St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR ALLOGENEIC LYMPHOCYTE INFUSIONS

Professional

Both

$511.00

Service Code	HCPCS 38242
Min. Negotiated Rate	$383.25
Max. Negotiated Rate	$383.25
Rate for Payer: Cash Price	$140.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$383.25
Rate for Payer: SOMOS Essential	$383.25

PR ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL

Professional

Both

$514.78

Service Code	HCPCS 20931
Min. Negotiated Rate	$386.08
Max. Negotiated Rate	$386.08
Rate for Payer: Cash Price	$135.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$386.08
Rate for Payer: SOMOS Essential	$386.08

PR ALVEOLECTOMY W/CURTG OSTEITIS/SEQUESTRECTOMY

Professional

Both

$1,377.71

Service Code	HCPCS 41830
Min. Negotiated Rate	$1,033.28
Max. Negotiated Rate	$1,033.28
Rate for Payer: Cash Price	$370.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,033.28
Rate for Payer: SOMOS Essential	$1,033.28

PR ALVEOLOPLASTY EACH QUADRANT SPECIFY

Professional

Both

$1,023.02

Service Code	HCPCS 41874
Min. Negotiated Rate	$767.26
Max. Negotiated Rate	$767.26
Rate for Payer: Cash Price	$282.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$767.26
Rate for Payer: SOMOS Essential	$767.26

PR AMBULATORY BP MNTR W/SW 24 HR+ RECORDING ONLY

Professional

Both

$97.62

Service Code	HCPCS 93786
Min. Negotiated Rate	$73.22
Max. Negotiated Rate	$73.22
Rate for Payer: Cash Price	$26.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$73.22
Rate for Payer: SOMOS Essential	$73.22

PR AMBULATORY BP MNTR W/SW 24 HR+ REC SCAN ALYS I&R

Professional

Both

$192.36

Service Code	HCPCS 93784
Min. Negotiated Rate	$144.27
Max. Negotiated Rate	$144.27
Rate for Payer: Cash Price	$53.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$144.27
Rate for Payer: SOMOS Essential	$144.27

PR AMBULATORY BP MNTR W/SW 24 HR+ REVIEW W/I&R

Professional

Both

$70.46

Service Code	HCPCS 93790
Min. Negotiated Rate	$52.84
Max. Negotiated Rate	$52.84
Rate for Payer: Cash Price	$19.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$52.84
Rate for Payer: SOMOS Essential	$52.84

PR AMBULATORY BP MNTR W/SW 24 HR+ SCANNING A/R

Professional

Both

$24.29

Service Code	HCPCS 93788
Min. Negotiated Rate	$18.22
Max. Negotiated Rate	$18.22
Rate for Payer: Cash Price	$6.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18.22
Rate for Payer: SOMOS Essential	$18.22

PR AMNIOCENTESIS DIAGNOSIC

Professional

Both

$370.30

Service Code	HCPCS 59000
Min. Negotiated Rate	$277.72
Max. Negotiated Rate	$277.72
Rate for Payer: Cash Price	$99.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$277.72
Rate for Payer: SOMOS Essential	$277.72

PR AMNIOCENTESIS THER AMNIOTIC FLUID RDCTJ US GUID

Professional

Both

$826.14

Service Code	HCPCS 59001
Min. Negotiated Rate	$619.60
Max. Negotiated Rate	$619.60
Rate for Payer: Cash Price	$218.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$619.60
Rate for Payer: SOMOS Essential	$619.60

PRAMOXINE-ZINC OXIDE OINT 30 GRAMS

Facility

$8.08

Hospital Charge Code	41654392
Hospital Revenue Code	250
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$6.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.04
Rate for Payer: Aetna Government	$4.04
Rate for Payer: Brighton Health Commercial	$6.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.49
Rate for Payer: Group Health Inc Commercial	$4.04
Rate for Payer: Group Health Inc Medicare	$2.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.04
Rate for Payer: Hamaspik Choice Inc Medicare	$4.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.25

PRAMOXINE-ZINC OXIDE OINT 30 GRAMS

Facility

$8.08

Hospital Charge Code	41644392
Hospital Revenue Code	250
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$6.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.04
Rate for Payer: Aetna Government	$4.04
Rate for Payer: Brighton Health Commercial	$6.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.49
Rate for Payer: Group Health Inc Commercial	$4.04
Rate for Payer: Group Health Inc Medicare	$2.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.04
Rate for Payer: Hamaspik Choice Inc Medicare	$4.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.25

