St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR ACUP 1/> NDLS W/ELEC STIMJ EA 15 MIN W/RE-INSJ

Professional

Both

$115.78

Service Code	HCPCS 97814
Min. Negotiated Rate	$86.84
Max. Negotiated Rate	$86.84
Rate for Payer: Cash Price	$31.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$86.84
Rate for Payer: SOMOS Essential	$86.84

PR ACUPUNCTURE 1/> NDLES W/O ELEC STIMJ INIT 15 MIN

Professional

Both

$124.92

Service Code	HCPCS 97810
Min. Negotiated Rate	$93.69
Max. Negotiated Rate	$93.69
Rate for Payer: Cash Price	$34.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$93.69
Rate for Payer: SOMOS Essential	$93.69

PR ACUPUNCTURE 1/> NDLS W/ELEC STIMJ 1ST 15 MIN

Professional

Both

$135.49

Service Code	HCPCS 97813
Min. Negotiated Rate	$101.62
Max. Negotiated Rate	$101.62
Rate for Payer: Cash Price	$36.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$101.62
Rate for Payer: SOMOS Essential	$101.62

PR ACUPUNCTURE 1/> NDLS W/O ELEC STIMJ EA 15 MIN

Professional

Both

$106.65

Service Code	HCPCS 97811
Min. Negotiated Rate	$79.99
Max. Negotiated Rate	$79.99
Rate for Payer: Cash Price	$28.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$79.99
Rate for Payer: SOMOS Essential	$79.99

PR ACUTE NURSING FACILITY CARE

Professional

Both

$759.75

Service Code	HCPCS G9685
Min. Negotiated Rate	$569.81
Max. Negotiated Rate	$569.81
Rate for Payer: Cash Price	$206.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$569.81
Rate for Payer: SOMOS Essential	$569.81

PR ADDING WALKER PREVIOUSLY APPLIED CAST

Professional

Both

$112.53

Service Code	HCPCS 29440
Min. Negotiated Rate	$84.40
Max. Negotiated Rate	$84.40
Rate for Payer: Cash Price	$31.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$84.40
Rate for Payer: SOMOS Essential	$84.40

PR ADENOIDECTOMY PRIMARY <AGE 12

Professional

Both

$919.03

Service Code	HCPCS 42830
Min. Negotiated Rate	$689.27
Max. Negotiated Rate	$689.27
Rate for Payer: Cash Price	$252.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$689.27
Rate for Payer: SOMOS Essential	$689.27

PR ADENOIDECTOMY PRIMARY AGE 12/>

Professional

Both

$1,001.88

Service Code	HCPCS 42831
Min. Negotiated Rate	$751.41
Max. Negotiated Rate	$751.41
Rate for Payer: Cash Price	$273.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$751.41
Rate for Payer: SOMOS Essential	$751.41

PR ADENOIDECTOMY SECONDARY AGE 12/>

Professional

Both

$1,061.73

Service Code	HCPCS 42836
Min. Negotiated Rate	$796.30
Max. Negotiated Rate	$796.30
Rate for Payer: Cash Price	$290.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$796.30
Rate for Payer: SOMOS Essential	$796.30

PR ADENOIDECTOMY SECONDARY<AGE 12

Professional

Both

$861.04

Service Code	HCPCS 42835
Min. Negotiated Rate	$645.78
Max. Negotiated Rate	$645.78
Rate for Payer: Cash Price	$235.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$645.78
Rate for Payer: SOMOS Essential	$645.78

PR ADENOVIRUS VACCINE TYPE 4 LIVE ORAL

Professional

Both

$80.00

Service Code	HCPCS 90476
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$60.00
Rate for Payer: SOMOS Essential	$60.00

PR ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<

Professional

Both

$2,184.11

Service Code	HCPCS 14000
Min. Negotiated Rate	$1,638.08
Max. Negotiated Rate	$1,638.08
Rate for Payer: Cash Price	$595.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,638.08
Rate for Payer: SOMOS Essential	$1,638.08

