St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR AS-AORT GRF W/CARD BYP F/AORTIC DS OTH/THN DSJ

Professional

Both

$10,775.52

Service Code	HCPCS 33859
Min. Negotiated Rate	$8,081.64
Max. Negotiated Rate	$8,081.64
Rate for Payer: Cash Price	$2,861.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,081.64
Rate for Payer: SOMOS Essential	$8,081.64

PR ASCENDING AORTA GRF VALVE SPARE ROOT REMODEL

Professional

Both

$14,225.68

Service Code	HCPCS 33864
Min. Negotiated Rate	$10,669.26
Max. Negotiated Rate	$10,669.26
Rate for Payer: Cash Price	$3,770.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10,669.26
Rate for Payer: SOMOS Essential	$10,669.26

PR ASPIRATION AND/OR INJECTION THYROID CYST

Professional

Both

$200.59

Service Code	HCPCS 60300
Min. Negotiated Rate	$150.44
Max. Negotiated Rate	$150.44
Rate for Payer: Cash Price	$54.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$150.44
Rate for Payer: SOMOS Essential	$150.44

PR ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER

Professional

Both

$595.63

Service Code	HCPCS 51102
Min. Negotiated Rate	$446.72
Max. Negotiated Rate	$446.72
Rate for Payer: Cash Price	$161.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$446.72
Rate for Payer: SOMOS Essential	$446.72

PR ASPIRATION BLADDER NEEDLE

Professional

Both

$163.87

Service Code	HCPCS 51100
Min. Negotiated Rate	$122.90
Max. Negotiated Rate	$122.90
Rate for Payer: Cash Price	$44.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$122.90
Rate for Payer: SOMOS Essential	$122.90

PR ASPIRATION BLADDER TROCAR/INTRACATHETER

Professional

Both

$210.91

Service Code	HCPCS 51101
Min. Negotiated Rate	$158.18
Max. Negotiated Rate	$158.18
Rate for Payer: Cash Price	$57.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$158.18
Rate for Payer: SOMOS Essential	$158.18

PR ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ

Professional

Both

$175.42

Service Code	HCPCS 20612
Min. Negotiated Rate	$131.56
Max. Negotiated Rate	$131.56
Rate for Payer: Cash Price	$47.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$131.56
Rate for Payer: SOMOS Essential	$131.56

PR ASPIRATION & INJECTION TREATMENT BONE CYST

Professional

Both

$688.73

Service Code	HCPCS 20615
Min. Negotiated Rate	$516.55
Max. Negotiated Rate	$516.55
Rate for Payer: Cash Price	$189.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$516.55
Rate for Payer: SOMOS Essential	$516.55

PR ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL

Professional

Both

$2,508.14

Service Code	HCPCS 67015
Min. Negotiated Rate	$1,881.10
Max. Negotiated Rate	$1,881.10
Rate for Payer: Cash Price	$688.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,881.10
Rate for Payer: SOMOS Essential	$1,881.10

PR ASPIR &/NJX RENAL CYST/PELVIS NEEDLE PRQ

Professional

Both

$386.61

Service Code	HCPCS 50390
Min. Negotiated Rate	$289.96
Max. Negotiated Rate	$289.96
Rate for Payer: Cash Price	$104.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$289.96
Rate for Payer: SOMOS Essential	$289.96

PR ASSESSMENT APHASIA W/INTERP & REPORT PER HOUR

Professional

Both

$397.50

Service Code	HCPCS 96105
Min. Negotiated Rate	$298.12
Max. Negotiated Rate	$298.12
Rate for Payer: Cash Price	$107.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$298.12
Rate for Payer: SOMOS Essential	$298.12

PR ASSESSMENT TINNITUS

Professional

Both

$244.09

Service Code	HCPCS 92625
Min. Negotiated Rate	$183.07
Max. Negotiated Rate	$183.07
Rate for Payer: Cash Price	$66.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$183.07
Rate for Payer: SOMOS Essential	$183.07

PR ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT

Professional

Both

$786.42

Service Code	HCPCS 99483
Min. Negotiated Rate	$589.82
Max. Negotiated Rate	$589.82
Rate for Payer: Cash Price	$214.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$589.82
Rate for Payer: SOMOS Essential	$589.82

PR ASSTV TECHNOL ASSMT DIR CNTCT W/REPRT EA 15 MIN

Professional

Both

$156.45

Service Code	HCPCS 97755
Min. Negotiated Rate	$117.34
Max. Negotiated Rate	$117.34
Rate for Payer: Cash Price	$42.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$117.34
Rate for Payer: SOMOS Essential	$117.34

PRASUGREL 10 MG TAB

Facility

$11.68

Hospital Charge Code	41645614
Hospital Revenue Code	250
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$9.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.84
Rate for Payer: Aetna Government	$5.84
Rate for Payer: Brighton Health Commercial	$8.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.94
Rate for Payer: Group Health Inc Commercial	$5.84
Rate for Payer: Group Health Inc Medicare	$4.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.84
Rate for Payer: Hamaspik Choice Inc Medicare	$5.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.59