PR AMP ANKLE-MALLI TIBFIB W/PLSTC CLSR&RESCJ NRV

Professional

Both

$2,813.02

Service Code	HCPCS 27888
Min. Negotiated Rate	$2,109.76
Max. Negotiated Rate	$2,109.76
Rate for Payer: Cash Price	$686.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,109.76
Rate for Payer: SOMOS Essential	$2,109.76

PR AMP ARM THRU HUMERUS SECONDARY CLSR/SCAR REVJ

Professional

Both

$2,536.84

Service Code	HCPCS 24925
Min. Negotiated Rate	$1,902.63
Max. Negotiated Rate	$1,902.63
Rate for Payer: Cash Price	$687.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,902.63
Rate for Payer: SOMOS Essential	$1,902.63

PR AMP F/ARM THRU RADIUS&ULNA SEC CLOSURE/SCAR RE

Professional

Both

$2,733.01

Service Code	HCPCS 25907
Min. Negotiated Rate	$2,049.76
Max. Negotiated Rate	$2,049.76
Rate for Payer: Cash Price	$741.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,049.76
Rate for Payer: SOMOS Essential	$2,049.76

PR AMP FOREARM THRU RADIUS & ULNA OPEN CIRCULAR

Professional

Both

$3,117.84

Service Code	HCPCS 25905
Min. Negotiated Rate	$2,338.38
Max. Negotiated Rate	$2,338.38
Rate for Payer: Cash Price	$844.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,338.38
Rate for Payer: SOMOS Essential	$2,338.38

PR AMP FOREARM THRU RADIUS&ULNA RE-AMPUTATION

Professional

Both

$3,048.96

Service Code	HCPCS 25909
Min. Negotiated Rate	$2,286.72
Max. Negotiated Rate	$2,286.72
Rate for Payer: Cash Price	$823.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,286.72
Rate for Payer: SOMOS Essential	$2,286.72

PR AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP

Professional

Both

$3,031.70

Service Code	HCPCS 26952
Min. Negotiated Rate	$2,273.78
Max. Negotiated Rate	$2,273.78
Rate for Payer: Cash Price	$817.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,273.78
Rate for Payer: SOMOS Essential	$2,273.78

PR AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR

Professional

Both

$3,102.47

Service Code	HCPCS 26951
Min. Negotiated Rate	$2,326.85
Max. Negotiated Rate	$2,326.85
Rate for Payer: Cash Price	$842.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,326.85
Rate for Payer: SOMOS Essential	$2,326.85

PR AMP LEG THRU TIBFIB W/IMMT FITG TQ W/1ST CST

Professional

Both

$3,798.41

Service Code	HCPCS 27881
Min. Negotiated Rate	$2,848.81
Max. Negotiated Rate	$2,848.81
Rate for Payer: Cash Price	$1,003.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,848.81
Rate for Payer: SOMOS Essential	$2,848.81

PR AMP LEG THRU TIBIA&FIBULA RE-AMPUTATION

Professional

Both

$2,890.69

Service Code	HCPCS 27886
Min. Negotiated Rate	$2,168.02
Max. Negotiated Rate	$2,168.02
Rate for Payer: Cash Price	$774.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,168.02
Rate for Payer: SOMOS Essential	$2,168.02

PR AMP LEG THRU TIBIA&FIBULA SEC CLOSURE/SCAR REV

Professional

Both

$2,580.10

Service Code	HCPCS 27884
Min. Negotiated Rate	$1,935.08
Max. Negotiated Rate	$1,935.08
Rate for Payer: Cash Price	$692.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,935.08
Rate for Payer: SOMOS Essential	$1,935.08

PR AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER

Professional

Both

$3,384.36

Service Code	HCPCS 26910
Min. Negotiated Rate	$2,538.27
Max. Negotiated Rate	$2,538.27
Rate for Payer: Cash Price	$910.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,538.27
Rate for Payer: SOMOS Essential	$2,538.27

PR AMP THIGH THRU FEMUR SEC CLOSURE/SCAR REVISION

Professional

Both

$2,245.43

Service Code	HCPCS 27594
Min. Negotiated Rate	$1,684.07
Max. Negotiated Rate	$1,684.07
Rate for Payer: Cash Price	$605.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,684.07
Rate for Payer: SOMOS Essential	$1,684.07

PR AMP THI THRU FEMUR LVL IMMT FITG TQ W/1ST CST

Professional

Both

$4,268.57

Service Code	HCPCS 27591
Min. Negotiated Rate	$3,201.43
Max. Negotiated Rate	$3,201.43
Rate for Payer: Cash Price	$1,149.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,201.43
Rate for Payer: SOMOS Essential	$3,201.43

Know your out-of-pocket cost for care.

All Charges