St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS

Professional

Both

$2,114.95

Service Code	HCPCS 33214
Min. Negotiated Rate	$1,586.21
Max. Negotiated Rate	$1,586.21
Rate for Payer: Cash Price	$561.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,586.21
Rate for Payer: SOMOS Essential	$1,586.21

PR URETERAL EMBOLIZATION/OCCLUSION W/IMG GID RS&I

Professional

Both

$735.14

Service Code	HCPCS 50705
Min. Negotiated Rate	$551.36
Max. Negotiated Rate	$551.36
Rate for Payer: Cash Price	$196.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$551.36
Rate for Payer: SOMOS Essential	$551.36

PR URETERAL ENDOSCOPY VIA URETEROSTOMY

Professional

Both

$1,266.86

Service Code	HCPCS 50951
Min. Negotiated Rate	$950.14
Max. Negotiated Rate	$950.14
Rate for Payer: Cash Price	$346.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$950.14
Rate for Payer: SOMOS Essential	$950.14

PR URETERAL ENDOSCOPY VIA URETEROSTOMY W/BIOPSY

Professional

Both

$1,454.22

Service Code	HCPCS 50955
Min. Negotiated Rate	$1,090.66
Max. Negotiated Rate	$1,090.66
Rate for Payer: Cash Price	$397.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,090.66
Rate for Payer: SOMOS Essential	$1,090.66

PR URETERAL ENDOSCOPY VIA URETEROST W/RMVL FB/STONE

Professional

Both

$1,311.45

Service Code	HCPCS 50961
Min. Negotiated Rate	$983.59
Max. Negotiated Rate	$983.59
Rate for Payer: Cash Price	$357.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$983.59
Rate for Payer: SOMOS Essential	$983.59

PR URETERAL ENDOSCOPY VIA URETEROST W/WO DIL URETER

Professional

Both

$1,350.76

Service Code	HCPCS 50953
Min. Negotiated Rate	$1,013.07
Max. Negotiated Rate	$1,013.07
Rate for Payer: Cash Price	$367.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,013.07
Rate for Payer: SOMOS Essential	$1,013.07

PR URETERAL ENDOSCOPY VIA URETEROTOMY W/O IMAGING

Professional

Both

$1,529.68

Service Code	HCPCS 50970
Min. Negotiated Rate	$1,147.26
Max. Negotiated Rate	$1,147.26
Rate for Payer: Cash Price	$417.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,147.26
Rate for Payer: SOMOS Essential	$1,147.26

PR URETERAL ENDOSCOPY VIA URETEROT W/O IMAGING W/BX

Professional

Both

$1,954.26

Service Code	HCPCS 50974
Min. Negotiated Rate	$1,465.70
Max. Negotiated Rate	$1,465.70
Rate for Payer: Cash Price	$532.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,465.70
Rate for Payer: SOMOS Essential	$1,465.70

PR URETERAL ENDOSCOPY W/DEST&/INC W/WO BIOPSY

Professional

Both

$1,463.39

Service Code	HCPCS 50957
Min. Negotiated Rate	$1,097.54
Max. Negotiated Rate	$1,097.54
Rate for Payer: Cash Price	$398.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,097.54
Rate for Payer: SOMOS Essential	$1,097.54

PR URETERAL ENDOSC VIA URETEROT W/DEST&/INC W/WO BX

Professional

Both

$1,921.26

Service Code	HCPCS 50976
Min. Negotiated Rate	$1,440.94
Max. Negotiated Rate	$1,440.94
Rate for Payer: Cash Price	$525.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,440.94
Rate for Payer: SOMOS Essential	$1,440.94

PR URETERECTOMY TOT ECTOPIC URETER CMBN APPR

Professional

Both

$4,760.28

Service Code	HCPCS 50660
Min. Negotiated Rate	$3,570.21
Max. Negotiated Rate	$3,570.21
Rate for Payer: Cash Price	$1,302.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,570.21
Rate for Payer: SOMOS Essential	$3,570.21

PR URETEROCALYCOSTOMY ANAST URETER RENAL CALYX

Professional

Both

$4,803.58

Service Code	HCPCS 50750
Min. Negotiated Rate	$3,602.68
Max. Negotiated Rate	$3,602.68
Rate for Payer: Cash Price	$1,313.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,602.68
Rate for Payer: SOMOS Essential	$3,602.68

PR URETEROCOLON CONDUIT INTESTINE ANASTOMOSIS

Professional

Both

$5,110.14

Service Code	HCPCS 50815
Min. Negotiated Rate	$3,832.60
Max. Negotiated Rate	$3,832.60
Rate for Payer: Cash Price	$1,396.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,832.60
Rate for Payer: SOMOS Essential	$3,832.60

