St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS

Professional

Both

$508.97

Service Code	HCPCS 64611
Min. Negotiated Rate	$381.73
Max. Negotiated Rate	$381.73
Rate for Payer: Cash Price	$139.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$381.73
Rate for Payer: SOMOS Essential	$381.73

PR CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE

Professional

Both

$579.18

Service Code	HCPCS 64615
Min. Negotiated Rate	$434.38
Max. Negotiated Rate	$434.38
Rate for Payer: Cash Price	$151.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$434.38
Rate for Payer: SOMOS Essential	$434.38

PR CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL

Professional

Both

$520.45

Service Code	HCPCS 64612
Min. Negotiated Rate	$390.34
Max. Negotiated Rate	$390.34
Rate for Payer: Cash Price	$142.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$390.34
Rate for Payer: SOMOS Essential	$390.34

PR CHEMO EXTEND IV INFUS W/PUMP

Professional

Both

$1,035.44

Service Code	HCPCS G0498
Min. Negotiated Rate	$776.58
Max. Negotiated Rate	$776.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$776.58
Rate for Payer: SOMOS Essential	$776.58

PR CHEMOTHERAPY ADMIN INTRA-ARTERIAL INFUS <1 HR

Professional

Both

$688.35

Service Code	HCPCS 96422
Min. Negotiated Rate	$516.26
Max. Negotiated Rate	$516.26
Rate for Payer: Cash Price	$185.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$516.26
Rate for Payer: SOMOS Essential	$516.26

PR CHEMOTHERAPY ADMIN INTRA-ARTERIAL PUSH TQ

Professional

Both

$445.97

Service Code	HCPCS 96420
Min. Negotiated Rate	$334.48
Max. Negotiated Rate	$334.48
Rate for Payer: Cash Price	$120.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$334.48
Rate for Payer: SOMOS Essential	$334.48

PR CHEMOTHERAPY ADMINISTRATION INTRALESIONAL </7

Professional

Both

$119.21

Service Code	HCPCS 96405
Min. Negotiated Rate	$89.41
Max. Negotiated Rate	$89.41
Rate for Payer: Cash Price	$31.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$89.41
Rate for Payer: SOMOS Essential	$89.41

PR CHEMOTHERAPY ADMINISTRATION INTRALESIONAL >7

Professional

Both

$182.74

Service Code	HCPCS 96406
Min. Negotiated Rate	$137.06
Max. Negotiated Rate	$137.06
Rate for Payer: Cash Price	$49.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$137.06
Rate for Payer: SOMOS Essential	$137.06

PR CHEMOTHERAPY ADMN INTRAARTERIAL INFUSION EA HR

Professional

Both

$315.42

Service Code	HCPCS 96423
Min. Negotiated Rate	$236.56
Max. Negotiated Rate	$236.56
Rate for Payer: Cash Price	$86.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$236.56
Rate for Payer: SOMOS Essential	$236.56

PR CHEMOTHERAPY ADMN IV INFUSION TQ EA HR

Professional

Both

$119.84

Service Code	HCPCS 96415
Min. Negotiated Rate	$89.88
Max. Negotiated Rate	$89.88
Rate for Payer: Cash Price	$32.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$89.88
Rate for Payer: SOMOS Essential	$89.88

PR CHEMOTX ADMN CNS REQ SPINAL PUNCTURE

Professional

Both

$316.19

Service Code	HCPCS 96450
Min. Negotiated Rate	$237.14
Max. Negotiated Rate	$237.14
Rate for Payer: Cash Price	$85.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$237.14
Rate for Payer: SOMOS Essential	$237.14

PR CHEMOTX ADMN IA NFS >8 HR PRTBLE IMPLTBL PMP

Professional

Both

$738.50

Service Code	HCPCS 96425
Min. Negotiated Rate	$553.88
Max. Negotiated Rate	$553.88
Rate for Payer: Cash Price	$200.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$553.88
Rate for Payer: SOMOS Essential	$553.88

