St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR URETEROTOMY INSERTION INDWELLING STENT ALL TYPES

Professional

Both

$4,484.55

Service Code	HCPCS 50605
Min. Negotiated Rate	$3,363.41
Max. Negotiated Rate	$3,363.41
Rate for Payer: Cash Price	$1,203.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,363.41
Rate for Payer: SOMOS Essential	$3,363.41

PR URETEROURETEROSTOMY

Professional

Both

$4,865.18

Service Code	HCPCS 50760
Min. Negotiated Rate	$3,648.88
Max. Negotiated Rate	$3,648.88
Rate for Payer: Cash Price	$1,310.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,648.88
Rate for Payer: SOMOS Essential	$3,648.88

PR URETHRECTOMY TOT W/CYSTOST FEMALE

Professional

Both

$3,260.36

Service Code	HCPCS 53210
Min. Negotiated Rate	$2,445.27
Max. Negotiated Rate	$2,445.27
Rate for Payer: Cash Price	$891.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,445.27
Rate for Payer: SOMOS Essential	$2,445.27

PR URETHRECTOMY TOT W/CYSTOST MALE

Professional

Both

$3,879.26

Service Code	HCPCS 53215
Min. Negotiated Rate	$2,909.44
Max. Negotiated Rate	$2,909.44
Rate for Payer: Cash Price	$1,057.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,909.44
Rate for Payer: SOMOS Essential	$2,909.44

PR URETHROLSS TRVG SEC OPN W/CSTO

Professional

Both

$3,195.29

Service Code	HCPCS 53500
Min. Negotiated Rate	$2,396.47
Max. Negotiated Rate	$2,396.47
Rate for Payer: Cash Price	$867.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,396.47
Rate for Payer: SOMOS Essential	$2,396.47

PR URETHROMEATOPLASTY W/MUCOSAL ADVANCEMENT

Professional

Both

$1,720.88

Service Code	HCPCS 53450
Min. Negotiated Rate	$1,290.66
Max. Negotiated Rate	$1,290.66
Rate for Payer: Cash Price	$472.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,290.66
Rate for Payer: SOMOS Essential	$1,290.66

PR URETHROMEATOPLASTY W/PRTL EXC DSTL URTL SGM

Professional

Both

$1,921.15

Service Code	HCPCS 53460
Min. Negotiated Rate	$1,440.86
Max. Negotiated Rate	$1,440.86
Rate for Payer: Cash Price	$528.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,440.86
Rate for Payer: SOMOS Essential	$1,440.86

PR URETHROPLASTY 1 STG RECNST MALE ANTERIOR URETHRA

Professional

Both

$4,091.36

Service Code	HCPCS 53410
Min. Negotiated Rate	$3,068.52
Max. Negotiated Rate	$3,068.52
Rate for Payer: Cash Price	$1,119.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,068.52
Rate for Payer: SOMOS Essential	$3,068.52

PR URETHROPLASTY 1ST STG FISTULA/DIVERTICULUM/STRIX

Professional

Both

$3,356.01

Service Code	HCPCS 53400
Min. Negotiated Rate	$2,517.01
Max. Negotiated Rate	$2,517.01
Rate for Payer: Cash Price	$917.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,517.01
Rate for Payer: SOMOS Essential	$2,517.01

PR URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR <3 CM

Professional

Both

$3,004.33

Service Code	HCPCS 54308
Min. Negotiated Rate	$2,253.25
Max. Negotiated Rate	$2,253.25
Rate for Payer: Cash Price	$821.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,253.25
Rate for Payer: SOMOS Essential	$2,253.25

PR URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR > 3 CM

Professional

Both

$3,426.47

Service Code	HCPCS 54312
Min. Negotiated Rate	$2,569.85
Max. Negotiated Rate	$2,569.85
Rate for Payer: Cash Price	$937.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,569.85
Rate for Payer: SOMOS Essential	$2,569.85

PR URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR SKIN GRF

Professional

Both

$4,154.26

Service Code	HCPCS 54316
Min. Negotiated Rate	$3,115.70
Max. Negotiated Rate	$3,115.70
Rate for Payer: Cash Price	$1,135.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,115.70
Rate for Payer: SOMOS Essential	$3,115.70