PR URETEROENTEROSTOMY ANAST URETER INTESTINE

Professional

Both

$3,892.46

Service Code	HCPCS 50800
Min. Negotiated Rate	$2,919.34
Max. Negotiated Rate	$2,919.34
Rate for Payer: Cash Price	$1,054.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,919.34
Rate for Payer: SOMOS Essential	$2,919.34

PR URETEROILEAL CONDUIT W/INTESTINE ANASTOMOSIS

Professional

Both

$5,504.07

Service Code	HCPCS 50820
Min. Negotiated Rate	$4,128.05
Max. Negotiated Rate	$4,128.05
Rate for Payer: Cash Price	$1,499.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,128.05
Rate for Payer: SOMOS Essential	$4,128.05

PR URETEROLYSIS FOR OVARIAN VEIN SYNDROME

Professional

Both

$4,433.80

Service Code	HCPCS 50722
Min. Negotiated Rate	$3,325.35
Max. Negotiated Rate	$3,325.35
Rate for Payer: Cash Price	$1,194.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,325.35
Rate for Payer: SOMOS Essential	$3,325.35

PR URETEROLYSIS W/WORPSG URETER RETROPERIT FIBROSIS

Professional

Both

$5,224.24

Service Code	HCPCS 50715
Min. Negotiated Rate	$3,918.18
Max. Negotiated Rate	$3,918.18
Rate for Payer: Cash Price	$1,416.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,918.18
Rate for Payer: SOMOS Essential	$3,918.18

PR URETERONEOCYSTOSTOMY ANAST 1 URETER BLADDER

Professional

Both

$4,706.21

Service Code	HCPCS 50780
Min. Negotiated Rate	$3,529.66
Max. Negotiated Rate	$3,529.66
Rate for Payer: Cash Price	$1,284.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,529.66
Rate for Payer: SOMOS Essential	$3,529.66

PR URETERONEOCYSTOSTOMY ANAST DUPLICATE URETER BLDR

Professional

Both

$4,484.06

Service Code	HCPCS 50782
Min. Negotiated Rate	$3,363.04
Max. Negotiated Rate	$3,363.04
Rate for Payer: Cash Price	$1,224.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,363.04
Rate for Payer: SOMOS Essential	$3,363.04

PR URETERONEOCYSTOSTOMY W/URETERAL TAILORING

Professional

Both

$4,698.93

Service Code	HCPCS 50783
Min. Negotiated Rate	$3,524.20
Max. Negotiated Rate	$3,524.20
Rate for Payer: Cash Price	$1,284.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,524.20
Rate for Payer: SOMOS Essential	$3,524.20

PR URETEROPLASTY PLASTIC OPERATION URETER

Professional

Both

$3,869.71

Service Code	HCPCS 50700
Min. Negotiated Rate	$2,902.28
Max. Negotiated Rate	$2,902.28
Rate for Payer: Cash Price	$1,058.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,902.28
Rate for Payer: SOMOS Essential	$2,902.28

PR URETEROPYELOSTOMY ANAST URETER RENAL PELVIS

Professional

Both

$5,539.10

Service Code	HCPCS 50740
Min. Negotiated Rate	$4,154.32
Max. Negotiated Rate	$4,154.32
Rate for Payer: Cash Price	$1,479.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,154.32
Rate for Payer: SOMOS Essential	$4,154.32

PR URETERORRHAPHY SUTURE URETER SEPARATE PROCEDURE

Professional

Both

$3,525.06

Service Code	HCPCS 50900
Min. Negotiated Rate	$2,643.80
Max. Negotiated Rate	$2,643.80
Rate for Payer: Cash Price	$964.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,643.80
Rate for Payer: SOMOS Essential	$2,643.80

PR URETEROSIGMOIDOSTOMY W/SIGMOID BLADDER & COLOSTO

Professional

Both

$6,362.58

Service Code	HCPCS 50810
Min. Negotiated Rate	$4,771.94
Max. Negotiated Rate	$4,771.94
Rate for Payer: Cash Price	$1,696.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,771.94
Rate for Payer: SOMOS Essential	$4,771.94

PR URETEROSTOMY TRANSPLANTATION URETER SKIN

Professional

Both

$3,948.18

Service Code	HCPCS 50860
Min. Negotiated Rate	$2,961.14
Max. Negotiated Rate	$2,961.14
Rate for Payer: Cash Price	$1,080.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,961.14
Rate for Payer: SOMOS Essential	$2,961.14

Know your out-of-pocket cost for care.

All Charges