PR CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR

Professional

Both

$277.31

Service Code	HCPCS 96417
Min. Negotiated Rate	$207.98
Max. Negotiated Rate	$207.98
Rate for Payer: Cash Price	$75.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$207.98
Rate for Payer: SOMOS Essential	$207.98

PR CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG

Professional

Both

$564.55

Service Code	HCPCS 96413
Min. Negotiated Rate	$423.41
Max. Negotiated Rate	$423.41
Rate for Payer: Cash Price	$152.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$423.41
Rate for Payer: SOMOS Essential	$423.41

PR CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG

Professional

Both

$436.03

Service Code	HCPCS 96409
Min. Negotiated Rate	$327.02
Max. Negotiated Rate	$327.02
Rate for Payer: Cash Price	$118.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$327.02
Rate for Payer: SOMOS Essential	$327.02

PR CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG

Professional

Both

$238.67

Service Code	HCPCS 96411
Min. Negotiated Rate	$179.00
Max. Negotiated Rate	$179.00
Rate for Payer: Cash Price	$63.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$179.00
Rate for Payer: SOMOS Essential	$179.00

PR CHEMOTX ADMN PERTL CAVITY IMPLANTED PORT/CATH

Professional

Both

$123.06

Service Code	HCPCS 96446
Min. Negotiated Rate	$92.30
Max. Negotiated Rate	$92.30
Rate for Payer: Cash Price	$24.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$92.30
Rate for Payer: SOMOS Essential	$92.30

PR CHEMOTX ADMN PLEURAL CAVITY REQ&W/THORACNTS

Professional

Both

$545.34

Service Code	HCPCS 96440
Min. Negotiated Rate	$409.00
Max. Negotiated Rate	$409.00
Rate for Payer: Cash Price	$151.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$409.00
Rate for Payer: SOMOS Essential	$409.00

PR CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO

Professional

Both

$144.27

Service Code	HCPCS 96402
Min. Negotiated Rate	$108.20
Max. Negotiated Rate	$108.20
Rate for Payer: Cash Price	$41.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$108.20
Rate for Payer: SOMOS Essential	$108.20

PR CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO

Professional

Both

$313.25

Service Code	HCPCS 96401
Min. Negotiated Rate	$234.94
Max. Negotiated Rate	$234.94
Rate for Payer: Cash Price	$84.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$234.94
Rate for Payer: SOMOS Essential	$234.94

PR CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP

Professional

Both

$555.77

Service Code	HCPCS 96416
Min. Negotiated Rate	$416.83
Max. Negotiated Rate	$416.83
Rate for Payer: Cash Price	$150.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$416.83
Rate for Payer: SOMOS Essential	$416.83

PR CHEMOTX NJX SUBARACHND/INTRAVENTR RSVR 1/MULT

Professional

Both

$172.17

Service Code	HCPCS 96542
Min. Negotiated Rate	$129.13
Max. Negotiated Rate	$129.13
Rate for Payer: Cash Price	$47.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$129.13
Rate for Payer: SOMOS Essential	$129.13

PR CHIROPRACTIC MANIPULATIVE TX SPINAL 1-2 REGIONS

Professional

Both

$86.24

Service Code	HCPCS 98940
Min. Negotiated Rate	$64.68
Max. Negotiated Rate	$64.68
Rate for Payer: Cash Price	$23.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$64.68
Rate for Payer: SOMOS Essential	$64.68

PR CHIROPRACTIC MANIPULATIVE TX SPINAL 3-4 REGIONS

Professional

Both

$131.92

Service Code	HCPCS 98941
Min. Negotiated Rate	$98.94
Max. Negotiated Rate	$98.94
Rate for Payer: Cash Price	$36.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$98.94
Rate for Payer: SOMOS Essential	$98.94

PR CHIROPRACTIC MANIPULATIVE TX SPINAL 5 REGIONS

Professional

Both

$177.59

Service Code	HCPCS 98942
Min. Negotiated Rate	$133.19
Max. Negotiated Rate	$133.19
Rate for Payer: Cash Price	$48.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$133.19
Rate for Payer: SOMOS Essential	$133.19

Know your out-of-pocket cost for care.

All Charges