PR ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM

Professional

Both

$2,844.14

Service Code	HCPCS 14001
Min. Negotiated Rate	$2,133.10
Max. Negotiated Rate	$2,133.10
Rate for Payer: Cash Price	$772.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,133.10
Rate for Payer: SOMOS Essential	$2,133.10

PR ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM

Professional

Both

$3,737.72

Service Code	HCPCS 14301
Min. Negotiated Rate	$2,803.29
Max. Negotiated Rate	$2,803.29
Rate for Payer: Cash Price	$1,015.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,803.29
Rate for Payer: SOMOS Essential	$2,803.29

PR ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM

Professional

Both

$3,222.80

Service Code	HCPCS 14041
Min. Negotiated Rate	$2,417.10
Max. Negotiated Rate	$2,417.10
Rate for Payer: Cash Price	$880.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,417.10
Rate for Payer: SOMOS Essential	$2,417.10

PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM

Professional

Both

$3,020.40

Service Code	HCPCS 14021
Min. Negotiated Rate	$2,265.30
Max. Negotiated Rate	$2,265.30
Rate for Payer: Cash Price	$824.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,265.30
Rate for Payer: SOMOS Essential	$2,265.30

PR ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM

Professional

Both

$3,458.49

Service Code	HCPCS 14061
Min. Negotiated Rate	$2,593.87
Max. Negotiated Rate	$2,593.87
Rate for Payer: Cash Price	$946.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,593.87
Rate for Payer: SOMOS Essential	$2,593.87

PR ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM

Professional

Both

$936.71

Service Code	HCPCS 14302
Min. Negotiated Rate	$702.53
Max. Negotiated Rate	$702.53
Rate for Payer: Cash Price	$250.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$702.53
Rate for Payer: SOMOS Essential	$702.53

PR ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<

Professional

Both

$2,421.06

Service Code	HCPCS 14020
Min. Negotiated Rate	$1,815.80
Max. Negotiated Rate	$1,815.80
Rate for Payer: Cash Price	$662.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,815.80
Rate for Payer: SOMOS Essential	$1,815.80

PR ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<

Professional

Both

$2,816.63

Service Code	HCPCS 14060
Min. Negotiated Rate	$2,112.47
Max. Negotiated Rate	$2,112.47
Rate for Payer: Cash Price	$769.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,112.47
Rate for Payer: SOMOS Essential	$2,112.47

PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<

Professional

Both

$2,648.87

Service Code	HCPCS 14040
Min. Negotiated Rate	$1,986.65
Max. Negotiated Rate	$1,986.65
Rate for Payer: Cash Price	$724.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,986.65
Rate for Payer: SOMOS Essential	$1,986.65

PR ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES

Professional

Both

$1,924.41

Service Code	HCPCS 20693
Min. Negotiated Rate	$1,443.31
Max. Negotiated Rate	$1,443.31
Rate for Payer: Cash Price	$530.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,443.31
Rate for Payer: SOMOS Essential	$1,443.31

PR ADMIN INFLUENZA VIRUS VAC

Professional

Both

$84.42

Service Code	HCPCS G0008
Min. Negotiated Rate	$63.32
Max. Negotiated Rate	$63.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$63.32
Rate for Payer: SOMOS Essential	$63.32

PR ADMIN PNEUMOCOCCAL VACCINE

Professional

Both

$94.47

Service Code	HCPCS G0009
Min. Negotiated Rate	$70.85
Max. Negotiated Rate	$70.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70.85
Rate for Payer: SOMOS Essential	$70.85

PR ADRENALECTOMY EXPL W/EXC RETROPERTINEAL TUMOR

Professional

Both

$5,565.28

Service Code	HCPCS 60545
Min. Negotiated Rate	$4,173.96
Max. Negotiated Rate	$4,173.96
Rate for Payer: Cash Price	$1,491.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,173.96
Rate for Payer: SOMOS Essential	$4,173.96

Know your out-of-pocket cost for care.

All Charges