St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR ADRENALECTOMY W/EXPL W/WO BX ABDL/LMBR/DRSAL SPX

Professional

Both

$4,764.97

Service Code	HCPCS 60540
Min. Negotiated Rate	$3,573.73
Max. Negotiated Rate	$3,573.73
Rate for Payer: Cash Price	$1,281.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,573.73
Rate for Payer: SOMOS Essential	$3,573.73

PR ADVANCE CARE PLANNING EA ADDL 30 MINS

Professional

Both

$290.40

Service Code	HCPCS 99498
Min. Negotiated Rate	$217.80
Max. Negotiated Rate	$217.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$217.80
Rate for Payer: SOMOS Essential	$217.80

PR ADVANCE CARE PLANNING FIRST 30 MINS

Professional

Both

$305.80

Service Code	HCPCS 99497
Min. Negotiated Rate	$229.35
Max. Negotiated Rate	$229.35
Rate for Payer: Cash Price	$83.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$229.35
Rate for Payer: SOMOS Essential	$229.35

PR AEP HEARING STATUS DETER BROADBAND STIMULI I&R

Professional

Both

$350.39

Service Code	HCPCS 92651
Min. Negotiated Rate	$262.79
Max. Negotiated Rate	$262.79
Rate for Payer: Cash Price	$94.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$262.79
Rate for Payer: SOMOS Essential	$262.79

PR AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT

Professional

Both

$350.63

Service Code	HCPCS 92653
Min. Negotiated Rate	$262.97
Max. Negotiated Rate	$262.97
Rate for Payer: Cash Price	$94.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$262.97
Rate for Payer: SOMOS Essential	$262.97

PR AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R

Professional

Both

$468.51

Service Code	HCPCS 92652
Min. Negotiated Rate	$351.38
Max. Negotiated Rate	$351.38
Rate for Payer: Cash Price	$127.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$351.38
Rate for Payer: SOMOS Essential	$351.38

PR AGMNTJ MNDBLR BDY/ANGL W/GRF ONLAY/INTERPOSAL

Professional

Both

$3,196.41

Service Code	HCPCS 21127
Min. Negotiated Rate	$2,397.31
Max. Negotiated Rate	$2,397.31
Rate for Payer: Cash Price	$885.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,397.31
Rate for Payer: SOMOS Essential	$2,397.31

PR AGMNTJ MNDBLR BODY/ANGLE PROSTHETIC MATERIAL

Professional

Both

$2,786.21

Service Code	HCPCS 21125
Min. Negotiated Rate	$2,089.66
Max. Negotiated Rate	$2,089.66
Rate for Payer: Cash Price	$763.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,089.66
Rate for Payer: SOMOS Essential	$2,089.66

PR AIRWAY RESISTANCE BY OSCILLOMETRY

Professional

Both

$167.41

Service Code	HCPCS 94728
Min. Negotiated Rate	$125.56
Max. Negotiated Rate	$125.56
Rate for Payer: Cash Price	$51.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$125.56
Rate for Payer: SOMOS Essential	$125.56

PR AIRWAY RESISTANCE BY OSCILLOMETRY

Professional

Both

$119.18

Service Code	HCPCS 94728 TC
Min. Negotiated Rate	$89.38
Max. Negotiated Rate	$89.38
Rate for Payer: Cash Price	$38.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$89.38
Rate for Payer: SOMOS Essential	$89.38

PR AIRWAY RESISTANCE BY OSCILLOMETRY

Professional

Both

$48.23

Service Code	HCPCS 94728 26
Min. Negotiated Rate	$36.17
Max. Negotiated Rate	$36.17
Rate for Payer: Cash Price	$13.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36.17
Rate for Payer: SOMOS Essential	$36.17

PR ALBUTEROL IPRATROP NON-COMP

Professional

Both

$25.00

Service Code	HCPCS J7620
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Cash Price	$0.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18.75
Rate for Payer: SOMOS Essential	$18.75

PR ALBUTEROL NON-COMP CON

Professional

Both

$30.00

Service Code	HCPCS J7611
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Cash Price	$0.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22.50
Rate for Payer: SOMOS Essential	$22.50

PR ALCOHOL/SUB ABUSE ASSESS

Professional

Both

$66.92

Service Code	HCPCS G2011
Min. Negotiated Rate	$50.19
Max. Negotiated Rate	$50.19
Rate for Payer: Cash Price	$18.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$50.19
Rate for Payer: SOMOS Essential	$50.19

