267.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,536.27
Rate for Payer: SOMOS Essential	$3,536.27

PR TYMPP ANTRT/MASTOID W/O OSSICULAR CHAIN RECNSTJ

Professional

Both

$5,628.00

Service Code	HCPCS 69635
Min. Negotiated Rate	$4,221.00
Max. Negotiated Rate	$4,221.00
Rate for Payer: Cash Price	$1,512.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,221.00
Rate for Payer: SOMOS Essential	$4,221.00

Know your out-of-pocket cost for care.

All Charges