St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR URTP TRANSPUBIC/PRNL 1 STG RCNSTJ/RPR URT

Professional

Both

$4,714.57

Service Code	HCPCS 53415
Min. Negotiated Rate	$3,535.93
Max. Negotiated Rate	$3,535.93
Rate for Payer: Cash Price	$1,287.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,535.93
Rate for Payer: SOMOS Essential	$3,535.93

PR URTP W/TUBULARIZATION POST URT&/LWR BLDR

Professional

Both

$4,805.78

Service Code	HCPCS 53431
Min. Negotiated Rate	$3,604.34
Max. Negotiated Rate	$3,604.34
Rate for Payer: Cash Price	$1,313.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,604.34
Rate for Payer: SOMOS Essential	$3,604.34

PR URTROLITHOTOMY LOWER ONE-THIRD URETER

Professional

Both

$3,727.05

Service Code	HCPCS 50630
Min. Negotiated Rate	$2,795.29
Max. Negotiated Rate	$2,795.29
Rate for Payer: Cash Price	$1,019.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,795.29
Rate for Payer: SOMOS Essential	$2,795.29

PR URTROLITHOTOMY MIDDLE ONE-THIRD URETER

Professional

Both

$3,772.86

Service Code	HCPCS 50620
Min. Negotiated Rate	$2,829.64
Max. Negotiated Rate	$2,829.64
Rate for Payer: Cash Price	$1,030.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,829.64
Rate for Payer: SOMOS Essential	$2,829.64

PR URTROLITHOTOMY UPPER ONE-THIRD URETER

Professional

Both

$3,941.88

Service Code	HCPCS 50610
Min. Negotiated Rate	$2,956.41
Max. Negotiated Rate	$2,956.41
Rate for Payer: Cash Price	$1,077.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,956.41
Rate for Payer: SOMOS Essential	$2,956.41

PR URTROLSS RETROCAVAL URTR W/REANAST

Professional

Both

$4,598.16

Service Code	HCPCS 50725
Min. Negotiated Rate	$3,448.62
Max. Negotiated Rate	$3,448.62
Rate for Payer: Cash Price	$1,255.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,448.62
Rate for Payer: SOMOS Essential	$3,448.62

PR URTRONEOCSTOST W/VESICO-PSOAS HITCH/BLDR FLAP

Professional

Both

$5,101.92

Service Code	HCPCS 50785
Min. Negotiated Rate	$3,826.44
Max. Negotiated Rate	$3,826.44
Rate for Payer: Cash Price	$1,385.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,826.44
Rate for Payer: SOMOS Essential	$3,826.44

PR URTROTOMY W/EXPL/DRG SEPARATE PROCEDURE

Professional

Both

$3,913.32

Service Code	HCPCS 50600
Min. Negotiated Rate	$2,934.99
Max. Negotiated Rate	$2,934.99
Rate for Payer: Cash Price	$1,069.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,934.99
Rate for Payer: SOMOS Essential	$2,934.99

PR URTT/URTS XTRNL SPX PENDULOUS URETHRA

Professional

Both

$623.00

Service Code	HCPCS 53000
Min. Negotiated Rate	$467.25
Max. Negotiated Rate	$467.25
Rate for Payer: Cash Price	$172.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$467.25
Rate for Payer: SOMOS Essential	$467.25

PR USE OF ECHO CONTRAST AGENT DURING STRESS ECHO

Professional

Both

$144.27

Service Code	HCPCS 93352
Min. Negotiated Rate	$108.20
Max. Negotiated Rate	$108.20
Rate for Payer: Cash Price	$40.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$108.20
Rate for Payer: SOMOS Essential	$108.20

PR USE OPHTHALMIC ENDOSCOPE

Professional

Both

$358.51

Service Code	HCPCS 66990
Min. Negotiated Rate	$268.88
Max. Negotiated Rate	$268.88
Rate for Payer: Cash Price	$98.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$268.88
Rate for Payer: SOMOS Essential	$268.88

PR USE VERTICAL ELECTRODES

Professional

Both

$45.99

Service Code	HCPCS 92547
Min. Negotiated Rate	$34.49
Max. Negotiated Rate	$34.49
Rate for Payer: Cash Price	$12.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34.49
Rate for Payer: SOMOS Essential	$34.49

PR UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE

Professional

Both

$2,470.23

Service Code	HCPCS 59870
Min. Negotiated Rate	$1,852.67
Max. Negotiated Rate	$1,852.67
Rate for Payer: Cash Price	$659.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,852.67
Rate for Payer: SOMOS Essential	$1,852.67