PRASUGREL 10 MG TAB

Facility

$11.68

Hospital Charge Code	41655614
Hospital Revenue Code	250
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$9.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.84
Rate for Payer: Aetna Government	$5.84
Rate for Payer: Brighton Health Commercial	$8.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.94
Rate for Payer: Group Health Inc Commercial	$5.84
Rate for Payer: Group Health Inc Medicare	$4.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.84
Rate for Payer: Hamaspik Choice Inc Medicare	$5.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.59

PRASUGREL 5 MG TAB

Facility

$12.63

Hospital Charge Code	41655613
Hospital Revenue Code	250
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$10.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.32
Rate for Payer: Aetna Government	$6.32
Rate for Payer: Brighton Health Commercial	$9.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.59
Rate for Payer: Group Health Inc Commercial	$6.32
Rate for Payer: Group Health Inc Medicare	$4.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.32
Rate for Payer: Hamaspik Choice Inc Medicare	$6.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.21

PRASUGREL 5 MG TAB

Facility

$12.63

Hospital Charge Code	41645613
Hospital Revenue Code	250
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$10.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.32
Rate for Payer: Aetna Government	$6.32
Rate for Payer: Brighton Health Commercial	$9.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.59
Rate for Payer: Group Health Inc Commercial	$6.32
Rate for Payer: Group Health Inc Medicare	$4.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.32
Rate for Payer: Hamaspik Choice Inc Medicare	$6.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.21

PRASUGREL HCL 10 MG PO TABS [98373]

Facility

$16.51

Service Code	NDC 16729027310
Hospital Charge Code	16729027310
Hospital Revenue Code	250
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$13.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.25
Rate for Payer: Aetna Government	$8.25
Rate for Payer: Brighton Health Commercial	$12.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.22
Rate for Payer: Group Health Inc Commercial	$8.25
Rate for Payer: Group Health Inc Medicare	$5.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.25
Rate for Payer: Hamaspik Choice Inc Medicare	$8.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.73

PRASUGREL HCL 10 MG PO TABS [98373]

Facility

$16.51

Service Code	NDC 60505464303
Hospital Charge Code	60505464303
Hospital Revenue Code	250
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$13.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.25
Rate for Payer: Aetna Government	$8.25
Rate for Payer: Brighton Health Commercial	$12.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.22
Rate for Payer: Group Health Inc Commercial	$8.25
Rate for Payer: Group Health Inc Medicare	$5.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.25
Rate for Payer: Hamaspik Choice Inc Medicare	$8.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.73

PRASUGREL HCL 10 MG PO TABS [98373]

Facility

$16.51

Service Code	NDC 65862083030
Hospital Charge Code	65862083030
Hospital Revenue Code	250
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$13.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.25
Rate for Payer: Aetna Government	$8.25
Rate for Payer: Brighton Health Commercial	$12.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.22
Rate for Payer: Group Health Inc Commercial	$8.25
Rate for Payer: Group Health Inc Medicare	$5.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.25
Rate for Payer: Hamaspik Choice Inc Medicare	$8.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.73

PRASUGREL HCL 5 MG PO TABS [98372]

Facility

$16.51

Service Code	NDC 00378518593
Hospital Charge Code	00378518593
Hospital Revenue Code	250
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$13.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.25
Rate for Payer: Aetna Government	$8.25
Rate for Payer: Brighton Health Commercial	$12.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.22
Rate for Payer: Group Health Inc Commercial	$8.25
Rate for Payer: Group Health Inc Medicare	$5.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.25
Rate for Payer: Hamaspik Choice Inc Medicare	$8.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.73

PRASUGREL HCL 5 MG PO TABS [98372]

Facility

$16.51

Service Code	NDC 60505464203
Hospital Charge Code	60505464203
Hospital Revenue Code	250
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$13.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.25
Rate for Payer: Aetna Government	$8.25
Rate for Payer: Brighton Health Commercial	$12.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.22
Rate for Payer: Group Health Inc Commercial	$8.25
Rate for Payer: Group Health Inc Medicare	$5.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.25
Rate for Payer: Hamaspik Choice Inc Medicare	$8.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.73

PR ATRIA ABLATE & RCNSTJ W/OTHER PROCEDURE LIMITE

Professional

Both

$2,582.09

Service Code	HCPCS 33257
Min. Negotiated Rate	$1,936.57
Max. Negotiated Rate	$1,936.57
Rate for Payer: Cash Price	$688.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,936.57
Rate for Payer: SOMOS Essential	$1,936.57

PR ATRIA ABLTJ & RCNSTJ W/OTHER PX EXTENSIV W/O BYP

Professional

Both

$2,864.19

Service Code	HCPCS 33258
Min. Negotiated Rate	$2,148.14
Max. Negotiated Rate	$2,148.14
Rate for Payer: Cash Price	$763.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,148.14
Rate for Payer: SOMOS Essential	$2,148.14

Know your out-of-pocket cost for care.

All Charges