PR URETHROPLASTY 2ND STAGE W/URINARY DIVERSION

Professional

Both

$3,654.67

Service Code	HCPCS 53405
Min. Negotiated Rate	$2,741.00
Max. Negotiated Rate	$2,741.00
Rate for Payer: Cash Price	$998.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,741.00
Rate for Payer: SOMOS Essential	$2,741.00

PR URETHROPLASTY 3RD STG HYPOSPADIAS RPR RLS PENIS

Professional

Both

$2,988.02

Service Code	HCPCS 54318
Min. Negotiated Rate	$2,241.02
Max. Negotiated Rate	$2,241.02
Rate for Payer: Cash Price	$817.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,241.02
Rate for Payer: SOMOS Essential	$2,241.02

PR URETHROPLASTY RCNSTJ FEMALE URETHRA

Professional

Both

$4,123.70

Service Code	HCPCS 53430
Min. Negotiated Rate	$3,092.78
Max. Negotiated Rate	$3,092.78
Rate for Payer: Cash Price	$1,121.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,092.78
Rate for Payer: SOMOS Essential	$3,092.78

PR URETHRORRHAPHY SUTR URETHRAL WOUND/INJ FEMALE

Professional

Both

$2,041.55

Service Code	HCPCS 53502
Min. Negotiated Rate	$1,531.16
Max. Negotiated Rate	$1,531.16
Rate for Payer: Cash Price	$561.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,531.16
Rate for Payer: SOMOS Essential	$1,531.16

PR URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PENILE

Professional

Both

$2,040.12

Service Code	HCPCS 53505
Min. Negotiated Rate	$1,530.09
Max. Negotiated Rate	$1,530.09
Rate for Payer: Cash Price	$560.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,530.09
Rate for Payer: SOMOS Essential	$1,530.09

PR URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PERINEAL

Professional

Both

$2,654.16

Service Code	HCPCS 53510
Min. Negotiated Rate	$1,990.62
Max. Negotiated Rate	$1,990.62
Rate for Payer: Cash Price	$727.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,990.62
Rate for Payer: SOMOS Essential	$1,990.62

PR URETHROTOMY/URETHROSTOMY XT SPX PERINEAL URETHRA

Professional

Both

$1,252.93

Service Code	HCPCS 53010
Min. Negotiated Rate	$939.70
Max. Negotiated Rate	$939.70
Rate for Payer: Cash Price	$345.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$939.70
Rate for Payer: SOMOS Essential	$939.70

PR URETRECECTOMY W/BLADDER CUFF SEPARATE PROCEDURE

Professional

Both

$4,340.32

Service Code	HCPCS 50650
Min. Negotiated Rate	$3,255.24
Max. Negotiated Rate	$3,255.24
Rate for Payer: Cash Price	$1,189.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,255.24
Rate for Payer: SOMOS Essential	$3,255.24

PR URINALYSIS, NONAUTO, W/SCOPE

Professional

Both

$16.00

Service Code	HCPCS 81000
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Cash Price	$4.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$12.00
Rate for Payer: SOMOS Essential	$12.00

PR URINARY UNIDIVERSION

Professional

Both

$7,495.85

Service Code	HCPCS 50830
Min. Negotiated Rate	$5,621.89
Max. Negotiated Rate	$5,621.89
Rate for Payer: Cash Price	$2,044.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,621.89
Rate for Payer: SOMOS Essential	$5,621.89

PR URTORR SUTR URETHRAL WND/INJ PROSTATOMEMBRANOUS

Professional

Both

$3,328.75

Service Code	HCPCS 53515
Min. Negotiated Rate	$2,496.56
Max. Negotiated Rate	$2,496.56
Rate for Payer: Cash Price	$910.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,496.56
Rate for Payer: SOMOS Essential	$2,496.56

PR URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 1ST STAGE

Professional

Both

$3,513.90

Service Code	HCPCS 53420
Min. Negotiated Rate	$2,635.42
Max. Negotiated Rate	$2,635.42
Rate for Payer: Cash Price	$960.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,635.42
Rate for Payer: SOMOS Essential	$2,635.42

PR URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 2ND STAGE

Professional

Both

$3,910.97

Service Code	HCPCS 53425
Min. Negotiated Rate	$2,933.23
Max. Negotiated Rate	$2,933.23
Rate for Payer: Cash Price	$1,068.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,933.23
Rate for Payer: SOMOS Essential	$2,933.23

Know your out-of-pocket cost for care.

All Charges