PR UTERINE SUSPENSION W/WO SHORTENING LIGAMENTS SPX

Professional

Both

$2,007.99

Service Code	HCPCS 58400
Min. Negotiated Rate	$1,505.99
Max. Negotiated Rate	$1,505.99
Rate for Payer: Cash Price	$545.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,505.99
Rate for Payer: SOMOS Essential	$1,505.99

PR UTERINE SUSP W/WO SHORT LIGAMNTS W/SYMPATHECTOMY

Professional

Both

$3,565.52

Service Code	HCPCS 58410
Min. Negotiated Rate	$2,674.14
Max. Negotiated Rate	$2,674.14
Rate for Payer: Cash Price	$959.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,674.14
Rate for Payer: SOMOS Essential	$2,674.14

PR U-TUBE HEPATICOENTEROSTOMY

Professional

Both

$6,898.36

Service Code	HCPCS 47802
Min. Negotiated Rate	$5,173.77
Max. Negotiated Rate	$5,173.77
Rate for Payer: Cash Price	$1,836.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,173.77
Rate for Payer: SOMOS Essential	$5,173.77

PR UVULECTOMY EXCISION UVULA

Professional

Both

$702.52

Service Code	HCPCS 42140
Min. Negotiated Rate	$526.89
Max. Negotiated Rate	$526.89
Rate for Payer: Cash Price	$192.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$526.89
Rate for Payer: SOMOS Essential	$526.89

PR VAG HYST > 250 GM RMVL TUBE&/OVARY

Professional

Both

$5,429.17

Service Code	HCPCS 58291
Min. Negotiated Rate	$4,071.88
Max. Negotiated Rate	$4,071.88
Rate for Payer: Cash Price	$1,459.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,071.88
Rate for Payer: SOMOS Essential	$4,071.88

PR VAG HYST > 250 GM RMVL TUBE&/OVARY W/RPR ENTRCLE

Professional

Both

$5,722.82

Service Code	HCPCS 58292
Min. Negotiated Rate	$4,292.12
Max. Negotiated Rate	$4,292.12
Rate for Payer: Cash Price	$1,537.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,292.12
Rate for Payer: SOMOS Essential	$4,292.12

PR VAG HYST 250 GM/< W/COLPO-URTCSTOPEXY

Professional

Both

$4,671.03

Service Code	HCPCS 58267
Min. Negotiated Rate	$3,503.27
Max. Negotiated Rate	$3,503.27
Rate for Payer: Cash Price	$1,257.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,503.27
Rate for Payer: SOMOS Essential	$3,503.27

PR VAG HYST 250 GM/< W/RMVL TUBE&/OVARY

Professional

Both

$4,036.52

Service Code	HCPCS 58262
Min. Negotiated Rate	$3,027.39
Max. Negotiated Rate	$3,027.39
Rate for Payer: Cash Price	$1,089.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,027.39
Rate for Payer: SOMOS Essential	$3,027.39

PR VAG HYST 250 GM/< W/RMVL TUBE OVARY W/RPR NTRCL

Professional

Both

$4,332.90

Service Code	HCPCS 58263
Min. Negotiated Rate	$3,249.68
Max. Negotiated Rate	$3,249.68
Rate for Payer: Cash Price	$1,167.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,249.68
Rate for Payer: SOMOS Essential	$3,249.68

PR VAG HYSTER W/TOT/PRTL VAGINECT W/RPR ENTEROCELE

Professional

Both

$4,628.47

Service Code	HCPCS 58280
Min. Negotiated Rate	$3,471.35
Max. Negotiated Rate	$3,471.35
Rate for Payer: Cash Price	$1,246.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,471.35
Rate for Payer: SOMOS Essential	$3,471.35

PR VAGINAL DELIVERY AFTER CESAREAN DELIVERY

Professional

Both

$4,225.48

Service Code	HCPCS 59612
Min. Negotiated Rate	$3,169.11
Max. Negotiated Rate	$3,169.11
Rate for Payer: Cash Price	$1,112.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,169.11
Rate for Payer: SOMOS Essential	$3,169.11

PR VAGINAL DELIVERY ONLY

Professional

Both

$3,675.77

Service Code	HCPCS 59409
Min. Negotiated Rate	$2,756.83
Max. Negotiated Rate	$2,756.83
Rate for Payer: Cash Price	$970.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,756.83
Rate for Payer: SOMOS Essential	$2,756.83

Know your out-of-pocket cost for care.

All Charges