PR ALCOHOL/SUBS INTERV 15-30MN

Professional

Both

$126.84

Service Code	HCPCS G0396
Min. Negotiated Rate	$95.13
Max. Negotiated Rate	$95.13
Rate for Payer: Cash Price	$35.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$95.13
Rate for Payer: SOMOS Essential	$95.13

PR ALCOHOL/SUBS INTERV >30 MIN

Professional

Both

$268.98

Service Code	HCPCS G0397
Min. Negotiated Rate	$201.74
Max. Negotiated Rate	$201.74
Rate for Payer: Cash Price	$72.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$201.74
Rate for Payer: SOMOS Essential	$201.74

PR ALCOHOL/SUBSTANCE ABUSE SKIL

Professional

Both

$50.00

Service Code	HCPCS T1012
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37.50
Rate for Payer: SOMOS Essential	$37.50

PRALIDOXIME 1 GRAM INJ

Facility

$171.00

Service Code	HCPCS J2730
Hospital Charge Code	41643428
Hospital Revenue Code	636
Min. Negotiated Rate	$85.50
Max. Negotiated Rate	$85.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.50
Rate for Payer: Hamaspik Choice Inc Medicare	$85.50

PRALIDOXIME 1 GRAM INJ

Facility

$171.00

Service Code	HCPCS J2730
Hospital Charge Code	41643428
Hospital Revenue Code	636
Min. Negotiated Rate	$59.85
Max. Negotiated Rate	$111.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$71.79
Rate for Payer: Aetna Government	$71.79
Rate for Payer: Brighton Health Commercial	$102.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$85.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$98.32
Rate for Payer: Group Health Inc Commercial	$85.50
Rate for Payer: Group Health Inc Medicare	$59.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.50
Rate for Payer: Hamaspik Choice Inc Medicare	$85.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$111.15

PRALIDOXIME 1 GRAM INJ

Facility

$171.00

Service Code	HCPCS J2730
Hospital Charge Code	41653428
Hospital Revenue Code	636
Min. Negotiated Rate	$59.85
Max. Negotiated Rate	$111.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$71.79
Rate for Payer: Aetna Government	$71.79
Rate for Payer: Brighton Health Commercial	$102.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$85.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$98.32
Rate for Payer: Group Health Inc Commercial	$85.50
Rate for Payer: Group Health Inc Medicare	$59.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.50
Rate for Payer: Hamaspik Choice Inc Medicare	$85.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$111.15

PRALIDOXIME 1 GRAM INJ

Facility

$171.00

Service Code	HCPCS J2730
Hospital Charge Code	41653428
Hospital Revenue Code	636
Min. Negotiated Rate	$85.50
Max. Negotiated Rate	$85.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.50
Rate for Payer: Hamaspik Choice Inc Medicare	$85.50

PRALIDOXIME CHLORIDE 1 G IV SOLR [6462]

Facility

$104.04

Service Code	NDC 60977014101
Hospital Charge Code	60977014101
Hospital Revenue Code	278
Min. Negotiated Rate	$36.41
Max. Negotiated Rate	$109.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$52.02
Rate for Payer: Aetna Government	$52.02
Rate for Payer: Brighton Health Commercial	$62.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.82
Rate for Payer: EmblemHealth Commercial	$52.02
Rate for Payer: Fidelis Medicare Advantage	$109.24
Rate for Payer: Group Health Inc Commercial	$52.02
Rate for Payer: Group Health Inc Medicare	$36.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.02
Rate for Payer: Hamaspik Choice Inc Medicare	$52.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$67.63

PRALIDOXIME CHLORIDE 1 G IV SOLR [6462]

Facility

$104.04

Service Code	NDC 60977014101
Hospital Charge Code	60977014101
Hospital Revenue Code	278
Min. Negotiated Rate	$52.02
Max. Negotiated Rate	$52.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.02
Rate for Payer: Hamaspik Choice Inc Medicare	$52.02

PR ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/I&R

Professional

Both

$28.91

Service Code	HCPCS 95018
Min. Negotiated Rate	$21.68
Max. Negotiated Rate	$21.68
Rate for Payer: Cash Price	$7.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21.68
Rate for Payer: SOMOS Essential	$21.68

PR ALLG TSTG PERQ & IC VENOMS IMMED REACT W/I&R

Professional

Both

$15.82

Service Code	HCPCS 95017
Min. Negotiated Rate	$11.86
Max. Negotiated Rate	$11.86
Rate for Payer: Cash Price	$4.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$11.86
Rate for Payer: SOMOS Essential	$11.86

Know your out-of-pocket cost for care.

All Charges