St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR TYMPP ANTRT/MASTOID W/OSSICULAR CHAIN RECNSTJ

Professional

Both

$6,124.09

Service Code	HCPCS 69636
Min. Negotiated Rate	$4,593.07
Max. Negotiated Rate	$4,593.07
Rate for Payer: Cash Price	$1,649.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,593.07
Rate for Payer: SOMOS Essential	$4,593.07

PR TYPHOID VACCINE VI CAPSULAR POLYSACCHARIDE IM

Professional

Both

$427.00

Service Code	HCPCS 90691
Min. Negotiated Rate	$320.25
Max. Negotiated Rate	$320.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$320.25
Rate for Payer: SOMOS Essential	$320.25

PRUITT-INAHARA SHUNT

Facility

$269.68

Hospital Charge Code	40202100
Hospital Revenue Code	270
Min. Negotiated Rate	$94.39
Max. Negotiated Rate	$215.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$148.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.84
Rate for Payer: Aetna Government	$134.84
Rate for Payer: Brighton Health Commercial	$202.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$215.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$183.38
Rate for Payer: Group Health Inc Commercial	$134.84
Rate for Payer: Group Health Inc Medicare	$94.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.84
Rate for Payer: Hamaspik Choice Inc Medicare	$134.84

PR UMBILECTOMY OMPHALECTOMY EXC UMBILICUS SPX

Professional

Both

$2,663.61

Service Code	HCPCS 49250
Min. Negotiated Rate	$1,997.71
Max. Negotiated Rate	$1,997.71
Rate for Payer: Cash Price	$714.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,997.71
Rate for Payer: SOMOS Essential	$1,997.71

PR UNLISTED LAPAROSCOPIC PROCEDURE STOMACH

Professional

Both

$4,250.00

Service Code	HCPCS 43659
Min. Negotiated Rate	$3,187.50
Max. Negotiated Rate	$3,187.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,187.50
Rate for Payer: SOMOS Essential	$3,187.50

PR UNLISTED LAPAROSCOPIC PX ABD PERTONEUM & OMENTUM

Professional

Both

$1,785.00

Service Code	HCPCS 49329
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$1,338.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,338.75
Rate for Payer: SOMOS Essential	$1,338.75

PR UNLISTED LAPAROSCOPY PX INTESTINE XCP RECTUM

Professional

Both

$7,150.00

Service Code	HCPCS 44238
Min. Negotiated Rate	$5,362.50
Max. Negotiated Rate	$5,362.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,362.50
Rate for Payer: SOMOS Essential	$5,362.50

PR UNLISTED PREVENTIVE MEDICINE SERVICE

Professional

Both

$25.00

Service Code	HCPCS 99429
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18.75
Rate for Payer: SOMOS Essential	$18.75

PR UNLISTED PROCEDURE ARTHROSCOPY

Professional

Both

$1,965.00

Service Code	HCPCS 29999
Min. Negotiated Rate	$1,473.75
Max. Negotiated Rate	$1,473.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,473.75
Rate for Payer: SOMOS Essential	$1,473.75

PR UNLISTED PROCEDURE BREAST

Professional

Both

$1,499.00

Service Code	HCPCS 19499
Min. Negotiated Rate	$1,124.25
Max. Negotiated Rate	$1,124.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,124.25
Rate for Payer: SOMOS Essential	$1,124.25

PR UNLISTED PROCEDURE FOREARM/WRIST

Professional

Both

$895.00

Service Code	HCPCS 25999
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$671.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$671.25
Rate for Payer: SOMOS Essential	$671.25

PR UNLISTED PROCEDURE HANDS/FINGERS

Professional

Both

$1,215.00

Service Code	HCPCS 26989
Min. Negotiated Rate	$911.25
Max. Negotiated Rate	$911.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$911.25
Rate for Payer: SOMOS Essential	$911.25

PR UNLISTED PROCEDURE HEMIC OR LYMPHATIC SYSTEM

Professional

Both

$470.00

Service Code	HCPCS 38999
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$352.50
Rate for Payer: SOMOS Essential	$352.50

PR UNLISTED PROCEDURE HUMERUS/ELBOW

Professional

Both

$1,442.35

Service Code	HCPCS 24999
Min. Negotiated Rate	$1,081.76
Max. Negotiated Rate	$1,081.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,081.76
Rate for Payer: SOMOS Essential	$1,081.76

PR UNLISTED PROCEDURE MALE GENITAL SYSTEM

Professional

Both

$1,500.00

Service Code	HCPCS 55899
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,125.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,125.00
Rate for Payer: SOMOS Essential	$1,125.00

PR UNLISTED PROCEDURE MUSCSKELETAL SYSTEM GENERAL

Professional

Both

$1,106.00

Service Code	HCPCS 20999
Min. Negotiated Rate	$829.50
Max. Negotiated Rate	$829.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$829.50
Rate for Payer: SOMOS Essential	$829.50

PR UNLISTED PROCEDURE NERVOUS SYSTEM

Professional

Both

$2,100.00

Service Code	HCPCS 64999
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$1,575.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,575.00
Rate for Payer: SOMOS Essential	$1,575.00

PR UNLISTED PROCEDURE RECTUM

Professional

Both

$2,750.00

Service Code	HCPCS 45999
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$2,062.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,062.50
Rate for Payer: SOMOS Essential	$2,062.50

PR UNLISTED PROCEDURE SMALL INTESTINE

Professional

Both

$5,275.00

Service Code	HCPCS 44799
Min. Negotiated Rate	$3,956.25
Max. Negotiated Rate	$3,956.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,956.25
Rate for Payer: SOMOS Essential	$3,956.25

PR UNLISTED PROCEDURE STOMACH

Professional

Both

$4,250.00

Service Code	HCPCS 43999
Min. Negotiated Rate	$3,187.50
Max. Negotiated Rate	$3,187.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,187.50
Rate for Payer: SOMOS Essential	$3,187.50

PR UNLISTED PROCEDURE TRACHEA BRONCHI

Professional

Both

$525.00

Service Code	HCPCS 31899
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$393.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$393.75
Rate for Payer: SOMOS Essential	$393.75

PR UNLISTED PROCEDURE VASCULAR SURGERY

Professional

Both

$1,350.00

Service Code	HCPCS 37799
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,012.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,012.50
Rate for Payer: SOMOS Essential	$1,012.50

PR UNLISTED PX ABDOMEN MUSCULOSKELETAL SYSTEM

Professional

Both

$1,765.00

Service Code	HCPCS 22999
Min. Negotiated Rate	$1,323.75
Max. Negotiated Rate	$1,323.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,323.75
Rate for Payer: SOMOS Essential	$1,323.75

PR UNLISTED PX FEMALE GENITAL SYSTEM NONOBSTETRICAL

Professional

Both

$2,159.00

Service Code	HCPCS 58999
Min. Negotiated Rate	$1,619.25
Max. Negotiated Rate	$1,619.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,619.25
Rate for Payer: SOMOS Essential	$1,619.25

PR UNLISTED PX SALIVARY GLANDS/DUCTS

Professional

Both

$1,146.00

Service Code	HCPCS 42699
Min. Negotiated Rate	$859.50
Max. Negotiated Rate	$859.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$859.50
Rate for Payer: SOMOS Essential	$859.50

Know your out-of-pocket cost for care.

All Charges